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It is available in glass vials of 100 units & 50 units, which is a vacuum dried product. It must be stored at or below –5C. To reconstitute 100 units, 2.5 cc of preservative-free normal saline (0.9% sodium chloride) is injected into the vial and “gently” rotated. Do not shake the vial.


One must record the date and time of reconstitution.

Storage should be in the refrigerator and not the freezer because if ice crystals form the toxin is damaged and its potency decreases. Storage time is usually 4 weeks after reconstitution under ideal conditions.

Factors that may decrease potency are:

  • Alcohol on the skin or bottle cap
  • Bubbles formed by foaming
  • Agitation of bottle and syringe
  • Storage time of diluted toxin



Before beginning the procedure confirm that the patient is not on any of the drugs like Aspirin, Warfarin, Aminoglycosides. Give them a realistic idea via counseling. Take before and after photographs. Take written consent of the patient. Apply a topical anaesthetic cream under occlusion (prilox, emla) 1 hr. before the procedure.


Ask the patient to sit comfortable. Wipe the area to be injected with isopropyl alcohol and allow it to dry. Ask the patient to contract the muscles and mark the injection sites. The injection should be given 1 cm above the brow and 1 cm away from the orbital bony margin. For the forehead refer to the diagram above. Use a 30-gauge needle and insulin syringe. Calculate how much will be required for each area and inject 2-4 units per site as required. Males may require more units and more injection sites as the muscle mass is larger






Observations and Instructions

Results begin to show in 2-3 days and the full effect is seen in a week.

  • The effect lasts for 4-6 months. With successive treatments effect lasts for long.
  • It has been used for dynamic expression lines.
  • It is better to under correct than to overcorrect.
  • Patient should be called back after 2 weeks for a touch up session if required.
  • It has a preventive effect on further deepening of the facial wrinkles.
  • It can be used on the lower half of the face but requires greater expertise.


Side Effects

Only seen if proper assessment and proper care while injecting is not done. Side effects are usually temporary and localized.


Excessive arching of eyebrows:

  • Asymmetry
  • Ptosis
  • Bruising
  • Tolerance
  • Headache 

Combination Techniques

It could be combined with fillers, non-surgical face-lift, glycolic peels, Microdermabrasion, photo facials etc. to enhance and rejuvenate overall appearance.

E.g. if a patient has static frown lines first botox is injected to smoothen the lines and then filler is injected 2 weeks later into the static line.

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