Palavras-chave
Propriocepção
Neurobiologia
Amígdala
Transtorno Depressivo Maior
Resumo
A toxina botulínica tipo A (BoNT-A) transcendeu sua aplicação estética original para tornar-se uma ferramenta de modulação emocional fundamentada na Hipótese do Feedback Facial (HFF).¹² Esta revisão analisa como a paralisia muscular facial altera a experiência intrapessoal e a comunicação interpessoal.³,⁵ Evidências sugerem que a injeção glabelar reduz a hiperatividade da amígdala cerebral por meio da interrupção do feedback proprioceptivo, auxiliando na remissão da depressão maior.⁶,⁸ O “sinal de ômega” destaca-se como um biomarcador visual de agitação psicomotora e tristeza, sendo preditor de alta resposta terapêutica.⁹,¹⁰ Por outro lado, o tratamento excessivo em áreas de expressão positiva pode induzir achatamento afetivo, prejudicar o mimetismo social e reduzir a empatia.¹¹,¹² Conclui-se que o esteta contemporâneo deve atuar com consciência neurobiológica para equilibrar o bem-estar mental e a autenticidade expressiva do paciente.
Referências
Darwin C. The expression of the emotions in man and animals. London: John Murray; 1872.
Ekman P, Friesen WV. Facial Action Coding System. Palo Alto: Consulting Psychologists Press; 1978.
Finzi E, Wasserman E. Treatment of depression with botulinum toxin A: a case series. Dermatol Surg. 2006;32(5):645-9.
Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.
Costa ACF, Silva EC, Gondim DV. Botulinum Toxin in Facial Aesthetics Affects the Emotion Process: A Meta-analysis of Randomized Controlled Trials. Clin Psychopharmacol Neurosci. 2022;20(4):600-608.
Demchenko I, Swiderski A, Liu H, et al. Botulinum Toxin Injections for Psychiatric Disorders: A Systematic Review of the Clinical Trial Landscape. Toxins. 2024;16(4):191.
Hanayama H, Tada J, Terashi H. Botulinum Toxin A Therapy for Glabellar Lines Improves Emotional States: Evaluation of 47 Cases without Mental Disorders. J Plast Reconstr Surg. 2025;4(2):75-80.
Segundo A, Reis MSC, Lopes LAS, et al. Effect of Botulinum Toxin Type A on Depression: Clinical Evidence and Possible Neurobiological Mechanisms. REMUNOM. 2026;13(03):1-14.
Hennenlotter A, Dresel C, Castrop F, et al. The Link between Facial Feedback and Neural Activity within Central Circuitries of Emotion. Cereb Cortex. 2009;19(3):537-42.
Stark S, Stark C, Wong B, et al. Modulation of amygdala activity for emotional faces due to botulinum toxin type A injections that prevent frowning. Sci Rep. 2023;13(1):3333.
Wollmer MA, Magid M, Kruger THC, Finzi E. Depression. In: Botulinum Toxin Therapy. Handb Exp Pharmacol. 2021;263:265-278.
Muñoz-Gonzalez C, Zarate JM, Fakih-Gomez N. The Overlooked Sad Face Expression: Understanding the Omega Sign in Botulinum Toxin Treatment. J Cosmet Dermatol. 2025;24(6):e70200.
Ceolato-Martin C, Chevallier-Collins C, Clément JP, et al. OnabotulinumtoxinA in Resistant Depression: A Randomized Trial Comparing Two Facial Injection Sites (OnaDEP Study). Depression and Anxiety. 2024;2024:1177925.
Gambini M, Gurrieri R, Russomanno G, et al. Botulinum Toxin: An Unconventional Tool for the Treatment of Depression? Brain Sci. 2025;15(9):971.
Magid M, Reichenberg JS, Poth PE, et al. Treatment of major depressive disorder using botulinum toxin A: a 24-week randomized, double-blind, placebo-controlled study. J Clin Psychiatry. 2014;75(8):837-44.
Wollmer MA, de Boer C, Kalak N, et al. Facing depression with botulinum toxin: a randomized controlled trial. J Psychiatr Res. 2012;46(5):574-81.
Brin MF, Durgam S, Lum A, et al. OnabotulinumtoxinA for the treatment of major depressive disorder: a phase 2 randomized trial. Int Clin Psychopharmacol. 2020;35(1):19-28.
Lewis MB. The interactions between botulinum-toxin-based facial treatments and embodied emotions. Sci Rep. 2018;8(1):14720.
Harth W. Botulinumtoxin als Irrweg [Botulinum toxin: the misguided path]. Hautarzt. 2013;64(6):410-3.
Hopf AGM, Buchheim A, Hopf M, et al. A Psychological Guide to Upper Face Botulinum Toxin Injections. J Cosmet Dermatol. 2025;24(10):e70508.
Hopf AGM, Buchheim A, Hopf M, et al. A Psychological Guide to Lower Face Botulinum Toxin Injections. J Cosmet Dermatol. 2026;25:e70833.
Vanaria RJ, Chaudry A, Marrero-Perez AC, et al. The Face of Emotion: Botulinum Toxin, Emotional Anatomy, and Mood Modulation. J Cosmet Dermatol. 2025;24(6):e70264.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5-TR. 5th ed. Washington, DC: APA Publishing; 2022.
Wollmer MA, Krueger THC. Botulinum Toxin as a Treatment for Depression - Current Data Situation. Toxicon. 2024;237:107511.
Finzi E. Botulinum Toxin Treatment for Depression: A New Paradigm for Psychiatry. Toxins. 2023;15(5):336.
Wollmer MA, Magid M, Kruger THC, Finzi E. Treatment of Depression with Botulinum Toxin. Toxins. 2022;14(6):383. [Referência adicionada do Documento 2].

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Copyright (c) 2026 Eugenio Miguel Santomauro Vaz, Nina Sato (Autor)