I have OCD and trouble smiling fully. Will Botox help?

Hi doctor,

I wanted to get your opinion on my situation to see if you guys might be able to help. For several years now, I have had trouble smiling fully in certain situations. Generally, in social situations, it is almost like I give an awkward half-smile. It is hard for me to smile fully. This does not really occur when I am alone, only when I am in a social setting around people. Needless to say, I also suffer from OCD, which seems to have gotten worse over the years. But it really just involves me checking things several times. The smile issue is affecting my life way more.

However, I want to know if it is more of a physical thing or a mental thing. What leads me to believe it is physical is that I have tried exercises like smile practice, in which I hold a smile in the mirror for about five minutes. About three minutes in of holding the smile, I feel a tightness in the cheek area, and then right after that, my smile feels normal, almost as if I have released tension in a muscle or something.

This does work, but constantly having to do this multiple times a week is super annoying. This led me to look into Botox, specifically the DAO procedure, which essentially freezes up the depressor angularis oris muscle in the face, which prevents frowning, and allows people to smile a lot easier. I went to two local cosmetic surgeons, but they said they were not too familiar with this procedure, and that they felt that it might work or might not, but did not feel comfortable doing it. This problem is really ruining my life and has been for years.

Being able to only give a half smile in social situations is embarrassing and something that everyone notices. This often leads me to take MDMA in social situations, which makes me really happy, and not care about my smile. However, I know that I cannot keep doing this. It is not a sustainable way to cope with this issue. I wanted to get your thoughts on my situation.

Please guide.