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Sarah Steinberg
August 28, 2019

The Case Against Botox

I worry (causing wrinkles no doubt) that Botox is harming us as a society.

"I’m not judging individuals who use Botox. But I want to start a conversation."

I’m 46 and I have two young children. Not a day goes by that I don’t fantasize about a little Botox. Just to smooth out the “elevens” between my brows or to lift up the outer corners of my eyebrows and halt their downward descent. Becoming a mother at the age of 39 is a blessing and I’m grateful. Still, there’s nothing like seeing your face smushed up next to the face of an infant to remind you how far your face has traveled in this world.

To be clear, I have nothing against anti-aging treatments or procedures. But I think Botox is in a class of its own. I worry (causing wrinkles no doubt) that Botox is harming us as a society – blunting our emotions, limiting our empathy, hampering our children’s emotional education and stifling our relationships.This is not a popular position. Every time I read an article whose title hints at an anti-Botox attitude, I find something else, like a primer on how to keep your skin looking young during those nine months of pregnancy when Botox is a no-no. Amanda Peet wrote a beautiful and courageous article in Lenny about what kind of example it sets for one’s daughter to be forever chasing down pretty. I’ve always loved Amanda Peet. She’s one of those actors whose work I will see – even if I think I’ll hate the movie itself – because it’s worth it to watch her expressive face on screen. And therein lies the root of my worry.

Understanding emotional expression is a learned skill. Training begins in infancy. There are 42 muscles in the human face. The permutations of expression are so vast that the psychologist Paul Eckman and his colleagues have developed a 500–page volume called the Facial Action Coding System (FACS). So what happens when we freeze some of them? Let me rephrase: what would happen if piano virtuoso Glenn Gould had been limited to 10 keys on the piano instead of all 88? The complex ability to read a face, interpret an emotion, and react in kind is a critical life skill.

Remember the movie Spotlight, starring Rachel McAdams? After this incredibly riveting and socially important movie I had so many conversations (with my most thoughtful friends) that started with, “Did you see Rachel McAdams’ forehead?” She received an Oscar nomination for her remarkable and un-botoxed performance, but she didn’t win. Perhaps if the Academy had singled Rachel McAdams out for her stellar performance, it would have become a thing. I still have hope, as Hollywood becomes ever more paralyzed, that the tide will turn and giving up Botox will be an Oscar hack in the tradition of looking unattractive (Charlize Theron, Monster) or playing the role of a person with a disability (Dustin Hoffman, Rainman). If the Academy started rewarding facial expressive freedom, maybe Oscar fever would be the methadone that saves actors from Botox addiction. Otherwise, we as the audience are losing out. Our kids are losing out.

Why are our kids losing out? Because of the trickle-down effect.Yes, they’re missing out on learning about emotions from actors, but much more importantly, because their mothers are Botoxed. One of the best pieces of parenting advice I ever got was from a retired psychiatrist. He said, “never lie to your children about your emotions because they’ll see it on your face and it will confuse their emotional education.” So if you’re sad and they ask you what’s wrong and you say “nothing, I’m not sad”, then you’re teaching them the wrong thing. But what happens when your face is lying? All the time. Makes it pretty hard to learn, no?

Here’s another conundrum – relationships. In this era of the snap judgements on Tinder and attention-sucking, omnipresent screens, the moments when we actually make eye contact are precious. If, in those rare moments, our emotional reactions are blunted, then those connections are diminished even further. You know that feeling when you meet someone and ‘you just know?’ It’s made of a lot of subconscious emotional shorthand – shorthand that requires your whole face. So if part of your face is frozen, that’s the ultimate ‘missed connection.’ And it isn’t just ‘first’ meetings – imagine a whole marriage made up of ‘missed connections.’

Botox is as pervasive in politics as it is in acting. It’s just more subtle. Rewind to 2016. Hilary Clinton takes the podium with a carefully crafted, gentle grandmotherly face. Her face was the pinnacle of D.C. Botox. Truly a work of art. How else could someone get through those debates and listen to Donald Trump with a poker face? Now shift your gaze to the other side of the stage. Bring your mind’s eye to the two women sitting behind the large lurking figure. Ivanka and Melania are wearing a different breed of Botox. This is Manhattan Botox: Full Frontal Frozen. Are they the same age? No. Ivanka is 36 and Melania is 48. But neither of their faces move. Melania lives in RBF (resting b#*&* face), and Ivanka lives in “worshipful teenage daughter” face. Despite the live feed video, they have transformed to snapshots, their faces frozen as Trump hurls insults at women, minorities, immigrants, and disabled people. What did Melania really think of “grab them by the pussy?” Thanks to Botox, we’ll never know.

In our ‘melting pot’ nation, some people rant against societies in which women are repressed and hidden behind burqas. In addition to thinly veiled anti-Muslim sentiment in these complaints, there’s also feminist hypocrisy. There’s something just as repressive going on right here in our own backyard – American women are freezing their faces. They are silencing their emotions. And why? To look pretty? To look younger? And why are the lines between our eyebrows and on our foreheads so important? What are we saying when we knit or furrow our brows? That’s the look of frustration and anger. That’s the look of questioning and thinking hard. Are those emotions that women shouldn’t have? Who’s wearing a burqa now? And even more importantly, who’s requiring them to wear it? We are. We’re silencing ourselves.

I’m not judging individuals who use Botox. But I want to start a conversation. Botox is prescribed by doctors and used by actors, politicians and all sorts of ordinary people. There’s an implicit assumption that medically prescribed treatments are not only safe, but also good for you. Yes, Botox is FDA approved. But there’s no regulatory body that approves or bans treatments based solely on how they affect our psychological health and well-being.The pharmaceutical companies and doctors profiting (hugely) from Botox aren’t worried about our relationships and emotional well being. That’s not their job, it’s ours.


Sarah Adams Steinberg, MD/PhD lives in Brooklyn with her husband and two sons. Currently on an extended maternal hiatus from medicine, Sarah studied at Swarthmore, Johns Hopkins and Yale and did her Internal Medicine and Gastroenterology training at Mount Sinai. She’s a lifelong yogini who loves painting and bright colors and she hates to wear any shoes that aren’t clogs

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