The commercially available “face slimming injection” generally refers to the injection of botulinum toxin into the bite muscle to reduce the size of the bite muscle, which is known for its good cosmetic effect. However, Botox was first used in ophthalmology in the 1970s by Dr. Alan Scott of the Smith-Kettlewell Eye Institute in San Francisco to treat strabismus, and was then officially approved by the FDA for the treatment of strabismus and blepharospasm. Only after this was Botox gradually used in dermatology, neurology, dentistry, and otolaryngology. Botulinum toxin is a neurotoxin produced by Clostridium botulinum that blocks the release of acetylcholine from the axon terminal vesicles of the nerve-muscle junction, which in turn prevents acetylcholine from binding to N2-type acetylcholine receptors on the muscle membrane, eventually causing a transient paralysis of the muscle and weakening the original strength of the muscle, thus correcting the eye position. Botulinum toxin has been approved by the FDA for strabismus treatment for about 30 years, and there have been few reports of serious complications. The main side effects of Botox for strabismus are ptosis, vertical strabismus, diplopia, dry eyes, tearing, subconjunctival hemorrhage, hypotony, and dilated pupils, but most of these can recover on their own within a few weeks. Serious complications such as retrobulbar hemorrhage and scleral perforation are occasionally seen, but are mainly related to the skill of the injecting physician and the degree of cooperation of the patient. Due to the small volume of injections, no systemic side effects have been reported. Botulinum toxin injections into the ocular muscle are mostly performed under the guidance of ocular electromyographic amplifiers, using very fine monopolar needle-like electrodes, which basically leave no conjunctival scarring or other abnormalities. However, if the conjunctiva is surgically opened and the eye muscle is injected under direct vision, there is a risk of forming a conjunctival purpura that may affect the appearance. Is it necessary to repeat Botox injections for strabismus? It varies from person to person and from condition to condition. If the patient is sensitive to botulinum toxin and the strabismus is small, the probability of correction is higher with a single injection. However, depending on the mechanism of action of botulinum toxin, many patients with strabismus may require repeat injections. The peak effect of botulinum toxin is 2 to 4 weeks after injection, and the effect of the drug basically wears off after 3 to 4 months, at which time it is necessary to determine whether the strabismus has been cured and whether repeat injections are needed based on the eye position and eye movement. Whether the eye position is completely stable is usually determined more than 6 months after the injection. There is no definite answer to the question of whether Botox treatment can replace surgery. Some micro-angle strabismus and infantile strabismus can be completely corrected by Botox injections alone, but large-angle strabismus mostly requires surgery for further correction. It is relatively certain that botulinum toxin injections can be combined with surgical treatment to correct strabismus. Most scholars believe that adductor nerve palsy and thyroid-related strabismus can be treated early with botulinum toxin injections followed by surgery. Overcorrection or undercorrection after surgery for common strabismus can be treated with botulinum toxin injections. Because there are many different types of strabismus, a comprehensive evaluation and selection of treatment modalities is required by an experienced ophthalmologist. There are no special dietary contraindications following Botox injections. However, it is important to prevent eye infections, avoid getting dirty water into the eye, and avoid swimming and heavy eye makeup. There is no evidence to suggest that menstrual periods can affect Botox injections in the eye. Although injections during menstruation may theoretically increase the risk of subconjunctival hemorrhage, no clinically significant difference has been seen. Also diabetes and hypertension are not contraindications to botulinum toxin injections in the eye muscle and can be injected at your discretion. Never buy Botox outside and inject it in the hospital! First of all, Botox is a prescription drug and retail pharmacies do not sell it. Second, botulinum toxin is strictly managed by hospitals according to toxic drugs, and regular hospitals will not sell it to individuals. Finally, botulinum toxin needs to be refrigerated at 2~8℃ and needs to be used promptly after configuration or refrigerated at 2~8℃ for up to 4 hours. Therefore, botulinum toxin can only be purchased at a regular hospital and injected by a qualified physician.