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Psychosocial Aspects of Botox in Aesthetic Surgery



The human preoccupation of experimenting with potentially toxic substances at sublethal doses to enhance beauty spans the ages. The Botox injection is the fastest growing cosmetic procedure, and its physiologic safety profile is considered to be excellent. The psychosocial consequences of Botox have been largely ignored in the literature.


This cross-sectional study investigated the psychosocial issues that can arise as either an antecedent to the treatment or a consequence of it.


Significant differences between clients and control subjects were observed in the four major areas of psychosocial functioning implicated in this study: (a) distress arising from the procedure (anxiety/phobia), (b) worry about the facial changes after the procedure, (c) expectations, involving the discrepancy between expected and actual outcomes of treatment; and (d) dependence, involving the desire for repetitive administration.


The impact of Botox on the psychosocial functioning of individuals was investigated in this study from a psychosocial and clinical perspective in an effort to pave the way for the formulation of national standardized guidelines for the use of Botox. This study empowers the clinician to understand the basis for the relative contraindications of Botox, which are largely psychological in nature, and thus to ensure its administration in a safe and responsible manner.

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  1. American Society for Aesthetic Plastic Surgery 2000 statistics on cosmetic surgery. p. 4. Retrieved 2002 at

  2. Bradbury E: The perception of ageing: Abstracts and biographies. Presented at the Ageing Skin in the New Millenium Conference at The Royal Society of Medicine, London, 11 April, 2002

  3. Diagnostic and statistical manual of mental disorders. American Psychological Association, 1994. Washington, D.C.

  4. Jancovic J, Brin MF: Therapeutic uses of botulinum toxin. N Engl J Med 324:1186–1193, 1991

    Google Scholar 

  5. Matarasso SL: Complications of botulinium A exotoxin for hyperfrontal lines. Dermatol Surg 24:1249, 1998

    Article  CAS  PubMed  Google Scholar 

  6. Misra VP: The changed image of botulinum toxin. BMJ 325:1188, 2002

    Article  PubMed  Google Scholar 

  7. Rankin M, Borah G: Anxiety disorders in plastic surgery. Plast Reconstr Surg 100:525–542, 1997

    Google Scholar 

  8. Salmon P: Clinicians’ decisions and patients’ adherence. In: Salmon P (ed) Psychology of medicine and surgery. John Wiley and Sons: Chichester, pp.137–153, 2000

    Google Scholar 

  9. Singh G, Kelly MBH: Botox an “elixir of youth”? Eur J Plast Surg 26:273–4, 2003

    Article  Google Scholar 

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Correspondence to G. Carter Singh B.Sc.(Hons), M.B.B.S. (Distinction).

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None of the authors received any funding for this study, nor have they any commercial associations that might pose or create a conflict of interest with information presented in any submitted manuscript.

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Carter Singh, G., Hankins, M.C., Dulku, A. et al. Psychosocial Aspects of Botox in Aesthetic Surgery. Aesth Plast Surg 30, 71–76 (2006).

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