Introduction: Botulinum toxin is a mainstay of treatment in cosmetic dermatology and neurology. Initially approved for ocular disorders, it is now widely used for cosmetic procedures and neurological conditions, such as chronic migraine and spasticity. This review explores the clinical approach to botulinum toxin in patients with overlapping aesthetic and therapeutic needs, highlighting current evidence, safety considerations, and interdisciplinary coordination. Methods: A review of literature on botulinum toxin in cosmetic dermatology and neurology was performed. Original and review articles published before July 4th, 2025 were evaluated for relevance. Discussion: Botulinum toxin inhibits acetylcholine release at the neuromuscular junction by cleaving SNAP-25, leading to reversible muscle paralysis. It reduces dynamic facial wrinkles by relaxing overactive muscles and has additional uses like treating hyperhidrosis and possibly enhancing dermal remodeling. In neurology, botulinum toxin inhibits pain neurotransmitters in chronic migraine and reduces spasticity in conditions like stroke or multiple sclerosis by blocking excessive motor neuron activity. It also relieves dystonia by targeting abnormal muscle contractions. Botulinum toxin is a safe treatment, with common side effects limited to mild local reactions; serious risks are rare but include unwanted diffusion and antibody formation. Careful dosing, anatomical precision, and patient selection minimize complications and improves outcomes. Conclusion: A coordinated, interdisciplinary approach is essential for patients needing both therapeutic and cosmetic treatment. Synchronizing injection timing, dosing, and communication between providers ensures optimal outcomes and minimizes risk.
Burshtein et al. (Sun,) studied this question.