Journal of Plastic, Reconstructive & Aesthetic Surgery
Despite its ubiquity in cosmetic circles and brand general awareness, a literature search on botulinum neurotoxin in JPRAS and BJPS yielded a mere 4 articles germane to cosmesis. A pair each detailing its application in masseteric hypertrophy and the use of cryoanalgesia. Given that botulinum neurotoxin A is the most commonly used cosmetic treatment, with American figures being most accurate, a review of the background, development and scientific evidence would be perhaps useful, if not overdue, as Plastic Surgeons increasingly incorporate non-surgical interventions into their practices as part of a comprehensive facial rejuvenation strategy.
Introduction & historical background
The use of botulinum neurotoxin A (BoNT-A) for medical and cosmetic applications has enjoyed a short, but remarkable, life so far despite considerable inherent toxicity. Based on its estimated inhalational lethal dose, a single gram is reportedly sufficient to kill one millions people. Therapeutic BoNT-A was born in the 1970s originally as a non-surgical alternative for strabismus and the list of medical used has mushroomed. Its cosmetic infancy arose from the serendipitous observation of diminished wrinkles during treatment for belpharpspasm. Now, many millions of injections later, safety and role have been clarified and sits in, relatively, comfortable adulthood as an increasingly routine part of the aesthetic regimen for many both in and out of the publis eye. New uses continue to emerge, many of which have arisen in a similarly fortuitous fashion.
The storey of BoNT-A starts with its description by a German, Justinus Kerner, sometime between 1817 and 1822. Perhaps combining his dual professions of poet and physician, he named it 'sausage poison', having observed that the toxin tended to thrive in poorly-prepared meat products, particularly those self-canned. Half a century later, his compatrios Muller Latinised sausage into "botulus" - the name the disease is produced i.e., botulism. The causative bacterium, Clastridium botulinum, was first culture by van Ermengern in 1897 and neuromuscular blockade as the mechanism of action was elucidated in 1949. The potential role of BoNT-A as a bio terrorism agent...