Standard Dosage and Injection Points for Forehead Complex Botox
For the forehead complex, the FDA-approved standard dosage is 40 Units total, with 20 Units for glabellar lines and 20 Units for forehead lines, administered at specific injection points to maximize efficacy while minimizing complications. 1
Anatomical Considerations
The forehead complex consists of two primary treatment areas:
- Glabellar lines (frown lines between eyebrows)
- Horizontal forehead lines
Standard Dosing Protocol
Glabellar Lines
- Total dose: 20 Units
- Administration: 4 Units (0.1 mL) per injection site
- Number of sites: 5 total injection points
- 2 in each corrugator muscle
- 1 in the procerus muscle
Forehead Lines
- Total dose: 20 Units
- Administration: 4 Units (0.1 mL) per injection site
- Number of sites: 5 total injection points
- Placement: Two horizontal treatment rows:
- Lower treatment row: midway between superior margin of frontalis activity and eyebrow (at least 2 cm above eyebrow)
- Upper treatment row: midway between superior margin of frontalis activity and lower treatment row
Precise Injection Technique
Glabellar Injections
- Place lateral corrugator injections at least 1 cm above the bony supraorbital ridge
- Do not inject closer than 1 cm above the central eyebrow
- Inject perpendicular to the skin surface
Forehead Injections
- Place injections at the intersection of horizontal treatment rows with specific vertical landmarks:
- On lower treatment row: at midline of face, and 0.5-1.5 cm medial to the temporal fusion line (both sides)
- On upper treatment row: midway between lateral and medial sites on the lower treatment row (both sides)
Critical Safety Considerations
To avoid complications, particularly ptosis:
- Avoid injection near the levator palpebrae superioris
- Keep injected volume/dose accurate and minimal where feasible
- Maintain proper distance from eyebrows (at least 2 cm)
- Ensure proper depth of injection (intramuscular)
Expected Outcomes
- Onset of action: 1-2 days after injection, increasing in intensity during first week
- Duration of effect: Approximately 3-4 months 1, 2
- Mechanism: Botulinum toxin blocks acetylcholine release at neuromuscular junctions, causing localized muscle relaxation that smooths overlying skin 2
Patient Selection Considerations
Botox treatment is contraindicated in patients with:
- Keloidal scarring
- Neuromuscular disorders (e.g., myasthenia gravis)
- Allergies to constituents of botulinum toxin products
- Body dysmorphic disorder 2
Potential Complications
- Minor bruising (common)
- Temporary blepharoptosis and eyebrow ptosis (rare, technique-dependent)
- Incidence of complications decreases as injector skill improves 2
Research shows that dynamic wrinkles (seen during muscle contraction) yield more dramatic results than static wrinkles (visible at rest), which should be considered when setting patient expectations 2.