Thirty-five years ago, ophthalmologist Alan Scott first described the therapeutic use of botulinum toxin in the nonsurgical correction of strabismus.1 During the ensuing years, the use of botulinum toxin in ophthalmology expanded to other conditions, including blepharospasm and nystagmus, and quickly became a widely accepted treatment. It was while caring for a patient with blepharospasm that ophthalmologist Jean Carruthers, MD, made the serendipitous observation that injection of the glabellar region with botulinum toxin resulted in a softer, more youthful facial expression. She and her husband, Alastair Carruthers, MD, went on to treat a series of patients for aesthetic improvement, with impressive results; they first introduced the cosmetic use of botulinum toxin to the field of dermatology in 1991 at the Annual Meeting of the American Society for Dermatologic Surgery.2 Since that time, the use of botulinum toxin has expanded to include numerous other medical indications, including cervical dystonia, hyperhidrosis, and migraines. However, the greatest expansion of the use of botulinum toxin has been for cosmetic treatment of dynamic rhytids. In fact, dermatologists performed more than 1.7 million cosmetic injections of botulinum toxin in 2014 alone, making it the most commonly performed aesthetic procedure in the United States.3
Council ML. Improving Patient Satisfaction and Quality of Care During Aesthetic Use of Botulinum Toxin. JAMA Dermatol. 2015;151(11):1179–1180. doi:10.1001/jamadermatol.2015.2816
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