Where to Inject Botox: A Guide to Common Treatment Areas for Professionals

As a healthcare professional in the field of aesthetic and therapeutic medicine, mastering Botox (botulinum toxin) injection sites is critical for achieving optimal patient outcomes while minimizing risks. Botox works by temporarily blocking nerve signals to muscles, reducing contractions that cause wrinkles or spasms. Approved by the FDA for various uses since 1989, including cosmetic wrinkle reduction and medical conditions like chronic migraines and blepharospasm, its applications span cosmetic enhancements (e.g., forehead lines, crow's feet) to therapeutic relief (e.g., TMJ disorders, migraines). With over 7.5 million procedures in 2023, according to the American Society of Plastic Surgeons, precise knowledge of anatomy, dosing, and techniques is essential to avoid complications like ptosis or asymmetry. This guide, based on established medical sources and protocols as of 2025, details common injection sites for both cosmetic and medical purposes. Always tailor treatments to individual patient anatomy, and consult state regulations for administration authority.

Understanding Botox Injection Fundamentals

Before delving into specific sites, note key principles:

Muscle Targeting: Botox is injected into specific muscles to relax them. Injections can be intramuscular, subcutaneous, or supraperiosteal, depending on the area.
Dosing: Measured in units (e.g., onabotulinumtoxinA), typical ranges vary by site and patient factors like age, gender, and muscle strength. Women often require lower doses than men.
Techniques: Use fine needles (e.g., 30-32 gauge) for precision. Patients may be asked to contract muscles (e.g., frown or smile) to identify targets. Apply ice or topical numbing to reduce discomfort.
Safety Tips: Maintain at least 1-1.5 cm distance from sensitive areas like the orbital rim to prevent diffusion into unintended muscles. Advise patients to stay upright for 2-4 hours post-injection and avoid rubbing sites. Effects last 3-6 months, with follow-ups recommended.
Contraindications: Avoid in patients with neuromuscular disorders, allergies to Botox components, or active infections at sites.

Professional training is vital, as improper placement can lead to adverse effects like brow ptosis or diplopia. Resources like the American Med Spa Association offer guidelines on best practices. (External link: https://americanmedspa.org/ – a comprehensive resource for aesthetic procedure protocols.)

Cosmetic Injection Sites: Upper Face

The upper face is the most common area for cosmetic Botox, targeting dynamic wrinkles from repetitive expressions.

Forehead Wrinkles (Horizontal Lines):

Muscle Target: Frontalis muscle, responsible for raising eyebrows and creating lines.
Injection Sites and Technique: 4-8 points across the mid and upper forehead, at least 1.5 cm above the brow to avoid ptosis. Inject intramuscularly or subcutaneously; pull skin inferiorly to assess brow position.
Typical Units: 10-20 units for women, 20-30 for men.
Safety Tips: Balance with glabellar injections to prevent "Mephisto" deformity (over-arched brows); correct by adding lateral units.

Crow's Feet (Lateral Canthal Lines):

Muscle Target: Orbicularis oculi, causing wrinkles when squinting.
Injection Sites and Technique: 1-5 points per side, 1 cm lateral to the orbital rim, superficially (1-2 mm deep) to create small wheals. Have patient close eyes tightly to locate fibers.
Typical Units: 4-15 units per side.
Safety Tips: Avoid inferior/medial injections to prevent asymmetric smiles or ectropion; monitor for temporary edema.

Brow Lift (Eyebrow Elevation):

Muscle Target: Lateral orbicularis oculi for lateral lift; corrugator supercilii, depressor supercilii, and procerus for medial lift.
Injection Sites and Technique: For lateral: 3 points inferior to lateral brow. For medial: Superficial at brow level into depressor supercilii.
Typical Units: 8-10 units for lateral; integrated into glabellar dosing.
Safety Tips: Slow injection to limit diffusion; avoid deep placement to spare frontalis.

Frown Lines (Glabellar Lines or "11s"):

Muscle Target: Corrugator supercilii (vertical lines) and procerus (horizontal).
Injection Sites and Technique: Deep medially (supraperiosteal), superficial laterally; 1 cm above brow. Pinch medial brow to identify.
Typical Units: Roughly half forehead dose, e.g., 10-25 units.
Safety Tips: Keep patient vertical post-injection; avoid proximity to levator palpebrae to prevent ptosis.

Hooded Eyes and Under Eye Wrinkles:

Muscle Target: Orbicularis oculi for hooded lids; lower orbicularis for under-eye creases.
Injection Sites and Technique: Careful placement under lateral brow for lift; superficial for under-eye lines.
Typical Units: 2-5 units per side for brow; 5-10 for under-eye.
Safety Tips: Use cautiously to avoid lid drop; combine with fillers if needed.

Cosmetic Injection Sites: Lower Face

Lower face treatments address expression lines and contours.

Lip Flip:

Muscle Target: Orbicularis oris to roll upper lip outward.
Injection Sites and Technique: Along upper lip border.
Typical Units: 10 units.
Safety Tips: Minimize fine lines; avoid over-relaxation affecting speech.

Marionette Lines and Nasolabial Folds (Smile Lines):

Muscle Target: Depressor anguli oris for marionette; levator labii for nasolabial.
Injection Sites and Technique: Corners of mouth, 3-6 units/side.
Typical Units: 3-6 units/side.
Safety Tips: Often combined with fillers; prevent drooping.

Jowls:

Muscle Target: Platysma or depressor anguli oris.
Injection Sites and Technique: Along jawline, similar to smile lines.
Typical Units: 3-6 units/side.
Safety Tips: Enhances jawline; monitor for asymmetry.

Medical Injection Sites

Botox excels in treating neurological and muscular conditions.

Migraines:

Muscle Target: Frontal, temporal, occipital, trapezius, cervical paraspinal.
Injection Sites and Technique: PREEMPT protocol: 31 sites across 7 head/neck areas (e.g., 5 units behind ears for bilateral headaches). Up to 39 sites in variations.
Typical Units: 155-195 units.
Safety Tips: For chronic migraines (15+ days/month); reduces frequency.

TMJ (Temporomandibular Joint Disorders):

Muscle Target: Masseter, temporalis, pterygoids.
Injection Sites and Technique: Into jaw muscles for tension relief.
Typical Units: 25-50 units/side.
Safety Tips: Relieves grinding, headaches; combine with therapy.

Bell's Palsy:

Muscle Target: Affected facial muscles for synkinesis.
Injection Sites and Technique: Into hyperactive muscles to reduce asymmetry.
Typical Units: 10-30 units.
Safety Tips: Treats partial paralysis; monitor for balance.

Blepharospasm:

Muscle Target: Orbicularis oculi for spasms.
Injection Sites and Technique: Around eyelids.
Typical Units: 4-15 units/side.
Safety Tips: FDA-approved for eye twitching; avoid over-relaxation.

Trigeminal Neuralgia and Tension Headaches:

Muscle Target: Trigger points in head/neck for neuralgia; similar to migraines for tension.
Injection Sites and Technique: Into affected nerves/muscles; frontal/temporal for headaches.
Typical Units: 50-100 units for neuralgia; 155 for headaches.
Safety Tips: Off-label but effective; lasts months.

Advancing Your Skills in Botox Administration

Precision in injection sites demands hands-on training to refine techniques and ensure safety. For professionals, accredited courses provide the expertise needed.

Ready to master these sites? AAOPM's Comprehensive Botox Training course offers CME-accredited, practical instruction on all areas discussed. Enroll at https://aaopm.com/courses/comprehensive-botox-training/ to enhance your practice today.

In conclusion, accurate Botox placement optimizes results across cosmetic and medical applications. By adhering to evidence-based protocols, providers can deliver safe, transformative care.