Botox is the most effective tool in cosmetic medicine and should be used first and most often. BOTOX dosing and injection points should be based on assessing the patient’s anatomy, goals, preferences, and the physician’s own professional experience with prior treatments. Gender, cultural, and ethnic standards of attractiveness may significantly influence the patient’s preference. Each patient’s treatment should be individualized for the best results. The use of cosmetic BOTOX in the mid and lower face and neck has increased drastically over the past few years. Indeed, there is now a greater appreciation that BOTOX-A is one part of overall facial rejuvenation therapy, in which all aspects of aging are addressed in the same individual. Finally, new esthetic indications are starting to emerge, including the treatment for scars, the horizontal upper lip line, musculus risorius excessive gingival display (‘‘gummy smile’’), and masseter reduction to improve facial shape. BOTOX is also beneficial with other aesthetic modalities, such as dermal fillers, laser, skin resurfacing, and surgery. Several more general applications push BTX-A toward an ‘‘art,’’ rather than a clinical procedure.