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Current Uses of Botulinum Neurotoxins in Plastic Surgery

Noland, Marie E., M.D., M.Ed.; Lalonde, Donald H., M.D.; Yee, G. Jackie, M.D.; Rohrich, Rod J., M.D.

Plastic and Reconstructive Surgery: September 2016 - Volume 138 - Issue 3 - p 519e-530e
doi: 10.1097/PRS.0000000000002480
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Learning Objectives: After reading this article, the participant should be able to: 1. Recognize the various types of botulinum toxins and their differences. 2. Identify current indications, both approved and off-label. 3. Inject botulinum toxin to counteract various natural aging processes, including facial descent and rhytides.

Summary: Botulinum neurotoxin is a naturally synthesized microbial protein that has been applied in the management of various disorders. In particular, its application within the realm of plastic surgery is addressed in this article. After evaluating the medical literature, the seven indications with the highest quality trials for the use of botulinum neurotoxin in plastic surgery were as follows: rhytides, facial dystonias, facial nerve palsy and aberrant regeneration, hand tremor, palmar hyperhidrosis, neuropathic pain, and upper limb spasticity.

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Halifax, Nova Scotia, and Saint John, New Brunswick, Canada; Miami, Fla.; and Dallas, Texas

From Dalhousie University; Baker Plastic Surgery; and the University of Texas Southwestern Medical Center.

Received for publication April 19, 2015; accepted May 11, 2015.

Disclosure:The authors have no financial interests to declare in relation to the content of this article. No internal or external funding was received.

A “Hot Topic Video” by Editor-in-Chief Rod J. Rohrich, M.D., accompanies this article. Go to and click on “Plastic Surgery Hot Topics” in the “Videos” tab to watch. On the iPad, tap on the Hot Topics icon

Related Video content is available for this article. The videos can be found under the “Related Videos” section of the full-text article, or, for Ovid users, using the URL citations published in the article.

Marie E. Noland, M.D., M.Ed., 15 Hubleys Drive, Halifax, Nova Scotia B3P 1G9, Canada,

Copyright © 2016 by the American Society of Plastic Surgeons