Botulinum toxin management of upper facial rhytidosis and blepharospasm

Botulinum toxin is a neuromuscular blocking agent produced by Clostridium botulinum that has been proven to be an effective agent in the treatment of facial dystonia and upper facial rhytidosis. Since the original description of the toxin by Alan Scott [1] for strabismus 3 decades ago, the clinical use of this medication has expanded in an exponential fashion. Although the cosmetic benefits of botulinum toxin have become widely known, the full potential of this agent is yet to be realized. Its applications have grown to include treatment of a variety of disorders spanning many subspecialties including gastroenterology, pain management, otolaryngology, ophthalmology, dermatology, and neurology. Botulinum toxin is considered as a potential treatment in any situation involving inappropriate or exaggerated muscle contraction. The Food and Drug Administration (FDA) approved the use of botulinum toxin (Botox; Allergan Pharmaceuticals, Inc, Irvine, CA) to treat blepharospasm and strabismus in 1989. In December 2000, approval was given to treat cervical dystonia, a neurologic movement disorder causing severe neck and shoulder contractions, in December 1989. In April 2002, the FDA announced the approval of botulinum toxin type A (Botox Cosmetic; Allergan) to improve temporarily the appearance of glabellar lines. The product's manufacturer has marketed botulinum toxin type A for this new indication, and the use of this product has skyrocketed. This article discusses the development of the use of botulinum toxin and then focuses on its benefits in treating facial dystonia and upper facial rhytidosis.