26 ESSENTIAL

BOTULINUM TOXIN
INJECTION PATTERNS
GLABELLA LINES
(FROWN LINES)

4 4
4 4

LICENCED DOSES

OFF LABEL VARIANTS

1 1 2 2
4 4 4 4
4 4 6 6
4 4

WIDE STRONG
Wide insertion point of the corrugator It is common to increase the dose in men or
muscle may leave lateral activity without a women with obviously stronger muscles
small, superficial dose lateral to the mid than average. Up to 80 units have been
pupil. found to have a similar side effect profile.

1 1
2 2 3 3
4 4 4 4
8 4

DOWN PULL CAUTIOUS

Dominant procerus & depressor supercilli Lower dose above the midpupillary line may
may require stronger doses medially. decrease eyelid ptosis risk.
LATERAL CANTHAL LINES
(CROWS FEET)

LICENCED DOSES

OFF LABEL VARIANTS

2 4 4
2
4 3
2
4 2
2
2 4 1

More gentle results may be attained, preserving Higher Doses are Over-treatment is a risk. In
some activity but also reducing longevity. Even less sometimes required in some cases, a sag or a ledge
may be appropriate in some cases. 1,1,1 or 2,2 is in people with stronger around the eye can occur,
the realm of ‘baby botox’ for mild results and than average orbicularis and a more graduated dose
normal expression. oculi muscles. may reduce the risk of this.

4 1
4
4 2
4 4
4 0.5 4
2 4 1
4

Lower dose inferiorly may Under eye lines are sometimes Superiorly there can be
treated as above. However, the activity outside of the
reduce the “pinched” look
result can be disappointing if licenced areas, and small
caused by the relative the lines are formed by action doses superficially
dominance of central muscles from the Zygomatic muscles. administered can soften
This area is important for
after a treatment. lines and aid lift in this area.
expression.
FOREHEAD LINES
(FRONTALIS) LICENCES FOR TREATMENT OF FOREHEAD LINES (NOT FOR BROW LIFT)

LICENCED DOSES

LICENCED DOSES

Licensed patterns are designed to give acceptable results to the greatest proportion
of people treated. They therefore less good at treating atypical patients. You can see
that there are areas of untreated muscle in these diagrams which may require
patient follow up or cause undesired results in some cases. Below are some
variations of the patterns that enable personalisation of the treatment design to
different shaped foreheads and to create different results. For example if a patient
wants to increase the arch of the brow instead of just softening the lines.
VARIATIONS IN
FOREHEAD TREATMENT DESIGN

Foreheads are highly variable, as are the desired goals from botulinum toxin treatments. Eyebrow lifts,
frozen or soft treatments are often requested in the context of a wide variety in the physical size and
dynamic characteristics of foreheads. The skilled clinician must learn to design treatments around all
these variables, as the licenced dosages reveal their limits in many of these contexts.

It’s vital to understand that both licences are for treatment of horizontal lines, and do not claim to prevent
brow ptosis as a side effect. Variations below are ways of attaining lift and reducing the incidence of ptosis
through a variation of dose and position.

To understand the forehead, you must understand the 4 zones- lateral forehead is important for eyebrow lift, and
should be left untreated if an eyebrow arch is desired. Medial zone is the site of most lines in the average forehead.
The drop zone is higher risk for ptosis and eyebrow asymmetry.

Most females look better with an angle in their eyebrow For bigger lifts, less toxin should be injected in the lateral
of about 15 degrees from the medial low point. To frontalis. There is an increase in resting tone of untreated
achieve this you must leave some lateral muscle activity muscle when the medial frontalis is treated.
above the eyebrow. 3-4 cm of muscle untreated from the
orbital rim in a direction which would pull the arch. If too NB: ALL SUGGESTED TREATMENTS IN THE FOREHEAD
much is left you can get ladder lines. To soften them, add ASSUME GLABELLA TREATMENT IS ALSO BEING
a little more in the top of the triangle illustrated. PLANNED.
VARIATIONS IN
(FOREHEAD TREATMENT DESIGN)

AVERAGE FOREHEAD SHORT FOREHEAD

TALL FOREHEAD RARE HIGH LEVEL DOSE -

EG LARGE MUSCULAR MAN

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 licenced doses in my opinion risks a
higher than needed rate of forehead
TOO MUCH ptosis, and limits the chance of a lift to
the eyebrows- which are a very
common request from females.
On average they also use more product
in females than may be required to get
TOO LITTLE a good result, increasing costs with
limited benefit for many clients.

You can learn the most from seeing poor results and deciding what
may have caused the disharmony you can see. Greater
understanding through case studies will decrease the risk of poor
results with your patients.

Finally, remember that with foreheads more than any area, it’s
important to see the first treatment as stage 1 on a journey, and
leave room for a top up once you have gained some experience of
the patient's face. Brow drops are harder to fix than overly lifted
brow lifts.
GLABELLA LINES
(GLABELLA LINES)

10 10
10 10

10

LICENCED DOSES

LATERAL CANTHAL LINES

(CROWS FEET)

LICENCED DOSES
Text copyright © Dr Tim Pearce 2024.
Dr Tim Pearce has asserted his right to be identified as the
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