Chemodenervation for facial dystonias and wrinkles

Purpose of review: Chemodenervation has evolved greatly over the past 30 years since botulinum toxin was first introduced as a therapeutic injection for managing strabismus. Recent findings: Botulinum toxins are now accepted as a first-line treatment for patients suffering from spasms secondary to facial dystonias. These treatments are extremely effective and well tolerated by most patients. New agents including doxorubicin, Doxil, and ricin mab35 are being developed to create a longer- lasting treatment option for patients with facial dystonias. Recently the use of chemodenervation for managing facial wrinkles has expanded the use of these agents. The botulinum toxins have been found to be extremely efficacious in managing facial wrinkles, especially in the upper half of the face. The federal drug administration approved the use of Botox (Allergan, Irvine, CA) for glabellar furrows. Periocular crow's feet lines and horizontal forehead lines are also amenable to treatment with the botulinum toxins. Further uses including chemical browlift, as well as lower face and neck line treatments have also been described. Summary: The use of the botulinum toxins has revolutionized the treatment of a broad array of diseases from benign essential blepharospasm to facial wrinkles.