26
ESSENTIAL
INJECTION
PATTERNS
FOR BOTULINUM TOXINS
4
4
4
[Link] 3
4 2
4 1
[Link]
4 4
4
1
4
2
2-4 2-4 2-4 2-4 2-4
4 4
0.5
4 1 4
2
2
2
2
2
4 4
4 4
2
[Link]
GLABELLA LINES
(Frown Lines)
LICENCED
DOSES
4 4
4 4
4
[Link]
OFF LABEL VARIANTS
WIDE STRONG
1 1
4 4 2 2
4 4 4 4
4 6 6
4
[Link]
[Link]
Wide insertion point of the corrugator muscle may It is common to increase the dose in men or women
with obviosly stronger muscles than average. Up to 80
lateral to the mid pupil.
DOWN PULL CAUTIOUS
1 1
3 3
2 4 4 4
4 2 4
8
[Link] [Link]
Doninant Procerus & depressor supercilli may require Lower dose above the midpupillary line may decrease
stronger doses medially. eyelid ptosis risk.
LATERAL CANTHAL LINES
(Crows’ Feet)
LICENCED
DOSES
[Link]
30 O
4 Variant
4 1.5 to 2cm
4
1.5 to 2cm
4
30 O
4
4
OFF LABEL VARIANTS
[Link] [Link]
4 [Link]
[Link]
4
2 4
2 3
4
x
2
2 4 1
2
2
Over Treatment
More gentle result may be attained, preserving some activity but also Higher Doses are sometimes required Overtreatment is a risk. In some cases a sag or a
reducing longevity. Even less may be appropriate in some cases. 1,1,1 or in people with stronger than average ledge around the ye can occur, and a more
2,2 is in the realm of ‘baby botox’ for mild results and normal expression. orbicularis oculi muscles. graduated dose may reduce the risk of this.
1
4 4
4 2
4 4 4 4
0.5
2 4 1 4
[Link] [Link]
[Link] [Link]
Lower dose inferiorly may reduce the “pinched” look caused by the Under eye lines are sometimes Superiorly there can be activity outside of the
relative dominace of central muscles after a treatment. Lip elevators, and treated as above. This can be
medial orbicularis oculi. dissapointing if the energy is admininsterd can soften lines and aid lift in this
coming from the zygomatic area.
muscles. This area is important for
expression.
FOREHEAD LINES
(Crows’ Feet)LICENCES FOR TREATMENT OF FOREHEAD LINES (NOT FOR BROW LIFT)
LICENCED
DOSES
4 4
[Link]
4 4
4
LICENCED
DOSES
[Link]
2-4 2-4 2-4 2-4 2-4
Licenced patterns are designed to give acceptable results to the greatest proportion of people treated. They therefore are less good at treating anone with
atypical. You can see that there are areas of untreated muscle in these diagrams which may result in follow up or undesired results in some cases. What follows
brow shape instead of just softening of the lines, which these lines .
VARIATIONS IN
FOREHEAD TREATMENT DESIGN [Link]
Foreheads are highy variable, as are the desired goals from botulinum toxin treatments. Eyebrow lifts, frozen or soft treat-
ments are often requested in the context also of wide variaties in the physical size and dysnamic characterists of foreheads.
The skilled clinician must learn to design treatments around all these variables, as the licence dosages reveal their limits in
many of these contexts.
It’s vital to understand that both licences are for treatment of horizontil lines, and do not claim to prevent brow ptosis as a
LIFT SKIN CREASES LIFT 4 4 4 4
DROPZONE
2cm
LATERAL MEDIAL
To understand the forehead, you must understand To understand the forehead, you must understand the
the 4 zones- lateral foread is important for eyebrow 4 zones- lateral foread is important for eyebrow lift,
lift, and should be left untreated if an eyebrow arch is and should be left untreated if an eyebrow arch is
desired. Medial zone is the site of most lines in the desired. Medial zone is the site of most lines in the
average forehead. The drop zone is higher risk for average forehead. The drop zone is higher risk for
ptosis and eyebrow asymetry. ptosis and eyebrow asymetry.
1 1 1 1 1 1 1 1
1 1 LIFT 1 1 LIFT
1 1 1 1 1 1 1 1
1 1
SMALL SMALL
LIFT LIFT
Most females look better with an angle in their For bigger lifts, less toxin should be injected in the
eyebrow of about 15 degrees from the medial low lateral frontalis. There is an increase in resting tone of
point. To achieve this you must leave some lateral unteated muscle when the medial frontalis is treated.
muscle active above the eyebrow. 3-4 cm of muscle
untreated from the orbital rim in a direction which
would pull the arch. If too much is left you can get NB: ALL SUGGESTED TREATMENTS IN THE FOREHEAD ASSUME
ladder lines. To soften them, add a little more in the GLABELLA TREATMENT IS ALSO BEEN PLANNED.
top of the triangle illustrated.
VARIATIONS IN
FOREHEAD TREATMENT DESIGN
Average Forehead Short Forehead
2 2 2 2
2 2 2 2 2 2 2 2 2 2 2
2
Tall Forehead Rare High Level Dose- Eg Large Muscular Man
2 2 2 2 2 2 2 2
2 2 2 2 2 2 4 4 4 4 4 4
2 2 2 2 2 2 2 2 2 2 2 2
Learning from poor results.
The forehead is the hardest area of the face because it is literally a
balancing act.
It is essential to leave some parts untreated to support the eyebrows
and the medial forehead, but if you leave too much muscle it can lift.
Thus the boundary placement between treated and untreated muscle
is the deciding factor for results.
The licensed doses in my opinion risk a higher than needed
rate of forehead ptosis, and limit the
chance of a lift to the eyebrows- which
Too Much are a very common request from females.
On average they also use more product in
females than may be required to get a
good result, increasing costs with limited
Too Little benef it for many clients.
You can learn the most from seeing poor
results and deciding what may have caused the dysharmony you can
[Link] understanding through case studies will decrease the risk
of poor results with your patients.
Finally, remember that with forheads more than any area, it’s
room for a top up once you have gained some experience of the
GLABELLA LINES
(Frown Lines)
LICENCED
DOSES
[Link]
10 10
10 10
10
LATERAL CANTHAL LINES
(Crows Feet)
LICENCED
DOSES
[Link]
10 10
10 1.5 to 2cm 10
10 10
LATERAL CANTHAL LINES
(Crows Feet)
LICENCED
DOSES
[Link]
30 O
4 Variant
4 1.5 to 2cm
4
1.5 to 2cm
4
30 O
4
4
OFF LABEL VARIANTS
[Link] [Link]
4 [Link]
[Link]
4
2 4
2 3
4
x
2
2 4 1
2
2
Over Treatment
More gentle result may be attained, preserving some activity but also Higher Doses are sometimes required Overtreatment is a risk. In some cases a sag or a
reducing longevity. Even less may be appropriate in some cases. 1,1,1 or in people with stronger than average ledge around the ye can occur, and a more
2,2 is in the realm of ‘baby botox’ for mild results and normal expression. orbicularis oculi muscles. graduated dose may reduce the risk of this.
1
4 4
4 2
4 4 4 4
0.5
2 4 1 4
[Link] [Link]
[Link] [Link]
Lower dose inferiorly may reduce the “pinched” look caused by the Under eye lines are sometimes Superiorly there can be activity outside of the
relative dominace of central muscles after a treatment. Lip elevators, and treated as above. This can be
medial orbicularis oculi. dissapointing if the energy is admininsterd can soften lines and aid lift in this
coming from the zygomatic area.
muscles. This area is important for
expression.
