"Hey, do you know how to inject botox? Because I'd love to get some of these wrinkles smoothed out."
I was chatting with a group of anesthesia students after class. One of the girls (in her late twenties) asked me that question, which prompted another three of them to excitedly repeat it.
"Oh wow, do you?! That'd be so great if you could."
I wasn’t so sure it would actually be as great as they claimed.
“What about how it could affect your kids?” I replied. “You have a baby at home. If you can’t fully express your emotions on your face, will it impair their development?”
“Oh whatever,” they laughed. “They’ll be fine. Just make me look a bit younger. How much do you charge?”
Physicians worldwide are sworn to the principle of primum non nocere: “first do no harm”. However, I’m concerned many of us may not be following this principle by performing cosmetic botox injections. Nor do many women understand there may be unintended consequences when they walk into their local aesthetic clinic.
Botox is a powerful medication with many uses. The name is short for botulinum toxin, which is a potent chemical responsible for a disease called botulism. When the bacteria Clostridium botulinum infects someone, this toxin causes widespread muscle paralysis. Eventually, people can get so weak they don't even have the strength to breathe.
However, small amounts of botox injected into specific muscles can improve a variety of medical conditions. Chronic migraines, bladder inflammation, and spastic muscles all have the potential to improve with carefully-placed microdoses. When used cosmetically (i.e. to improve one’s appearance), botox paralyzes muscles in the face, which subsequently smooths out wrinkles in the skin. It lasts a few months at a time, after which the procedure needs to be repeated.
As you may have noticed in some over-botoxed celebrities, this wrinkle-free skin comes at the expense of facial expression. With muscles paralyzed, the ability to show emotion on your face - smiling, confusion, anger - is drastically impaired. With too much, the face can become a blank, expressionless slate. The subtle messages we communicate with our eyebrows, cheeks, and forehead are lost. There's nothing inherently wrong with botox itself, but using it may inadvertently affect those we love most in this world.
Specifically, our children.
You see, there's a phenomenon in the brain called the Mirror Neuron System. It's when you detect someone doing a particular behavior and subconsciously mirror it. Like when you're walking down the aisle of the grocery store and someone smiles as they pass you. Inevitably, you'll smile too, and most likely continue to smile down the next aisle and all the way through the checkout. Or have you ever watched a mother spoon-feeding her baby? She contorts her face into all sorts of strange shapes, opening her own mouth as the spoon approaches her baby's lips. And what happens next? The baby opens up, mimicking her mother, and the food gets shoved in. The mirror neuron system is critical for early childhood education. Toddlers learn by observing and copying their role models’ actions. This mimicry is innate and the behaviors we replicate gets imprinted to some degree in our brains.
Perhaps this is perhaps why laughter is so contagious. Just witnessing another person giggling is funny itself - it causes the observer to laugh even if they don't know why. And maybe this is why anger is so offensive - the instant someone is mad at us, we immediately feel offended and get angry back at them. Or take yawning: watch a school classroom when one student inadvertently yawns - before long the whole class is doing the same, including the teacher!
Maybe Jesus was onto something when he said, "Do to others as you want them to do for you” (Mt 7:12), since what you do to others (including the emotions you express to them) may come right back at you as they subconsciously mirror your behavior.
The Mirror Neuron System is important for many things, and is one of the reasons I'm not convinced excessive cosmetic botox is good for children. Women (the most common users) can't fully smile, frown, or otherwise express themselves with their whole face. And if a child has stunted smiles to mimic and learn from, will their emotional development similarly become stunted? Not sure. Definitive research is lacking. But this we know: the Mirror Neuron System is powerful and subconsciously affects us all, for better or for worse.
CNN reported on this same potential problem. The subtle facial expressions used in conversation are crucial to communication and understanding, especially among female children. Additionally, the impaired ability to mimic other people’s facial expressions (via mirror neurons) reduced the perception of empathy.
Not all celebrities opt to have their faces paralyzed, as the legendary Julia Roberts said in an interview, “I want my kids to know when I’m pissed, when I’m happy and when I’m confounded. Your face tells a story and it shouldn’t be a story about your drive to the doctor’s office.”
The impaired facial expression that cosmetic botox produces may have consequences we don’t fully understand yet. Everyone wants to look younger, but is our pursuit of eternal youth costing our children some degree of emotional development?
Please be careful with botox. Our children are worth more.