Wrinkle Treatment & the Brain Skin Connection

Ep 64: The Brain-Skin Connection: Anti-age Your Face with Your Mind 
Dr Teo Wan Lin, dermatologist at TWL Specialist Skin & Laser Centre, has published research in the area of the Brain-Skin connection. Her work on the relationship between facial wrinkles in skin ageing, as well as psychological states and perception has been published in the International Journal of Dermatology, a peer reviewed dermatology journal by the International Society of Dermatology¹.

Hollywood movies have caricatured the hearts and intents of personalities with faces designed to elicit an emotional response from the viewer.  An individual’s facial expression tells us much about what they are thinking, and we pride ourselves on reading characters. Perhaps, also with the stereotypes imprinted in our minds by filmmakers. An inherent flaw in such a concept outside of reel life is that personalities are never black and white, and motivations for behaviours can fluctuate within an individual’s lifetime depending on social contexts. However, the predominance of an emotion-driven by habitual thought processes throughout one’s lifetime, likely past formative years into adulthood, may start imprinting physical residue via static rhytids developed as part of photoaging.

This podcast episode expounds on Dr. Teo Wan Lin’s research on the brain-skin connection. Can our emotions, via chronic facial expressions leave a permanent residue on our faces? 

Media, stereotypes & facial expressions

Hi guys this is Dr. Teo Wan Lin of TWL Specialist Skin & Laser Centre. Welcome to my podcast Dermatologist Talks: Science of Beauty. Hollywood movies have caricatured the hearts and intents of personalities with faces designed to elicit an emotional response from the viewer.  An individual’s facial expression tells us much about what they are thinking, and we pride ourselves on reading characters. Perhaps, also with the stereotypes imprinted in our minds by filmmakers. An inherent flaw in such a concept outside of reel life is that personalities are never black and white. Motivations for behaviours can fluctuate within an individual’s lifetime depending on social contexts. However, the predominance of an emotion driven by habitual thought processes throughout one’s lifetime. Likely past formative years into adulthood, may start imprinting physical residue via static rhytids developed as part of photoaging.

The brain skin connection

This podcast episode will focus on an area of my research. Specifically, the brain-skin connection. The question we are going to answer today is can our emotions, via chronic facial expressions leave a permanent residue on our faces? Well, it’s interesting to discuss this topic. For example, I’ve always wondered, does evil really have a face? Because our cultural perceptions of evil are inadvertently influenced by religious symbols. Evil and diabolical energy appears to be a force that can change our faces as per depictions in fairytale characters. For example, we can conjure up an image when we talk about certain characters like the evil stepmother. It is fascinating that in our pursuit of beauty in this age, we have more information now than ever to link the science behind how the human face ages, and if psychology can play an important role in this.

Beauty isn’t always in black and white.
Facial expressions and aging

The little psychological research that has been performed shows the intersection of the brain and the skin in the aging process. In my paper On thoughts, emotions, and facial expressions and aging published in the International Journal of Dermatology in February 2021, I hypothesized that based on psychological research, individuals are attracted to kindness and altruism which is perceived via certain facial expressions. This can over time, leave a residue on the aging face. The very powerful connection between our emotions and our muscles of facial expression is key in understanding this brain skin connection.

A neutral face is best understood as one which is devoid of expression. As one ages, the interesting phenomenon is that muscles which are used most often, start to become static wrinkles and static lines. This means that when the individual is not actively expressing an emotion, the lines can still be physical on the individual’s face.

Traditional wrinkle treatment

The difference between dynamic and static wrinkles is this. A child and young adult can have wrinkles in the same way an older adult does. In a child, the dynamic wrinkles are visible only when the specific facial expression is observed. However, in an older adult, these dynamic lines actually become fixed. Those are what we refer to as static wrinkles. In terms of what we are targeting in the treatment of photoaging, it is these static wrinkles. For wrinkle treatment and reducing frown lines, periorbital wrinkles, nasolabial folds with toxin injections, lasers, and surgical or non-surgical facelifts. These can be viewed as temporizing measures that anatomically correct some of the causes of these lines.

Traditional wrinkle treatment
Traditional wrinkle treatment has been focused on injectables such as Botulinum toxin, improvement of the skin texture with fillers and a cosmeceutical skincare regimen. Dr. Teo’s research paper on the brain-skin connection, suggests that another form of wrinkle treatment can be via conscious control of one’s pscyhological state, which affects the facial expressions as one ages.
What causes wrinkles?

In the world of medicine, as far as possible, we try to get to the root cause of problems. With the development of static rhytids, we understand that it is primarily due to a reduction in collagen in the dermis, the second layer of the skin, as well as loss of subcutaneous fat. There can be changes in efficiency of cell talk mechanisms that occur in the epidermis and the dermis. These lead to an overall inability to fight oxidative stress. Moreover, they can contribute to the formation of wrinkles.

Genuine smiles vs fake smiles

In light of research that clearly demonstrates individuals who’ve had Botox actually had a similar correlation in terms of elevation in their moods, the converse would actually be a probable phenomenon that an improvement in your mood can lead to less negative facial expressions. According to psychologists, when other people evaluate individuals based on the physical features of attractiveness, they are also subconsciously evaluating you on other features such as altruism and kindness, which they can infer from certain visual cues. That is referenced in psychological research in the assessment of smiles, genuine Duchenne smiles versus fake smiles. It involves very subtle movements around the eye and mouth area. This is which the laypersons were nevertheless able to perceive and pick up.

Does evil have a face?

Interestingly, in another article published in JAMA dermatology in 2017. There was a review of what the authors termed as the dermatologic features of classic movie villains². The outcome of the review was that a disproportionate frequency was found amongst the top 10 American film villains of certain dermatologic findings. This is when compared with their counterparts of the film heroes, the top 10 film heroes. These includes features such as periorbital hyperpigmentation, or in laypersons terms, darkness around the eye area, deep wrinkles. As well as scars in the face, wart lesions, also known as verruca- a form of rosacea known as Rhinophyma, which is disfiguring.

The authors came up with the hypothesis that the film industry us these dermatologic conditions to illustrate the distinct dichotomy between good and evil via visual representation – which was very concerning. This is because it tends to exacerbate existing prejudices and biases about dermatologic conditions.

Can our hearts and intentions be effective wrinkle treatment?
Many prejudices about beauty and ugliness, as well as their links with good vs evil can be found in depictions of film characters. Typically, that physical ugliness correlates with an evil character. This podcast episode presents a novel viewpoint, backed by science, that our hearts and intentions can actually change our faces, via chronic expressions.
Media depictions can promote prejudice

The conclusion was that these depictions actually do foster tendencies towards prejudice. Which our society is already suffering from the harmful effects of. The fascinating point was also the use of skin colour. This was employed as a tool rather consistently to demonstrate evil. Fair skin in film has been described and termed as the ‘evil albino trope’. This is a convenient reference to European folklore. Which was rich with very pale zombie-like creatures, which may have influenced these stereotypes. The ‘evil albino’ stereotype is very relevant in dermatology. Because, it may actually foster, especially in Caucasian populations. The idea that you need to be tanned in order to look attractive or healthy.

Dermatological features of ‘evil old witch’ stereotype

This is the same with facial scars and deep wrinkles. We all remember the hag, the evil stepmother, the cruel witch that is portrayed in film as having all these features. These imprint in our minds that these facial features are related to an evil personality. This is very easily identified in our own childhood memories. For example, in Snow White and the Seven Dwarf, the Queen, who typically embodies the old hag, villain stereotype. She clearly had advanced photoageing with periorbital swelling, hyperpigmentation, deep wrinkles, and interestingly, a permanent scorn on her face. The conclusion of this study was that these features are statistically significant in terms of its prevalence in these Hollywood movie villains. The depiction of these warrants societal concern. Because, it may further bias the mentalities of many individuals towards those who have dermatologic disease.

Just an interesting thought. In Beauty and the Beast, we actually asked if the viewers found ourselves changing our attitude towards the beast. This was even before his appearance was transformed back to that of a prince. This is fascinating because even in a cartoon, or at least in part of the storytelling, there are certain influences that enable us to perceive a certain sort of beauty, which is beyond the physical morphology of the person. In this case, it probably has to do with the expression of the beast after his heart was changed.

On thoughts, emotions, facial expressions and aging

Anti-age your face with your mind

The face carries emotional residue from expressive experiences that reveal current, previous, or chronic emotional states – the rationale for how accurate person-perception occurs by facial assessment alone. While aesthetic interventions can alter the perception of a neutral aged face, predominant facial expressions throughout the individual’s lifetime undoubtedly play a role to “freeze” the neutral aged visage.”— Excerpt from Dr. Teo Wan Lin’s research letter published in the International Journal of Dermatology¹ in February this year. Human faces are not 3D models. They are more than dynamic, more than tissue volume, muscle mechanics or even bony structures. Your face expresses your conscious state, a feedback loop that communicates via hormones controlled by the hypothalamic-pituitary-axis.

Can our emotions and facial expressions leave permanent wrinkles on our face?

An individual’s facial expression can tell us a lot about what they are thinking. However, can our emotions, via chronic facial expressions, actually leave a permanent residue on our faces? There is another interesting study performed in Harbin China, and published in the journal neuroplasticity in 2020³. It’s very relevant because it touches on the link between mental health and facial expressions. Specifically, depression and facial expressions. Depression may be thought of as a persistently depressed mood. A state probably fueled by certain recurring thoughts in neural circuitry that also involves endocrine factors such as depressed levels of happy hormones.

Facial expressions, though, aren’t just a tool for communicating how we feel. Instead, according to this study, it’s also vital in terms of its psychosocial impact in how it affects the way people feel about us. This is key because it can play a role in terms of determining our very own attractiveness to other people. The point here is that science is telling us that the ability to induce these positive emotions is a form of physical attractiveness. Not just this rhetoric that being happy is beautiful. This is overly emotional and these days, has some form of a new age spiritual connotation.

Depression and facial expressions

Going back to the study, the researchers explored face classification processing mechanisms in depressed patients³. Essentially, the researchers wanted to find out if depressed individuals were able to process positive facial expressions of other individuals in the same way as non-depressed subjects. This is very relatable. Because, we all know that our mood can be mirrored by individuals with whom we are interacting with.

If we were to consider the key diagnostic features of psychopathology. For example, in depression, we realise that one of the key criteria is a feature called empathy. This means that they do not have a lot of interest in things that are going on around them. Definitely, not in other people. There is another term we use, which is known as anhedonia. This relates to the inability to have pleasure in activities that previously would have been regarded as pleasurable or interesting. Either by themselves, or a non depressed person.

Facial expressions affect our mood

Apathy, essentially, is a state where individuals are not able to mirror appropriate emotions involved in social interactions. This is particularly concerning because it also means that depressed individuals may be less able to rely on this sort of positive interaction to get themselves out of depression. I find this very relevant to our discussion today. As literally processing a happy face could actually transmit a positive emotion to our own psyche. I think that in our experiences, when we see a smile on another person’s face, or we view genuine happiness, or joy in someone else that we’re interacting with, our mood is elevated and it makes us feel better. Inherent in this study is the assumption that our facial expressions are intricately and undeniably linked to our mood. We know that our mood also affects facial expressions as well.

In terms of the formation of wrinkles, I think it is very short-sighted to overlook the role that your expression plays in terms of determining the face that you have when you age. I think there is a correlation within our human psyche in terms of an understanding of the face of evil, and also that this face doesn’t develop overnight. Scientifically speaking, we can understand it to be the chronic practice of an evil expression. For example, that results in these static wrinkles on the face that determine the expression on an aged face.

Memories in black and white.
Research shows that as we grow older, the colors of our memories fade in our minds- eventually to black and white.

What would you like to remember from your past?
What makes a smile evil?

An evil expression, interestingly, can also be seen in a smiling face. We remember the Queen in Snow White and the Seven Dwarfs having a smile on her face as well in many of the scenes. In the cartoon, she is depicted as being somewhat beautiful. But, having a certain look in her eyes, or maybe the way her lips were pursed that conveys this sense of cruelty and evil that had nothing to do with her having wrinkles, or even distorted features. I believe that that has to do with our ability to pick up on innate beliefs that we can identify if an individual inherently has altruistic tendencies or evil tendencies. What do we call as intuition? Psychiatrists and psychologists have actually performed research on this and they have delineated the science behind this as well.

What we refer to as genuine Duchenne smiles involve the micro expressions of muscles around our eyes and our mouth. These differ from frozen, fake or fixed smiles, which perhaps is what is observed in the Evil Queen. Perhaps, because we are imbued with this capacity as emotionally healthy individuals to identify this. The converse hypothesis also means that if we were to focus on developing genuine emotions, genuine intentions of goodness and kindness, this may also be picked up in the facial cues that will be observed by external persons as well.

Appearances can be deceiving

In conclusion, I’d like to highlight that the multi dimensional appeal of modern anti-fairytale characters like Maleficent is also worth researching. Perhaps this reflects a change in our societal perceptions. Also, maybe lending an extra dimension to the age-old adage that appearances can be deceiving. However, we also know about Silas Marner, the scrooge, whose heart of stone was redeemed by the love and innocence of a little child. In reading the story, our hearts towards him was equally changed at the end. The true gift of humanity with all the pervasive evil observed could actually be in our ability to respond to redemption and repentance. And that, in fact, may be the most moving form of beauty we witness in our souls. A transformation from evil to good that also leaves a mark on the ageing face.

In the book of Proverbs, the wise man Solomon writes, “As water reflects the face, so the heart reflects the true man”. This ancient proverb rings truer than ever. Especially as we dive deeper into the realm of the brain skin connection. As a tool to achieve greater beauty as we age. Well, that’s it for today’s podcast episode. I hope this inspires you to have good thoughts and genuine intentions for the rest of the week at least.


Teo WL. On thoughts, emotions, facial expressions, and aging. Int J Dermatol. 2021 Feb 9. doi: 10.1111/ijd.15443.

Croley, J. A., Reese, V., & Wagner, R. F., Jr (2017). Dermatologic Features of Classic Movie Villains: The Face of Evil. JAMA dermatology153(6), 559–564.

Tong, Y., Zhao, G., Zhao, J., Xie, N., Han, D., Yang, B., Liu, Q., Sun, H., & Yang, Y. (2020). Biases of Happy Faces in Face Classification Processing of Depression in Chinese Patients. Neural plasticity2020, 7235734.