Botulinum toxin A (Botox), administered by subcutaneous or intramuscular injection, is the most commonly used and most successful medication for many craniocervical dystonias. Although some patients experience side effects related to the neuroparalylic action of the medication, these side effects are temporary. In 1996, permanent periocular cutaneous depigmentation was reported in three white patients after repeated Botox injections, suggesting that loss or alteration of melanin pigment might be a permanent side effect of longterm Botox injections. The authors examined and photographed 26 African American patients who were receiving periocular Botox injections for hemifacial spasm and essential blepharospasm. The authors found no evidence of periocular cutaneous depigmentation in any of these patients.