Although the existing forms of botulinum toxins used for aesthetic purpose are in general safe, there are well described long term effects that can be rather devastating. This long term side effect is called the Impaired Neuronal Communication Syndrome (INCS) that manifests itself in many ways related to Central Nervous System, peripheral nervous system, autonomic nervous system including hypothalamic syndrome as well as psychiatric disturbances. The INCS is considered a very rare complication, related to distant spread of the toxin. With only about 300 cases reported the question remains whether the illness is indeed very rare indeed or just very rarely diagnosed due to lack of awareness and diagnostic limitations? In summary, considering the number of Botox injections around the world , the product is quite safe. Yet, denying a possibility of rare, at times debilitating, long term side effects limits our credibility.