Botulinum Toxin A Myths, Evidence, and Global Media Narratives

Botulinum Neurotoxin A (BoNT-A) is clinically safe and effective, yet public discourse remains saturated with myths. This review investigates how misconceptions are produced and sustained within peer-reviewed literature and traditional media.

A narrative synthesis of English-language publications (2000-2024) from PubMed, Scopus, Web of Science (peer-reviewed) and ProQuest, Factiva, LexisNexis (media) was conducted. AI-assisted search, clustering (UMAP-HDBSCAN), and VADER sentiment analysis were integrated. Inter-rater reliability (κ = 0.87-0.94) and AI-human agreement (89.5%) were established. "Botox" is used as a generic term for all BoNT-A products consistent with public and social media discourse.

Of 513 sources (186 academic, 327 media), myths clustered into eight categories. Media coverage showed strongly negative sentiment (mean - 0.58), while academic literature remained neutral (71% neutral). Safety/toxicity myths were 3.2 times more frequent in media (χ² = 29.8, p < 0.001). Psychological myths carried a mean sentiment of - 0.61 (Kruskal-Wallis H = 28.4, p < 0.001). Geographic mapping identified misinformation spikes following litigation, celebrity disclosures, and regulatory advisories. Novel myths (e.g. immune suppression, "patchwork ageing") emerged post-2019 (mean sentiment - 0.69).

A quantifiable asymmetry exists between scientific evidence and media framing of BoNT-A. Misinformation is culturally embedded, emotionally charged, and event driven. Bridging this gap requires pre-consultation educational tools, scripted clinical responses, and cross-disciplinary media engagement.

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .