Botulinum Toxin Use in Aesthetic Medicine
Summary
Botulinum toxin, a neurotoxic protein derived from Clostridium botulinum, has been repurposed over the past three decades for aesthetic indications. By selectively inhibiting acetylcholine release at neuromuscular junctions, botulinum toxin produces muscle relaxation and smooths dynamic facial rhytides such as glabellar frown lines, crow’s feet and forehead creases. Multiple formulations of type A toxin are approved in Europe and Asia, differing in potency units and excipient profiles. Injection protocols have evolved from empirical dosing to anatomically guided techniques, often assisted by ultrasonography, which enhance precision and minimise adverse events. Beyond wrinkle reduction, off-label applications increasingly target masseter hypertrophy, gummy smile correction and submandibular gland reduction. Emerging evidence also supports intradermal use to modulate sebaceous gland activity for acne and seborrhoea. Safety remains paramount, with transient eyelid ptosis, headache and local discomfort the most frequently reported complications. Patient selection, practitioner training and standardisation of dosing regimens underpin treatment predictability. Future directions include individualised dosing algorithms, novel toxin serotypes with longer duration of effect and combination approaches with energy-based devices to maximise facial rejuvenation while preserving natural expression.
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Botulinum Toxin Use in Aesthetic Medicine publication trend
The graph below shows the total number of articles in botulinum toxin use in aesthetic medicine across all publications each year (not limited to Nature Index journals).
Technical terms
Botulinum toxin (BoNT): A neurotoxic protein that induces temporary muscle paralysis by blocking acetylcholine release at the neuromuscular junction.
Dynamic wrinkles (rhytides): Skin creases formed by repetitive muscle contractions, prominent during facial expression.
Glabellar lines: Vertical frown lines between the eyebrows caused by corrugator and procerus muscle activity.
Ultrasonography-assisted injections: Use of high-frequency ultrasound imaging to visualise muscle depth and adjacent structures for precise toxin delivery.
Masseter hypertrophy: Enlargement of the masseter muscle, often treated to slim the lower face and improve facial contour.
References
- Cosmetic Treatment Using Botulinum Toxin in the Oral and Maxillofacial Area: A Narrative Review of Esthetic Techniques. Toxins (2023).
- Complications of Cosmetic Botulinum Toxin A Injections to the Upper Face: A Systematic Review and Meta-Analysis. Aesthetic Surgery Journal (2022).
- Botulinum Neurotoxin Type A in the Treatment of Facial Seborrhea and Acne: Evidence and a Proposed Mechanism. Toxins (2021).
- Botulinum toxin for cosmetic treatments in young adults: An evidence‐based review and survey on current practice among aesthetic practitioners. Journal of Cosmetic Dermatology (2022).
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