Highly Cited Research on Botulinum Toxin: A Bibliometric Analysis of Clinical Trends, Influential Evidence, and Healthcare-Relevant Applications (1991–2022)

Background/objectives: Botulinum toxin is widely used across medical specialties, with expanding indications in neurology, pain management, urology, and aesthetic medicine. Highly cited publications can reflect influential evidence and clinical priorities within healthcare. This study aimed to identify and characterize highly cited research on botulinum toxin as indicators of influential evidence within the field, with a focus on clinical trends, collaboration patterns, and healthcare-relevant applications. Methods: A bibliometric analysis was conducted using the Science Citation Index Expanded (SCI-EXPANDED) within the Web of Science Core Collection. Publications from 1991 to 2022 with ≥100 citations (TC₂₀₂₄ ≥ 100) were included. Data on publication characteristics, authorship, institutional and country contributions, and citation impact were extracted. Bibliometric indicators, including total publications, citations per publication, and the Y-index, were applied. Keyword and title analyses were used to identify major research themes. Results: A total of 643 highly cited articles were identified, with 118,175 citations. The United States was the leading contributor, and industry-linked research, particularly from Allergan, demonstrated high citation impact. Five major clinical themes emerged: spasticity management, dystonia and movement disorders, chronic pain, urinary disorders, and cosmetic applications. Highly cited research was predominantly produced through collaborative teams, most commonly involving two to six authors, and international collaborations were associated with higher citation impact. Conclusions: Highly cited botulinum toxin research may partially reflect evolving clinical demand and interdisciplinary use across healthcare fields. The prominence of collaborative and industry-linked research highlights the role of translational and practice-driven innovation. These findings provide insight into influential evidence and may support future research prioritization, interdisciplinary collaboration, and evidence-based decision-making in clinical and healthcare contexts.