Cosmetic denervaton has gained a lot of popularity in recent years, becoming the fifth most performed cosmetic procedure in the United States and a $100 million business. The cosmetic use of Botulinium toxin has been very successful because it is safe, effective, time-effective, and a repeatable treatment for facial wrinkles. 265

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Botulinum toxin (BT) has been utilised as a non-invasive injectable treatment for aesthetic facial enhancement since 1992 after Carruthers JDA and Carruthers JA published their study observing that BT improved glabellar lines. Numerous aesthetic indications were steadily devised, enabling aesthetic medical practitioners to utilise BT as a stand-alone treatment strategy. However, while effective stand-alone BT treatments are functionally limited to targeted attenuation of muscular hyperactivity. Furthermore, BT treatment outcomes are of relatively short duration, requiring repeated treatments at approximately 12-16-week intervals to maintain effectiveness. Minimally invasive treatment strategies such as volumising filler injections, thread lifting, injectable/photo-thermal biomodulation and blepharoplasty are relatively durable aesthetic treatments that can be enhanced by adjuvant BT treatments. Accordingly, rather than relying on the commonly isolated utilisation of BT, the authors suggest a more comprehensive treatment model, whereby the synergistic interplay between minimally invasive treatments and adjuvant BT is demonstrated to advance and harmonise aesthetic outcomes.