Botulinum neurotoxins: fundamentals for the facial plastic surgeon

The most commonly performed nonsurgical cosmetic procedure in the facial plastic surgery armamentarium involves the various commercial preparations of botulinum neurotoxins. These drugs have undergone a transformation from public health scourge to near ubiquitous therapeutic modality across the entire medical spectrum. Herein, the history of botulinum neurotoxins is reviewed, including an exploration of their pharmacology, neuromuscular junction physiology, a description of the commercially available preparations, and the recent research concerning the practicalities of their clinical use.