Update on Botulinum Toxins in Oculofacial Plastic Surgery

Joseph N. Giacometti, MD; Michael T. Yen, MD


Int Ophthalmol Clin. 2013;53(3):21-31. 

In This Article


Over the past 2 decades, the use of botulinum toxin in clinical practice has grown exponentially across all fields of medicine. Initially approved by the US Food and Drug Administration (FDA) in 1989 for the treatment of strabismus and blepharospasm, the neurotoxin's utility in the realm of ophthalmology and oculofacial plastic surgery has expanded to include both functional and cosmetic indications.

Cosmetic use for the improvement of facial rhytids was first described in the literature in 1992.[1] In 2002, after years of off-label esthetic use, the FDA announced approval of botulinum toxin for the treatment of glabellar furrows. Since that time, off-label oculofacial cosmetic indications have continued to emerge.[2,3] The drug is an extremely popular and highly reliable option in minimally invasive facial rejuvenation. Indeed, injection of botulinum toxin is now the most frequently performed nonsurgical cosmetic procedure.[4] Given its widespread use in the facial region, all ophthalmologists should be well versed in the mechanism, preparations, indications, and potential complications of botulinum toxin.

Several preparations of botulinum toxin have emerged over the past decade. The different preparations possess distinct chemical structures and pharmacologic characteristics. However, there is considerable overlap among these formulations with regard to therapeutic indication and practical use. In this manuscript, we will present a brief overview of the use of botulinum toxin in oculofacial plastic surgery and discuss the similarities and differences between its many preparations, not only with regard to their structural and pharmacologic properties, but also from a practical clinical standpoint.