Role of botulinum toxin A in improving facial erythema and skin quality

Arch Dermatol Res. 2022 Oct;314(8):729-738. doi: 10.1007/s00403-021-02277-0. Epub 2021 Sep 14.


Botulinum toxin A (BTX-A) injections have become the most popular noninvasive cosmetic procedures performed worldwide. With growing interest, investigators continue to uncover an expanding array of aesthetic indications for BTX-A. Botulinum toxin A has been used off-label in the management of masseter hypertrophy for facial slimming, platysmal bands, nasal 'bunny' lines, perioral rhytides, gummy smile and scars, to name a few. Interestingly, the injection of multiple microdroplets of dilute BTX-A into the dermis, sometimes referred to as 'microbotox', has been investigated as a tool for facial rejuvenation. A handful of prospective studies and case series have demonstrated the benefit of BTX-A in the treatment of facial erythema and improving skin texture. The aim of this review is to summarize and appraise currently available data on the role of BTX-A in treating facial erythema and skin quality, with a special focus on potential pathophysiologic mechanisms.

Keywords: Botulinumtoxin A; Cosmetic dermatology; Facial erythema; Facial rejuvenation; Fillers; Fine lines; General dermatology; Injectables; Medical dermatology; Neuromodulators; Pore size; Rhytids; Rosacea; Sebum production; Skin quality; Wrinkles.

Publication types

  • Review

MeSH terms

  • Botulinum Toxins, Type A* / therapeutic use
  • Cosmetic Techniques*
  • Erythema / drug therapy
  • Esthetics, Dental
  • Gingiva
  • Humans
  • Prospective Studies
  • Skin Aging*
  • Smiling


  • Botulinum Toxins, Type A