Multiple intradermal small bolus injection of botulinum toxin: the limit and the potentiality

Since the first introduction of botulinum toxin in cosmetic surgery, techniques and indications using botulinum toxin, mainly intramuscularly, have expanded greatly. Some of cosmetic surgeons are trying to inject the toxin intradermally and, anecdotally or through clinical studies, they sometimes show positive cosmetic results. The mechanism of which is unclear but we should not always belittle the results of this technique. Also there are lots of confusing terms for this intradermal technique, so I propose a new descriptive term "multiple intradermal small bolus injection of botulinum toxin (MISBIB)". In this article, I reviewed important papers on this topic including my own experiences and summarized possible mechanism of action and, finally, discussed the limitations and potential of MISBIB.