Abstract
An ophthalmic plastic clinical experience of 22 years of Botox ® use is reviewed, beginning with the clinical trials at Manhattan Eye, Ear and Throat Hospital in 1980 for benign, essential blepharospasm control, and continuing with the current ever-expanding facial cosmetic applications in private practice today. We have reviewed the advantages and potential complications of its use as a primary rhytid ablator for crow’s feet, glabellar furrows, transverse forehead creases, lower eyelid creases and hypertrophic orbicularis muscle folds, upper lip furrows and “smokers” lines, and neck ring creases. We discuss its use in relaxation of platysmal bands and persistent frowning. Patients who are not good candidates for these indications are discussed. Chemodenervation with Botox ® has become an integral step in the preparation of our patients undergoing non-ablative laser facial rejuvenation as well as those undergoing laser resurfacing and Intense Pulsed Light photorejuvenation. Botox apparently has a beneficial effect on the ultimate result if it is applied prior to the onset of collagen remodeling. Our therapeutic regimens are reviewed.