Management of Facial Cosmesis and Blepharospasm with Botox: A 24 Year Ophthalmic Plastic Surgical Perspective

Since 1980 Botulinum Toxin type A has been used by ophthalmic plastic surgeons in the United States, at first for blepharospasm, hemi-facial spasm, strabismus, and then for cosmetic enhancement and facial rejuvenation. It has become the foundation of non-invasive facial rejuvenation, used in combination with multiple modalities -injectable fillers (Restylane and Perlane), ablative and non-ablative lasers, non-laser radio frequency therma-lifting, and laser-assisted blepharoplasty. The use of Botox has become an elevated art form. The goal is a natural enhancement, a softening and not complete obliteration of every rhytid and furrow. We will review our 24 year experience of Botox use and our most advanced combination therapies, doses and locations of injections.