Botox Training Houston, TX
06/01/2024

Additional dates available below

Event Organized by:
Empire Medical Training

 866-261-5164

Learn More about Empire Medical Training

Botox Training - Accredited CME Course

Botox injections remain the #1 requested non-invasive aesthetic service by patients. This 1-day intensive Botox course is a comprehensive course with hands-on training for attendees. Learn all the various Botox facial injections including specialty injections for the face in a safe and efficacious manner to improve the appearance of dynamic wrinkles and enhanced patient care.

The course is taught by Board Certified Physicians who not only enjoy teaching but perform these procedures within their own practice. Review facial anatomy, consultation considerations (patient presentations), protocols, and treatment pearls to perform these injections with the highest standard of care. Empire Medical Training is the #1 Private CME Accreditation Educational Institute for physicians, dentists, and nurses in the field of aesthetics, regenerative medicine, and interventional pain management training.

Empire Medical Training workshops are fully accredited for AMA PRA Category 1 CME™ and participants will receive their course certificate and certification upon completion of the course. For more information about this course or any of the 22 Aesthetics, Anti Aging and Regenerative Medicine, Medicine, Pain Management, Surgery, as well as medical/ Business courses, visit Empire Medical Training website.

Event Organized by:
Empire Medical Training

Date: Jun 01 2024 - 8:30am - 6:00pm

Venue: Hyatt Regency Houston Intercontinental

Address: 425 North Sam Houston Parkway East - Houston, TX 77060

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Additional Dates & Venues

DateCourse/Event - Venue - Date
1Oct 05 2024 - San Diego, CASan Diego, CA - Oct 05 2024 - Botox Training
2Oct 05 2024 - Boston, MABoston, MA - Oct 05 2024 - Botox Training
3Oct 12 2024 - New York, NYNew York, NY - Oct 12 2024 - Botox Training
4Oct 12 2024 - Washington, DCWashington, DC - Oct 12 2024 - Botox Training
5Oct 13 2024 - New York, NYNew York, NY - Oct 13 2024 - Botox Training
6Oct 19 2024 - Los Angeles, CALos Angeles, CA - Oct 19 2024 - Botox Training
7Oct 19 2024 - Nashville, TNNashville, TN - Oct 19 2024 - Botox Training
8Oct 26 2024 - Philadelphia, PAPhiladelphia, PA - Oct 26 2024 - Botox Training
9Oct 26 2024 - Phoenix, AZPhoenix, AZ - Oct 26 2024 - Botox Training
10Oct 26 2024 - Denver, CODenver, CO - Oct 26 2024 - Botox Training
11Nov 02 2024 - Fort Lauderdale, FLFort Lauderdale, FL - Nov 02 2024 - Botox Training
12Nov 02 2024 - Dallas, TXDallas, TX - Nov 02 2024 - Botox Training
13Nov 03 2024 - Chicago, ILChicago, IL - Nov 03 2024 - Botox Training
14Nov 09 2024 - Atlanta, GAAtlanta, GA - Nov 09 2024 - Botox Training
15Nov 09 2024 - Online Course, webOnline Course, web - Nov 09 2024 - Botox Training
16Nov 15 2024 - Los Angeles, CALos Angeles, CA - Nov 15 2024 - Botox Training
17Nov 16 2024 - Charleston, SCCharleston, SC - Nov 16 2024 - Botox Training
18Nov 30 2024 - New York, NYNew York, NY - Nov 30 2024 - Botox Training
19Nov 30 2024 - Online Course, webOnline Course, web - Nov 30 2024 - Botox Training
20Dec 07 2024 - Los Angeles, CALos Angeles, CA - Dec 07 2024 - Botox Training
21Dec 07 2024 - Miami Beach, FLMiami Beach, FL - Dec 07 2024 - Botox Training
22Dec 14 2024 - Detroit, MIDetroit, MI - Dec 14 2024 - Botox Training
23Dec 14 2024 - Cincinatti, OHCincinatti, OH - Dec 14 2024 - Botox Training
24Dec 14 2024 - , , - Dec 14 2024 - Botox Training
25Jan 04 2025 - Fort Lauderdale, FLFort Lauderdale, FL - Jan 04 2025 - Botox Training
26Jan 04 2025 - Oklahoma City, OKOklahoma City, OK - Jan 04 2025 - Botox Training
27Jan 11 2025 - Charlotte, NCCharlotte, NC - Jan 11 2025 - Botox Training
28Jan 11 2025 - Las Vegas, NVLas Vegas, NV - Jan 11 2025 - Botox Training
29Jan 11 2025 - Online Course, webOnline Course, web - Jan 11 2025 - Botox Training
30Jan 18 2025 - Orlando, FLOrlando, FL - Jan 18 2025 - Botox Training
31Jan 18 2025 - New Orleans, LANew Orleans, LA - Jan 18 2025 - Botox Training
32Jan 18 2025 - Boston, MABoston, MA - Jan 18 2025 - Botox Training
33Jan 18 2025 - Online Course, webOnline Course, web - Jan 18 2025 - Botox Training
34Jan 25 2025 - New York, NYNew York, NY - Jan 25 2025 - Botox Training
35Jan 25 2025 - San Francisco, CASan Francisco, CA - Jan 25 2025 - Botox Training
36Feb 01 2025 - Chicago, ILChicago, IL - Feb 01 2025 - Botox Training
37Feb 01 2025 - San Juan, PRSan Juan, PR - Feb 01 2025 - Botox Training
38Feb 08 2025 - Philadelphia, PAPhiladelphia, PA - Feb 08 2025 - Botox Training
39Feb 08 2025 - Dallas, TXDallas, TX - Feb 08 2025 - Botox Training
40Feb 08 2025 - Online Course, webOnline Course, web - Feb 08 2025 - Botox Training
41Feb 14 2025 - Fort Lauderdale, FLFort Lauderdale, FL - Feb 14 2025 - Botox Training
42Feb 15 2025 - Atlanta, GAAtlanta, GA - Feb 15 2025 - Botox Training
43Feb 15 2025 - Naples, FLNaples, FL - Feb 15 2025 - Botox Training
44Feb 22 2025 - Nashville, TNNashville, TN - Feb 22 2025 - Botox Training
45Feb 22 2025 - East Rutherford, NJEast Rutherford, NJ - Feb 22 2025 - Botox Training
46Mar 01 2025 - Las Vegas, NVLas Vegas, NV - Mar 01 2025 - Botox Training
47Mar 01 2025 - Online Course, webOnline Course, web - Mar 01 2025 - Botox Training
48Mar 01 2025 - Phoenix, AZPhoenix, AZ - Mar 01 2025 - Botox Training
49Mar 01 2025 - Miami Beach, FLMiami Beach, FL - Mar 01 2025 - Botox Training
50Mar 08 2025 - Detroit, MIDetroit, MI - Mar 08 2025 - Botox Training
51Mar 09 2025 - Queens, NYQueens, NY - Mar 09 2025 - Botox Training
52Mar 15 2025 - Anaheim, CAAnaheim, CA - Mar 15 2025 - Botox Training
53Mar 22 2025 - Orlando, FLOrlando, FL - Mar 22 2025 - Botox Training
54Mar 22 2025 - San Francisco, CASan Francisco, CA - Mar 22 2025 - Botox Training
55Mar 29 2025 - Denver, CODenver, CO - Mar 29 2025 - Botox Training
56Mar 29 2025 - Cincinatti, OHCincinatti, OH - Mar 29 2025 - Botox Training
57Apr 05 2025 - Las Vegas, NVLas Vegas, NV - Apr 05 2025 - Botox Training
58Apr 05 2025 - Charleston, SCCharleston, SC - Apr 05 2025 - Botox Training
59Apr 05 2025 - Alexandria, VAAlexandria, VA - Apr 05 2025 - Botox Training
60Apr 11 2025 - Online Course, webOnline Course, web - Apr 11 2025 - Botox Training
61Apr 12 2025 - Houston, TXHouston, TX - Apr 12 2025 - Botox Training
62Apr 12 2025 - Fort Lauderdale, FLFort Lauderdale, FL - Apr 12 2025 - Botox Training
63Apr 12 2025 - Philadelphia, PAPhiladelphia, PA - Apr 12 2025 - Botox Training
64Apr 19 2025 - Seattle, WASeattle, WA - Apr 19 2025 - Botox Training
65Apr 26 2025 - Phoenix, AZPhoenix, AZ - Apr 26 2025 - Botox Training
66Apr 26 2025 - Brooklin, NYBrooklin, NY - Apr 26 2025 - Botox Training
67May 03 2025 - Orlando, FLOrlando, FL - May 03 2025 - Botox Training
68May 03 2025 - Kansas City, MOKansas City, MO - May 03 2025 - Botox Training
69May 04 2025 - Anaheim, CAAnaheim, CA - May 04 2025 - Botox Training
70May 09 2025 - Online Course, webOnline Course, web - May 09 2025 - Botox Training
71May 17 2025 - Nashville, TNNashville, TN - May 17 2025 - Botox Training
72May 17 2025 - Minneapolis, MNMinneapolis, MN - May 17 2025 - Botox Training
73May 31 2025 - Houston, TXHouston, TX - May 31 2025 - Botox Training
74May 31 2025 - Naples, FLNaples, FL - May 31 2025 - Botox Training
75May 31 2025 - Online Course, webOnline Course, web - May 31 2025 - Botox Training
76May 31 2025 - Brooklin, NYBrooklin, NY - May 31 2025 - Botox Training
77Jun 01 2025 - Brooklin, NYBrooklin, NY - Jun 01 2025 - Botox Training
78Jun 07 2025 - Charlotte, NCCharlotte, NC - Jun 07 2025 - Botox Training
79Jun 07 2025 - Chicago, ILChicago, IL - Jun 07 2025 - Botox Training
80Jun 14 2025 - Philadelphia, PAPhiladelphia, PA - Jun 14 2025 - Botox Training
81Jun 14 2025 - Denver, CODenver, CO - Jun 14 2025 - Botox Training
82Jun 21 2025 - Ann Arbor, MIAnn Arbor, MI - Jun 21 2025 - Botox Training
83Jun 21 2025 - Long Island, NYLong Island, NY - Jun 21 2025 - Botox Training
84Jun 21 2025 - Miami Beach, FLMiami Beach, FL - Jun 21 2025 - Botox Training
85Jun 22 2025 - Online Course, webOnline Course, web - Jun 22 2025 - Botox Training
86Jun 28 2025 - Dallas, TXDallas, TX - Jun 28 2025 - Botox Training
87Jun 28 2025 - Anaheim, CAAnaheim, CA - Jun 28 2025 - Botox Training
88Jul 12 2025 - Atlanta, GAAtlanta, GA - Jul 12 2025 - Botox Training
89Jul 12 2025 - Oklahoma City, OKOklahoma City, OK - Jul 12 2025 - Botox Training
90Jul 19 2025 - New Orleans, LANew Orleans, LA - Jul 19 2025 - Botox Training
91Jul 19 2025 - Nashville, TNNashville, TN - Jul 19 2025 - Botox Training
92Jul 20 2025 - Orlando, FLOrlando, FL - Jul 20 2025 - Botox Training
93Jul 26 2025 - Las Vegas, NVLas Vegas, NV - Jul 26 2025 - Botox Training
94Jul 26 2025 - Boston, MABoston, MA - Jul 26 2025 - Botox Training
95Aug 02 2025 - Charlotte, NCCharlotte, NC - Aug 02 2025 - Botox Training
96Aug 02 2025 - San Juan, PRSan Juan, PR - Aug 02 2025 - Botox Training
97Aug 09 2025 - Austin, TXAustin, TX - Aug 09 2025 - Botox Training
98Aug 09 2025 - Minneapolis, MNMinneapolis, MN - Aug 09 2025 - Botox Training
99Aug 16 2025 - Fort Lauderdale, FLFort Lauderdale, FL - Aug 16 2025 - Botox Training
100Aug 16 2025 - Philadelphia, PAPhiladelphia, PA - Aug 16 2025 - Botox Training
101Aug 16 2025 - Kansas City, MOKansas City, MO - Aug 16 2025 - Botox Training
102Aug 23 2025 - Brooklin, NYBrooklin, NY - Aug 23 2025 - Botox Training
103Sep 06 2025 - Detroit, MIDetroit, MI - Sep 06 2025 - Botox Training
104Sep 06 2025 - Miami Beach, FLMiami Beach, FL - Sep 06 2025 - Botox Training
105Sep 12 2025 - Los Angeles, CALos Angeles, CA - Sep 12 2025 - Botox Training
106Sep 13 2025 - Houston, TXHouston, TX - Sep 13 2025 - Botox Training
107Sep 13 2025 - Chicago, ILChicago, IL - Sep 13 2025 - Botox Training
108Sep 20 2025 - Orlando, FLOrlando, FL - Sep 20 2025 - Botox Training
109Sep 21 2025 - Long Island, NYLong Island, NY - Sep 21 2025 - Botox Training
110Sep 27 2025 - Las Vegas, NVLas Vegas, NV - Sep 27 2025 - Botox Training
111Sep 27 2025 - Atlanta, GAAtlanta, GA - Sep 27 2025 - Botox Training
112Oct 24 2025 - Online Course, webOnline Course, web - Oct 24 2025 - Botox Training
113Nov 08 2025 - Online Course, webOnline Course, web - Nov 08 2025 - Botox Training
114Dec 13 2025 - Online Course, webOnline Course, web - Dec 13 2025 - Botox Training

Learn More about Botox Procedures

Botox® is the trade name for Botulinum Toxin, a neurotoxin in the form of a purified protein. The mechanism of action for Botulinum Toxin (Botox) is really quite simple; it is injected into facial muscles but doesn’t affect the muscle at all. Botulinum Toxin (Botox) works by blocking the transmitters between the motor nerves that innervate the muscle.

The areas typically treated with Botulinum Toxin (Botox) for wrinkles are the forehead, between the eyes (glabellar region), around the corners of the eyes (crow’s feet) and around the lips (smokers lines or gummy smile). There is no loss of sensory feeling in the muscles. Once the motor nerve endings are interrupted, the muscle cannot contract, causing wrinkles in the skin to smooth. The effects of Botulinum Toxin (Botox) last approximately three to four months, at which time the patient will require retreatment.

Botulinum Toxin (Botox) has important clinical uses as an adjunct in facial pain and bruxism cases for patients with chronic TMJ and orofacial pain. Botulinum Toxin (Botox) is also used to complement esthetic dentistry as a minimally invasive alternative to surgery.

Dysport is a Botulinum Toxin product developed in the United Kingdom during the early 1990’s. Originally created to treat neurological and ophthalmic conditions, Dysport is now known to treat a variety of conditions, including moderate to severe frown lines.

During the procedure, a small amount of Dysport is injected directly into the facial muscles that correspond with wrinkles and lines. No local anesthetic is required and patients can expect treatment to take 10-20 minutes.

The esthetic results of Dysport injections generally last 12 to 16 weeks. Fortunately, due to muscles “unlearning” the habit of frowning and/or squinting, the need for injections may become less frequent. Side effects may include; dry mouth, injection site discomfort or pain, tiredness, headache, neck pain, muscle pain, and eye or vision problems.

Xeomin (incobotulinumtoxinA), is a neurotoxin approved by the US FDA for the treatment of moderate to severe frown lines in adults. Xeomin is made of a protein purified from the bacterium Clostridium botulinum. Botulinum Toxins block nerve activity in the muscles, causing a temporary reduction in muscle activity, thus a reduction in wrinkles and lines.

Xeomin is the first Botulinum Toxin that does not need to be refrigerated before use, which simplifies distribution. It has no additives, containing only Botulinum Toxin type A - this may mean there is less risk of developing antibodies against Xeomin compared to other available neurotoxins. The effects of Xeomin are visable within one week, with results lasting 3 to 6 months.

Xeomin should not be used interchangeably with other botulinum products. There is a risk all botulinum toxin products may spread from the area injected, causing potentially life-threatening swallowing and breathing problems. Other risks may include bleeding and bruising at the injection site and allergic reactions such as itching, swelling or shortness of breath.

Botulinum Toxin (Botox) is used esthetically to decrease the appearance of aging by reducing muscle movement. Areas of treatment include; the glabellar area (the 11's/frown lines between the eyes), frontalis muscles (forehead lines), crow’s feet, chin dimples, radial lip lines (smoker’s lines) and nose lines. Botulinum Toxin can also be used to reduce the muscle mass in the masseters (jaw line) for a slimming facial esthetic result.

Receiving Botulinum Toxin takes only a few minutes and there’s no need for anesthesia or down time. The injections are made using a very fine needle and are virtually painless.

Generally, results are visible within two to ten days. To reduce the possibility of bruising/swelling, it is recommended to avoid alcohol for at least 24 hours and aspirin/anti-inflammatory medications for a period of two weeks prior to the procedure. As always, consult your physician before stopping any medications.

The most common side effects of Botulinum Toxin injections are bruising, redness, and swelling. Other, rare side effects are possible and will be reviewed by the treating physician. To avoid adverse reactions/results, do not manipulate the treated area for 2 hours after injections and maintain an upright position.

The esthetic effects of Botulinum Toxin typically last three to four months. As the treated muscles regain movement, lines and wrinkles will begin to reappear and require retreatment. Over time, these lines and wrinkles should appear less noticeable due to training the treated muscles to relax.

The benefits for physicians and mid-levels in obtaining Botox certification allows others (i.e. malpractice insurance carriers, Allergan, and patients) to know you have successfully completed the learning objectives and hands-on technical training to safely and effectively administer Botox within a practice setting as well as acquire the medication.

All healthcare providers benefit in learning these “in-demand” procedures whether a physician practice owner or mid-level provider expanding their skill set. The manufacturers of the various medical supplies such as Botox or dermal fillers, will not sell the medicines to you if they believe you are not qualified so it is in your best interest to become certified.

You must be a medical professional and have the necessary Botox certification requirements.

The requirements include having a valid medical, professional license in the state for which you're practicing medicine and performing Botox injections. Once you enroll in a Botox certification training program, you will need to provide documentation that proves you are licensed in your state. Your medical license also must be active and in good standing with the state. Without a valid medical license you will not be able to become BOTOX certified

For more information about State requirements and Botox certification, contact your local State Medical Board.

For Botox training, you must provide documentation that shows you are a licensed medical practitioner. Specifically, only medical practitioners who hold an MD, DO, DDS, DMD, NP, and nurses under the supervision of a physician may inject at a Botox certification program. For practitioners who are not Physicians, there are usually state specific requirements to be aware of. Every state is different regarding who is allowed to perform a medical procedure, other than Physicians. . Even a simple injection, or piercing the skin, is considered to be performing a medical procedure so it is important to be aware of the regulations.

Foreign medical doctors or foreign medical graduates may attend a Botox training program however, may not perform the injections unless they are licensed in the United States. There is no International reciprocity in medicine. Foreign medical graduates and medical doctors must pass all US licensure requirements to be able to inject at a Botox certification course.

Non-medical Personnel may enroll in an Botox Certification program, however, are not eligible to perform any medical procedures or live injections on patients. Non-medical individuals must be sponsored by a professional who holds an MD, DO, NP, DDS, or DMD degree.

Botulinum Toxin-A and HA Dermal Filler injections are very safe procedures to perform in-office and has a high safety profile. These non-invasive, non-surgical procedures though safe to perform due carry a risk aesthetically as well as medically due to incorrect needle placement. The following summary will review possible complications associated with the most popular Botulinum Toxin-A and HA Dermal Filler injections. 

As with any hypodermic needle injection there is always possibility of bruising associated with the procedure as well as certain patients that are more susceptible to bruising we will concentrate on the various areas for incorrect needle placement and associated adverse events.

Botulinum Toxin-A Injections

The most common injections for Botulinum Toxin-A injections are the (3) main areas of the upper 1/3 of the face. The (3) regions are the Forehead (Frontalis Muscle), Glabella Region (Procerus and Depressor Corrugator), and the Lateral Canthal Rhytid Region (Orbicularis Occuli).

Forehead (Frontalis Muscle) 


The injections should be intra-dermal which is taking a 5-10º angle at the point of needle penetration and breaking the skin. When the needle is below the skin a small amount (typically .05 – 1.0cc) is administered within the soft tissues of the epidermis or dermis (avoiding the periosteum). The areas of the injection for the Frontalis is at least (1) finger breath above the eyebrow and should not extend laterally beyond the frontal limbus. The injection may be painful due to superficial nerves throughout the forehead and visual observation should be used to avoid the (2) large veins of the forehead; supratochlear vein and supraorbital vein. Other possible (potential) complications due to incorrect needle placement after the procedure are:
  • Brow Ptosis / Heaviness: This condition occurs where either the injection of the Botulinum Toxin-A was delivered too low (less than one finger breath above the eye brow) or the Glabella Region was not treated at the same time. The Frontalis Muscle is the only elevator muscle in the upper 1/3 of the face – if relaxed and the depressing muscles interacting with the frontalis are not relaxed it is possible for the eyebrow to lower and or feel heavy to the patient. Other possible reasons for this condition could be administering a too large amount (units) of the Botulinum Toxin-A in the area. This is a cosmetic condition and could last the duration of the expected treatment.
Glabella Region (Procerus and Corrugator Muscles)
There are (3) distinct muscles that make up the Glabella Region of the face and are depressing muscles; Procerus, Corrugator, and Depressor Supercilii). Only the Procerus and Corrugator muscles are typically injected in a procedure. These injections for the Glabella area are intermuscular injections since there is a possibility of diffusion and there are fibers of the frontalis muscle that if infiltrated with the botulinum toxin-A could cause ptosis of the eyebrow or possibly the eyelid. Proper technique demands that you isolate these muscles by pinching these muscles prior and during the injection to confirm location as well as the ability to feel resistance during the needle penetration of the muscle and when infiltrating the muscle with the medication. The most common complications in this area are:
  • Asymmetry: Unevenness of the eyebrow can be eliminated by ensuring that the proper dosing is administered at each injection point. Other reasons for a exaggerated asymmetry of the eyebrow would be a pre-existing asymmetry of the brow that was not addressed before treatment.
  • Eyelid Ptosis: Botulinum Toxin-A cannot migrate or diffuse within the orbital rim as the medication will affect other muscles within the eye that work with acetylcholine for muscle contraction specifically the levator palpebrae superioris muscle that controls the elevating of the eyelid. If weakened or relax the eyelid will not raise correctly – this condition typically lasts (2) weeks as the histamine release within the eye will break down the botulinum toxin-A quickly. This condition is avoided by using the pinch technique when injecting the Glabella Region.
  • Eyebrow Ptosis: Unevenness of the eyebrow can be eliminated by ensuring that the proper dosing is administered at each injection point. Other reasons for a exaggerated asymmetry of the eyebrow would be a pre-existing asymmetry of the brow that was not addressed before treatment.
Lateral Canthal Rhytids (Crows Feet Area)
Hypertrophic Platysmal Bands can be relaxed with the Botulinum Toxin-A and works very well in minimizing the look of these protruding bands. The injection needs to be directly into the bands at approximately .75in apart both proximal and distal of the indication of the protruded bands. Patients typically grimace which over exaggerates the bands and the physician will be able to isolate the band and enter into these bands with a slight lateral approach. Confirmation of location is achieved when the needle breaks into the band and the medicine is dispersed. However safe this injection there are complications associated with incorrect placement and they are:
  • Weakened Neck Flexors/Dysphagia: Though usually associated with the side effects of using botulinum toxin for neck, tongue, and jaw dystonia there is a possibility of it occurring in a platysmal band aesthetic injection. The issue is that every patient is different and if injecting the sternocleidomastoid (SCM) muscles the botulinum toxin may diffuse to the strap muscles on the hyoid bone that may inhibit the tongue to push food back and trigger the throat to swallow. The frequency of this type of side effect are related when the bilateral injections are more frequent or if large doses are injected. The side effects are transient and last typically 4-6 weeks after the incorrect placement of the injections.
Lips (Vertical Rhytids – Orbularis Oris)
Vertical Lip Lines and Perioral Rhytids can be treated with Botulinum Toxin-A and are administered as an intradermal injection at small dosages (1-2u). The muscle itself covers a number of other muscles needed for facial expression so location of the injections and performing them as an intradermal injection will keep you safe from complication. Other considerations associated with the injection is that the injections need to be above the vermillion border and lateral to the philtrum as well as away from the corner commissure. Each of these areas will lead to a poor aesthetic result and complication associated with needle placement. Injections that pierce through the Orbicularis Oris also have a number of complications associated with these injections, however he most common complications for injections for vertical lip lines are:
  • Asymmetric Smile: This occurs when the proper dosing is not administered equally to both sides of the muscle. This is not a strong muscle and is the reason for the smaller dosing volumes even the smallest difference in units may weaken one side of the lip compared to the other. It is possible to create asymmetry even if everything was done correctly and why it is better to use a smaller initial dose so that you have the ability to titrate to give correction to the asymmetry with no further side effects.
  • Drooling | Speech Interference: Botulinum toxin injections in this area need to be conservative, there are a number of people that are sensitive to the medication where the effect is greater than in other individuals. Drooling and speech interference for these types of injection is almost always associated with excessive dosing and volumes when treating this area.
Bunny Lines (Nasalis)
This common injection is not without its need for proper placement of the injection or has risk associated with the injection. Most dosing charts state that the nasalis muscle injection needs to be intermuscular however it is difficult to know if you are in the muscle when it is very thin banded muscle. Therefore, the proper technique to inject this muscle is to have the patient form these lines by facial expression and inject the peaks (not valleys) of the rhytids portrayed by the patient. It is typically one injection per side and should not go lateral to the side bridge of the nose with the needle direction pointing medial due to the possibility of diffusion. Slow infiltration will limit unwanted diffusion as the botulinum toxin will stay encapsulated with soft tissue chambers rather than forcefully injecting the medication. The major complication associated with improper needle placement for the Bunny Line area is:
  • Asymmetric Smile | Dropping of Upper Lip: This occurs when the injection is too far lateral in the nasalis muscle and the direction of the needle was not medial. The botulinum toxin may diffuse to the labii superioris aleque nasi muscle that controls the elevation of the facial upper lip. If weakened by the medication it would lead to relaxation of the muscle and may affect the upper lip either bilaterally (if both injections were done improperly) or unilaterally. Proper technique will avoid this complication.
Sad Smile (Depressor Anguli Oris)
When injecting the Depressor Anguli Oris (DAO) it is important to understand that this is not a deep muscle but is more superficial. The Depressor Anguli Oris is in proximity to and in many cases is covering another muscle, Depressor Labii Inferioris muscle that controls your lower lip movement. Either by making too deep an injection or by diffusion (injecting to hard) it may affect the lower lip. Injecting more distal within the muscle will also reduce any other complication with the various muscles associated with the corner commissure. The major complication associated with this injection is:
  • Inability to Lower Bottom Lip: This complication is aesthetic and will last the duration of a normal botulinum toxin injection (13 weeks). The diffusion from the injection of the DAO muscle into the Depressor Labii Inferioris muscle is not allowing the lower botton lip to lower. To avoid this complication take a 15-20º angle to the injection and aim for the corner commissure but start lower in the muscle and do not go too deep – about 4-5mm in depth.

Other Considerations

Botulinum Toxin-A Systemically: For cosmetic Botulinum Toxin treatments, the amount injected does not warrant permanent disability or nerve damage associated with an intervascular injection. However, there has been studies in rats that show that large doses of botulinum toxin systemically may affect distant muscles as they have very small bodies and diffusion would be greater. There are theories that the reason some patients suffer headaches from botulinum toxin injections is the possibility of the medication systemic after the injection. However, the majority of evidence does not support any claim that Botulinum Toxin-A cosmetically (under 100u) could cause any problems of any major significance or have much spread at all since it has never been confirmed in any patient receiving botulinum toxin.



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