THE ART OF INJECTION

with BOTOX® Cosmetic

A step-by-step guide to your 6 key considerations
when assessing and treating patients

Real patient treated for the appearance of moderate to severe forehead lines, lateral canthal lines, and glabellar lines. Results may vary.

BOTOX® Cosmetic (onabotulinumtoxinA) IMPORTANT SAFETY INFORMATION, INCLUDING BOXED WARNING

Important Information
WARNING: DISTANT SPREAD OF TOXIN EFFECT
Indications
Postmarketing reports indicate that the effects of BOTOX® Cosmetic and all botulinum toxin products may spread from the area of injection
BOTOX® Cosmetic (onabotulinumtoxinA) is indicated
to produce symptoms consistent with botulinum toxin effects. These may include asthenia, generalized muscle weakness, diplopia, ptosis,
in adult patients for the temporary improvement in
dysphagia, dysphonia, dysarthria, urinary incontinence, and breathing difficulties. These symptoms have been reported hours to weeks after
the appearance of: injection. Swallowing and breathing difficulties can be life threatening and there have been reports of death. The risk of symptoms is probably
- Moderate to severe glabellar lines associated with greatest in children treated for spasticity, but symptoms can also occur in adults treated for spasticity and other conditions, particularly in those
corrugator and/or procerus muscle activity patients who have an underlying condition that would predispose them to these symptoms. In unapproved uses and approved indications,
- Moderate to severe lateral canthal lines associated cases of spread of effect have been reported at doses comparable to those used to treat cervical dystonia and spasticity and at lower doses.
with orbicularis oculi activity
- Moderate to severe forehead lines associated with Please see additional Important Safety Information on following pages.
frontalis activity
SUPPORTING YOUR EXPERTISE
Outlined in this guide are 6 key considerations to
support your knowledge when assessing patients
and treating them with BOTOX® Cosmetic.

1 START
with understanding fundamental
assessment education

2 ELEVATE
your consult with 6 comprehensive
best practices

3 UNDERSTAND
individualized anatomy and interrelated
muscle anatomy prior to injections

4-6 INDIVIDUALIZE
approved injection points to your
patient’s anatomy

IMPORTANT SAFETY INFORMATION (continued)

CONTRAINDICATIONS
BOTOX® Cosmetic is contraindicated in the presence of infection at the proposed injection site(s) and in individuals with
known hypersensitivity to any botulinum toxin preparation or to any of the components in the formulation.
WARNINGS AND PRECAUTIONS
Lack of Interchangeability Between Botulinum Toxin Products
The potency units of BOTOX® Cosmetic are specific to the preparation and assay method utilized. They are
not interchangeable with other preparations of botulinum toxin products and, therefore, units of biological
activity of BOTOX® Cosmetic cannot be compared to nor converted into units of any other botulinum toxin
products assessed with any other specific assay method.
Please see additional Important Safety Information on following pages.
THE ONE AND ONLY BOTOX® COSMETIC
BRINGS YOU THE LOOK OF 3 SM1-5

3 AREAS, 64 UNITS, AT LEAST 3 TIMES A YEAR1

•O
 nly BOTOX® Cosmetic is FDA approved to temporarily improve the look of 3 areas—
moderate to severe forehead lines, lateral canthal lines, and glabellar lines in adults1-5

•F
 DA approved for 64 Units—20 Units in forehead lines, 24 Units in lateral canthal
lines, and 20 Units in glabellar lines1

•O
 nly BOTOX® Cosmetic has been proven to deliver consistent results with
simultaneous treatment. See your patients at least 3 times a year and schedule
treatments at least 90 days apart1

moderate to severe
FOREHEAD LINES
20 Units

moderate to severe
GLABELLAR LINES
20 Units

moderate to severe
LATERAL CANTHAL LINES
24 Units (12 Units each side)

Real patient treated for the appearance of moderate to severe forehead lines,
lateral canthal lines, and glabellar lines. Results may vary.
1
ASSESS ALL 3 AREAS
EVERY TIME
Ask patients to do the following
to check for:

moderate to severe

Crow’s feet lines

Smile!
moderate to severe

Frown lines

Frown!

moderate to severe

Forehead lines
Raise your
eyebrows!

IMPORTANT SAFETY INFORMATION (continued)

WARNINGS AND PRECAUTIONS (continued)
Spread of Toxin Effect
Please refer to Boxed Warning for Distant Spread of Toxin Effect.
No definitive serious adverse event reports of distant spread of toxin effect associated with dermatologic use of
BOTOX® Cosmetic at the labeled dose of 20 Units (for glabellar lines), 24 Units (for lateral canthal lines), 40 Units
(for forehead lines with glabellar lines), 44 Units (for simultaneous treatment of lateral canthal lines and glabellar
lines), and 64 Units (for simultaneous treatment of lateral canthal lines, glabellar lines, and forehead lines) have
been reported. Patients or caregivers should be advised to seek immediate medical care if swallowing, speech, or
respiratory disorders occur.
Please see additional Important Safety Information on following pages.
Additionally, look for:

• Existing brow or lid ptosis, which may

present as asymmetry in the upper face

ASSESSMENT
• Which muscles act as elevators and
which act as depressors

• The overall relationship between the

size of your patient´s forehead and the
distribution of frontalis activity

• The anatomy extent of the

corrugator muscle

• How the orbicularis oculi and cheek

mound move during a full smile to
avoid injection of the zygomatici

• The proximity of the corrugator muscle

to the levator palpebrae superioris, the
muscle just beneath it

Real patient before treatment.

2
ELEVATE
YOUR CONSULT

BUILD TRUST KNOW EDUCATE

with your expertise what they want on the science

79% of patients receive Motivators to get Explain the underlying

neurotoxin treatment treated vary across ages. causes of facial lines
after a discussion with 20-year-olds consider the and discuss how
their specialist.6,* safety profile.7,† 30-year- BOTOX® Cosmetic can
olds want natural-looking temporarily reduce muscle
results.7,‡ 40-year-olds want activity to improve the
a brand they can trust.8,§ appearance of facial lines.

Highlight that
BOTOX® Cosmetic can
provide natural-looking
results in moderate to
severe forehead lines,
lateral cantonal lines,
and glabellar lines.1,8,9,II,¶

IMPORTANT SAFETY INFORMATION (continued)

WARNINGS AND PRECAUTIONS (continued)
Serious Adverse Reactions With Unapproved Use
Serious adverse reactions, including excessive
weakness, dysphagia, and aspiration pneumonia,
with some adverse reactions associated with fatal
outcomes, have been reported in patients who received
BOTOX® injections for unapproved uses. In these cases,
the adverse reactions were not necessarily related to
distant spread of toxin, but may have resulted from the
administration of BOTOX® to the site of injection and/or
adjacent structures. In several of the cases, patients had
pre-existing dysphagia or other significant disabilities.
There is insufficient information to identify factors
associated with an increased risk for adverse reactions
associated with the unapproved uses of BOTOX®. The
safety and effectiveness of BOTOX® for unapproved uses
Real patient treated for the appearance of moderate have not been established.
to severe forehead lines, lateral canthal lines, and
glabellar lines. Results may vary. Please see additional Important Safety
Information on following pages.
 VALIDATE EMPHASIZE ENCOURAGE
FDA approval of The Look of 3 with SM
booking their
64 Units in 3 areas BOTOX® Cosmetic next assessment

88% of patients want Talk to your patients Schedule their visit at

a product that is FDA about desired outcomes least 90 days out so that
approved (n = 526)—and with treatments of 3 they can see repeatable
91% of millennials (n = 231) areas, 64 Units, at least 3 BOTOX® Cosmetic results.
say FDA approval is very times a year. Treatments
or somewhat important should be spaced at least
to them.10,# 90 days apart.1

Share that Discuss that they may

BOTOX® Cosmetic is backed see results in 1 to 2 days,
by over 20 years of published with full results in 30
studies reviewing its safety days, and their results
and efficacy.11,12 may last up to 4 months.1

Reinforce, for appropriate Highlight that patients

patients, that for an are satisfied with
aesthetically desirable result, treatment results.1,13,**
you treat regions together
because muscles are
interrelated and you treat
with the FDA-approved dose
of 64 units.1

*Based on 2022 online survey of 242 healthcare professionals who answered how many patients received treatment after a discussion.6
†
Based on a 2022 online survey of 251 neurotoxin patients, of which 40 were between the ages of 18 and 29. This subpopulation answered what drives them to BOTOX® Cosmetic.7
‡
Based on a 2022 online survey of 251 neurotoxin patients, of which 82 were between the ages of 30 and 39. This subpopulation answered what drives them to BOTOX® Cosmetic.7
§
Based on a 2022 online survey of 251 neurotoxin patients, of which 104 were labeled as Gen X. This subpopulation answered what drives them to BOTOX® Cosmetic.8
II
84% of pooled subjects (n = 592) who received 20 Units in forehead lines and glabellar lines, respectively, reported being “Very Satisfied” or “Mostly Satisfied” with the natural-looking results of treatment compared to
5.8% (n = 241) with placebo at day 30. This item was part of the Facial Line Satisfaction Questionnaire Follow-Up Treatment Satisfaction domain. In addition, 96% of market research subjects (n = 134) treated for
lateral canthal lines reported they “Completely Agree” or “Somewhat Agree” that BOTOX® Cosmetic provides natural-looking results.8,9
¶
In 2 clinical trials, 90% and 82% of patients (n = 260 each) who received 20 Units in forehead lines and glabellar lines, respectively, reported they were “Very Satisfied” or “Mostly Satisfied” (top 2 out of 5 responses)
with their treatment results at day 60 vs 1% and 3%, respectively, for placebo (n = 6 total).1
#
Based on a 2021 online survey of 526 neurotoxin patients, of which 231 were millennials. Results from respondents who replied “Very Important” or “Somewhat Important” when asked, “How important is FDA approval
in cosmetic treatments?”10
**In 2 multicenter, double-blind, placebo-controlled studies of BOTOX® Cosmetic treatment, 90% and 82% of patients (n = 260 each) who received 20 Units in forehead lines and 20 Units in glabellar lines reported
they were “Very Satisfied” or “Mostly Satisfied” (top 2 out of 5 responses) with their treatment results at day 60 vs 1% and 3%, respectively, for placebo (n = 6 total). 88% of patients (n = 313) treated with 20 Units in
forehead lines, 24 Units in lateral canthal lines, and 20 Units in glabellar lines reported being “Very Satisfied“ or “Mostly Satisfied“ with BOTOX® Cosmetic compared to 3% with placebo (n = 156). This item was part of
the Facial Line Satisfaction Questionnaire (FLSQ) Follow-Up Treatment Satisfaction domain, a validated scale from 1 to 5 where 1 = “Very Dissatisfied” and 5 = “Very Satisfied.” In clinical trials, full results of treatment
were seen at day 30.1,13
3
UNDERSTAND INDIVIDUALIZED
ANATOMY AND INTERRELATED
MUSCLES FOR DESIRED OUTCOMES
Consider the functiontal relationship of
the upper face muscles.

Frontalis14,15

Procerus 14,15

Corrugator 14,15

Orbicularis oculi14,15

Understanding the relevant anatomy is important for outcomes, such as

variability between individuals in frontalis structure and frontal anatomy.1,16

IMPORTANT SAFETY INFORMATION (continued)

WARNINGS AND PRECAUTIONS (continued)
Hypersensitivity Reactions
Serious and/or immediate hypersensitivity reactions have been reported. These reactions include anaphylaxis, serum sickness, urticaria, soft-tissue edema, and dyspnea. If such reactions
occur, further injection of BOTOX® Cosmetic should be discontinued and appropriate medical therapy immediately instituted. One fatal case of anaphylaxis has been reported in which
lidocaine was used as the diluent and, consequently, the causal agent cannot be reliably determined.
Please see additional Important Safety Information on following pages.
 Frontalis14,15

Contraction (elevation) of the frontalis draws eyebrows

superiorly and creates horizontal forehead lines.17

INDIVIDUALIZED ANATOMY
Orbicularis oculi14,15

The orbicularis oculus closes the eyelid as it contracts,

producing lateral canthal lines.17

Procerus 14,15

Corrugator 14,15

The procerus draws down the medial brow while the

corrugators draw the brow toward the midline. Repeated
movements contribute to vertical glabellar lines.17
4
INJECTING MODERATE TO
SEVERE FOREHEAD LINES
3 TYPES OF LINE PATTERNS

Most common18

Full forehead lines V-shaped forehead lines Central forehead lines

Real patient before treatment.

Total Dosage:
5 Injection Sites1
20 Units1

Middle frontalis 4 Units

Left lateral frontalis 4 Units

Right lateral frontalis 4 Units

Left medial frontalis 4 Units

Right medial frontalis 4 Units

20
Treatment goal: blockage of muscle
activity, leading to temporarily
improved appearance of moderate
UNITS to severe forehead lines.1

Real patient before treatment.

IMPORTANT SAFETY INFORMATION (continued)

WARNINGS AND PRECAUTIONS (continued)
Cardiovascular System
There have been reports following administration of BOTOX® of adverse events involving the cardiovascular system, including arrhythmia and myocardial infarction, some with fatal
outcomes. Some of these patients had risk factors including pre-existing cardiovascular disease. Use caution when administering to patients with pre-existing cardiovascular disease.
Please see additional Important Safety Information on following pages.
 FOREHEAD LINES LATERAL CANTHAL LINES GLABELLAR LINES

INDIVIDUALIZE INJECTION
POINTS TO PATIENT’S ANATOMY1

1.5-2.0 cm
A

INJECTION These injection patterns are consistent with the approved injection pattern in the
PATTERN IN THE Prescribing Information, which states the lower treatment row can vary 0.5 cm to
1.5 cm medially from the palpated temporal fusion line. Injectors should assess the
PRESCRIBING frontalis muscle activity when identifying the location of the appropriate injection sites.1
INFORMATION 30o

A
1.5-2.0 cm

30o

0.5
cm

FULL PATTERN FULL PATTERN

1.5 cm 1.5 cm

0.5

INJECTION TECHNIQUES
cm

CENTRAL PATTERN CENTRAL PATTERN

Real patient before treatment.

 PRECISE INJECTION
TECHNIQUES1
FOR MODERATE TO SEVERE FOREHEAD LINES
When identifying the location of the appropriate
injection sites in the frontalis muscle, assess the overall
relationship between the size of the subject’s forehead
and the distribution of frontalis muscle activity.

LOCATE the following horizontal INJECT 4 Units/0.1 mL of

treatment rows by light palpation of the reconstituted BOTOX® Cosmetic into
forehead at rest and maximum eyebrow 5 sites in the frontalis muscle for a
elevation: total of 20 Units/0.5 mL. Place the 5
• SUPERIOR MARGIN OF injections at the intersection of the
FRONTALIS ACTIVITY: horizontal treatment rows with the
approximately 1 cm above the most following vertical landmarks:
superior forehead crease • ON THE LOWER TREATMENT
• LOWER TREATMENT ROW: ROW: at the midline of the face,
midway between the superior and 0.5 cm to 1.5 cm medial to
margin of frontalis activity and the palpated temporal fusion line
Watch step-by-
the eyebrow, at least 2 cm above (temporal crest); repeat for the
step injection
techniques. the eyebrow other side
• UPPER TREATMENT ROW: • ON THE UPPER TREATMENT ROW:
Real patient before treatment. midway between the superior midway between the lateral and
margin of frontalis activity and medial sites on the lower treatment
lower treatment row row; repeat for the other side

CAUTIONS AND
CONSIDERATIONS
REMEMBER
• Treat forehead lines in conjuction with glabellar lines to
minimize potential for brow ptosis1 The reconstituted formulation
of BOTOX® Cosmetic was
• Lateral injection sites can be 0.5 cm to 1.5 cm medial to studied in clinical trials and
the temporal fusion line, and the distance between the is critical to achieve the
brow and lower treatment row should be no less than 2 cm1 correct dose. Results seen in
clinical trials were achieved
• When targeting the corrugator, inadvertently injecting the using the FDA-approved
frontalis too shallowly may lead to brow ptosis17 reconstitution process.1
 START SEEING RESULTS​ IN 1 TO 2 DAYS
WITH FULL RESULTS IN 30 DAYS1
20 Units • Moderate to severe forehead lines (FHL)

BEFORE AFTER DAY 2

RESULTS UP TO 4 MONTHS
PRIMARY END POINT

AFTER DAY 30 AFTER MONTH 4

Real patient treated for the appearance of moderate to severe forehead lines, lateral canthal lines, and glabellar lines. Results may vary.
Photos taken at maximum eyebrow elevation before and after treatment with BOTOX® Cosmetic at days 2, 30, and 120. In clinical trials at day 30, 61% (178/290) and 46% (145/318) of patients
demonstrated a ≥ 2-grade improvement from baseline in forehead line severity at maximum eyebrow elevation as compared to 0% (0/101) and 1% (1/156) in placebo, as assessed by both investigators
and subjects.1 In clinical trials at day 120, approximately 40% of patients in Study 1 and approximately 32% in Study 2 achieved a grade of none or mild improvement from baseline in forehead
line severity at maximum eyebrow elevation as compared to approximately 5% of patients in Study 1 and approximately 3% in Study 2 for placebo, as assessed by investigators.1

IMPORTANT SAFETY INFORMATION (continued)

WARNINGS AND PRECAUTIONS (continued)
Increased Risk of Clinically Significant Effects With Pre-existing Neuromuscular Disorders
Individuals with peripheral motor neuropathic diseases, amyotrophic lateral sclerosis, or neuromuscular junction disorders (eg, myasthenia gravis or Lambert-
Eaton syndrome) should be monitored when given botulinum toxin. Patients with neuromuscular disorders may be at increased risk of clinically significant effects
including generalized muscle weakness, diplopia, ptosis, dysphonia, dysarthria, severe dysphagia, and respiratory compromise from onabotulinumtoxinA (see
Warnings and Precautions).
Please see additional Important Safety Information on following pages.
5
INJECTING MODERATE
TO SEVERE LATERAL
CANTHAL LINES
2 TYPES OF LINE PATTERNS

Most common19

Lower lid/upper
Full-fan pattern
cheek pattern
Real patients before treatment.

Injection Patterns 1 and 2

Total Dosage1:
3 Injection Sites 1
12 Units per Side

First injection (A): 1.5 cm to 2 cm temporal

to the lateral canthus and just temporal to 4 Units
the orbital rim

Lateral orbicularis oculi 4 Units

Lateral orbicularis oculi 4 Units

24
UNITS
Treatment goal: temporary blockage
of muscle activity, leading to
temporarily improved appearance
of moderate to severe lateral
canthal lines.1
Real patient before treatment.
 FOREHEAD LINES LATERAL CANTHAL LINES GLABELLAR LINES

INDIVIDUALIZE INJECTION
POINTS TO PATIENT’S ANATOMY1
Injection pattern 1
1.5-2.0 cm
A

INJECTION PATTERN IN THE

PRESCRIBING INFORMATION
Injection 30°
pattern 1

30o

1.5 cm-2.0 cm
A

A
1.5-2.0 cm

30o

30°

Injection Injection pattern 2

pattern 2

1.5-2.0 cm
A

1.5 cm-2.0 cm
A

These injection patterns are consistent with the approved injection pattern
in the Prescribing Information
30 and have been individualized to each patient’s
o

unique anatomy. Injectors should assess the orbicularis oculi muscle activity
when identifying the location of the appropriate injection sites.1
A
Real patients treated for the appearance of moderate to severe forehead lines,
1.5-2.0 cm
lateral canthal lines, and glabellar lines. Results may vary.

30o

IMPORTANT SAFETY INFORMATION (continued)

WARNINGS AND PRECAUTIONS (continued)
Dysphagia and Breathing Difficulties
Treatment with BOTOX® and other botulinum toxin products can result in swallowing or breathing difficulties. Patients with pre‑existing swallowing or breathing difficulties may
be more susceptible to these complications. In most cases, this is a consequence of weakening of muscles in the area of injection that are involved in breathing or oropharyngeal
muscles that control swallowing or breathing (see Boxed Warning).
Please see additional Important Safety Information on following pages.
 PRECISE INJECTION
TECHNIQUES1
FOR MODERATE TO SEVERE
LATERAL CANTHAL LINES

– Injections should be given with the • Third injection: 1.0 cm to 1.5 cm

needle bevel tip up and oriented below the first injection site and at
away from the eye an approximate 30° angle medially
– Inject 4 Units/0.1 mL into each of
the 6 sites (3 injections per side) for 2. If lines are primarily below the
a total dose of 24 Units lateral canthus:
• First injection: at least 1.5 cm to
TWO APPROVED 2.0 cm temporal to the lateral
INJECTION PATTERNS canthus and just temporal to the
1. If lines are both above and lateral orbital rim
below the lateral canthus: • Inject along a line that angles from
• First injection: at least 1.5 cm to antero inferior to super posterior
2.0 cm temporal to the lateral • Ensure that the most anterior
Watch step-by-
canthus and just temporal to the injection is lateral to a line drawn
step injection
techniques. lateral orbital rim vertically from the lateral canthus
• Second injection: 1.0 cm to 1.5 cm • Remember to keep the most
Real patient before treatment. above the first injection site and at inferior injection superior to the
an approximate 30° angle medially maxillary prominence

CAUTIONS AND
CONSIDERATIONS1
• If lateral canthal lines are above and below the lateral REMEMBER
canthus, use injection pattern 1
• If lateral canthal lines are primarily below the lateral canthus, Achieve desired outcomes
use injection pattern 2 with approved dosing and
• Injections should be given with the needle bevel tip up and
injection techniques.
oriented away from the eye
 START SEEING RESULTS​ IN 1 TO 2 DAYS
WITH FULL RESULTS IN 30 DAYS1
24 Units • Moderate to severe lateral canthal lines (LCL)

BEFORE AFTER DAY 2

RESULTS UP TO 4 MONTHS
PRIMARY END POINT

AFTER DAY 30 AFTER MONTH 4

Real patient treated for the appearance of moderate to severe forehead lines, lateral canthal lines, and glabellar lines. Results may vary.
Photos taken at maximum smile before and after treatment with BOTOX® Cosmetic at days 2, 30, and 120. In clinical trials at day 30, 26.1% (58/222) and 20.3% (62/306) of patients
demonstrated a ≥ 2-grade improvement from baseline in lateral canthal line severity at maximum smile as compared to 1.3% (3/223) and 0% (0/306) in placebo, as assessed by both
investigators and subjects.1 In clinical trials at day 120, approximately 25% of patients achieved a grade of none or mild from baseline in lateral canthal line severity at maximum smile
as compared to approximately 5% in placebo, as assessed by investigators.1

IMPORTANT SAFETY INFORMATION (continued)

WARNINGS AND PRECAUTIONS (continued)
Pre-existing Conditions at the Injection Site
Caution should be used when BOTOX® Cosmetic treatment is used in the presence of inflammation at the proposed injection site(s) or when excessive weakness or
atrophy is present in the target muscle(s).
Dry Eye in Patients Treated With BOTOX® Cosmetic
There have been reports of dry eye associated with BOTOX® Cosmetic injection in or near the orbicularis oculi muscle. If symptoms of dry eye (eg, eye irritation,
photophobia, or visual changes) persist, consider referring patients to an ophthalmologist.
Please see additional Important Safety Information on following pages.
6
INJECTING MODERATE TO
SEVERE GLABELLAR LINES
4 TYPES OF LINE PATTERNS

Most common20

Converging-arrows
U-shaped pattern V-shaped pattern Omega pattern
pattern
Real patients before treatment.

Total Dosage:
5 Injection Sites1
20 Units1

Procerus 4 Units

Left corrugator muscle—medial 4 Units

Left corrugator muscle—lateral 4 Units

Right corrugator muscle—medial 4 Units

Right corrugator muscle—lateral 4 Units

20
Treatment goal: temporary blockage
of muscle activity, leading to
temporarily improved appearance of
UNITS moderate to severe glabellar lines.1

Real patient before treatment.

IMPORTANT SAFETY INFORMATION (continued)

WARNINGS AND PRECAUTIONS (continued)
Human Albumin and Transmission of Viral Diseases
This product contains albumin, a derivative of human blood. Based on effective donor screening and product manufacturing processes, it carries an extremely
remote risk for transmission of viral diseases and variant Creutzfeldt‑Jakob disease (vCJD). There is a theoretical risk for transmission of Creutzfeldt-Jakob disease
(CJD), but if that risk actually exists, the risk of transmission would also be considered extremely remote. No cases of transmission of viral diseases, CJD or vCJD
have ever been identified for licensed albumin or albumin contained in other licensed products.
Please see additional Important Safety Information on following pages.
 FOREHEAD LINES LATERAL CANTHAL LINES GLABELLAR LINES

INDIVIDUALIZE INJECTION
POINTS TO PATIENT’S ANATOMY1
INJECTION PATTERN
IN THE PRESCRIBING
INFORMATION
These injection patterns have been adapted from
the approved injection pattern in the Prescribing
Information and individualized to each patient’s
unique anatomy. Injectors should assess the
glabellar muscle activity when identifying the
location of the appropriate injection sites.1

OMEGA-SHAPED LINES

U-SHAPED LINES

V-SHAPED LINES
Real patients treated for the appearance of moderate to severe forehead lines, lateral canthal lines, and
glabellar lines. Results may vary.
 PRECISE INJECTION
TECHNIQUES1
FOR MODERATE TO SEVERE
GLABELLAR LINES

INJECT 4 Units/0.1 mL into each of the 5 sites—2 in each corrugator

muscle and 1 in the procerus muscle—for a total dose of 20 Units.

CAUTIONS AND CONSIDERATIONS1

• Avoid injection near the levator palpebrae superioris, particularly in
patients with larger brow depressor complexes
• Lateral corrugator injections should be placed at least 1 cm above the
bony supraorbital ridge
• Ensure the injected volume/dose is accurate and, where feasible, kept
Watch step-by- to a minimum
step injection • Do not inject neurotoxin closer than 1 cm above the central eyebrow
techniques.

Real patient before treatment. *Based on a 2023 online survey of 258 consumers who received BOTOX® Cosmetic within the past 6 months who agreed that they wish that
they had started treatment with BOTOX® Cosmetic sooner to temporarily improve the appearance of their moderate to severe lines.21

REMEMBER
60% of patients say that they wish they had started
treatment with BOTOX® Cosmetic sooner to temporarily
improve the appearance of their moderate to severe lines. 21,*
 START SEEING RESULTS​ IN 1 TO 2 DAYS
WITH FULL RESULTS IN 30 DAYS1
20 Units • Moderate to severe glabellar lines (GL)

BEFORE AFTER DAY 2

RESULTS UP TO 4 MONTHS
PRIMARY END POINT

AFTER DAY 30 AFTER MONTH 4

Real patient treated for the appearance of moderate to severe forehead lines, lateral canthal lines, and glabellar lines. Results may vary.
Photos taken at maximum frown before and after treatment with BOTOX® Cosmetic at days 2, 30, and 120. In clinical trials at day 30 as assessed by investigators, 80% (325/405) of patients
demonstrated none or mild glabellar line severity at maximum frown as compared to 3% (4/132) in placebo. In clinical trials at day 30 as evaluated by patients, 89% (362/405) of patients
achieved at least a moderate improvement in their glabellar line appearance compared to 7% (9/132) in placebo.1 In clinical trials at day 120 as assessed by investigators, 25% (102/403) of
patients demonstrated none or mild glabellar line severity at maximum frown as compared to 2% (2/128) in placebo. In clinical trials at day 120 as evaluated by patients, 39% (157/403) of
patients achieved at least a moderate improvement in their glabellar line appearance compared to 1% (1/128) in placebo.1

IMPORTANT SAFETY INFORMATION (continued)

WARNINGS AND PRECAUTIONS (continued)
ADVERSE REACTIONS
The most frequently reported adverse reactions following injection of BOTOX® Cosmetic for glabellar lines were eyelid ptosis (3%), facial pain (1%), facial paresis
(1%), and muscular weakness (1%).
The most frequently reported adverse reaction following injection of BOTOX® Cosmetic for lateral canthal lines was eyelid edema (1%).
The most frequently reported adverse reactions following injection of BOTOX® Cosmetic for forehead lines with glabellar lines were headache (9%), brow ptosis
(2%), and eyelid ptosis (2%).
Please see additional Important Safety Information on following pages.
 THE ONE THAT DELIVERS THE PROVEN
BENEFITS YOU CAN RELY ON

#
1 REQUESTED
NEUROTOXIN

BOTOX® Cosmetic is the most

2
requested neurotoxin by patients.8,*

-DAY ONSET

Patients may start to see results

within 1 to 2 days in all 3 areas.1
Patients will continue to see results,
with full results in 30 days.1
3 INDICATIONS

Only BOTOX® Cosmetic is FDA

approved for the temporary
improvement in the appearance of

4
moderate to severe forehead lines,
lateral canthal lines, and glabellar
lines in adults.1-5 -MONTH
DURATION

BOTOX® Cosmetic provides long-

lasting results up to 4 months
in all 3 approved areas.1

*Based on a 2022 online survey of 251 patients who had received treatment with a neurotoxin within the past 2 years. Of the
48% of patients (n = 112/235) who requested treatment with a specific brand, 83% specifically requested BOTOX® Cosmetic.8
IMPORTANT SAFETY INFORMATION (continued)
WARNINGS AND PRECAUTIONS (continued)
DRUG INTERACTIONS
Co-administration of BOTOX® Cosmetic and aminoglycosides or other agents interfering with neuromuscular transmission (eg, curare-like compounds) should only be performed with
caution as the effect of the toxin may be potentiated. Use of anticholinergic drugs after administration of BOTOX® Cosmetic may potentiate systemic anticholinergic effects.
The effect of administering different botulinum neurotoxin products at the same time or within several months of each other is unknown. Excessive neuromuscular weakness may be
exacerbated by administration of another botulinum toxin prior to the resolution of the effects of a previously administered botulinum toxin.
Excessive weakness may also be exaggerated by administration of a muscle relaxant before or after administration of BOTOX® Cosmetic.
Please see additional Important Safety Information on following page.
 ADVANCE YOUR PRACTICE
WITH BOTOX® COSMETIC
Only BOTOX® Cosmetic can
deliver The Look of 3 SM 1-5

• A treatment of 3 areas, 64 Units, at least 3 times a year*

• BOTOX® Cosmetic delivers natural-looking results1,8,9,†,‡

Assess every patient in all 3 indicated

areas, every time
• It is important to assess the entire upper face since the
muscles are interrelated
•P
 atient anatomy is highly variable, making a thorough
knowledge of facial anatomy essential1

Use FDA-approved and established

injection techniques
• Individualize injection points to patient's anatomy
•A
 esthetically desired outcomes were achieved in clinical
trials using the approved dose per site1
Learn more at
hcp.BotoxCosmetic.com FDA-approved 64 Units maximizes
*Treatments should be spaced at least 90 days apart.1
outcomes for appropriate patients
†
84% of pooled subjects (n = 592) who received 20 Units in forehead lines and glabellar lines, • Efficacy in clinical trials was based on specific dosing and
respectively, reported being “Very Satisfied” or “Mostly Satisfied” with the natural-looking results of injection sites
treatment compared to 5.8% (n = 241) with placebo at day 30. This item was part of the Facial Line
Satisfaction Questionnaire Follow-Up Treatment Satisfaction domain. In addition, 96% of market • The reconstituted formulation of BOTOX® Cosmetic
research subjects (n = 134) treated for lateral canthal lines reported they “Completely Agree” or was studied in clinical trials and is critical to achieve the
“Somewhat Agree” that BOTOX® Cosmetic provides natural-looking results.8,9
‡
In 2 clinical trials, 90% and 82% of patients (n = 260 each) who received 20 Units in forehead lines and correct dose1
glabellar lines, respectively, reported they were “Very Satisfied” or “Mostly Satisfied” (top 2 out of 5
responses) with their treatment results at day 60 vs 1% and 3%, respectively, for placebo (n = 6 total).1
REFERENCES: 1. BOTOX® Cosmetic Prescribing Information, July 2020. 2. Dysport Prescribing Information, January
IMPORTANT SAFETY INFORMATION (continued) 2023. 3. Xeomin Prescribing Information, September 2023. 4. Jeuveau Prescribing Information, January 2020.
Indications 5. Daxxify Prescribing Information, August 2023. 6. Data on file, Allergan Aesthetics, January 2022; HCP Facial
NTX ATU. 7. Data on file, Allergan Aesthetics, May 2023; Consumer NTX A&U. 8. Data on file, Allergan Aesthetics,
BOTOX® Cosmetic (onabotulinumtoxinA) is indicated in adult patients for the February 2023; Consumer NTX A&U. 9. Ogilvie P, Rivkin AZ, Dayan S, et al. Pooled subject-reported outcomes from
temporary improvement in the appearance of: 2 phase 3 studies of onabotulinumtoxinA for simultaneous treatment of forehead and glabellar lines. Dermatol
- Moderate to severe glabellar lines associated with corrugator and/or procerus Surg. 2020;46:950-957. 10. Data on file, Allergan Aesthetics, February 2021; Consumer NTX. 11. Data on file,
muscle activity Allergan Aesthetics, March 2022; Botulinum Toxin Peer-Reviewed Publications. 12. Data on file, Allergan Aesthetics;
- Moderate to severe lateral canthal lines associated with orbicularis oculi activity FDA Product Approval Information. 13. Data on file, Allergan Aesthetics, 2016; Clinical Study Report Satisfaction
Table. 14. Standring S, ed. Gray’s Anatomy: The Anatomical Basis of Clinical Practice. 40th ed. Churchill Livingstone;
- Moderate to severe forehead lines associated with frontalis activity
2008. 15. Beer JI, Sieber DA, Scheuer JF III, Greco TM. Three-dimensional facial anatomy: structure and function as it
WARNINGS AND PRECAUTIONS (continued) relates to injectable neuromodulators and soft tissue fillers. Plast Reconstr Surg Glob Open. 2016;4(suppl 12):e1175.
USE IN SPECIFIC POPULATIONS 16. Monheit G. Neurotoxins: Current concepts in cosmetic use on the face and neck—upper face (glabella,
There are no studies or adequate data from postmarketing surveillance on forehead, and crow’s feet). Plast Reconstr Surg. 2015;136(suppl 5):72S-75S. 17. Benedetto AV, ed. Botulinum Toxin
the developmental risk associated with use of BOTOX® Cosmetic in pregnant in Clinical Dermatology. Taylor & Francis; 2006. 18. Abramo AC, Do Amaral TP, Lessio BP, De Lima GA. Anatomy of
women. There are no data on the presence of BOTOX® Cosmetic in human or forehead, glabellar, nasal and orbital muscles, and their correlation with distinctive patterns of skin lines on the
upper third of the face: reviewing concepts. Aesth Plast Surg. 2016;40(6):962-971. 19. Kane MA. Classification
animal milk, the effects on the breastfed child, or the effects on milk production.
of crow’s feet patterns among Caucasian women: the key to individualizing treatment. Plast Reconstr Surg.
Please see accompanying BOTOX® Cosmetic full Prescribing Information, 2003;112(suppl 5):33S-39S. 20. de Almeida AR, da Costa Marques ER, Banegas R, Kadunc BV. Glabellar contraction
including Boxed Warning, or visit https://www.rxabbvie.com/pdf patterns: a tool to optimize botulinum toxin treatment. Dermatol Surg. 2012;38(9):1506-1515. 21. Data on file,
/botox-cosmetic_pi.pdf Allergan Aesthetics; April 2023; BOTOX® Cosmetic Claims Assessment.

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