Can Botox Treat Anxiety? The Fascinating Link Between Botox and Anxiety

As a millennial therapist, I work with many women my age and younger, and it’s clear that how we view ourselves shapes the way we move through the world. Whether it’s the confidence we bring into a job interview, the vulnerability we allow in relationships, or the sense of worth we carry within ourselves. Plastic surgery and cosmetic enhancements aren’t new—rhinoplasty, breast augmentations, and Botox have been around for decades. What feels different now is the intensity of the pressure on younger women to pursue these interventions, not later in life, but preemptively as so-called “preventive care.”

But preventive from what? From happy lines etched by laughter, sun-kissed wrinkles from vacations, or the faint creases that come from sipping your favorite drink through a straw? When did the natural markers of joy, living, and experience become conditions to be treated?

Yet, if so many women and their role models are getting treatments like Botox, there must be some benefits. Beyond smoothing wrinkles, Botox is lauded for reducing anxiety, boosting confidence, reducing subtle facial cues of negative emotions, and giving a sense of control over appearance. 

These effects suggest that, for some, Botox is not just about looks, it’s about feeling more like themselves. The conversation around beauty standards and mental health is more prevalent than ever, and Botox is at the center of it.

What is the facial feedback hypothesis?

The facial feedback hypothesis is a psychological theory that suggests a person's facial expressions can directly influence their emotional state. In other words, it proposes that the physical act of making a certain facial expression can cause you to feel the corresponding emotion. For example, the hypothesis suggests that smiling can make you feel happier, and frowning can make you feel sadder.

The correlation between Botox and anxiety

Research suggests that Botox can do more than just smooth wrinkles—it can also impact our emotional state. A recent study found that while Botox injections didn’t significantly change participants’ overall quality of life, they did lead to measurable increases in happiness. The likely reason is that by relaxing the muscles responsible for frowning, Botox interrupts the facial feedback loop that reinforces negative emotions. In other words, altering facial expressions can subtly shift mood and boost self-confidence, even if nothing else in a person’s life has changed. 

Researchers at UC San Diego's Skaggs School of Pharmacy analyzed reports from almost 40,000 Botox recipients in the FDA's Adverse Effect Reporting system. They discovered a drastically reduced risk of anxiety, finding that reported anxiety was 22 to 72 percent less common in patients treated with Botox. 

In short, Botox didn’t objectively improve people’s lives, but it did make them feel happier, reminding us that the way we inhabit our faces can have a profound impact on our experience of the world.

Injecting insecurity

However, even minimally invasive procedures like Botox are not without psychological risks. Research on aesthetic interventions shows that many patients seeking cosmetic enhancements already experience anxiety, depression, or body dysmorphic disorder. While most studies focus on surgical procedures, the same concerns likely apply to Botox. This highlights the complex relationship between beauty standards and mental health.

That means that Botox could reinforce appearance-related obsessions, heighten self-scrutiny, or foster reliance on cosmetic treatments for self-esteem. Combined with subtle changes in facial expression that may blunt emotions and affect social interactions, these findings highlight that while Botox can boost confidence for some, it can also exacerbate underlying mental health vulnerabilities when used to cope with deeper psychological issues rather than for purely cosmetic reasons.

As a therapist, I often talk with clients about the ways we manage self-esteem and emotions, and cosmetic procedures like Botox can play a surprising role in that. Research shows that Botox, which temporarily paralyzes facial muscles, can subtly blunt emotional experience. In one study, participants who received Botox had decreased emotional responses to mildly positive video clips compared to those who got a cosmetic filler that didn’t affect muscle movement. This effect can be explained by the facial feedback hypothesis, which suggests that the inability to fully express an emotion on one's face can reduce its intensity.

Essentially, when your face can’t fully move, it can reduce the intensity of certain emotions, which may impact how we recognize our own feelings and connect with others socially. While Botox can definitely boost confidence for some, it’s important to be aware that relying on it for self-esteem or emotional regulation can carry hidden psychological risks.

Can confidence come from a syringe?

​​Even minimally invasive cosmetic procedures like Botox and dermal fillers can have a noticeable impact on how people feel about themselves. A study looking at 35 patients who received facial injectables measured their psychological and social wellbeing before treatment and two weeks afterward using the validated FACE-Q survey. Participants reported improvements across the board, feeling more confident and positive about themselves, more comfortable in social situations, and experiencing less stress and self-consciousness about their appearance.

Interestingly, those who received a combination of fillers and Botox saw slightly bigger improvements, suggesting that a tailored approach can have an even stronger effect on overall wellbeing. While the effects were significant, they are also temporary.

From a therapist’s perspective, this reinforces that aesthetic treatments can sometimes support mental health by boosting self-confidence and reducing appearance-related stress. At the same time, it’s essential to acknowledge that cosmetic procedures aren’t a substitute for addressing deeper emotional or self-esteem issues. They’re most beneficial when used thoughtfully in conjunction with personal growth and emotional care, like self-care and therapy.

Botox and anxiety: Perfection over process

Celebrity “before and after” photos are everywhere. They are splashed across headlines, dissected on TikTok, and passed around as proof of who has “aged well” and who hasn’t. If you clicked on one of these articles, chances are you’ve seen Lindsay Lohan’s “new face” trending online. But here’s what often goes unnoticed: most of the comparisons circulating on social media aren’t really about cosmetic work at all. They’re side-by-sides of a woman in the depths of addiction next to a woman in recovery. Sobriety gave her back her health, her presence, her spark. Yet that’s not what trends. What captures attention is her smoother skin and her seemingly ageless look.  

While the facial feedback hypothesis suggests that a happier expression can lead to happier feelings, we’ve reversed the logic in this narrative. We're celebrating the smooth face rather than the inner journey that created the genuine light behind it.

And that raises a harder question: what are we teaching young girls? If the narrative is that value lies in wrinkle-free skin rather than resilience, then beauty becomes the proof of worth. Struggle is something to hide, not overcome. Healing is only celebrated if it also looks picture-perfect.
 

Laugh lines, Botox, or both

In my work as a therapist, I’ve seen how cosmetic procedures can be empowering—they can support confidence, ease appearance-related stress, and help people feel more at home in their own skin. The principles of the facial feedback hypothesis provide some insight into why this might be the case.

But they’re not a substitute for the deeper work of self-acceptance, emotional growth, and mental wellness. True beauty isn't about meeting a mirror's external standard; it's about agency. Your face carries the story of your life. Whether that includes laugh lines, Botox, or both. What matters most is that it reflects your own self-acceptance, growth, and healing, not society’s pressure. Whether you choose to embrace every laugh line or opt for cosmetic enhancement, your face should not reflect the pressures of society. The essential work remains internal: cultivating the self-acceptance that makes your outer decision—whatever it may be—a deliberate act of personal authority.