Botulinum Toxin protocol

Typical aesthetic dosing (units)

Glabella (frown lines)

~20 U (5 points) · Every 3–4 months

FDA-approved cosmetic dose.

Forehead lines

~10–20 U · Every 3–4 months

Often combined with glabella (~40 U upper face).

Crow’s feet

~12 U per side · Every 3–4 months

Phase	How often	Dose	Units	Notes
Glabella (frown lines)	Every 3–4 months	~20 U (5 points)	–	FDA-approved cosmetic dose.
Forehead lines	Every 3–4 months	~10–20 U	–	Often combined with glabella (~40 U upper face).
Crow’s feet	Every 3–4 months	~12 U per side	–

Critical: max cumulative ~400 U per 3 months.

What to expect

Smoothing of treated lines over 3–7 days, lasting ~3–4 months, then repeat.

How much to buy

For clinician-dependent:

one upper-face treatment (~40–60 U) with margin

× 100U vials

Men & women

Dosed by muscle / treatment area, not sex (men often need slightly more units for larger muscles). Contraindicated in pregnancy & breastfeeding.

Recommended mixes

Vial	Water	Strength
100 U	2.5 mL saline (0.9% preserved)	4 U / 0.1 mL

100 U: Common dilution. Other dilutions used per technique. Clinician-only.

Storage

Refrigerate 36–46°F; use reconstituted product within hours–days per label.

Don't use if: Self-administration (this is a clinician-only prescription drug) · Neuromuscular junction disorders (myasthenia gravis, Lambert-Eaton, ALS) · Infection at the injection site · Pregnancy and lactation; known hypersensitivity

Stop if you notice

Difficulty swallowing, speaking, or breathing; emergency care immediately
Significant eyelid droop or vision change
Signs of allergic reaction

Side effects

Bruising, headache, eyelid/brow droop, asymmetry, dry eye; rarely toxin spread (difficulty swallowing/breathing; emergency).

Drug interactions

Aminoglycoside antibiotics, muscle relaxants: potentiate the toxin. Anticoagulants: increased bruising. Other neuromuscular-blocking agents: additive effect.

Labs

None routine; medical history and neuromuscular screening beforehand

What these labs mean →

Warnings

Boxed warning: toxin spread, distant effects (swallowing/breathing difficulty) can be life-threatening. Eyelid/brow ptosis, asymmetry from misplacement. Potency varies by product/brand, units are NOT interchangeable. Counterfeit/underground product carries serious risk.

Patient education

Clinician-administered prescription drug, never self-inject or use underground product. Brand units are not interchangeable. Effects last ~3–4 months. Seek emergency care for any swallowing or breathing difficulty.

These apply on top of the universal safety rules.

Pairs well with

Dermal fillers / topical anti-aging

clinician-coordinated. Not a self-administered stack

Avoid with

Self-injection

never

Neuromuscular disorders

myasthenia gravis, ALS, Lambert-Eaton

Infection at site

Pregnancy/lactation

Aminoglycoside antibiotics

What it does

Botulinum toxin type A blocks acetylcholine release at the neuromuscular junction, temporarily paralyzing the injected muscle (effects last ~3–4 months). Cosmetically it softens dynamic wrinkles; medically it treats migraine, hyperhidrosis, spasticity, and more. Dosed in units; reconstitution and placement are precise and clinician-only.

Critical

Critical: max cumulative ~400 U per 3 months.

Precise muscle placement determines safety, wrong placement causes drooping eyelids/brows, asymmetry, or swallowing/breathing problems.

This is a clinician-administered prescription drug, do not self-inject.

References

rxlist dailymed PubMed

From the guide, page 21.