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The Many Faces of Botulinum Toxins: Dr Sadick on Off Label Uses

Age prophylaxis is increasing in popularity, said Neil Sadick, MD, a clinical professor of dermatology at Weill Cornell Medical College in New York, NY, during his presentation at the 2019 Fall Clinical Dermatology Conference.

There are several botulinum toxins available, but only onabotulinumtoxinA (Botox) has been used regularly for other areas, said Dr Sadick. Botox is only approved for glabellar lines, horizontal lines, and crow’s feet, while all other uses are considered off-label, he added. The number of muscles dermatologists can inject with the neurotoxin is nearly similar to the number of muscles that need to be avoided. Thus, it is important to know facial anatomy, he stated. He also discussed how various areas require different injection depths for optimal results.

Dr Sadick reviewed steps for injecting botulinum toxins for treating the brow and under-region of the eye, as well as the nasal region, gummy smile, smoker’s lines, Marinette lines, jawlines, and neck area. Some adverse effects include difficulty swallowing and asymmetry, he said, stating providers should be careful when injecting botulinum toxin in areas around the mouth and neck.

Body contouring is a new trend, with many individuals wanting to contour their calves, said Dr Sadick. Other “hot” uses of botulinum toxins include:

  • Blotox
  • Scrotox
  • Microbotox facial
  • Acne and Pore Size
  • Rosacea
  • Scarring and Keloids

Blotox is used to increase the duration of hairstyling, said Dr Sadick. Although there is no data to support this use, it is recommended all over the internet. Scrotox is being investigated in 1 clinical trial and is used to improve sexual function.

For the treatment of rosacea, botulinum toxins have been found to improve complexion and reduce erythema, said Dr Sadick. He noted that dermatologist can use it if they do not have a laser. In addition, botulinum toxins have been found to reduce keloids and scars. Dr Sadick said he used it as prophylaxis by injecting it into the surgical line zone after surgery to decrease the incidence of keloids forming in high-risk patients.

One final area Dr Sadick covered was reconstruction. He discussed a patient who underwent bilateral mastectomy, but not reconstructive surgery, and experienced significant improvement of the area with botulinum toxins.

In conclusion, botulinum toxin is very safe and effective, especially when combined with energy devices and fillers, and there is some suggestion that early use may slow down the aging process, stated Dr Sadick.


Sadick N. Off label uses of botulinum toxin. Presented at: 2019 Fall Clinical Dermatology Conference; October 19, 2019; Las Vegas, NV.

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