Objective: To determine the safety and effectiveness of botulinum toxin for cosmetic oculofacial use. Methods: Literature searches for relevant citations were conducted in October 2003 for the years 1965 to 2003. The panel reviewed and rated the articles for study design, methods, and results. Results: Randomized double-masked controlled studies showed statistically significant improvement in glabellar, frontal, and lateral canthal rhytids (wrinkles) when injected with botulinum toxin. Standardized documentation using photographs and masked grading by the patient and physician support the efficacy of botulinum toxin for treatment of dynamic rhytids in the glabellar region, forehead, and lateral canthal area. Complications and adverse effects associated with treatment are infrequent and short lived. Conclusions: Botulinum toxin is safe in the short term and effective in the temporary treatment of glabellar, frontal, and lateral canthal rhytids. Potential functional complications should be discussed with patients who are seeking cosmetic rejuvenation of the periocular and facial region. Further research is needed to determine the ideal effective dose for particular anatomic areas, ideal concentration, applicable doses across the different serotypes of botulinum toxin, duration of effect, changes in efficacy (if any) over extended periods of treatment, and long-term safety.