The Multispecialty Toxin: A Literature Review of Botulinum Toxin

Karen Bach, BS; Richard Simman, MD, FACS, FACCWS


Plast Reconstr Surg Glob Open. 2022;10(4):e4228 

In This Article

Abstract and Introduction


Background: Botulinum toxin (BoNT) is a potent biological exotoxin produced from Clostridium botulinum. Although it was first used therapeutically to treat strabismus, its clinical role has since expanded rapidly over the years to include treatment of a variety of head and neck, gastrointestinal, urogenital, musculoskeletal, neurological, dermatological, and cosmetic disorders. The main purpose of this review is to provide a brief updated overview of the history, mechanism of action, and clinical applications of BoNT therapy across multiple medical specialties, including the most common adverse effects and recommended Botox dosages.

Methods: A literature review was conducted in the PubMed database limited to English language articles. Specific search terms related to botulinum toxin in combination with various subspecialty fields were used, and relevant articles were identified and analyzed. The reference section for each article was also searched to find additional articles.

Results: BoNT is a powerful therapeutic tool and has a vast array of clinical uses in many specialties, including ophthalmology, neurology, plastic surgery, dermatology, orthopedic, gastrointestinal, gynecology, urology, and rheumatology. Due to its chemodenervation effects at the presynaptic nerve terminal, it is useful in treatments of disorders characterized by abnormal inappropriate muscle contractions.

Conclusions: BoNT has many clinical applications in several medical specialties. Future studies should focus on any additional indications of BoNT therapy as they arise and on any novel product developments.


Botulinum toxin (BoNT) is a neurotoxin produced by the Gram-positive, rod-shaped, spore-forming anaerobic bacterium Clostridium botulinum. Although there are seven major serotypes of Botulinum Neurotoxin (BoNT/A-G), only type A and B are used clinically.[1] For the purpose of this article, we will refer to this agent as BoNT, and the distinction of Botox and Botox Cosmetic will be used when referring to Food and Drug Administration (FDA)-approved dosages. This literature review primarily serves to provide a historical review of the toxin, assess its mechanism of action, and highlight the many clinical applications of BoNT therapy in an organized, specialty-based manner. Secondary goals aim to cover the most common side effects and toxicity, including their management options, and the recommended Botox dosage relative to their FDA-approved clinical application. Some of the conditions mentioned may be treated by multiple specialties.