Botulinum toxin has come a long way from once being considered as a dreaded toxin to the present day when it is being most sought after for its cosmetic application.
Three preparations of botulinum toxin are commercially available at present.
1.Botox (Allergan Inc., Irvine, CA, USA)
2. Dysport (Ipsen Pharmaceuticals, France) are the type A toxins.
3.Myobloc (Elan Pharmaceuticals, San Diego, CA, USA) is the type B toxin.
The use of botulinum toxin for decreasing the dynamic wrinkles in the facial region has become the most popular indication for its use now ever since Carruthers et al. reported its use for dynamic wrinkles in the glabellar area in 1992.
Glabellar frown lines
The glabellar wrinkles are caused by the actions of corrugator supercilli, depressor supercilli and procerus muscles(. 2.5-5 U of botulinum toxin type A are injected at five to seven sites into both corrugators and into the procerus muscle which provides relief for upto 6 months.
Horizontal forehead wrinkles
These occur due to the chronic action of the underlying frontalis muscles. Injection of botulinum toxin type A (Botox) in four to eight sites spaced evenly over the forehead may relax the muscle and soften these lines. The injections are typically given 2-3 cm above the orbital rim using 2.5-5 U per injection sites.
Periocular crow's feet
The contraction of the lateral orbicularis fibers, zygomaticus and risorius muscles gives rise to dynamic wrinkles spreading out from the lateral canthus, known as the crow's feet). Three to four injections of 2.5-5 U of Botox into lateral orbicularis oculi are required for effective treatment of crow's feet.
Chemical brow lift
Botulinum toxin can be used to create a chemical browlift by selectively paralyzing the depressors of the eyebrow.
Other aesthetic facial applications of botulinum toxin include 'bunny lines', peri-oral treatment, dimpled chin, 'marionette lines' and platysmal bands.