THE COSMETIC use of botulinum toxin is now well established. The extended clinical use, multiple publications, and recent Food and Drug Administration (FDA) approval have combined to create this fact, demonstrated in the current media frenzy. But will this situation increase the number of novice injectors and hence increase the incidence of adverse effects, amplifying the "BOTOX backlash" that we are seeing? Will we now see a rash of eyelid and eyebrow ptosis? An epidemic of paralyzed and patulous perioral and cervical muscles? BOTOX losing its shiny reputation as the New Age wonder drug due to an epidemic of avoidable complications? An example of what can happen comes from the scientific basis of the FDA approval. Presumably, the manufacturers of BOTOX (Allergan, Inc, Irvine, Calif) selected physicians they believed were experienced in the cosmetic use of botulinum toxin to perform the FDA studies. And yet, one half of the study population had an eyelid ptosis rate of over 5.4%, which is unacceptably high, compared with the approximately 1% in the other half of the study.1 This demonstrates that, even in the best hands, adverse events can occur and technique education is vital to reduce their incidence. In my opinion, the current "Botox Party" concept exemplifies how medicine should not be practiced.
Jean D. A. Carruthers. Caveat Emptor (Buyer Beware). Arch Dermatol. 2002;138(9):1243–1244. doi:10.1001/archderm.138.9.1243