Lower Face Botox Dosing Recommendations
For optimal aesthetic outcomes in the lower face, Botox (onabotulinumtoxinA) should be administered using the microbotox technique with 20-28 units per side, delivered via multiple microdroplets into the dermis or immediate subdermal plane.
Anatomical Considerations
The lower face presents unique challenges for Botox administration due to:
- Complex muscular anatomy with closely positioned muscles that interface at different levels and depths
- Multiple functional requirements (talking, eating, drinking, facial expressions)
- Higher risk of adverse events compared to upper face treatments
- Greater potential for asymmetry and functional complications
Recommended Dosing Protocol
Microbotox Technique
- Total dose per side: 20-28 units of onabotulinumtoxinA 1
- Dilution: Mix calculated dose with small volume of lidocaine in 2.5 mL saline
- Delivery method: 100-120 microinjections per side
- Needle size: 30- or 32-gauge
- Injection depth: Intradermal or immediate subdermal plane
Target Areas and Effects
- Improves skin texture and appearance
- Smoothens horizontal creases
- Decreases vertical banding of the neck
- Improves contour of the cervicomental angle
- Achieves better apposition of the platysma to the jawline
Precautions and Risk Mitigation
Pre-Treatment Considerations
- Discuss specific risks of functional impairment with patients 2
- Evaluate facial symmetry at rest and during animation
- Assess for pre-existing asymmetry that may be accentuated by treatment
Post-Treatment Instructions
- Remain upright for 3-4 hours after treatment 3
- Avoid touching, rubbing, or massaging treated areas
- Refrain from strenuous exercise for 24 hours
- Avoid alcohol consumption for 24 hours
- Maintain normal facial expressions but avoid excessive facial movements
- Avoid drinking through straws for 24-48 hours to prevent toxin spread 3
Potential Complications
Common Adverse Events
- Smile asymmetry
- Excessive or unconscious lowering of the lower lip
- Difficulty with certain oral functions
Management of Complications
- For asymmetry: Consider additional targeted injections (3 units) to the hyperactive side 4
- For excessive effect: Allow time for resolution (effects typically last 3-6 months) 5
- For insufficient effect: Additional treatment may be considered after 2 weeks
Efficacy and Duration
- Onset of action: 24 hours to 2 weeks following injection 5
- Duration of effect: 3-6 months
- Effects gradually resolve over time
Key Points for Practitioners
- Lower face Botox administration requires precise technique and thorough understanding of facial anatomy
- The microbotox approach with multiple small-dose injections provides more natural results with fewer complications
- Patient counseling about realistic expectations and potential adverse effects is essential
- Documentation of pre-treatment facial appearance is recommended for comparison
By following these specific dosing recommendations and technical considerations, practitioners can optimize outcomes while minimizing the risk of complications when administering Botox in the lower face.