While emotional expression literature has garnered considerable attention in the field of organizational behavior, research has mainly paid attention to the effect of leader emotional expression on follower outcomes. However, an increasingly prevalent phenomenon that followers express emotions to the leader has been unexamined. In this regard, our research shifts the focus of emotional expression from a leader-centric to a follower-centric lens by exploring the impacts of follower anxiety expression to the leader on the leader’s role performance (i.e., leader effectiveness) and well-being (i.e., insomnia). Drawing upon the EASI model, we propose that follower anxiety expression hurts leader effectiveness and enhances the likelihood of insomnia through leader anxiety as an emotional pathway, whereas it also benefits leader effectiveness and reduces insomnia through leader feeling trusted as an inferential pathway. Moreover, servant leadership acts as a vital contingency which amplifies the double-edged impacts of follower anxiety expression on leaders through both emotional and inferential pathways. The results from a pre-registered two-wave, multi-source survey study containing 286 leader-follower dyads from China supported our hypotheses. Theoretical contributions to the literature on emotional expression, servant leadership, and trust are discussed.