What are the recommended injection points and dosages for botulinum toxin (Dysport) in the lower face?

Recommended Injection Points for Botulinum Toxin (Dysport) in the Lower Face

For lower face rejuvenation with botulinum toxin (Dysport), injections should target the mentalis, platysma, and depressor anguli oris muscles using precise anatomical landmarks with appropriate dosing to achieve optimal aesthetic outcomes while minimizing complications.

Key Anatomical Injection Points

1. Mentalis Muscle

• Location: 5-10 mm lateral to the midsagittal line and 20-30 mm below a horizontal line connecting the mouth corners 1
• Depth: 6.7-10.7 mm below the skin surface 1
• Dosage: 10-20 units of Dysport per injection point 2
• Technique: Use small gauge needles (30G) for intradermal injection 3

2. Platysma Bands

• Location: Along visible vertical bands in the neck, with injections placed at standardized points based on mandibular anatomical landmarks 4
• Dosage: 15-30 units of Dysport per band, with multiple injection points along each band 5
• Purpose: Treats platysmal bands and provides jawline lifting

3. Depressor Anguli Oris (DAO)

• Location: 1 cm lateral and 1 cm inferior to the oral commissure
• Dosage: 10-15 units of Dysport per side 5
• Purpose: Creates lift at the corners of the mouth

Injection Technique Guidelines

1. Patient Positioning: Seated upright with head in neutral position
2. Preparation: Cleanse area with alcohol or antiseptic
3. Needle Selection: Use 30G needles for precision and minimal discomfort 3
4. Injection Method:
   • Point-by-point intradermal injections
   • Perpendicular needle insertion
   • Slow, steady injection with even pressure 3
   • Wait 10 seconds before removing needle to prevent leakage 3

Dosage Considerations

• Total Dosage Range: 60-90 units of Dysport for the lower face 2
• Dose Adjustment Factors:
  • Muscle bulk (larger muscles require higher doses)
  • Severity of wrinkles
  • Intensity of muscle contraction
  • Previous treatment response

Safety Considerations and Contraindications

• Avoid injecting:

  • Too close to the oral commissure (risk of oral incompetence)
  • Too lateral in the mentalis (risk of lip depression)
  • Too deep in the platysma (risk of dysphagia or dysphonia)

• Common Side Effects:

  • Bruising at injection sites
  • Temporary asymmetry
  • Difficulty with certain facial expressions

Expected Outcomes

• Onset of Action: 3-7 days
• Peak Effect: 2-3 weeks
• Duration: 3-4 months 2
• Results: Improved jawline contour, reduced mentalis dimpling, smoother neck appearance, and overall lifting effect in the lower face 5

Follow-up Recommendations

• Evaluate results at 2 weeks post-injection
• Consider touch-up injections if asymmetry is present
• Recommend maintenance treatments every 3-4 months

Remember that lower face injections require greater precision than upper face treatments due to the risk of affecting oral function. Starting with conservative doses and increasing gradually with subsequent treatments is recommended for practitioners new to treating this area.