Beyond Aesthetics: How Non-Dermatology Clinicians View Botulinum Toxin: A Cross-Specialty Survey
DOI:
https://doi.org/10.66344/jpad.v36i2.3349Keywords:
Botulinum toxin, Botox, Aesthetic dermatology, Physician attitudes, Ethical perceptions, Cosmetic procedures, PakistanAbstract
Background Botulinum toxin (Botox) has become a popular choice for various uses in medicine, with rising acceptance among many different fields of medicine. Even as the use of botulinum toxin is being employed in increasingly diverse medical practices, several misunderstandings and ethical questions related to its use for cosmetic purposes persist. The opinions of non-dermatology practitioners can have a significant impact on public perception; thus, their perceptions of botulinum toxin are vital.
Objective To assess the knowledge, perceptions, and attitudes of the non-dermatological clinicians regarding the medical and cosmetic use of the botulinum toxin.
Methods Four hundred and eight (408) clinicians from various fields were enrolled in the study from October to December 2025. The study sample was selected via non-probability convenience sampling, excluding dermatologists, aesthetic doctors, and plastic surgeons. The data were gathered through a pre-tested Google form, and descriptive statistics were analyzed using IBM SPSS 26.
Results Out of 408 respondents, 70.6% were male. Social media was identified by 83.3% of participants as the primary source of cosmetic myths related to Botox. The majority (67.6%) regarded Botox treatment as a beauty salon-type service rather than a medically based process (9.8%). Conversely, 68.6% perceived the treatment as harmless as it does not necessarily produce an unnatural appearance. 76.5% believed cosmetic Botox use compromises a doctor’s professional identity, and 46.1% considered its use unethical in individuals with poor self-esteem.
Conclusion Non-dermatological clinicians exhibit significant gaps in clinical knowledge, accompanied by varied ethical perspectives regarding Botox. The prevailing perception among these participants treats Botox more as a beauty-related service than a legitimate medical procedure.
References
1. Monash A, Tam J, Rosen O, Soreq H. Botulinum neurotoxins: History, mechanism, and applications. A narrative review. J Neurochem. 2025 Aug;169(8):e70187.
2. Bach K, Simman R. The multispecialty toxin: a literature review of botulinum toxin. Plast Reconstr Surg Glob Open. 2022 Apr 1;10(4):e4228.
3. Etrusco A, Geru M, Laganà AS, Chiantera V, Giannini A, Buzzaccarini G. Use of botulinum toxin in aesthetic medicine and gynaecology: current approaches, controversies, and future directions. Prz Menopauzalny. 2023 Sep 25;22(3):155-60.
4. Kumar R, Singh BR. Botulinum toxin: a comprehensive review of its molecular architecture and mechanistic action. Int J Mol Sci. 2025 Jan 17;26(2):777.
5. Friedman O, Singolda R, Mehrabi JN, Artzi O, Boggio RF, Bento AM. Current use of botulinum neurotoxin in esthetic practice-clinical guide and review. J Cosmet Dermatol. 2021;20(6):1648-54.
6. Martina E, Diotallevi F, Radi G, Campanati A, Offidani A. Therapeutic use of botulinum neurotoxins in dermatology: systematic review. Toxins (Basel). 2021;13(2):120.
7. Rho NK, Han KH, Kim HS. An update on the cosmetic use of botulinum toxin: the pattern of practice among Korean dermatologists. Toxins (Basel). 2022 May 4;14(5):329.
8. Salameh R, Ghadban E, Murr EE, Hanna C. Influence of social media on the intent to undergo cosmetic facial injections among Lebanese university students. BMC Digit Health. 2025;3(1):46.
9. Thapa DP. Awareness of cosmetic dermatology procedures among health workers in a tertiary care hospital. Indian Dermatol Online J. 2019;10(2):139-43.
10. Imam S, Iffat W, Shakeel S, Qamar A, Usman N, Sultana N, et al. Acquaintance of Botox: a cross-sectional survey among female students in Karachi, Pakistan. RADS J Pharm Pharm Sci. 2019;7(2):77-83.
11. Rehman U, Freer FAJ, Sarwar MS, Dubb SS, Brennan PA. Non-surgical facial aesthetics: Should this be incorporated into medical education? Adv Oral Maxillofac Surg. 2022;8:100327.
12. Khan HB, Chitteti P, Nadeem M. Botulinum toxin in focus: evolution, pharmacology, and its expanding clinical impact. Expert Rev Clin Pharmacol. 2025 Dec 2;18(12):1053-62.
13. Tansley P, Fleming D, Brown T. Cosmetic surgery regulation in Australia: who is to be protected-surgeons or patients? Am J Cosmet Surg. 2022;39(3):161-5.
14. Ergur A, Akkaya B, Saral C. Defining faces, defying borders: authority conflicts between medical specialties through cosmetic interventions. Humanit Soc Sci Commun. 2024;11(1):958.
15. Marinelli G, Inchingolo AD, Trilli I, Pezzolla C, Sardano R, Inchingolo F, et al. Proactive aesthetic strategies: evaluating the preventive role of botulinum toxin in facial aging. Muscles. 2025;4(3):31.
16. Mafi NA, Nahidi Y, Layegh P, Rezayian MK, Nahidi M. Quality of life, body image and personality traits among women receiving botulinum toxin type A for cosmetic purposes. Aesthetic Plast Surg. 2023;47(4):1542-9.
17. Hemsworth B, Hemsworth C, Richmond SA. Nonsurgical medical aesthetics and patient quality of life: an umbrella review. Aesthet Surg J Open Forum. 2024;6:ojae096.
18. Almudimeegh A, Almukhadeb E, Nagshabandi KN, Alshehri N, Almusa HA, Aldosari O, et al. The impact of individuals’ self-esteem on cosmetic dermatology preferences assessed using the Rosenberg Self-Esteem Scale: a cross-sectional study. Medicine (Baltimore). 2025 Jun 27;104(26):e43109.
19. Fabi S, Alexiades M, Chatrath V, Colucci L, Sherber N, Heydenrych I, et al. Facial aesthetic priorities and concerns: a physician and patient perception global survey. Aesthet Surg J. 2022;42(4):NP218-NP229.
20. Lewis MB. The interactions between botulinum-toxin-based facial treatments and embodied emotions. Sci Rep. 2018;8(1):14720.
21. Michon A. Botulinum toxin for cosmetic treatments in young adults: an evidence-based review and survey on current practice among aesthetic practitioners. J Cosmet Dermatol. 2023;22(1):128-39.
22. Ghalamghash R. Social Botox and the commodification of beauty: interrogating economic and social consequences. Authorea. 07 August 2025 [cited 2025 Nov 24]. Available from: https://www.authorea.com/users/946270/articles/1323041
23. Ghalamghash R. Mental health interventions for mitigating "social Botox" effects: a systematic review of evidence-based strategies. Psych Archives. 2025 [cited 2025 Nov 24]. Available from: https://www.psycharchives.org/en/item/bd4a5ba7-a9fe-45b1-8011-d4927f927d0c
24. Qureshi KI, Vercessi F, Farooq H, Soenchen R, Amin M, Chattha I, et al. Are we in an ethical dilemma in aesthetic medicine? J Cosmet Dermatol. 2025 Jun;24(6):e70260.
25. Jankowska A. The profession of medical practitioners vs aesthetic medicine and dermatology treatment practice. Stud Adm. 2019;(11):45-53.
26. Rahmatipour H, Shabestari SM, Benisi SZ, Samadikhah H. Pioneering pain management with botulinum toxin type A: from anti-inflammation to regenerative therapies. Heliyon. 2025 Feb 28;11(4):e42350.
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