Botulinum Toxin A

Purified botulinum toxin type A was initially developed as an alternative to the surgical treatment of strabismus. In the early 1970s, many ophthalmologists participated in the Food and Drug Administration (FDA) approved study of the efficacy of botulinum toxin A in the treatment of benign essential blepharospasm and hemifacial spasm. Noting the coordinated beneficial effects on periocular wrinkles and glabellar frown lines first reported by Carruthers and Carruthers,125 surgeons began using botulinum toxin A for cosmetic purposes in the early 1990s. In 1994 others also reported on their experiences with the cosmetic use of botulinum. That same year, Keen and Blitzer126 performed a double-blind study confirming the efficacy of botulinum toxin A for the treatment of hyperkinetic facial lines. Facial aesthetic enhancement by botulinum toxin type A injection is currently the most commonly performed cosmetic procedure.
The perceived simplicity, unfortunately, has resulted in its use by non-physicians, as well as practitioners of every specialty outside those that traditionally perform cosmetic procedures (e.g. emergency room physicians, family practice physicians, anesthesiologists, obstetricians, dentists, nurses . . . and the list keeps growing). In our society today, a rapid demand has grown for procedures that are minimally invasive, safe, and effective. The popularity of botulinum continues to escalate, as results can be achieved with even novice injectors with no 'down time' in a non-clinical setting.