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Botox turns 20: Safety and efficacy unparalleled

Nearly two decades after the introduction of botulinum toxin A for therapeutic indications, Botox Cosmetic (botulinum toxin A, Allergan) ranks among the safest and most successful aesthetic treatments available, dermatologists say. But, because of its relatively high cost, doctors say they would welcome competitive botulinum toxin options.

Botox originally earned Food and Drug Administration (FDA) approval for treating blepharoplasty and strabismus in December 1989. It was approved to treat cervical dystonia in 2000 and primary axillary hyperhydrosis in 2004.

Approved for glabellar lines — its only cosmetic indication to date — in 2002, Botox Cosmetic ranks among the favorite and most frequently used treatments of all dermatologists interviewed by Dermatology Times.

Much gain, little pain

For patients, Botox Cosmetic provides "a lot of gain without much pain," says Judith Hellman, M.D., a New York dermatologist in private practice and assistant clinical professor of dermatology, Mount Sinai School of Medicine, New York.

Thanks to Botox, lasers and fillers, "There's been a major revolution in the field of rejuvenation, which now is much more nonsurgical. It's able to spare people from extensive downtime and surgical risk," she says.

Ross Kaplan, M.D., finds Botox to be predictable, with a minimal side effect profile. "And it makes many of my patients very happy with what I can do for a very small expenditure," he says.

Dr. Kaplan is medical director of Camarillo, Calif., Coastal Dermatology Medical and Cosmetic Center.

"I use Botox almost daily," says Gennady Rubinstein, M.D., clinical instructor, department of medicine (dermatology), University of California, Los Angeles, and director, Dermatology and Laser Center of Studio City.

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