What are the recommended injection sites for Dysport (botulinum toxin)?

Recommended Injection Sites for Dysport (Botulinum Toxin)

The recommended injection sites for Dysport (botulinum toxin) depend on the specific condition being treated, with the most common sites being the glabella, forehead, lateral canthal lines, cervical muscles for spasmodic dysphonia, and limb muscles for spasticity.

Facial Aesthetic Applications

Glabellar Lines

• Primary injection sites: 5-point pattern targeting:
  • 1 point in the procerus muscle
  • 2 points in the corrugator muscles (one on each side)
  • 2 points approximately 1 cm above the corrugator sites 1

Forehead Lines

• Recommended sites: 4 points in the hair-bearing scalp at the frontalis origin 2
• Total dose: 40 units divided across these points
• Additional 50 units may be used in the forehead region itself 2

Crow's Feet (Lateral Canthal Lines)

• Injection sites: 3 points on each side targeting the orbicularis oculi muscle
• Doses typically range from 10-20 units per injection site, varying according to:
  • Severity of wrinkles
  • Intensity of muscle contraction
  • Mass of the muscle 3

Medical Applications

Spasmodic Dysphonia

• Injection site: Intralaryngeal muscles
  • For adductor spasmodic dysphonia: thyroarytenoid muscles
  • For abductor spasmodic dysphonia: posterior cricoarytenoid muscles 4
• Botulinum toxin is considered the first-line treatment for laryngeal dystonia 4

Limb Spasticity

• Upper limb: Targeted injections into specific muscles based on functional impairment
  • Common sites include biceps, flexor digitorum, flexor carpi radialis/ulnaris
• Lower limb: Targeted injections into muscles that interfere with gait function
  • Common sites include gastrocnemius, soleus, tibialis posterior 4

Administration Technique

Injection Depth and Angle

• Injections should be made into healthy subcutaneous tissue
• Use a 90-degree angle for optimal placement
• Avoid intradermal or intramuscular injections in unintended locations 4

Site Rotation

• For patients requiring repeated treatments:
  • Rotate injection sites regularly
  • Keep at least 1 cm distance between previous injection sites
  • Avoid areas with lipodystrophy 4, 5

Important Considerations

Contraindications

• Avoid injections in:
  • Areas with active skin infections
  • Patients with known hypersensitivity to botulinum toxin
  • Patients with neuromuscular junction disorders (e.g., myasthenia gravis)

Dosing Factors

• Dosing should be adjusted based on:
  • Muscle mass and bulk
  • Intensity of muscle contraction
  • Severity of the condition being treated 3, 6
• More bulky muscles or greater intensity of muscle contraction requires higher doses

Duration of Effect

• Clinical effects typically last 3-5 months
• Patient satisfaction may extend to 6 months 6
• Duration is affected by dose, individual patient variation, and precise injection technique

Pitfalls to Avoid

1. Injecting too superficially (intradermal) or too deeply (intramuscular) when targeting subcutaneous tissue
2. Using the same injection sites repeatedly without proper rotation
3. Injecting into areas with lipodystrophy, which can lead to unpredictable absorption
4. Failure to adjust dosing based on individual muscle mass and contraction intensity

By following these specific injection site recommendations and techniques, clinicians can optimize the efficacy and safety of Dysport treatments while minimizing potential complications.