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Botulinum toxin was first described in the 1800's and has since found its permanent place in the medical community becoming the main ingredient of the most common cosmetic procedure.The injections have also gained multiple FDA approvals for both cosmetic and therapeutic indications.While the toxin injections have demonstrated a long history of safety, the drug remains highly controversial among regulators and legal entities.The following review provides a detailed, up-to-date description of botulinum toxin injection complications.Included topics are history, local and distal effects, long term safety, immunogenicity, use in pregnancy, and cosmetic use. Key Pointsa. Despite being one of the most studied pharmaceuticals and demonstrating a long history of safety, botulinum neurotoxin serotype A (BoNTA) remains to be a rather controversial drug and is under rigid scrutiny by the regulators and legal entities.b.Given that botulinum toxin injections have become the most frequent cosmetic procedure, providers must be familiar with the product and the data outlining its safety profile.