Quotes of the Day

Botox may not only provide a nonsurgical face-lift — it may also lift your spirits, new research suggests.

By paralyzing the facial muscles used for frowning, Botulinum Toxin A — or Botox — prevents people from physically displaying expressions of negative emotion. Building on previous research that suggests facial expressions not only reflect but influence mood levels, the new study hypothesizes that Botox may lighten people's moods by literally wiping the frowns off their faces. (Read "The Year in Medicine 2008: From A to Z.")

The study, published in the March issue of the Journal of Cosmetic Dermatology, followed 25 cosmetic-surgery patients, 12 of whom received injections of Botulinum Toxin A or similar neurotoxins, the others receiving fillers, peels or other cosmetic treatments for wrinkles. (Watch a TIME video on Botox.)

Two weeks after the treatments, the patients filled out a Hospital Anxiety and Depression test — a self-screening questionnaire for depression and anxiety. They also rated the success of their treatments.

"The Botox patients scored much lower on measures of depression, anxiety and irritability," explains Michael Lewis, a psychology professor at the University of Cardiff and lead author of the study. "Crucially, there was no significant difference in how much their treatment made them feel attractive from those who had other treatments, suggesting that [the mood boost] wasn't just down to a boost in self-confidence." (See pictures of facial yoga.)

In 2006, Dr. Eric Finzi, a cosmetic surgeon in Maryland, injected Botox into frown lines around the mouth or in the forehead furrows of 10 clinically depressed women. The treatment was found to eliminate depression symptoms in nine of them and to reduce symptoms in the 10th woman. At the time, Finzi explained the results using the facial-feedback hypothesis — a feedback loop in which people frown back at a depressed person, further deepening that person's sense of isolation. He suggested that if a depressed person can't frown because of Botox treatment, then others won't frown back at them, thereby breaking the loop. (See the top 10 medical breakthroughs of 2008.)

But Lewis says he favors the theory that facial muscles influence brain activity directly and points to earlier research that suggests such a neurological link. For example, studies have shown that subjects find comedy routines significantly funnier when they hold a pen between their teeth the way a dog holds a bone, a pose that stimulates the muscles used for smiling. Similarly, subjects laugh less when holding a pen between their lips, a pose that mimics frowning.

Such studies are part of a growing trend in counseling and therapy that focuses on behavioral change — a new approach summed up by the Alcoholics Anonymous slogan "Fake it till you make it" — rather than the stern "talk therapy" of the Freudian era. Cognitive behavioral therapy, for instance, teaches patients to alter the physiological feedback cycles of certain conditions by slowing their breathing during panic attacks or cutting the hangdog look during periods of depression. Other popular forms of therapy may draw directly from a facial-feedback loop: laughter therapy, for one, seeks to harness the salubrious effects of engaging the smiling muscles as well as release endorphins.

While the cosmetic industry did not fund Lewis' study, it will probably get a boost from his new Botox research. The industry has already shown interest in promoting Botox as a mood enhancer: "I have noted frequently that my patients who receive Botox seem happier," Joel Schlessinger, then president-elect of the American Society of Cosmetic Dermatology and Aesthetic Surgery and president of LovelySkin.com, said in 2006. And Botox has already proved to be somewhat of a wonder drug in its wide application: studies have shown it to be an effective treatment for enlarged prostates, migraines, excessive sweating, writer's cramp and even some forms of cancer. (See pictures of cancer survivors and read their inspirational stories.)

But Lewis warns that his and Finzi's studies both examined small sample groups, so it would be premature, he says, to consider Botox injections — at around $400 each — purely on the basis of their potential for mood enhancement. "The problem is that Botox paralyzes muscles used for communication — even if it is negative communication — so it's difficult to predict the full consequences," he says. "But certainly the research suggests possible treatments." And that, at least, could be something to smile about.

See the most common hospital mishaps.

Cast your votes for the TIME 100.

• Eben Harrell / London
• New research suggests that Botox could help ease depression simply by making it difficult to frown