Therapeutic Uses

As BT produces flaccid paralysis, it can be used therapeutically for the treatment of spasmodic conditions such as strabismus, blepharospasm, and myoclonus.

Blocking of acetylcholine release is permanent, but the action is short-lasting as the recovery occurs in 2 to 4 months once the new terminal axons sprout.

In cosmetic use after entry to the muscle, BT binds to the acetylcholine receptors on the neuromuscular junctions, resulting in blockage of the release of the neurotransmitter leading to flaccid paralysis.

Types of Botulinum Toxin used for Cosmetic Indications:

  • Licensed for use in the UK
    • Onabotulinumtoxin A BOTOX) or Vistabel 50 mgs for cosmetic use ALLERGAN
    • Incobotulinum toxin Bocouture (medical formulation is Xeomin) MERZ
    • Abobolotunum toxin Azzalure (medical formulation is Dysport) GALDERMA
    • (Letibotulinumtoxin A Letybo CROMA
  • Not licensed for use in the UK
    • Botulax
    • Parabotulinum toxin A Jeauveau
    • Daxibotulinumtoxin A Revance

Jean Carruthers, MD, FRCSC, FRC(OPHTH), remembers the ‘A-ha!’ moment when she realized that neuromodulators could transform cosmetic medicine.

It was the 1980s, and Dr. Carruthers wasn’t a cosmetic physician. She was an ophthalmologist. She had injected a patient with a neuromodulator to treat her blepharospasm, a painful and debilitating condition where people spasm in their eyelids, face and sometimes the neck and arms.

The patient, Dr. Carruthers recalls, was angry.

“She pointed at her inner brows and said, ‘You didn’t treat me here,’” Dr. Carruthers says. I apologised to her, saying, ‘I’m sorry but I didn’t think you were spasming there.’ And she responded, ‘I know. I’m not spasming there, but every time you treat me there, I get this beautiful untroubled expression.’”

That day, in her clinic with the angry patient, Dr. Carruthers was inspired. She thought about how her cosmetic dermatologist husband Alastair Carruthers, MA, BM, BCh, FRCP(LON), struggled to treat the ageing face with often sub-optimal options of collagen-based fillers and fat.

“Those options only supported the folds in the skin, they didn’t give any relaxation to the musculature in the region,” Dr. Carruthers says.
She went home that night and said to her husband, “You know, I think I have something for your cosmetic frown line patients.”