This is a concise review of the uses of botulinum toxins (BTXs) in dermatology and cosmetic procedures. It is a clinical rather than a basic science, pharmacological review. BTX had been initially used for selectively reducing and balancing periorbital muscle activity; thereby, reducing childhood strabismus and blepharospasm. This clinical research was initiated by Dr. Alan Scott over 40 years ago. BTX type A (BTX-A) was serendipitously observed to reduce forehead frown lines in patients being treated for blepharospasm. Extensive clinical research and development resulted in widespread aesthetic uses for BTX-A by reduction of selected hyperfunctional facial muscles. BTXs are also used for reduced localized hyperhidrosis. A topical BTX-A is being developed as a potential alternative to injected BTX.