Cosmetic Uses of Botulinum Toxin
The use of botulinum toxin in patients with blepharospasm and hemifacial spasm (HFS) led to the observation that botulinum toxin reduces or eliminates some facial wrinkles. The first neurotoxin available for aesthetic indications was onabotulinumtoxinA, which already had a long history of ophthalmic use in the treatment of blepharospasm and HFS. The US FDA approved it to temporarily reduce wrinkles in the glabellar area, the lateral canthal lines (crow’s-feet), and the forehead. AbobotulinumtoxinA, the second neurotoxin to become available in the United States, has also been approved for the treatment of wrinkles in the glabellar area. IncobotulinumtoxinA has been approved for both cosmetic and medical applications. A number of non–FDA-approved botulinum toxin products are available worldwide; however, US physicians should recognize the significant risks associated with using a non–FDA-approved substance for injection. Also, unit potency differs among these products, requiring that careful dosing adjustments be made.
Apart from the glabella, the areas most amenable to neuromodulation are the forehead, lateral canthal lines, perioral rhytids, and platysmal bands. The amount of botulinum toxin required and the location of injections vary significantly among patients and should be individualized.
The eyebrow can be chemically lifted when botulinum toxin is injected into the depressors of the eyebrow. The corners of the mouth can be elevated with injection into the depressor anguli oris muscle. The onset of action, peak effect, duration of effect, and complications of botulinum toxin for cosmetic purposes are the same as those noted for botulinum toxin as therapy for benign essential blepharospasm in Chapter 12 of this volume.
Lorenc ZP, Kenkel JM, Fagien S, et al. Consensus panel’s assessment and recommendations on the use of 3 botulinum toxin type A products in facial aesthetics. Aesthet Surg J. 2013;33(1 Suppl):35S–40S.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.