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Botulinum Toxin Vascular Effectiveness: Low or High Doses?

Shahriar Nazari1,2, Mohammad Saleh Sadeghi2, Mohammad Reza Pourani3,4

  • 1Department of ENT, Head and Neck Surgery, BMI Hospital, Tehran, Iran.

Aesthetic Plastic Surgery
|February 9, 2026
PubMed
Summary
This summary is machine-generated.

Botulinum toxin (BoNT) has dual vascular effects: higher doses promote blood flow and angiogenesis, while lower doses reduce inflammation. This highlights its potential in treating vascular conditions.

Keywords:
AngiogenesisBotulinum toxinVascular modulationVasoconstrictionVasodilation

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Area of Science:

  • Vascular Biology
  • Pharmacology
  • Regenerative Medicine

Background:

  • Botulinum toxin (BoNT) is recognized for vascular effects beyond neuromuscular applications.
  • BoNT exhibits dose-dependent mechanisms influencing vasodilation, perfusion, and inflammation.
  • Its vascular actions are relevant for ischemic, vasospastic, and inflammatory conditions.

Purpose of the Study:

  • To review current data on the dose-dependent vascular actions of Botulinum toxin (BoNT).
  • To outline the therapeutic relevance of BoNT's vascular effects in aesthetic and reconstructive medicine.

Main Methods:

  • A narrative review of studies published from 2000 to 2025.
  • Searches conducted on PubMed, MEDLINE, Embase, and Google Scholar.
  • Included clinical trials, animal studies, in vitro models, and systematic reviews.

Main Results:

  • BoNT demonstrates dual vascular mechanisms: high doses enhance perfusion and angiogenesis (VEGF, nitric oxide pathways), aiding ischemic flaps and Raynaud's.
  • Low doses reduce cholinergic vasodilation and neurogenic inflammation, benefiting rosacea and hyperhidrosis.
  • Effects are dose-dependent and tissue-specific, with high-dose typically >20 IU/ml.

Conclusions:

  • Botulinum toxin (BoNT) possesses versatile vascular activity.
  • Higher doses support vascular regeneration and angiogenesis; lower doses modulate hyperreactive vascular responses.
  • Further research is needed to clarify mechanisms, refine dose-response guidelines, and assess long-term safety.