Botulinum toxin is a neurotoxic protein produced by Clostridium botulinum, the bacterium responsible for botulism. Botulinum toxin was first used for therapeutic indications in the 1970s for the treatment of strabismus. With greater understanding of its underlying physiology and safety profile, the use of botulinum toxin has now expanded to a range of cosmetic and medical indications. We performed a systematic review of current literature on the applications of botulinum toxin on off-label esthetic uses. Electronic databases were searched for original published studies including randomized trials, observational or cohort studies, as well as relevant case reports. To add to the body of evidence, our review summarizes and synthesizes key study characteristics, results, and level of evidence for each use case. Although the body of evidence remains weak, there is increasing support for the use of botulinum toxin in emerging off-label esthetic uses of botulinum toxin in dermatology.

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BACKGROUND Patient's retention and recall of material discussed in a medical consultation is often inadequate. OBJECTIVE To assess patient's knowledge, anxiety, and understanding of Mohs surgery after viewing a brief educational video. METHOD A prospective, investigator-blinded, randomized controlled trial of 120 consecutive patients before the first Mohs surgery procedure. Sixty subjects viewed an instructional video and 60 subjects did not. A survey was administered to both groups, measuring knowledge, anxiety, and understanding of Mohs surgery. RESULTS The video group scored higher than the control group on the knowledge portion of the survey (median score 78% vs 56%, p < .01), but there were no differences in anxiety or understanding scores between groups. The percentage of subjects who answered each knowledge question correctly was greater in the video group than in the control group. In the subgroup of patients who had not previously had a consultation with a Mohs surgeon, the video group had higher median knowledge scores (67% vs 44%, p < .01), higher median understanding scores (8 vs 6, p = .05), and lower median visual analogue anxiety scores (4 vs 6, p = .01) compared with the control group. CONCLUSION A brief educational video increases patient's knowledge of Mohs surgery. For patients who have not yet had a consultation with a Mohs surgeon, the video may also reduce anxiety.