ABSTRACT
Botulinum toxin injections have become one of the most popular cosmetic treatments throughout the world over the past decade. However, the recognition of the effects of this toxin have been known for over a century. It was Justinus Kerner, a German physician, who first studied the potent effects of botulinum toxins during the Napoleonic Wars, after a reported increase in food-poisoning deaths in persons eating sausages. After a series of animal and self-experiments, he hypothesized that the toxin was produced under anaerobic conditions, acted on the autonomic and motor nervous systems, and was lethal in small doses.1 The use of botulinum toxins for modern day medical purposes began in the 1960s, when Scott et al investigated the therapeutic uses of this drug in humans suffering from strabismus and blepharospasm.2-4 In the USA, the Food and Drug Administration (FDA) approved botulinum toxin type A (BTX-A) for these conditions in 1989. In 2000, the FDA expanded the approved indications to include cervical dystonia. In 2002, the FDA approved the use of BTX-A for cosmetic uses. Independent surveys by the American Society for
Aesthetic Plastic Surgery and the American Society of Plastic Surgeons suggest that in 2002, between 1.1 and 1.6 million patients in the United States received cosmetic injections with BTX-A. These numbers are thought to be increasing yearly both in the USA and elsewhere throughout the world.5
