Botulinum neurotoxin type A (BTX-A) preparations are well established for cosmetic use. BTX-A inhibits the release of acetylcholine, resulting in temporary muscle paralysis, which has been utilized successfully to treat glabellar frown lines, periorbital wrinkles and other facial enhancement procedures. Two BTX-A products are approved for aesthetic procedures in the United States (U.S.) and Europe, and a next generation of preparations free from complexing proteins has recently been approved in Germany. Despite established efficacy profiles, concerns remain regarding the propensity for immunogenic reactions, which can lead to premature loss of effect and secondary therapy failure. NT 201 is a BTX-A preparation that is free from complexing proteins and is in the advanced stages of aesthetic development. Pivotal clinical studies in therapeutic indications demonstrate noneriority and comparable safety of NT 201 to another available BTX-A preparation. This article reviews the pharmacologic and clinical profiles of BTX-A preparations currently available and in development. Novel BTX-A preparations may offer advantages over existing products in terms of handling and immunogenicity.