• #1-7. Safe and Effective Botulinum Toxin Injection Techniques


    Figure 6. Injection points for glabellar frowning line.


    Horizontal wrinkles around the nasion can be corrected as following; perform superficial subcutaneous injections in 2-3 points along the first couple wrinkles at the nasion (Botox 4-5 unit, Dysport 10-12.5 unit). This paralyzes the procerus muscle and weakens its attachment to the skin (Figure 7). 


    Side effects of botulinum toxin injection in the glabella include eyelid edema and difficulty with opening the eyes, or ptosis which can be caused by the toxin seeping into the levator palpebral muscle. As a compensatory reaction, the lateral ends of the eyebrows can lift, creating an angry expression of the face.


    When injecting in the orbital rim, it is important to inject to the lateral of the rim margin along the course of the corrugator muscle to prevent the toxin spreading into the rim and subsequent ptosis. Make sure that the needle is also pointing in the lateral direction. Use a finger of the free hand to press down between the rim and the injection site and avoid excessive massaging.


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    When injecting at the area of corrugator muscle attachment, injecting deeper than the subcutaneous level is less effective and can affect other muscles. Be careful to adjust the injection depth. In case of compensatory ascending of the lateral eyebrows, inject botulinum toxin in the forehead muscle above the affected area to lower the eyebrows. If the patient complains of difficulty with opening the eyes, inject a small dose in the muscles to pull down the eyebrows to improve the symptom. This can alleviate the heaviness of the eyelids.


    Figure 7. Injection points for nasal root horizontal line.

    -To be continued

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