What is botulinum toxin?
DISCLAIMER
Botulinum toxin injections are one of the most effective ways to fight wrinkles. More than 2.5 million people in the United States use them each year to improve their appearance.
However, to get the best results, you need to understand the anatomy of the facial muscles and know where and how much botulinum toxin to inject. That's why we strongly recommend that botulinum toxin injections be performed only by a qualified physician. The information in this article is not intended to be a direct guide and is not a substitute for consultation with a physician.
Table of Contents
Botox or botulinum toxin?
Botox™ is a registered trademark of Allergan, and botulinum toxin is the active ingredient in Botox™. The same botulinum toxin is the active ingredient in all other similar products. But because Botox™ was the first product of its kind, it has become a household name. For now, the word “Botox” written in lower case and without the “™” symbol is often used to refer to all products containing botulinum toxin.
How to store botox, what is needed for botox injections, how to properly prepare botox solution for injection and other important questions we have already highlighted in this article.
Here we will only say that the standard dilution according to the manufacturer's recommendations is 2.5 ml of saline solution per vial containing 100 units of botulinum toxin. After that, 0.1 ml of the finished solution will contain 4 Units of botox.
Where to inject botox?
How do you know where to get botulinum toxin injections for the best results? The answer is simple. Botox is a product that works locally. This means that it should be injected exactly where the problem is, in the area of the wrinkle you want to eliminate.
Botox injection for horizontal forehead lines
Dose per injection point: 2-4 Units
Number of injection points: 4-8 points
Total dose: 8-32 Units
Injection technique: Intramuscular injections perpendicular to the skin to the depth of the middle third of the 30G needle.
Injection site: In the forehead below the hairline. The points should form a slightly curved V-shape in women and straight in men. For less experienced injectors, the points should be sufficiently high on the forehead (about 4–5 cm from the orbital rim) to avoid side effects such as brow ptosis. The lateral points should be on the outer lines of the orbital rim.
Botox injection for frown lines (glabellar complex)
Dose per injection point: 2-4 Units
Number of injection points: 5 points
Total dose: 10-20 Units
Injection technique: Deep intramuscular injections perpendicular to the skin to the depth of the last third of the 30G needle.
Injection site: A five-point injection. All points should be 0.5-1 cm from the upper orbital rims and inside the mid-pupil lines.
Botox injection for crow's feet
Dose per injection point: 1-2 Units
Number of injection points: 3 points per side, 6 points in total
Total dose: 6-12 Units
Injection technique: Superficial injections with the needle pointing away from the eyes (20–30° angle to the skin), to the depth of the first third of the 30G needle.
Injection site: All points should be on the outer part of the orbicularis oculi and approximately 1-2 cm from the outer orbital rim.
Botox injection for lateral eyebrow lift
Dose per injection point: 2-4 Units
Number of injection points: 2 points per side (1 main point and 1 additional), 4 points in total
Total dose: 4-16 Units
Injection technique: Injection should be superficial, intramuscular and perpendicular to the skin, to the depth of the middle third of the needle.
Injection site: Main injection point should be placed at eyebrow tail. An additional injection point should be located on the outer part of the frontalis muscle, approximately above where the eyebrow is at its maximum height.
Botox injection for lower eyelid wrinkles
Dose per injection point: 1-2 Units
Number of injection points: 1 point per side, 2 points in total
Total dose: 2-4 Units
Injection technique: Injection should be very superficial with the needle held tangential to the eye to create a small white “bubble”.
Injection site: At the mid-pupil line, approximately 2-3 mm below the lower eyelid margin.
Botox injection for bunny lines
Dose per injection point: 2-4 Units
Number of injection points: 2 points per side, 4 points in total
Total dose: 8-16 Units
Injection technique: The injection should be very superficial to create a “bubble”, to the depth of the first third of the needle, avoiding contact with blood vessels or the nasal bone. The orientation of the needle should be at an angle of approximately 45° to the nasal bone.
Injection site: About 1-2 cm above the upper lateral part of the nostril.
Botox injection for radial lip lines
Dose per injection point: 1-2 Units
Number of injection points: 4-6 points in total (2-4 symmetrical points on the upper lip and 2 points on the lower lip if necessary)
Total dose: 4-12 Units
Injection technique: Very superficial intramuscular injections perpendicular to the skin using only the tip of the needle.
Injection site: The injection points should be located on the border of the pigmented part of the lips.
Botox injection for softening the jaw contour
Dose per injection point: 4-8 Units
Number of injection points: 3 points per side, 6 points in total
Total dose: 24-48 Units
Injection technique: Intramuscular injection to depth of at least the middle third of the needle.
Injection site: The injection points should be below the line connecting the earlobe to the corner of the mouth and approximately 1.5 cm above the corner of the lower jaw.
Botox injection for marionette lines and drooping mouth corners
Dose per injection point: 2-4 Units
Number of injection points: 3 points per side (2 main points and 1 additional point), 4-6 points in total
Total dose: 8-24 Units
Injection technique: Superficial intramuscular injections perpendicular to the skin to the depth of the middle third of the needle.
Injection site: First major injection points should be 1 cm inferior to the lip angle, second major point – 1 cm inferior and 1 cm lateral. If additional hyperkinetic wrinkles appear lateral to the corner of the lips, it is recommended to also inject the additional lower point.
Botox injection for dimpled chin and chin lines
Dose per injection point: 4-8 Units
Number of injection points: 2 points
Total dose: 8-16 Units
Injection technique: Superficial intramuscular injections perpendicular to the skin to the depth of the middle third of the needle.
Injection site: 2 points close to a line running from top to bottom through the middle of the face and chin.
Botox injection for platysmal bands
Dose per injection point: 4 Units
Number of injection points: Maximum 10 points per side. The total number of injection points depends on the number and length of the platysmal bands, as long as the total maximum dose is not exceeded (e.g. total ≤20 points with 4 Units per point)
Total dose: Maximum total dose 80 Units
Injection technique: Very superficial intramuscular injections on the bands with horizontal orientation, to the depth of the first third of the needle.
Injection site: Start the first point at the jawline and go down every 2 cm until at least the middle part of the bands.
Botox injection for décolleté wrinkles
Dose per injection point: 8-12 Units
Number of injection points: 6-8 points per side, 12-16 points in total. The maximum number of injections is 12 points with 12 Units per point, or 16 points with 8 Units per point.
Total dose: Maximum total dose 144 Units
Injection technique: Injection should be performed to a depth of at least 4 mm with the needle oriented perpendicular to the skin.
Injection site: The points should form a “V” shape and the number of injection points depends on the severity and distribution of the wrinkles.
List of scientific sources used:
- Brennan R, Wells JSG, Van Hout M. "Saving Face": An Online Study of the Injecting Use of DIY Botox and Dermal Filler Kits. Plast Surg (Oakv). 2018;26(3):154-159. doi:10.1177/2292550318767432
- Biello A, Oney R, Zhu B. Botulinum Toxin Treatment of the Upper Face. [Updated 2023 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing;
- Padda IS, Tadi P. Botulinum Toxin. In: StatPearls. Treasure Island (FL): StatPearls Publishing; November 6, 2023.
- Kaplan JB. Consideration of Muscle Depth for Botulinum Toxin Injections: A Three-Dimensional Approach. Plast Surg Nurs. 2019;39(2):52-58. doi:10.1097/PSN.0000000000000265
- Swift A, Green JB, Hernandez CA, et al. Tips and Tricks for Facial Toxin Injections with Illustrated Anatomy. Plast Reconstr Surg. 2022;149(2):303e-312e. doi:10.1097/PRS.0000000000008708
- Small R. Botulinum toxin injection for facial wrinkles. Am Fam Physician. 2014;90(3):168-175.
- Ascher B, Rzany BJ, Kestemont P, et al. International Consensus Recommendations on the Aesthetic Usage of Ready-to-Use AbobotulinumtoxinA (Alluzience). Aesthet Surg J. 2024;44(2):192-202. doi:10.1093/asj/sjad222
- Sundaram H, Signorini M, Liew S, et al. Global Aesthetics Consensus: Botulinum Toxin Type A--Evidence-Based Review, Emerging Concepts, and Consensus Recommendations for Aesthetic Use, Including Updates on Complications. Plast Reconstr Surg. 2016;137(3):518e-529e. doi:10.1097/01.prs.0000475758.63709.23
- Ascher B, Talarico S, Cassuto D, et al. International consensus recommendations on the aesthetic usage of botulinum toxin type A (Speywood Unit)--Part I: Upper facial wrinkles. J Eur Acad Dermatol Venereol. 2010;24(11):1278-1284. doi:10.1111/j.1468-3083.2010.03631.x
- Johnson AJ, Chen DS. Office-based facial plastics procedures: Neuromodulators. World J Otorhinolaryngol Head Neck Surg. 2023;9(3):220-226. Published 2023 Jul 27. doi:10.1002/wjo2.121
- Ascher B, Talarico S, Cassuto D, et al. International consensus recommendations on the aesthetic usage of botulinum toxin type A (Speywood Unit)--Part II: Wrinkles on the middle and lower face, neck and chest. J Eur Acad Dermatol Venereol. 2010;24(11):1285-1295. doi:10.1111/j.1468-3083.2010.03728.x
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