Summary As surgeons, it is rare that one can perform a procedure with striking effects that are visible almost immediately. The use of BT A for hyperkinetic facial lines may reverse the aging appearance of the upper face by a decade or more literally overnight. The rhytids, lines, and folds of the forehead, glabellar, and lateral canthal area often have been described as dynamic wrinkles from repetitive muscle movements and the thinning of the epidermis and gravity. The use of BT A has shown that some of these wrinkles are eliminated totally by denervating these muscles. This result implies that the lines and wrinkles are not just structural but functional and caused by active muscle tone. Although BT A is an effective treatment, its use with laser resurfacing, chemical peeling, endoscopic brow and forehead lifts, and other rejuvenation procedures may improve their effect and longevity. Botulinum toxin A has been shown to be a reliable and reversible means of treating wrinkles and lines from hyperkinetic muscles of facial expression. Multiple studies2–4, 8, 9, 11, 13, 17 and the author's experience has shown Botox to be a safe, effective, and predictable treatment for hyperfunctional lines of the upper facial structures. The author has found the clinical use and patient acceptance to be excellent. No untoward side effects have been seen in the series performed by the author. The high cost of the BT A and its short storage life are relative drawbacks. Long-term follow-up past 1988 is not available for cosmetic treatment and will be helpful in determining the continuum of follow-up treatments, prolonged response, and development of immunity to BT A.