A short journey from the 19th century to the present day
The muscle-paralyzing effect of botulinum toxin was first described in the 1820s by the German physician Justinus Kerner, in cases of poisoning from poorly preserved sausages. Kerner was the first to suggest that this "muscle-strength-cutting" poison could be used for medical purposes. Approximately 150 years later, in the 1970s, ophthalmologist Alan Scott determined the safe dose for the treatment of strabismus. In 1989, the FDA approved this use — botulinum toxin A was now an approved drug.
On the cosmetic side, the turning point was the 1990s. Canadian ophthalmologist Jean Carruthers and dermatologist Alastair Carruthers observed that the frown lines of strabismus patients softened, and this observation led to clinical studies. FDA approval for cosmetic use for glabellar (frown) lines came in 2002. Since then, approvals for crow's feet (2013) and forehead lines (2017) have been added.
Each new use requires separate approval
The fact that a drug is approved for one indication does not automatically mean that its application to every area is approved. In Turkey and around the world, there are some off-label areas applied for aesthetic purposes: masseter, platysma, bunny lines, gummy smile, etc. These areas have been safely applied for years and are supported by extensive clinical publications — but official approval processes are still ongoing. Off-label use is done with clinical evidence and physician authority; it is not "forbidden," but "not yet officially on the label."
The practical difference the patient needs to know is this: in an approved area of application (e.g., glabella), the dose, frequency, and patient profile are detailed in the drug's license documents. In off-label areas, the physician calculates the dose based on data from similar areas and personal experience. Therefore, physician experience is more decisive in off-label areas.
Licensed products in Turkey
Botulinum toxin A products licensed by the Turkish Medicines and Medical Devices Agency (TİTCK): Botox (Allergan/AbbVie), Dysport (Ipsen), Xeomin (Merz), Neurobloc (type B — different indication). Each of these products has a different definition of its dose unit (Unit); "one unit of Botox is not equal to one unit of Dysport." Therefore, doses should be discussed on a product-by-product basis.
Products that are unlicensed, of unknown origin, or presented as "affordable imported" should be avoided. The packaging must have a Turkish label, a UTS QR code, and a serial number; the physician should be able to show the vial to the patient before application. This is a safety question, not a price question.
Attention:Some of the "at-home Botox party" videos seen on social media are not for cosmetic purposes, but for marketing illegal products. Products applied in uncalibrated doses, in non-sterile environments, are both ineffective and dangerous. Botox is a medical procedure; the moment it is taken outside a clinical setting, it is not a drug, but a risk.
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Facial Muscle Anatomy: Which Muscle, Which Mimic?