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⚠️ Professional Use Only This content is intended exclusively for licensed medical professionals. It does not constitute clinical advice. Always follow applicable regulations and guidelines in your jurisdiction. |
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✍️ Written by: Celmade Editorial Team | AI-Assisted Content 🔬 Medically Reviewed by: Stella Williams, Medical Aesthetic Injector 📅 Published: April 6th, 2026 | Last Reviewed: April 6th, 2026 🔗 View Reviewer Full Profile → celmade.co/pages/team-stella-williams |
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📌 Editorial Note: This article was drafted with AI assistance and reviewed, fact-checked, and approved by Stella Williams, a qualified Medical Aesthetic Injector. All clinical claims are supported by cited references. |
The upper face is where the majority of botulinum toxin treatments are performed and where the majority of complications occur. Glabellar ptosis, brow depression, asymmetric smiling, and the Spock brow phenomenon are all outcomes that happen not because practitioners lack skill, but because they lack a precise, patient-specific dosing framework.
This guide is a practical dosing reference for the three most commonly treated upper face areas: the glabellar complex, the frontalis, and the lateral canthal lines (crow's feet). It covers starting doses by patient profile, injection point maps, depth guidance, the clinical adjustments that make the difference between a satisfactory result and an excellent one, and the most frequent dosing errors to avoid.
This post sits within Celmade's Botulinum Toxin content cluster. For the full clinical background — mechanism of action, reconstitution, contraindications, and regulatory framework — see the Complete Guide to Botulinum Toxin Type A. For brand-specific dosing conversions, see our Unit Conversion guide. Doses in this post are expressed in Botox-equivalent units — apply the appropriate conversion for Botulax, Nabota, Bocouture, and Dysport as needed.
How to Use This Dosing Reference
Every dose in this guide is a starting point. Botulinum toxin dosing is inherently individualised — two patients requesting identical treatment of identical areas may require doses that differ by 50% or more, depending on their muscle mass, gender, treatment history, and desired aesthetic outcome.
The framework below structures dosing decisions around five clinical variables that should be assessed at every consultation:
|
Variable |
Low End of Range |
High End of Range |
|
Gender |
Female — lower muscle mass, smaller muscle bulk, typically more dose-sensitive |
Male — greater muscle mass, higher doses usually required, especially in glabella and masseter |
|
Muscle mass / bulk |
Thin muscle, minimal visible movement at rest |
Thick, bulky muscle with deep resting lines and strong dynamic movement |
|
Treatment history |
Long-term patient with established atrophy — muscle has diminished from repeated treatment |
First-time or infrequent patient with full muscle activity and no prior atrophy |
|
Desired endpoint |
Soft relaxation — some movement preserved. Typical for frontalis and patients who want a natural result |
Full chemodenervation — complete paralysis of target muscle. Typical for glabella and deep lines |
|
Residual activity at review |
Still significant movement at 2 weeks → increase next dose by 10–20% |
Fully relaxed at 2 weeks → maintain dose or reduce slightly if any spreading occurred |
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The 2-week review rule: Book every new patient — and every patient receiving a new brand or dose — for a 2-week review. This is the clinical standard of care, not optional. It is the only appointment where you can objectively assess whether your starting dose was correct, identify early asymmetry, and make evidence-based dose adjustments for future sessions. Without the 2-week review data, you are guessing at every subsequent appointment. |
Area 1: The Glabellar Complex (Frown Lines)
Anatomy
The glabellar complex comprises three muscle groups that together create the vertical and oblique creases of the frown:
• Corrugator supercilii: The primary frown muscle. Originates from the medial supraorbital ridge, runs obliquely superolaterally, and inserts into the skin of the medial brow. Contraction draws the brow medially and inferiorly, creating the vertical '11 lines' of the glabella. This is the most important muscle to target — inadequate corrugator treatment produces the most patient dissatisfaction.
• Procerus: A small pyramidal muscle running vertically between the nasal bones and the glabellar skin. Contraction pulls the skin inferiorly, creating horizontal creases at the nasal bridge. It is the muscle responsible for the 'angry' expression and contributes to the central frown line.
• Depressor supercilii: A small muscle at the medial brow that depresses and medially draws the brow. Often treated as part of the corrugator, though some practitioners target it separately. Its contribution to brow ptosis when undertreated is clinically significant in patients with medial brow heaviness.
Standard Injection Map
The classic 5-point glabellar injection map distributes toxin across the corrugators and procerus. Each injection point targets a specific muscle component:
|
Point |
Location |
Muscle Targeted |
Standard Dose |
|
Point 1 (Central) |
Midline, approximately 1.5 cm above the nasal root |
Procerus |
4–6U |
|
Point 2 (Right corrugator — medial) |
1 cm superior to the medial end of the right brow, slightly lateral to midline |
Right corrugator supercilii — medial head |
4–6U |
|
Point 3 (Left corrugator — medial) |
Mirror of Point 2 on the left side |
Left corrugator supercilii — medial head |
4–6U |
|
Point 4 (Right corrugator — lateral) |
1–1.5 cm lateral to Point 2, at the mid-corrugator |
Right corrugator supercilii — lateral head |
4–6U |
|
Point 5 (Left corrugator — lateral) |
Mirror of Point 4 on the left side |
Left corrugator supercilii — lateral head |
4–6U |
Note: In patients with a broad glabellar complex or deep lateral corrugator activity, a 7-point map adds two additional lateral points to ensure full coverage of the corrugator lateral heads.
Dosing by Patient Profile
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GLABELLAR COMPLEX — DOSING REFERENCE |
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Standard female patient, first treatment: 20U total — 4U per point × 5 points Standard female patient, established: 20–25U total — adjust based on 2-week review data Female with strong corrugator activity: 25–30U total — increase corrugator points to 6U each Standard male patient, first treatment: 25–30U total — 5–6U per point × 5 points Male with heavy brows / deep 11 lines: 30–40U total — consider 7-point map, 5–6U per point Experienced patient with atrophy: 15–20U — reduced muscle bulk means less product needed Dysport equivalent: Multiply all doses above by 2.5 (e.g. 20U = 50U Dysport) |
Technique and Safety
• Minimum 1 cm above the orbital rim: The most important safety rule in glabellar injection. Toxin placed below this level risks diffusion through the orbital septum to the levator palpebrae superioris, causing upper eyelid ptosis. This complication is largely preventable — the rule is simple, non-negotiable, and must be applied at every treatment.
• Inject while patient actively frowns: Asking the patient to frown maximally during injection confirms muscle position and ensures you are targeting active muscle, not subcutaneous tissue. Never inject the glabella with the patient's face at rest — you cannot reliably palpate the corrugator without active contraction.
• Injection depth — intramuscular: The corrugator lies deep to the frontalis in the medial brow region. Aim for intramuscular placement, not subcutaneous. Insert the needle perpendicular to the skin and advance until you feel the slight resistance change that indicates you have passed through subcutaneous fat into muscle.
• Procerus injection is subcutaneous to superficial muscular: The procerus is a superficial muscle at the nasal bridge. Injection is at 45 degrees angled superiorly into the muscle belly — do not advance deeply here as you are close to the nasal dorsum periosteum.
Managing Ptosis if It Occurs
Upper eyelid ptosis is the most significant glabellar complication, occurring in approximately 1–5% of treatments depending on technique. If ptosis develops, the first-line management is apraclonidine (Iopidine) 0.5% eye drops, instilled three times daily into the affected eye. Apraclonidine is an alpha-2 adrenergic agonist that stimulates Müller's muscle — an accessory eyelid elevator — producing 1–2 mm of additional eyelid elevation. This does not fully correct the ptosis but significantly reduces its cosmetic impact while the toxin wears off over 6–8 weeks.
Ptosis that appears to worsen after the first week, or that is bilateral and severe, requires urgent ophthalmology review to rule out other causes.
Area 2: The Frontalis (Forehead Lines)
Anatomy
The frontalis is a broad, flat, paired muscle that runs vertically from the galea aponeurotica superiorly to the skin of the eyebrows and forehead inferiorly. It is the only significant brow elevator in the face, making it one of the most clinically challenging muscles to treat correctly.
Critical anatomical constraint: Because the frontalis is the only brow elevator, injecting it without simultaneously treating the brow depressors — corrugators, procerus, orbicularis oculi — will allow the depressors to act unopposed, causing brow ptosis. Never treat the frontalis in isolation. Always treat the glabellar complex at the same session.
The frontalis has no clear inferior insertion line — it blends into the dermis of the forehead and brow region. This makes the inferior boundary of safe injection critical: injecting too low (within 2 cm of the brow) risks brow ptosis regardless of depressor treatment.
Standard Injection Map
Frontalis injection points are arranged in a horizontal row or grid pattern across the mid-forehead, staying at least 2 cm above the brow at all points:
|
Injection Pattern |
Number of Points |
Point Spacing |
Vertical Position |
Best For |
|
Single row — 4 points |
4 |
Evenly spaced across forehead width |
2–3 cm above brow |
Most patients — simple, predictable |
|
Single row — 6 points |
6 |
Evenly spaced — narrower gaps |
2–3 cm above brow |
Wide foreheads or patients with extensive horizontal lines |
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Double row grid — 8 points |
8 |
4 points per row, rows 1.5 cm apart |
Lower row: 2–3 cm above brow. Upper row: 4–5 cm above brow |
Deep, extensive lines; patients wanting maximum line reduction |
|
Lateral-only pattern |
4 (lateral) |
2 points per side, lateral thirds only |
2–3 cm above lateral brow |
Patients with central brow elevation concerns — preserves central frontalis movement |
Dosing by Patient Profile
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FRONTALIS — DOSING REFERENCE |
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Standard female patient, first treatment: 8–12U total — 2–3U per point × 4–6 points Standard female, strong horizontal lines: 12–15U total — aim for softening, not paralysis Female wanting complete line elimination: 15–20U — warn about possible brow heaviness; review at 2 weeks Standard male patient, first treatment: 10–16U total — larger muscle, but err conservative on first session Male with deep forehead lines: 16–22U total — document muscle mass at consultation Experienced patient with established atrophy: 6–10U — reduced dose to maintain effect, not over-treat atrophied muscle Dysport equivalent: Multiply all doses above by 2.5 |
The Partial Relaxation Principle
Frontalis dosing is governed by a different aesthetic philosophy than glabellar dosing. In the glabella, full chemodenervation is usually the goal — patients want the frown lines eliminated. In the frontalis, the goal is almost always partial relaxation: lines soften, but the brow continues to move naturally with expression.
Full frontalis paralysis produces a heavy, immobile forehead that reads as overtreated and ages the patient's appearance. It eliminates all dynamic brow elevation, which paradoxically makes patients look more tired. The optimal frontalis result is one where the patient can still raise their brows — just less dramatically — and where the lines are reduced by 60–80% rather than eliminated.
To achieve this, use the lower end of the dose range for most patients and position your injection points conservatively above 2.5 cm from the brow. Review at 2 weeks and increase if the patient wants further reduction — it is much easier to add dose at review than to manage the complaints of a patient with complete frontalis paralysis.
Avoiding the Spock Brow
The 'Spock brow' or 'Mephisto brow' — characterised by an exaggerated lateral brow arch with a peaked, surprised appearance — occurs when the medial frontalis is selectively paralysed while the lateral frontalis remains active. This happens when injection points are placed across the medial and central forehead without treating the lateral thirds.
To prevent it: always place at least one injection point in each lateral third of the forehead (beyond the lateral limbus of the eye, at a minimum). If a Spock brow does develop post-treatment, it can be corrected by injecting 2–4U into the peak of the lateral brow to relax the overactive lateral frontalis. Document the position carefully — a correction injection too medial will worsen the problem.
Technique
• Injection is subcutaneous: Unlike the corrugator, the frontalis is a superficial muscle that lies just beneath the skin. Subcutaneous injection is correct. Insert the needle at 30–45 degrees with a shallow bevel, depositing the product just below the skin surface. Deep intramuscular injection in this area risks periosteal injection and haematoma.
• Inject with the patient's face relaxed: Unlike the glabella, injecting the frontalis with the patient actively raising their brows can shift the muscle position and alter the injection plane. Ask the patient to relax their face fully before treating.
• Use fine-gauge needles (30–32G): The forehead skin is thin and the muscle superficial. Fine needles reduce bruising and allow more precise placement.
Area 3: Lateral Canthal Lines (Crow's Feet)
Anatomy
Crow's feet are created by the orbital portion of the orbicularis oculi — the circular muscle surrounding the eye. The orbital orbicularis runs concentrically around the orbital rim, contracting during genuine smiling, squinting, and strong eye closure. Unlike the pretarsal portion (which controls eyelid closure), the orbital portion is the aesthetic target for crow's feet treatment.
The orbital orbicularis has no bony insertion — it inserts entirely into the periorbital skin, which is why its contraction produces the characteristic radial creases of crow's feet. It is also responsible for the lateral brow depression that occurs during smiling — a phenomenon worth noting when patients complain that their brows drop when they smile after toxin treatment.
Standard Injection Map
Crow's feet injections are placed lateral to the orbital rim — never medial to the rim, and never below the zygomatic arch. A standard 3-point fan pattern is used for most patients:
|
Point |
Position |
Direction |
Standard Dose |
|
Point 1 (Superior) |
1–1.5 cm lateral to the lateral orbital rim at the level of the lateral canthus |
Perpendicular or slightly superiorly angled |
3–5U |
|
Point 2 (Central) |
1–1.5 cm lateral to the rim, slightly inferior to Point 1 (0.5–1 cm below) |
Perpendicular to skin surface |
3–5U |
|
Point 3 (Inferior) |
1–1.5 cm lateral to rim, at the level of the inferior orbital rim laterally |
Angled slightly inferiorly |
3–5U |
|
Optional Point 4 |
Further inferolateral to Point 3 — for patients with extensive inferior canthal lines |
Inferolateral angle |
2–3U (use only if lines extend significantly below standard pattern) |
Dosing by Patient Profile
|
LATERAL CANTHAL LINES (per side) — DOSING REFERENCE |
|
Standard female patient, first treatment: 9–12U per side (3U × 3 points) — 18–24U total for both sides Female with deep, extensive crow's feet: 12–15U per side — add a 4th point or increase to 4–5U per existing point Female wanting expression preserved: 6–9U per side — light treatment only, maintains natural smile lines Standard male patient, first treatment: 12–15U per side — larger orbicularis, more surface area to cover Male with very deep, established lines: 15–20U per side — 5U per point with possible 4-point map Patient with lower lid lines (infraorbital): Add 1–2U × 2 points directly inferior to the pupil in the subcutaneous plane — extreme caution, small doses only Dysport equivalent: Multiply all doses above by 2.5 |
Technique and Safety
• Stay lateral to the orbital rim at all times: Injecting medial to the orbital rim risks diffusion into the periorbital structures, potentially reaching the inferior oblique muscle (causing diplopia) or the lower eyelid (causing ectropion or chemosis). Palpate the rim before injecting and confirm each point is clearly lateral.
• Injection is subcutaneous: The orbital orbicularis is superficial and broad. Subcutaneous injection is correct — the product diffuses into the muscle naturally at this depth. Deep injection risks the periosteum and the zygomatic branch of the facial nerve.
• Avoid injecting below the zygomatic arch: The zygomatic arch is approximately 1.5–2 cm below the lateral canthus. Injecting below this level risks diffusing toxin into the zygomaticus major, causing unilateral smile weakness — one of the most distressing complications for patients and the most difficult to explain.
• Ask the patient to squint before and during injection: Squinting confirms the target muscle is active and helps you identify the zone of maximum contraction. Injection points placed at the peak contraction zone produce the most effective results.
• Use fine-gauge needles (31–33G): The periorbital skin is thin, mobile, and highly vascularised. Bruising is the most common side effect of crow's feet treatment. Fine needles, gentle technique, and post-injection pressure reduce but do not eliminate bruising risk. Advise patients to expect possible bruising and avoid anticoagulants for 24 hours pre-treatment where possible.
The Smile Quality Consideration
Crow's feet and smiling are physiologically linked — the orbital orbicularis contracts involuntarily during a Duchenne (genuine) smile. Treating crow's feet with botulinum toxin reduces this contraction, which some patients experience as a smile that feels 'flat' or lacks its previous warmth. This is a common but underappreciated side effect that should be discussed at consultation, particularly for patients who place high value on expressive, animated facial expression.
To manage this: use the lower end of the dose range for patients who describe their smile as an important part of their identity. A lighter treatment that softens lines without eliminating all orbital contraction produces higher patient satisfaction than an aggressive treatment that patients feel has changed their expression.
Treating the Upper Face as a System
The glabella, frontalis, and crow's feet do not function independently — they are part of an integrated system of expression. Treating them together, with an understanding of how each muscle group interacts with the others, produces consistently better outcomes than treating each area in isolation.
|
Muscle Interaction |
Clinical Implication |
Dosing Strategy |
|
Frontalis (elevator) + Corrugators (depressor) |
Treating frontalis without glabella allows depressors to act unopposed → brow ptosis. This is the most common cause of post-treatment brow heaviness. |
Always treat glabella at same session as frontalis. Use the glabella treatment to neutralise the depressors that the frontalis treatment will no longer counterbalance. |
|
Corrugator + Lateral orbicularis (crow's feet) |
Treating the glabella aggressively can shift the brow laterally and inferiorly. Crow's feet treatment affects the lateral brow position. Both influence each other. |
Assess brow position before treating. If brow is already at risk of depression, reduce frontalis dose and consider a light lateral brow lift technique (2–4U in the lateral orbital orbicularis, superiorly placed). |
|
Frontalis + Crow's feet |
Full frontalis paralysis combined with crow's feet treatment removes most dynamic upper face movement, producing a mask-like appearance. |
Use partial frontalis relaxation as the goal. Plan crow's feet dose so that some lateral brow movement is preserved — treat points superior to the lateral canthus at lower doses if brow mobility is a priority. |
|
Procerus + Frontalis |
A heavily treated procerus with undertreatment of the frontalis can produce a confused expression — the glabella is pulled down but the forehead is unconstrained. |
Balance procerus dose with frontalis dose. In patients with significant procerus activity, 6U in the procerus combined with conservative frontalis treatment produces a more natural result than the reverse. |
Quick Reference: Upper Face Starting Doses at a Glance
|
Area |
Female Standard |
Female Strong Muscle |
Male Standard |
Male Strong Muscle |
Dysport (×2.5) |
|
Glabella (5-pt map) |
20U |
25–30U |
25–30U |
30–40U |
×2.5 all doses |
|
Frontalis (4-pt row) |
8–12U |
12–15U |
10–16U |
16–22U |
×2.5 all doses |
|
Crow's feet (per side) |
9–12U |
12–15U |
12–15U |
15–20U |
×2.5 all doses |
|
Total upper face — female |
37–44U |
49–60U |
— |
— |
93–150U est. |
|
Total upper face — male |
— |
— |
47–61U |
61–82U |
118–205U est. |
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Reconstitution reminder: All doses above assume your standard reconstitution volume. Check the units per 0.1ml at your current dilution before drawing up. If you use 2ml saline per 100U vial, each 0.1ml delivers 5U. If you use 1ml saline per 100U vial, each 0.1ml delivers 10U. Mismatch between your intended dose and your reconstituted concentration is a common source of underdosing or overdosing errors. For a full reconstitution guide, see our post on botulinum toxin reconstitution. |
The Seven Most Common Upper Face Dosing Errors
• Treating frontalis without treating the glabella. This will almost always produce brow ptosis. There are very few clinical scenarios where isolated frontalis treatment is appropriate. Treat them together, every time.
• Using the same dose for every patient regardless of muscle mass. A 20U glabellar dose in a 30-year-old male with a heavy brow and deep 11 lines will produce partial treatment at best. Assess the patient in front of you, not the average patient.
• Injecting the frontalis too close to the brow. The 2 cm rule exists because toxin diffuses beyond the injection site. If you inject 1 cm above the brow, the effective paralysis zone reaches the brow-elevating fibres. Move your injection points superiorly and resist patient pressure to treat 'right above the brow'.
• Missing the lateral thirds of the frontalis. Concentrating all injection points in the medial and central forehead while the lateral frontalis remains active produces the Spock brow. Always include the lateral thirds in your injection plan.
• Injecting crow's feet too close to the orbital rim. Keep all injection points at least 1 cm lateral to the bony rim. Palpate before every injection — orbital rim position varies between patients.
• Using too high a dose in crow's feet in animated patients. The crow's feet region is where the balance between line reduction and expression preservation is most delicate. Err toward lower doses on first treatment and build from the 2-week review data.
• Not documenting injection points and doses. Without a consistent injection map and dose record, you cannot meaningfully optimise results over successive treatments. Every appointment should produce a record that allows the next practitioner — or your future self — to understand exactly what was done and what the outcome was.
Key Takeaways
• Assess five variables at every consultation: gender, muscle mass, treatment history, desired endpoint, and brand/reconstitution used. These determine the appropriate starting dose — not a fixed protocol.
• Glabella and frontalis must be treated together. Isolated frontalis treatment almost always causes brow ptosis. The brow depressors must be treated at the same session to maintain brow position.
• Partial relaxation is the goal for frontalis. Full paralysis of the forehead reads as overtreated. Use lower doses, stay 2+ cm above the brow, and include the lateral thirds.
• Crow's feet require lateral discipline. Every injection must be lateral to the orbital rim. Diffusion medial to the rim causes serious complications.
• Book the 2-week review and use its data. Starting doses are only meaningful when you review outcomes and adjust. Build your per-patient dose reference over time.
• Document everything: Injection point map, dose per point, brand, reconstitution volume, and outcome at review. This is the foundation of safe, optimised toxin practice.
Browse Celmade's full botulinum toxin range including Botulax and Nabota in 50U, 100U, and 200U vials. For related clinical guides, see the Complete Guide to Botulinum Toxin Type A, our Brand Comparison guide, and the Unit Conversion reference.
Frequently Asked Questions
How many units of botulinum toxin does a forehead typically need?
The frontalis typically requires 8–22U depending on gender, muscle mass, and desired endpoint. Female patients at a first treatment usually need 8–12U; male patients with heavier brows typically need 10–16U as a starting dose. Always treat the glabellar complex at the same session — isolated frontalis treatment risks brow ptosis.
What is the maximum safe dose for the glabellar complex?
There is no universal maximum, but most clinical guidelines and prescribing information for licensed products cite 20–50U for the glabella depending on the product. In clinical practice, male patients with pronounced corrugator hypertrophy may need up to 40U to achieve adequate results. Doses above 50U for the glabella alone are rarely justified and should prompt review of whether the injection technique is correctly targeting the muscle rather than increasing the dose further. For product-specific maximum doses, refer to the individual product SPC available on the MHRA product database.
Can I treat crow's feet in a patient who has had lower eyelid filler?
Yes, but with additional caution. Lower eyelid filler changes the tissue plane in the periorbital area, potentially affecting how toxin diffuses from crow's feet injection points. Use the lower end of the dose range, stay strictly lateral to the orbital rim, and advise the patient that the interaction between the two products means outcomes are less predictable than in an untreated patient. Document the presence of existing filler in the patient record.
How do I prevent bruising in the crow's feet area?
The periorbital skin is thin and highly vascularised, making bruising nearly unavoidable in some patients. To minimise risk: use the finest gauge needle available (31–33G), apply ice for 5–10 minutes before injection, inject slowly and steadily, apply firm pressure immediately after each injection, and advise patients to avoid alcohol and anticoagulant medications for 24 hours pre-treatment. Arnica gel applied topically post-treatment can reduce the duration of any bruising that does occur.
Is it safe to treat all three areas (glabella, forehead, crow's feet) in one session?
Yes — treating all three areas in a single session is standard practice and produces the most balanced result. A combined upper face treatment allows you to balance the competing muscle groups (elevator vs depressors) in a single session rather than introducing sequential imbalances. The total dose for a combined treatment typically ranges from 50–80U for a female patient and 60–100U for a male patient at standard dosing. Always calculate the combined dose against your reconstituted product to confirm sufficient supply before beginning treatment.
