Emerging off‐label esthetic uses of botulinum toxin in dermatology

Abstract

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.

Cosmetic Treatment Using Botulinum Toxin in the Oral and Maxillofacial Area: A Narrative Review of Esthetic Techniques

“…Patients with dynamic wrinkles, which are formed during facial expression are indicated [ 4 ]. Areas with dynamic motion such as the glabella, forehead, peri-orbital lines, nasal rhytides, and perioral rhytides are common injection areas [ 7 , 54 , 55 ]. Patients with static wrinkles that are present at rest can also be candidates.…”

“…Excessive contraction of muscles or hyperactivity of specific muscles can also cause non-cosmetic appearances. Patients with bulky masseters, cobble stone chins, gummy smiles, asymmetric smiles, depressed mouth corners, brow ptosis, flaring nostrils, depressed nasal tips, temporal hypertrophy, and trapezius hypertrophy can achieve esthetic results by targeting the precise muscles [ 7 , 22 ]. Patients with hypertrophic submandibular glands and parotid glands can also benefit esthetically in select cases [ 56 ].…”

“…These developed dynamic rhytides lead to atrophy of the dermis and pleating in the skin, which may give an impression of an angry, sad, or aging face. Botulinum neurotoxin (BoNT) can significantly soften dynamic wrinkles and even provide a lifting effect [ 6 , 7 ]. BoNT injection is the most popular cosmetic procedure worldwide with various applications.…”

“…The most potent serotype is A, followed by B and F [ 17 , 18 ]. BoNT serotypes A and B are the only ones that have been manufactured for clinical use [ 7 ]. The effects of BoNT appear after approximately 2–3 days on rhytides and 3 weeks on larger muscles, and last between 3 and 6 months [ 19 , 20 , 21 ].…”

How Does Botulinum Toxin Inhibit Itch?

“…There are several conditions for which BoNT is not yet approved for clinical use, but off-label use has been presented, with beneficial effects, for example, in dermatology [ 33 , 34 , 35 ], primary headaches other than migraine [ 36 ], depression [ 37 ], and neuropathic pain [ 38 , 39 ]. One large area in which the off-label use of BoNT has been practiced for the last two decades is dermatology, for various conditions that appear with or without itch [ 40 , 41 , 42 , 43 ].…”