Where and how to use botulinum toxin on the face and neck – Indications and techniques

Botulinum toxin (BT) is a proteinaceous substance that is derived from the bacterium Clostridium botulinum. It was initially used for the treatment of strabismus by Dr. Alan Scott in the late 1970s after which, it was regularly being used for the cosmetic correction of benign essential blepharospasm by the Carruthers couple. Jean Carruthers while treating one such patient noticed an improvement in the glabellar furrows with an effect on the brow of the patient as well. By the late 1980s through the 1990s, BT was used rampantly as an off-label indication to treat glabellar frown lines. In 2002, the US Food and Drug Administration approved the use of BT type A for the treatment of glabellar furrows. This changed the global scene of facial rejuvenation, heralding a new era. Ever since then, BT has proved to be effective and safe for the treatment of dynamic facial rhytides and is currently being used for various indications. These indications and techniques have evolved with a better understanding of the face and neck musculature and their interactions and actions as well as efficacy of the BT formulations. The authors present an overview of the various cosmetic indications of BT for the face and neck along with the approach to injection techniques for various muscle groups involved.