We are truly in an “era of injectables,” with access to a varied armamentarium of products that yield dramatic aesthetic results with minimal recovery downtime. From its first published mention as an aesthetic treatment for glabellar lines in 1992, the use of commercially available BoNT type A (BoNTA) has captivated healthcare professionals and lay people alike. The availability of newer BoNTA formulations, with more expected in the near future, poses an exciting opportunity for aesthetic practitioners to reach an ever expanding potential patient base and provide increasingly refined treatment

1. 2.Botox
BY
PROFESSOR OSAMA B MOAWAD
The Art of Liquid Face Lift

3.  BoNTA-ONA; Botox, Botox Cosmetic,
Allergan, Vistabel, Vistabex
What to Inject?

4. ABO-Botulinum-Toxin –
Dysport/Azzalure/Reloxin
What to Inject?

5. Inco-Botulinum-toxin-A
Xeomin/Xeomeen/Bocouture
What to Inject?

6. Where to inject? Glabella (frown
Lines )
Supraciliary wrinkles
Crow’s feet
Bunny Lines
Lip and Perioral
Nasolabial fold
Dimpled chin
Forehead
Nefertiti
Neck (platysmal band)

7. • Myasthenia Gravis, Eaton-Lamber
sydrome
• Myopathies
• Amyoitrophic lateral sclerosis
• Skin infection and inflammation
• Market facial asymmetry, ptosis,
dermatochalasis
• Deep dermal scarring
• Simultaneous aminoglycosides
Is Botox Good For Me?

9. Photography is a Must!!!!
At Rest

10. Making Funny Faces
Photography is a Must!!!!

11. Couch with adjustable head
Hand mirror
Makeup removal
Alcohol-free disinfectant
Marker Pen
1 mL insulin syringe with 0.1
mL graduations
How to Inject?

12. How to Inject?

13. How Much to Inject?

14. How Much to Inject?
Treatment Response is
Dose related with
regard to efficacy of
treatment and duration
of effect

15. Forehead-Glabella-Crow’s feet
Where to Inject?

16. Forehead Lines
(Thinker’s Lines)

17. Forehead Lines Injection Sites
4-8 injection sites, women 6-15U, Men
more than 15U

18. Forehead Lines Injection
The frontal region should
always be treated in
association with the
glabellar area for more
satisfactory results
Patients with narrow eye
brow should receive fewer
injections and lower doses

19. B

20. A

21. B

22. A

23. B

24. A

25. B

26. A

27. Glabella-Vertical Lines
Contractions of the Corrugators and to a Lesser
Degree the Medial Orbicularis Oculi and the Depressor
Supercilii Produce Vertical Lines Between the Eyebrow

28. Glabella-Horizontal Lines
Contraction of the procerus produces horizontal lines
over the bridge of the nose

29. Always above the supraorbital ridge regardless of
Eyebrow Position
GLABELLA INJECTION SITES

30. Glabella Injection Sites
5-7 injection sites, more in men.
Women -10U-30U, men 20U-40U

31. B

32. A

33. B

34. A

35. B

36. A

37. B

38. A

40. A

41. B

42. A

43. B

44. A

45. B

46. A

47. B

48. A

49. B

50. A

51. B

52. A

53. B

54. A

55. AB

56. AB

59. Orbicularis fibers
Zygomaticus fibers
• Snap Test is done first
• Determine the Source of wrinkles
• Assess while Patient Animate and at Rest

60. Crow’s Feet Injection Sites
• 2-5 Sites. Women 1oU-
30U ,Men 20U-40U
• The First Injection is in
the Center of Area of
Maximum Wrinkles 1cm
Lateral to Lateral
Orbital Rim
• The Second and Third
are 1-1.5cm above and
below

61. Wrinkles Primarily Below
the Lateral Canthus
should be injected in a
Line that Angles from
Antero-inferior to
Supero-posterior
Ant Injection Should be
lateral to a Lateral to a
line drawn vertically
from the Inner Canthus

62. AB

63. AB

64. AB

65. B

66. A

67. Eye Brow Contour Gender
Differences
whereas women require an arched eyebrow, men prefer a
lower, horizontal brow. We inject an additional 4 to 5U
into a point 1 cm above the supraorbital rim in the mid-
pupillary line in men.
Low horizontal
High arched

68. Chemical Eyebrow Lift
Medial Eyebrow Elevation
Botox injection is the same as for frown lines

69. Lateral Eye Brow Elevation
Chemical Brow Lift
Half Dose of Medial ye Brow Lift

70. B

71. A

73. A B

74. AB

75. AB

76. AB

77. A Snap Test is Done First
One injection Point in the Mid-pupillary Line on the
Margin of the Lower Eye Lid and Second 1cm Laterally

78. Lower Eyelids Wrinkles and
Widening Eye Aperture
1-BTX Smoothens Inferior Wrinkles
2-Widens Eye Aperture
3-Treat Dennie Morgan Folds

80. Widening Eye Aperture
A

81. B

82. Widening Eye Aperture
A

83. One Injection Point in the Mid-pupillary Line on the
Margin of the Lower Eye Lid

84. Botox & Middle Face

85. Bunny Lines or Nasal Wrinkles
Ask to Laugh, Sniff and to Squint Intensely

86. Facial muscles
work in
combination to
occasionally
produce, in some
patients, extreme
nasal wrinkling.
Nasalis,
nasoorbicular,
nasociliary, and
nasoalar wrinkles
are shown with
forced expression.
Bunny Lines or Nasal Wrinkles

87. BUNNY LINES OR NASAL WRINKLES

88. B

89. A

90. B

91. A

92. B

93. A

94. A

95. Nasal Flare: Injection Sites
2.BTX injections for bunny lines may help

96. Medical Rhinoplasty
2U-4U on the nasal spine deep injection
often with fillers at nasolabial fold

97. Gummy Simile
1 cm above the insertion of nostril. 1-2 U/Side
Deep injection- orthodontic treatment

98. LLSAN
Better in Young Patients in Combination with Fillers

99. Zm,Zmi
Better in Young Patients in Combination with Fillers

100. LLSAN,Zm,Zm
Better in Young Patients in
Combination with Fillers

101. Better in young patients in
combination with fillers

102. Botox & Lower Face

103. Upper Lip Wrinkles Or Smokers Lines
Rosebud Mouth
1-U at Four Points 1.5cm Away from the Corner of the
Mouth Superficial at the vermillion. Treat the lower lip
on the same session. Better in Combination with Filler
and Resurfacing

104. Treatment of Labial paracommissural wrinkles
2U/side injected 2cm on a horizontal line
passing through the mouth corner (risorius M)
SC.Better combine with fillers
B

105. A
Treatment of Labial paracommissural wrinkles

106. Treatment of Labial paracommissural wrinkles
B

107. ATreatment of Labial Paracommissural wrinkles
A

108. Nasolabial
Marionette line
Treatment of Marionette lines
1-2U Botox in each DAO superficially
better with Dermal Fillers
B

109. Treatment of Marionette lines
A

110. 2U Botox is injected in the depressor
anguli oris (DAO) muscles in combination
with dermal fillers

111. Peau D’orange Chin
2 sites on each side at 5 mm of the medial line on
the chin protuberance perpendicular deep injection with
filler at mental crease

112. 1-Hyper trophy of Masseter Muscle

113. BTX injection into
Three Different Points
that are 1.5cm Away
from the Border of
Mandibular angle
One Point in the
Thickest area and
Two other Points that
are Located ant and
post at the lower half
of the masseter

114. 1-5 sites total 18U-30U IM with 30 gauge needle
With volumizing filler at mid face
1-Hyper trophy of Masseter Muscle
Not an MSI patient

115. 2U deep intramuscular in 2-4 sites per
chord 2cm apart. No more than
50U/session
Platysmal Bands Injection Sites

117. Nefertiti Face Lift
2-3 BTX along and under each mandible and to Upper part of
the post platysmal band for a totoal of 15-20 U each side

118. Platysmal Bands Injection Sites
B

119. A
Platysmal Bands Injection Sites

120. Platysmal Bands Injection Sites
B

121. A
Platysmal Bands Injection Sites

122. A
Platysmal Bands Injection Sites
B

123. Platysmal Bands Injection Sites
AB

124. MESOBOTOX/MESOLIFT

125. Eyebrow shape
Greater Muscle Mass
Larger Botox Doses
Half Botox Dilutions

126. Prevent aging
Resurfacing
Procedures
Volume Restoration

127. Botox in Resurfacing Procedures
Facial surgery
Laser
Light
Peels
Radiofrequency
BTX-A should be injected 3 weeks before surgery. In
addition, BTX-A injections may optimize and prolong the
effect of the surface procedures

128. Botox is injected 3 weeks before
Blepharoplasty
Botox in Resurfacing Procedures
AB

129. Botox injection before dermal filler will improve the
results of both and keep it longer
Botox in Volume restoration
AB

130. Botox injection before dermal filler will
improve the results of both and keep it
longer
Botox in Volume restoration
AB

131. Botox in Volume restoration
Botox injection before dermal filler will improve the
results of both and keep it longer
AB

132. B

133. The combination of botulinum toxin type A
and hyaluronic acid filler can be used to
achieve a lateral brow-lift.
A

134. What Do I
Expect
Immediately
after
Injections?
Redness
BruisingEarly and expected
side effects include
swelling, bruising,
and redness at the
injection

135. Ice will lessen Bruises and Swelling

136. 1.Patients must remain in the
vertical position,
2.Patient must avoid intense
physical exercise
3.Patient must avoid
manipulating the injected area
4.Patient must use the injected
muscle for at least 4 hours after
injections.

137. 1.The first clinical effect
appear after 24h-72hrs
2.The effect generally last
for 3-6months
3.Repeated injection
may prolong the effect
up to 7-9months

138. • Avoid Injections Outside the Lateral Limbus of the Iiris
Particularly the Lower Portion or Danger Zone
• BTX is Injected Medial to the Temporal Fusion
Line at the Temporal Hair Line
AB

139. Pitfalls of Botox
Discomfort, Swelling
Rednes, Bruising
Eyebrow and lid ptosis
Supracillary wrinkles
‘‘Mr. Spock’’
Allergic reactions

140. Avoiding Injection in the Lateral Eyebrow and
Lateral Forehead
Lead to Raising the Lateral Eyebrows

141. Proper Selection
Higher
concentration
Glaberlla first
Follow Instruction
Avoid
dangerous zone
Apraclonidine

142. Eyelid Ptosis
• injection in the
Middle of
Glabella
Away from the
pupil line
Treatment with
0.5% Iopdine or
2.5%
Neosynephrine

143. Perioral Complications
Small doses
Superficial
Symmetrical
Proper selection
Follow instructions

144. Peri-orbital Complications
• Bruises
• Diplopia
• Ectropion
• Drooping
Lower
eyelid
• Proper
Selection
• Follow
instructions
• Injections
1.5cm
lateral to
lateral
canthus
• Snap Test

145. The use of injectable products for cosmetic enhancement is increasing
rapidly. This is due to the wide range of effective options, decrease in
social stigma, and the excellent safety profile.
AB

146. e use of injectable products for cosmetic enhancement is increasing
idly. This is due in large part to the wide range of effective options,
decrease in social stigma, and the excellent safety profile.
AB

147. The use of injectable products for cosmetic enhancement is increasing
rapidly. This is due in large part to the wide range of effective options
decrease in social stigma, and the excellent safety profile.
A