Botox Injection Sites on Face: Treatment Areas for Best Outcomes
Authors: David Li, MD, MBA, FAAD & Brian Hibler, MD, FAAD
David Li is a general and procedural dermatologist in private practice in downtown Boston and the Founder of BDA. Previously he was a resident at the Harvard Medical School Combined Dermatology Program.
Brian Hibler is a general and procedural dermatologist in private practice in New York City and a guest contributor at BDA. Previously he was a resident at New York-Presbyterian/Weill Cornell and a Laser and Cosmetic Fellow at the Harvard Medical School Combined Dermatology Program.
Botox injections are one of the most popular cosmetic treatments for reducing the appearance of dynamic wrinkles (caused by movement) and fine lines on the face. But which specific areas are the best targets to help you achieve your desired aesthetic results? This guide covers the most common and effective Botox injection sites to treat different signs of aging and facial concerns.
Disclaimer: If you are currently pregnant or will be in the near future, the data for Botox and pregnancy is still evolving, so it may be better to rely on pregnancy-safe skincare products for the time being. See our ultimate guide on pregnancy skincare 101 here.
How Does Botox Work?
Before exploring the prime injection sites, it helps to understand how Botox works. Botox contains botulinum toxin, which blocks nerve signals to the muscles where it is injected. This results in localized muscle relaxation that smooths overlying skin.
Botox takes effect in 3-10 days and results last 3-4 months. It can temporarily minimize facial lines caused by repetitive muscle movements like frowning, squinting, or smiling. The ideal Botox recipients have moderate dynamic wrinkles. Botox is less effective for lines which are already etched in; however, there may still be a role (see below).
Now let’s examine some of the most popular injection sites to help you revitalize different areas of your face.
Image by kjpargeter on Freepik, with adaptation by David Li, MD, MBA
Botox for Forehead Lines
Horizontal lines across the forehead are often the first signs of aging people want to smooth away. Botox can effectively reduce these wrinkles caused by raising the eyebrows, rendering this a very common Botox injection site. Horizontal forehead lines are caused by the frontalis muscle which raises the eyebrows. Botox areas will depend on the patient's forehead muscle pattern and strength.
The main injection sites for forehead lines can include:
· Centrally above the brows
· In the lower part of the forehead
· Along the hairline
Forehead Botox targets the frontalis muscles that elevate the brows. It relaxes the muscle activity to smooth forehead creases. The number of units depends on wrinkle severity, muscle strength, and desired cosmetic appearance.
Results include a refreshed, line-free forehead devoid of wrinkles when looking surprised or raised. Brow mobility is still preserved allowing natural facial expressions. This is generally a safe site to inject, but for many patients who depend on their frontalis to keep their eyes open, relaxation of the frontalis may cause a feeling of brow heaviness which can be unpleasant. Injections too low to the brow can also affect the brow shape, flattening the brow which can be an undesirable outcome.
Frown Lines Between the Eyebrows
Vertical glabellar frown lines between the brows are another prime Botox target. These etched “elevens” make you appear stressed, angry, or tired. Vertical frown lines form from the corrugator and procerus muscles that draw the brows down and together.
Botox is injected into 3 points along the glabellar complex, which are the paired corrugator and procerus muscles:
· At the inner part of each brow
· Between the brows above the nose
Relaxing these muscles softens the inner and middle frown lines. The number of units depends on wrinkle severity and muscle strength.
You should retain the ability to have natural expressions (furrow your brows), but the lines will be less noticeable. Overall, it creates a more pleasant, well-rested appearance.
Avoiding the danger zone: One adverse effect that may rarely occur is the paralysis of the levator palpebrae superioris leading to brow ptosis, or lid drop.
Crow’s Feet Around the Eyes
The outer eye area or “crow’s feet” is an area of the face amenable to cosmetic Botox. These fine radial lines are caused by the orbicularis oculi muscles that squeeze the eyes during smiling and squinting. With an appropriate amount of Botox, the outer eyes can appear more refreshed and youthful.
To smooth crow’s feet, Botox is typically injected into 3 points around the lateral orbital rim:
· A central lower point
· Upper point toward the temple
· Lower point toward the cheek
Relaxing the orbicularis oculi muscles here softens these fine creases, with typical dosing of 5-15 units per side. However, every patient should be examined individually, and the number of units depends entirely on wrinkle severity and the pattern of dynamic lines.
Bunny Lines Along the Nose
Subtle wrinkles called “bunny lines” can develop along the sides of your nose from frequent scrunching and nostril movement, due to the nasalis and the levator labii superioris alaeque nasi. Though fine, they can age the midface and is another common target for treatment with Botox.
Botox can be used in this area by placing 1-2 injections along the lateral aspects of the nasal bridge at the nasalis muscle, which can be accentuated by asking the patient to scrunch their face to expose. Extra care needs to be taken to avoid the levator labii muscles which can drop the smile or lead to asymmetry.
Neck Bands & Horizontal Neck Lines
While this is technically not the face, it is still a common treatment area for cosmetic Botox. The neck commonly betrays age even before the face. Horizontal neck lines or “necklace” wrinkles form from repetitive motions and loss of elasticity. Vertical platysmal bands on the neck are the target for smoothing vertical neck wrinkles.
Strategic Botox injections along the platysmal bands in the neck help relax the muscle activity creating these lines.
Neck Botox smooths bands but combines well with fillers or ultrasound/radiofrequency tissue tightening devices for best neck rejuvenation to reduce laxity and appearance of wrinkles. For severe laxity, intervention with plastic surgery may be most beneficial.
Jaw Slimming & Reduction of A Square Jaw (and for TMJ - temporomandibular joint disorder)
Botox can also be used to slim and contour the lower face by relaxing the masseter muscles along the jawline. This reduces a square, wide jawline. This is also used in patients with TMJ disorder or bruxism, leading to teeth grinding or excessive jaw pain. Botox can relax the masseters and reduce the amount of grinding, and over time reduce inflammation of the TMJ joint.
Masseter Botox uses a wide range of units divided into ~3 points into the belly of the masseter muscle. The amount depends on the individual and the strength of the muscles. Results last about 4-6 months before repeating treatment.
Landmarks to locate the masseter: Place fingers along the jawline with mouth open to feel the masseter bulge. The landmark we use is the area where the masseter overlaps with the area encompassed by the lines from the mental crease to the angle of the mandible, and then from the lower aspect of the earlobe to the oral commissure (corner of mouth).
However, there are important danger zones to avoid:
· Risorius muscle: The risorius runs along the side of the face in front of the masseter. Injecting too anteriorly risks paralyzing this muscle which could distort smiling. The smile could look forced as the corners of the mouth are not able to be elevated.
· Avoid the parotid gland: The parotid salivary gland overlies the posterior end of the masseter near the ear. Injecting too far back risks hitting this gland, reducing secretions.
· Avoid the lower third of muscle: Stay central within the bulky portion of the masseter, above the mandible and avoiding the lower third by the angle of the jaw.
· Risk of Facial Nerve Palsy: Inadvertent spread or inappropriate placement may cause facial nerve paralysis.
Botox to reduce bruxism and the appearance of a square jaw is a complex and detailed topic, and we will be writing separately and more extensively on this topic soon. Please subscribe to be alerted.
Landmarks for Botox used in TMJ (Not medical advice and not meant to be used as an injection guide).
Other Off-Label Botox Injection Sites
While Botox is FDA-approved for facial lines only, experienced injectors may use it “off-label” for:
· Upper lip wrinkles - this is generally a safe area to inject in most patients. Some patients may have difficulty pursing their lips (using a straw, playing a wind instrument, etc). Ablative CO2 lasers may be more effective in reducing deeply etched lines in this area than Botox.
· Lower corners of the mouth - injecting at the depressor anguli oris (DAO) may help to give a lifting effect to the corners of the mouth, but care needs to be taken to avoid the depressor labii inferioris (DLI). If the DLI is accidentally targeted instead of the DAO, there may be asymmetry with movement of the lower lip and affect certain facial expressions.
· Excessive exposure of gums when smiling - aka 'Gummy smile' - some patients have excessive gum exposure when smiling due to the strong action of the levator labii superioris alaeque nasi. Strategic placement here can weaken the action of this muscle to help expose less of the gums when smiling. This is in contrast to bunny lines, where you generally want to avoid the levator labii.
· Under eye wrinkles - some patients have a crepe-like appearance of the under-eye wrinkles, which can be treated with a very small amount of Botox placed superficially over the lower aspect of the orbicularis oculi.
· Lifting brows - the lateral aspect of the eyebrows can be injected to partially reduce the depressing action of the orbicularis oculi, but care needs to be taken to avoid the midpapillary brow in case of lid ptosis.
· Underarm and palmar sweating – We will be writing separately and more extensively on this topic soon. Please subscribe to be alerted.
We need to keep in mind that off-label botulinum toxin injection may carry greater risks of uneven effects or mild side effects like drooping. Ensure your provider has expertise before undergoing off-label treatment.
What to Expect During the Botox Procedure
The Botox injection process is relatively quick and comfortable in experienced hands:
· The provider marks planned injection sites with a pen.
· The skin is cleansed and a topical numbing cream may be applied briefly.
· Using a very fine needle, Botox is injected into the predetermined sites.
· Discomfort is minimal - a slight pinching sensation at most.
· Icing the area afterwards helps reduce swelling and tenderness.
· Results become noticeable in 3-10 days as the muscles gradually relax.
· Some common temporary side effects can include mild pain, swelling, bruising, headache, and asymmetry.
With an expert injector, Botox injections are a quick, well-tolerated procedure that can subtly enhance your appearance.
How to Choose the Right Botox Injector
An injector’s experience and aesthetic eye are crucial for achieving natural-looking Botox results tailored to your facial anatomy and goals:
✔Seek a board-certified plastic surgeon or dermatologist with specialized training in cosmetic procedures. They have the best anatomical knowledge and technical skill and will tailor your treatment with an individualized approach while avoiding danger zones.
✔Select a provider who primarily focuses on facial aesthetics in practice. Their artistic eye leads to more cosmetically pleasing outcomes.
✔View before-and-after photos to evaluate their work and aesthetic sensibility. Ensure results appear natural.
✔Choose an experienced injector who has performed hundreds to thousands of Botox treatments. Their experience leads to expert injection placement and dosing.
Planning Your Custom Botox Treatment Plan
The best aesthetic outcomes stem from careful treatment mapping during your consultation:
· Evaluation of your facial anatomy, muscle activity, and current degree of wrinkling
· Discussion of your specific aesthetic goals and most bothersome areas
· Review of areas of concern using a hand mirror to pinpoint desired injection points
· Mapping optimal injection sites and units needed for customized treatment
· Conservative dosing for first-timers to avoid overtreatment
· Combining synergistic treatments like fillers if indicated
With an individualized roadmap tailored to your particular needs, desired results become more achievable.
Maintaining Your Botox Results
A few useful tips will help you get the most from your Botox investment:
Stay consistent with repeat appointments every 3-4 months to prevent wrinkles from fully redeveloping.
Use proper skincare, hydration, and sun protection to extend results between sessions. You can find a minimalist skincare routine to follow in our previous article tips from board-certified dermatologists.
If you’re interested in a topical botox mimetic for maintenance, see our scientific exploration piece on argireline (aka misnomer as botox in a bottle)
Note when you start seeing some wearing off and schedule accordingly.
Adjust dosing and injection sites over time based on your evolving needs if required.
Be patient through the first 1-2 sessions as it takes time to optimize placement and dosage.
Consistency is vital to smoothing and preventing dynamic wrinkles long-term with Botox treatments started earlier in the aging process.
Takeaways: Prime Injection Sites for Optimal Botox Results
· The forehead, glabellar frown lines, crow’s feet, and neck are common Botox treatment sites for smoothing wrinkles.
· Less conventional areas like the nose, lower face, and neck may also benefit from properly administered Botox.
· Experienced injectors will customize your injections sites and dosing to match your unique facial anatomy and aesthetic goals.
· Careful injection placement and technique are vital to achieving natural-looking outcomes from Botox treatment.
· Consistent maintenance appointments every 3-4 months will help sustain your desired improvements long-term.
If you are considering Botox, consult with a qualified, aesthetically-focused provider to map out an optimal treatment plan tailored specifically to your needs.
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What are the most common areas that can be treated with Botox injections?
The forehead, glabella frown lines between the brows, and lateral crow's feet around the eyes are the most popular and effective areas for Botox injections. The neck bands, jawline, and nose/lip wrinkles are also frequently treated.
How many Botox units are needed in each area?
While there are unit recommendations based on FDA approval, the number of units depends entirely on the patient's degree of muscle movement and dynamic wrinkles. We recommend patients to be evaluated by a board-certified dermatologist for a customized and individualized treatment plan, and not a cookie-cutter approach.
How long does it take to inject all the treatment areas?
Most full-face Botox treatment sessions take 15-30 minutes from cleansing to completion. The actual injections only take a few minutes total. Larger treatment areas like the neck may prolong the visit.
How frequently do you need Botox touch-ups?
Consistency is key for the best results. Most patients need follow-up appointments every 3-4 months to refresh the muscle relaxation effects before they fully wear off.
Does Botox hurt during the injections?
Most patients report Botox injections feel like a quick pinching sensation at each site. Topical numbing creams can further minimize any discomfort. The small needles and precise injection technique limit pain. Using bacteriostatic saline can also help to reduce the pain due to the presence of benzyl alcohol in the preservative used in bacteriostatic saline.
What side effects can potentially occur?
Temporary side effects may include swelling, bruising, headache, muscle weakness, tenderness, and asymmetry. These usually resolve within a week or two. Significant side effects are rare when Botox is administered properly.
How soon can you see Botox results?
It takes 3-10 days to start seeing Botox taking effect as the muscles gradually relax and lines soften. Results peak in about 2 weeks. Some lingering swelling can obscure results for the first few days.
Is there anyone who should not have Botox injections?
Botox is contraindicated in those with a neuromuscular disease, myasthenia gravis, Eaton-Lambert syndrome, botulism, or hypersensitivity to the ingredients. It should also be avoided in pregnant and breastfeeding women.
Can Botox be used to treat other areas like the underarms or hands?
While FDA approved for facial wrinkles, Botox can be used "off-label" to treat excessive underarm sweating or excessive palmar sweating, known as hyperhidrosis.
What does the Botox procedure involve?
The process involves cleansing the skin, marking injection sites, administering Botox via very fine needles into the planned locations, icing if needed, and a short recovery. Most sessions take only around 15-30 minutes from start to finish.
How much Botox is needed for preventative use?
Younger patients in their 20s-30s starting Botox preventatively typically need lower doses. However, the number of units depends entirely on the patient's degree of muscle movement and dynamic wrinkles. This provides subtle improvements without appearing overly frozen or treated and can delay the formation of lines at rest.
Can I receive Botox treatments if I am pregnant or nursing?
No, Botox should be avoided if you are pregnant, trying to get pregnant, or breastfeeding. There is insufficient safety data for pregnant and nursing women. Make sure your provider knows your situation and see our ultimate guide on pregnancy-safe skincare products.
How does Botox relax wrinkles and facial lines?
Botox blocks nerve signals, preventing the muscles underneath wrinkles from contracting. This allows the overlying skin to smooth out. Results are visible in 3-10 days and peak around 2 weeks as the muscles relax.
Are there options besides Botox for wrinkle reduction?
Alternatives like Dysport, Jeuveau, and Xeomin are similar purified botulinum toxin options and great treatment options for dynamic wrinkles. Other wrinkle treatments like dermal fillers, chemical peels, laser skin resurfacing are also available. Discuss all options with your provider.
How long do the smoothing effects of Botox last?
Most patients can expect Botox results to last 3-4 months on average. Staying consistent with maintenance appointments every 3-6 months will help sustain the muscle relaxation effects before facial wrinkles fully return.
What results can be expected from Botox lip injection?
When properly injected, Botox can help minimize vertical lip lines around the mouth and mildly relax the upper lip muscles to subtly soften a gummy smile. Dramatic changes or lip fillers may be better options for major enhancement.
How do I maintain the benefits of Botox long-term?
Consistency with regular maintenance appointments every 3-4 months before the effects fully fade will promote the longest lasting improvements. Proper skincare, sun protection, hydration, and avoiding smoking also help extend results between sessions.
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We are a group of dermatology residents and attending physicians based in Boston, MA. Our team of Ivy League-trained dermatologists is demystifying the cosmeceutical industry by offering unbiased, scientifically supported reviews of skincare products. We are extremely passionate about skincare and making it accessible to all through education. We value integrity, practicality, and inclusivity. No sponsorships were received for the products prior to testing; we feel strongly about providing un-biased reviews. After blogs are published, following the links in this blog post may result in commission.
Dr. David Li is a recent graduate from the Harvard Combined Dermatology Residency Program. He is now in private practice as a procedural dermatologist in Downtown Boston where he offers skin cancer screenings, skin cancer surgeries, and laser and cosmetic rejuvenation. He has published more than 25 peer-reviewed research articles, is active as an advisor for multiple early-stage companies, and is an angel investor in the healthcare technology space. In his free time, he enjoys running to stay fit, cooking, and playing with his Australian shepherd, Laika.
Dr. Jacqueline Stevens is currently a resident in the Harvard Combined Dermatology Program. She completed her undergraduate studies and MD-PhD at the University of Virginia with a PhD in microbiology, immunology, and infectious disease. Jacqueline has interest in cutaneous oncology, melanoma, and dermatologic surgery. She has published work on the basic science of inflammation at skin barriers, dermatologic diseases, and systems used to classify squamous cell skin cancer. In her free time, she enjoys skiing, hanging with her rescue pup, and the outdoors.
Dr. Olivia Davies is a dermatology resident at the Harvard Combined Dermatology Residency Program. Her dermatology interests include inpatient dermatology, complex-medical dermatology and medical education. She enjoys exploring the intersection between medicine and media — with past experiences that include rotating through the ABC News Medical Unit, publishing a graphic perspective in the New England Journal, and serving as a poetry editor for Intima: A Journal of Narrative Medicine. When she’s not learning or working, she can be found making cheese plates for friends, sipping a warm cup of coffee, or solving the newest NYT crossword puzzle.
Dr. Nelson Ugwu is a dermatology resident at the Harvard Combined Dermatology Residency Program. His clinical interests include general dermatology, skin of color and skin cancer prevention. Nelson has discovered mutations that cause skin diseases, as well as new treatments for skin conditions. In his free time, Nelson enjoys weightlifting, playing soccer and trying new recipes.
Dr. Arash Mostaghimi is an associate professor of dermatology at Harvard Medical School, the director of the inpatient dermatology consult service, and co-director of the Complex Medical Dermatology Fellowship at Brigham & Women’s Hospital. He is also the principal investigator of the Mostaghimi Lab, where he leads a diverse group of physicians and researchers to study alopecia areata, an autoimmune hair loss condition which afflicts his daughter. In addition to his research, he is an advisor to multiple companies and is an associate editor of JAMA Dermatology.
