Abstract
Botulinum toxin type A has recently been licensed for cosmetic use for the glabellar frown in the USA (Botox Cosmetic ®, Allergan Inc), and has been used extensively since the early 1990s for the management of other wrinkles such as crow’s feet, horizontal forehead wrinkles, perioral lines and neck wrinkles. Botox ® is currently the only Botulinum toxin available in the USA but other European and South American countries may choose between Botox Cosmetic ® and Dysport ® (Ipsen pharmaceuticals). Differences relate to the time of onset of paralysis and the degree of diffusion of the toxin from the injection site. Both types have their own advantages. Limitations of use of Botulinum toxin type A relate in particular to the patient’s skin tone, eyebrow position, lid lash distance and position of their zygomatic arch. Long-term use is affected by the balance between hypertrophy of untreated muscle and atrophy of treated muscles. Careful analysis of facial features during the initial consultation will indicate the choice of toxin; the likely immediate and long-term results and the need for adjunctive treatments. The author describes her conclusions based on over 10,000 cosmetic Botulinum toxin type A treatments.