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Overview of botulinum toxin for cosmetic indications

Authors
Jean Carruthers, MD, FRCSC
Alastair Carruthers, FRCPC
Section Editor
Jeffrey S Dover, MD, FRCPC
Deputy Editor
Abena O Ofori, MD

INTRODUCTION

Botulinum toxin is an injectable neuromodulator derived from neurotoxins produced by Clostridium botulinum, the bacterium responsible for botulism. Through the inhibition of neurotransmission between peripheral nerve endings and muscle fibers, botulinum toxin weakens or paralyzes skeletal muscle. Initially used for medical indications, botulinum toxin injection has now become one of the most requested procedures in facial rejuvenation.

When used appropriately, botulinum toxin injection is an overwhelmingly safe method for improving cosmetic defects that are caused by or exacerbated by muscle contraction, such as prominent glabellar rhytides. The effects of botulinum toxin are transient; muscular function typically returns to baseline within a few months.

The mechanism of action, formulations, clinical use, and safety of botulinum toxin injections for cosmetic indications will be reviewed here. The use of botulinum toxin for specific cosmetic or medical indications is discussed elsewhere. (See "Botulinum toxin for cosmetic indications: Treatment of specific sites" and "Treatment of dystonia", section on 'Botulinum toxin injections' and "Treatment of myoclonus", section on 'Botulinum toxin injections'.)

DISCOVERY AND DEVELOPMENT

The clinical relevance of C. botulinum, a gram-positive bacillus, was first recognized in 1897, when the toxin produced by the organism was identified as the etiologic agent of botulism [1,2]. Since then, seven serotypes of botulinum toxin (A, B, C1, D, E, F, and G) produced by different strains of the bacterium have been identified. The pharmacologic properties of the serotypes differ, and only serotypes A and B are available for clinical use [3-5]. Botulinum toxin type A is the most common form of botulinum toxin used in aesthetic clinical practice.

The clinical utility of botulinum toxin initially became evident in the treatment of strabismus [6]. Subsequently, botulinum toxin has been utilized for a variety of other medical conditions characterized by muscular hyperactivity, including blepharospasm [7], hemifacial spasm [8,9], and cervical dystonia [10]. (See "Treatment of dystonia", section on 'Botulinum toxin injections' and "Treatment of myoclonus", section on 'Botulinum toxin injections'.)

                                 

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Literature review current through: Nov 2016. | This topic last updated: Fri Aug 12 00:00:00 GMT 2016.
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