Clinical Approach to Botulinum Toxin in Cosmetic Dermatology and Neurological Conditions
Main Article Content
Keywords
botulinum toxin, dermatology, neurology, cosmetic, clinical
Abstract
Introduction: Botulinum toxin is a mainstay of treatment in cosmetic dermatology and neurology. Initially approved for ocular disorders, it is now widely used for cosmetic procedures and neurological conditions, such as chronic migraine and spasticity. This review explores the clinical approach to botulinum toxin in patients with overlapping aesthetic and therapeutic needs, highlighting current evidence, safety considerations, and interdisciplinary coordination.
Methods: A review of literature on botulinum toxin in cosmetic dermatology and neurology was performed. Original and review articles published before July 4th, 2025 were evaluated for relevance.
Discussion: Botulinum toxin inhibits acetylcholine release at the neuromuscular junction by cleaving SNAP-25, leading to reversible muscle paralysis. It reduces dynamic facial wrinkles by relaxing overactive muscles and has additional uses like treating hyperhidrosis and possibly enhancing dermal remodeling. In neurology, botulinum toxin inhibits pain neurotransmitters in chronic migraine and reduces spasticity in conditions like stroke or multiple sclerosis by blocking excessive motor neuron activity. It also relieves dystonia by targeting abnormal muscle contractions. Botulinum toxin is a safe treatment, with common side effects limited to mild local reactions; serious risks are rare but include unwanted diffusion and antibody formation. Careful dosing, anatomical precision, and patient selection minimize complications and improves outcomes.
Conclusion: A coordinated, interdisciplinary approach is essential for patients needing both therapeutic and cosmetic treatment. Synchronizing injection timing, dosing, and communication between providers ensures optimal outcomes and minimizes risk.
References
2. Padda IS, Tadi P. Botulinum Toxin. StatPearls Internet. Published online November 6, 2023. https://www.ncbi.nlm.nih.gov/books/NBK557387/
3. Witmanowski H, Błochowiak K. The whole truth about botulinum toxin – a review. Adv Dermatol Allergol. 2020;37(6):853-861. doi:10.5114/ada.2019.82795
4. Orsini M, Leite MAA, Chung TM, et al. Botulinum neurotoxin type A in neurology: update. Neurol Int. 2015;7(2). doi:10.4081/ni.2015.5886
5. Sundaram H, Signorini M, Liew S, et al. Global Aesthetics Consensus: Botulinum Toxin Type A—Evidence-Based Review, Emerging Concepts, and Consensus Recommendations for Aesthetic Use, Including Updates on Complications. Plast Reconstr Surg. 2016;137(3):518e-529e. doi:10.1097/01.prs.0000475758.63709.23
6. Satriyasa BK. Botulinum toxin (Botox) A for reducing the appearance of facial wrinkles: a literature review of clinical use and pharmacological aspect. Clin Cosmet Investig Dermatol. 2019;Volume 12:223-228. doi:10.2147/CCID.S202919
7. Rho NK, Han KH, Kim HS. An Update on the Cosmetic Use of Botulinum Toxin: The Pattern of Practice among Korean Dermatologists. Toxins. 2022;14(5):329. doi:10.3390/toxins14050329
8. Dorizas A, Krueger N, Sadick NS. Aesthetic Uses of the Botulinum Toxin. Dermatol Clin. 2014;32(1):23-36. doi:10.1016/j.det.2013.09.009
9. Meretsky CR, Umali JP, Schiuma AT. A Systematic Review and Comparative Analysis of Botox Treatment in Aesthetic and Therapeutic Applications: Advantages, Disadvantages, and Patient Outcomes. Cureus. Published online August 27, 2024. doi:10.7759/cureus.67961
10. Dodick DW, Turkel CC, DeGryse RE, et al. OnabotulinumtoxinA for Treatment of Chronic Migraine: Pooled Results From the Double‐Blind, Randomized, Placebo‐Controlled Phases of the PREEMPT Clinical Program. Headache J Head Face Pain. 2010;50(6):921-936. doi:10.1111/j.1526-4610.2010.01678.x
11. Diener H, Dodick D, Aurora S, et al. OnabotulinumtoxinA for treatment of chronic migraine: Results from the double-blind, randomized, placebo-controlled phase of the PREEMPT 2 trial. Cephalalgia. 2010;30(7):804-814. doi:10.1177/0333102410364677
12. Burstein R, Blumenfeld AM, Silberstein SD, Manack Adams A, Brin MF. Mechanism of Action of OnabotulinumtoxinA in Chronic Migraine: A Narrative Review. Headache J Head Face Pain. 2020;60(7):1259-1272. doi:10.1111/head.13849
13. Jankovic J, Carruthers J, Naumann M, et al. Neutralizing Antibody Formation with OnabotulinumtoxinA (BOTOX®) Treatment from Global Registration Studies across Multiple Indications: A Meta-Analysis. Toxins. 2023;15(5):342. doi:10.3390/toxins15050342
14. Naik PP. Utilities of Botulinum Toxins in Dermatology and Cosmetology. Clin Cosmet Investig Dermatol. 2021;Volume 14:1319-1330. doi:10.2147/CCID.S332247
15. Biello A, Zhu B. Botulinum Toxin Treatment of the Upper Face. In: In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025. https://www.ncbi.nlm.nih.gov/books/NBK574523/
16. Yi KH, Lee HJ, Hur HW, Seo KK, Kim HJ. Guidelines for Botulinum Neurotoxin Injection for Facial Contouring. Plast Reconstr Surg. 2022;150(3):562e-571e. doi:10.1097/prs.0000000000009444
17. Moradi A, Shirazi A. A Retrospective and Anatomical Study Describing the Injection of Botulinum Neurotoxins in the Depressor Anguli Oris. Plast Reconstr Surg. 2022;149(4):850-857. doi:10.1097/prs.0000000000008967
18. Carruthers A, Carruthers J, Cohen J. A Prospective, Double-Blind, Randomized, Parallel- Group, Dose-Ranging Study of Botulinum Toxin Type A in Female Subjects With Horizontal Forehead Rhytides. Dermatol Surg. 2003;29(5):461-467. doi:10.1046/j.1524-4725.2003.29114.x
19. Ramos HHA, Amaral V, De Oliveira Afonso LP, et al. Advanced Injection of Botulinum Toxin in the Nasal Muscles: A Novel Dynamic Change in Facial Expression. Aesthetic Plast Surg. 2024;48(8):1511-1521. doi:10.1007/s00266-023-03751-y
20. Semchyshyn N, Sengelmann RD. Botulinum Toxin A Treatment of Perioral Rhytides. Dermatol Surg. 2003;29(5):490-495. doi:10.1046/j.1524-4725.2003.29118.x
21. Rojo-Sanchis C, Montiel-Company JM, Tarazona-Álvarez B, et al. Non-Surgical Management of the Gingival Smile with Botulinum Toxin A—A Systematic Review and Meta-Analysis. J Clin Med. 2023;12(4):1433. doi:10.3390/jcm12041433
22. Jabbour SF, Kechichian EG, Awaida CJ, Tomb RR, Nasr MW. Botulinum Toxin for Neck Rejuvenation: Assessing Efficacy and Redefining Patient Selection. Plast Reconstr Surg. 2017;140(1):9e-17e. doi:10.1097/prs.0000000000003429
23. Lowe N, Naumann M, Eadie N. Treatment of hyperhidrosis with Botox (onabotulinumtoxinA): Development, insights, and impact. Medicine (Baltimore). 2023;102(S1):e32764. doi:10.1097/md.0000000000032764
24. Han WY, Lee YS, Han HH. The Efficacy of Botulinum Toxin A Injection for Gastrocnemius Hypertrophy: A Prospective, Randomized, Double-blinded Controlled Trial. Plast Reconstr Surg - Glob Open. 2024;12(5):e5813. doi:10.1097/gox.0000000000005813
25. Spiegel LL, Ostrem JL, Bledsoe IO. FDA Approvals and Consensus Guidelines for Botulinum Toxins in the Treatment of Dystonia. Toxins. 2020;12(5):332. doi:10.3390/toxins12050332
26. Esquenazi A, Jost WH, Turkel CC, Wein T, Dimitrova R. Treatment of adult spasticity with Botox (onabotulinumtoxinA): Development, insights, and impact. Medicine (Baltimore). 2023;102(S1):e32376. doi:10.1097/md.0000000000032376
27. Simpson DM, Hallett M, Ashman EJ, et al. Practice guideline update summary: Botulinum neurotoxin for the treatment of blepharospasm, cervical dystonia, adult spasticity, and headache [RETIRED]: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2016;86(19):1818-1826. doi:10.1212/wnl.0000000000002560
28. Aurora S, Dodick D, Turkel C, et al. OnabotulinumtoxinA for treatment of chronic migraine: Results from the double-blind, randomized, placebo-controlled phase of the PREEMPT 1 trial. Cephalalgia. 2010;30(7):793-803. doi:10.1177/0333102410364676
29. Marques RE, Duarte GS, Rodrigues FB, et al. Botulinum toxin type B for cervical dystonia. Cochrane Movement Disorders Group, ed. Cochrane Database Syst Rev. 2016;2016(5). doi:10.1002/14651858.CD004315.pub3
30. Vázquez-Costa JF, Máñez I, Alabajos A, Guevara Salazar M, Roda C, Sevilla T. Safety and efficacy of botulinum toxin A for the treatment of spasticity in amyotrophic lateral sclerosis: results of a pilot study. J Neurol. 2016;263(10):1954-1960. doi:10.1007/s00415-016-8223-z
31. Wong HT, Khan R, Buture A, Khalil M, Ahmed F. OnabotulinumtoxinA treatment for chronic migraine in pregnancy: An updated report of real-world headache and pregnancy outcomes over 14 years in Hull. Cephalalgia. 2025;45(5). doi:10.1177/03331024251327387
32. Smirnoff L. Safety of OnabotulinumtoxinA in the [management of] chronic migraine in pregnancy. Front Pain Res. 2022;3. doi:10.3389/fpain.2022.967580
33. Yiannakopoulou E. Serious and Long-Term Adverse Events Associated with the Therapeutic and Cosmetic Use of Botulinum Toxin. Pharmacology. 2015;95(1-2):65-69. doi:10.1159/000370245
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
Creative Commons Attribution (CC BY): lets others distribute and copy the article, to create extracts, abstracts, and other revised versions, adaptations or derivative works of or from an article (such as a translation), to include in a collective work (such as an anthology), to text or data mine the article, even for commercial purposes, as long as they credit the author(s), do not represent the author as endorsing their adaptation of the article, and do not modify the article in such a way as to damage the author's honor or reputation.
Authors retain copyright in their work and license the publisher to publish the content. The publisher is the National Society for Cutaneous Medicine, with production and publishing support provided by OJS, Open Journal Systems,see https://pkp.sfu.
Prior to January 2022, authors transferred copyright to the National Society for Cutaneous Medicine. However, all articles are freely available to anyone in the world. There are no subscription fees, page charges, or article processing charges.