Journal of Aesthetic Nursing - How botulinum toxin affects nonverbal communication: a visualisation using artificial intelligence

Abstract

Marsha Wichers provides an insight into the link between botulinum toxin injections and facial expressions

The use of botulinum toxin is becoming exceedingly popular (Figure 1), particularly among younger people. Botulinum toxin works against wrinkles by relaxing facial muscles, and it may also profoundly affect facial expressions. Facial expressions are an important part of a person's individuality. They are not only important for feeling emotions and expressing them, but also for interpersonal communication.

Figure 1. Background information on the cosmetic use of botulinum toxin

Research question

The author raised the question: will we still understand one another if we can no longer fully use facial expressions in non-verbal communication?

Methods

This question was explored by running a standardised and protocolised routine of 18 facial expressions before and 2 weeks after full facial injections with botulinum toxin (Figure 2). Facial expressions were read out from high-resolution video using (1) facial emotion-reading software (i.e. artificial intelligence) and (2) the human eye (Figure 3).

Figure 2. Injection points of the full facial botulinum toxin treatment

Figure 3. Inventory of facial expressions (eight of 18) and the context in which they are used. There is also a listing of the associated facial muscles and the description of their action

Results

While the subject made the same effort to express emotions before and after botulinum toxin, the outcomes were clearly different. Depending on the readout (i.e. emotion-reading software or the human eye), clear inabilities to display disgust or a genuine smile (‘Duchenne smile’) were detected after botulinum toxin treatment (Figures 4 and 5). Some discrepancies were noted between the two different readouts, demonstrating the subjective and complex nature of emotions, and, perhaps, the complex nature of the effects of botulinum toxin thereon.

Figure 4. In this film still, this is an example of the expression of disgust in which, normally the corners of the mouth are depressed. Due to the absence of this movement after botulinum toxin treatment, the software interprets this facial expression as neutral, rather than disgusted. For human interpretation of this facial expression after botulinum toxin treatment, it seems mandatory to know the context in which it is made, otherwise, it would be difficult to interpret

Figure 5. In this film still, this is an example of a genuine smile, the so-called Duchenne smile (in which, normally, the muscle around the eye contracts and forms wrinkles). Due to the paralysing effect of botulinum toxin, the muscles around the eyes cannot contract. A magnification of this remarkably different feature is highlighted in the circles on the right. Notice that the software does not detect the absence of the contraction around the eye; it rates both expressions as ‘happy’. In human interpretation, this feature makes a very important difference between a real and a ‘fake’ smile

Conclusion

Botulinum toxin does not only prevent skin wrinkle formation, but it also affects the ability to display emotions. This can have an effect on interpersonal communication. In the author's opinion, doses and injection schemes should be carefully considered between clinicians and patients. The ability to express emotions is important for human interaction and may outweigh the disadvantages of wrinkles. In the modern digital world, which is presently recovering from a pandemic, it is particularly important to celebrate and embrace humanity by being empathic and able to mirror others.

Extra information

This research material originated from a design research project in 2019 about the effect of facial enhancement on the human condition by Marsha Wichers. For more information and the short version of the video work, please visit: www.studiomarshawichers.nl/project-face-design.