This document provides dosage and administration guidelines for Botox injections to treat forehead lines, glabellar lines, and lateral canthal lines. It recommends doses of 20 units for forehead lines, 20 units for glabellar lines, and 24 units for lateral canthal lines. When treating all three areas simultaneously, the recommended total dose is 64 units. It provides instructions for reconstituting Botox and describes injection techniques, including identifying injection sites and ensuring accurate dosing.

1. Priyanka Kalsi
Dose, dilution,
reconstitution and
injection techniques.
Botox

2. Botox, onabotulinumtoxin A
❖ Dose is dependent on the area being tested.
❖ Cosmetic dilution and reconstitution processes are same
for moderate to severe forehead lines, lateral canthus
lines and glabellar lines.

3. Dose
❖ Forehead 20 units.
❖ Lateral canthal 24 units.
❖ Glabellar lines 20 units.

4. Dose
❖ Treat forehead lines in connection with glabellar lines to
reduce brow ptosis.
❖ The approved dosage for treatment of forehead lines 20
units in conjunction with glabellar lines 20 units is 40
units.
❖ For simultaneous treatment of three areas dose is
20+24+20, 20 for forehead, 24 for lateral canthal lines, 20
for glabellar lines, with total dosage of 64 units.

5. Dose
❖ 40 unit dose provides efficacy without an increase in
side effects, compared with lower dose.

6. Dilution table
❖ Botox is supplied in 100 units and 50 unit single use vials
for reconstitution.
❖ Cosmetic should be reconstituted with sterile, preservative
free 0.9% sodium chloride injection USP.
❖ Once open and reconstituted, use within 24 hrs. Because of
lack of preservatives in product and diluent.
❖ During the 24 hrs, cosmetic should be stored in a
refrigerator at 2 degree Celsius to 8 degree Celsius. 36 F to
46 F. Vials are for single use only.

7. Dilution instructions for reconstitution.
❖ 100 unit vial, 2.50 ml diluent, preservative free 0.9%
sodium chloride injection. USP only.
❖ Resulting dose 4 units.

8. Dilution instructions for reconstitution.
❖ 50 unit vial, 1.25 ml, preservative free 0.9% sodium
chloride injection and USP only.
❖ Resulting dose 4 units.

9. Dilution instructions
❖ Forehead line treatment is 4 units per 0.1 ml at each of
the five injection sites. 20 units per 0.5 ml of frontalis
muscle.
❖ 4 units per 0.1 into each of the five glabellar lines. 20
units per 0.5 ml.
❖ Total 40 units per 1.0 ml.

10. Dilution instructions for reconstitution.
❖ Lateral canthal lines, 4 units per 0.1 ml. There is 6
injection sites, 3 on each site, for a total dose of 24 units
per 0.6 ml.

11. Injection techniques.
❖ For moderate to severe frontal lines.
❖ When identifying the location of the appropriate
injection sites in the frontalis muscle, assess the overall
relationship between size of forehead and distribution
of frontalis muscle activity.

12. Injection techniques.
❖ Locate the horizontal treatment dose, by light palpating of
forehead at rest and maximum eyebrow elevation.
❖ Superior margin of frontalis activity, approximately 1 cm
above the most superior frontal crease.
❖ Lower treatment row: midway between superior margin of
frontalis activity and eyebrow at least 2cm above the
eyebrow.
❖ Upper treatment row: midway between the superior
margin of frontalis activity and lower treatment row.

13. Injection techniques
❖ Inject 4 units/0.1ml reconstituted Botox solution into 5 sites
in the frontalis muscle for a total of 20 units/0.5 ml.
❖ Place the 5 injections at intersections of horizontal treatment
rows and vertical landmarks.
❖ On the lower treatment row, at the midline of face and 0.5 to
1.5 cm medial to palpated temporal fusion temporal crest,
repeat on other site.
❖ On the upper treatment row, midway between lateral and
medial sites on the lower treatment row, repeat for other site.

14. Injection techniques
❖ For moderate to severe glabellar lines.
❖ 4 units of 0.1 ml, into each of the 5 sites. 2 in corrugator,
1 in procerus for a total of 20 units.
❖ To reduce the risk of ptosis.
❖ Avoid injection near levator palpebral superioris,
especially in patient with large brow depressor
complexes.

15. Injection techniques
❖ Lateral corrugator injections should be placed at least 1
cm above the bony supraorbital ridge.
❖ Ensure the injected vol and dose are accurate and where
feasible kept to a minimum.
❖ Don’t inject Botox closer than one cm above the central
eyebrow.

16. Injection techniques
❖ Injection should be given with needle level tip up and
oriented away from the eye.
❖ 4 units 0.1 ml, each of the the 6 sites. ( 3 injections per
site.). Total dose of 24 units.

17. ❖ Two approved injection patterns. If lines are both above
and below the lateral canthus.
❖ First injection at least 1.5 cm to 2 cm, temporal to the
lateral canthus and just temporal to the lateral orbital
rim.
❖ Second injection, 1 to 1.5 cm above the first injection site
and an approximately 30 degree angle medially.
❖ Third injection 1 cm to 1.5 cm below the first injection
site and at 30 degree angle medially.

18. ❖ If lines are primarily below the lateral canthus.
❖ First injection 1.5 to 2 cm temporal to the lateral canthus
and just temporal to the lateral orbital rim.
❖ Inject along a line that angles from antero inferior to
superior posterior.
❖ Ensure the most anterior injection is lateral to a line
drawn vertically from lateral canthus.
❖ Remember to keep the most inferior injection superior
to maxillary prominence.