Anti‑Wrinkle Treatment: Differences Between Female and Male Anatomy

Scope

Clinical SOP for BoNT‑A injections (onabotulinumtoxinA / incobotulinumtoxinA / abobotulinumtoxinA) — planning and technique differences by sex.

Summary

Men generally need broader coverage and higher unit totals due to greater muscle mass and different aesthetic goals (straighter, lower brow; stronger frontalis laterally). Women typically retain a subtle lateral brow arch with lower totals. Do not rely on aspiration for safety; rely on anatomy, depth, dose control and avoidance of over‑treating the lower frontalis.¹ ² ³ ⁴ ⁹

Key Differences at a Glance

Region	Female — target look & approach	Male — target look & approach
Brow/forehead	Preserve subtle lateral arch; spare lateral frontalis; lower total units.	Straighter, slightly lower brow; include lateral frontalis; higher total units.
Glabella	Standard 5‑point; typical on‑label totals; titrate by strength.	Same pattern; frequently higher totals for stronger corrugators; balance to avoid Mephisto.
Crow’s feet	Soften, don’t erase; small aliquots in fan.	Mellow lines; modestly higher totals; avoid unintended lateral lift.
Masseter	Often for slimming; staged dosing; counsel on bite fatigue.	Functional (bruxism) or contour but avoid loss of width; generally higher per‑side totals.
Perioral	Subtle mentalis/DAO modulation for softening.	Cautious DAO/mentalis to avoid feminising perioral dynamics.

Rationale: male facial sexual dimorphism and muscle bulk require different patterns and totals.⁵ ⁶

Upper Face — Practical Adjustments

1. Frontalis (horizontal lines)

Female: prioritise central frontalis to preserve lateral arch; stay ≥1.5—2 cm above brow. Typical starting total ~10—20 U (onabotulinum/incobotulinum).
Male: include lateral frontalis to prevent arch; typical starting total ~20—30 U; distribute across width; avoid heavy lower band dosing.⁸ ¹⁰

Prevent/Correct Mephisto (lateral spiking): include small lateral points initially or add 2—4 U per side at review.⁸

2. Glabella (frown complex)

Use the on‑label 5‑point pattern (corrugator/procerus) with depth control (deeper medially, tangential laterally). Men often require higher totals given corrugator mass.⁸ ¹⁰

3. Crow’s feet (orbicularis oculi)

Female: fan of small aliquots to soften while preserving a natural smile.
Male: similar map with modest dose increase; avoid lateral brow lift.⁸

Lower Face — Selected Differences

Masseter (function & contour)

Women: often aesthetic slimming; stage doses; warn about bite fatigue.
Men: bruxism or contour refinement without losing width; higher per‑side totals; spread points across deep and superficial heads to minimise paradoxical bulging.¹¹

Chin/DAO/Perioral

Women: subtle mentalis smoothing and small DAO to soften downturn can be aesthetic. Men: keep vectors neutral and doses conservative to avoid feminising perioral expression.⁵

Typical Starting Ranges

Orientation Only — Titrate to Strength/Anatomy

Units refer to onabotulinumtoxinA/incobotulinumtoxinA (≈1:1). Other toxins (e.g., abobotulinumtoxinA) are not equivalent — check the specific Product Information.

Region	Female common starts	Male common starts
Frontalis	~10–20 U total	~20–30 U total
Glabella (5‑pt)	~20–30 U total	≥25–35 U total
Crow’s feet	~8–12 U per side	~10–14+ U per side
Masseter	~20–30 U per side	~30–50+ U per side

Always individualise by muscle bulk, previous response and product used; follow official PI dosing guidance and contraindications.⁸ ⁹ ¹⁰

Safety & Governance (Australia, 2025)

Avoid lower frontalis over‑treatment to reduce brow ptosis.
Keep lateral corrugator injections superficial/tangential to reduce ocular spread risk.
Have an anaphylaxis kit ready; follow ASCIA protocol if needed.
Ahpra: follow non‑surgical cosmetic procedure guidelines and advertising rules; TGA: no public advertising of S4 injectables.
RACGP IPC + NSQHS standards apply to injection workflow, medications, documentation.

Authorities: ¹ ² ³ ⁴ ⁷

Sources

Ahpra (2025) Performing non‑surgical cosmetic procedures — Guidelines hub., viewed 05 November 2025, https://www.ahpra.gov.au/Resources/Cosmetic-surgery-hub/Cosmetic-procedure-guidelines.aspx ↩
TGA (2025) Advertising health services & cosmetic injections — FAQ., viewed 05 November 2025, https://www.tga.gov.au/products/regulations-all-products/advertising/specialised-advertising-issues-and-topics/advertising-health-services-and-cosmetic-injections-frequently-asked-questions-and-answers ↩
RACGP (2024) Infection prevention & control guidelines (primary care)., viewed 05 November 2025, https://www.racgp.org.au/running-a-practice/practice-standards/racgp-infection-prevention-and-control-guidelines ↩
ACSQHC (2021, updated 2024) NSQHS Standards (2nd ed.)., viewed 05 November 2025, https://www.safetyandquality.gov.au/sites/default/files/2021-05/national_safety_and_quality_health_service_nsqhs_standards_second_edition_-_updated_may_2021.pdf ↩
Matthews HS et al. (2023) Data‑driven facial sexual dimorphism. PLoS Comput Biol., viewed 05 November 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC10335371/ ↩
Bannister JJ et al. (2022) Sex differences in adult facial 3D morphology. Facial Plast Surg Aesthet Med., viewed 05 November 2025, https://www.liebertpub.com/doi/full/10.1089/fpsam.2021.0301 ↩
NHMRC/ACSQHC (2024) Australian Guidelines for the Prevention and Control of Infection in Healthcare., viewed 05 November 2025, https://www.safetyandquality.gov.au/sites/default/files/2024-01/australian_guidelines_for_the_prevention_and_control_of_infection_in_healthcare_current_version_v11.22_9_january_2024.pdf ↩
Allergan/AbbVie (US FDA) Botox® (onabotulinumtoxinA) label — aesthetic dosing and warnings., viewed 05 November 2025, https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/103000s5327lbl.pdf ↩
Ipsen Biopharmaceuticals, Inc. (2023), DYSPORT® (abobotulinumtoxinA) for injection – USA prescribing information (label revision s125), viewed 05 November 2025, https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/125274s125lbl.pdf ↩
XEOMIN (incobotulinumtoxinA) – U.S. Food and Drug Administration (FDA) (2023), Full prescribing information – labeling revision s097, viewed 05 November 2025, https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/125360s097lbl.pdf ↩
Kim N.H., Park R.H., Park J.B. (2010), Botulinum Toxin Type A for the Treatment of Hypertrophy of the Masseter Muscle, Plastic and Reconstructive Surgery, 125(6), 1693–1705, viewed 05 November 2025, https://pubmed.ncbi.nlm.nih.gov/20517093/ ↩

Disclaimer for Newcastle Cosmetic Doctor Policies & Procedures

The policies and procedures contained within this document are the exclusive property of Newcastle Cosmetic Doctor and are provided for internal clinical governance and educational purposes only. These materials represent the internal operational framework, safety standards, and evidence-based protocols developed and implemented by Dr. Bart John Scanlon and the Newcastle Cosmetic Doctor team. They are designed specifically for use within Newcastle Cosmetic Doctor and reflect our clinic’s own professional standards, risk assessments, and compliance obligations under Australian law and regulatory authorities. External individuals, practitioners, or organisations must not copy, reproduce, distribute, or rely upon these materials, in whole or in part, for their own clinical, commercial, or educational use without prior written consent from Newcastle Cosmetic Doctor. These materials do not constitute medical, legal, or professional advice and are not intended to be adopted as official protocols or procedures by any other entity. Any external use or adaptation must be independently reviewed and modified to meet the relevant laws, guidelines, and standards applicable to the user’s own jurisdiction, scope of practice, and facility operations. Newcastle Cosmetic Doctor and Dr. Bart Scanlon accept no liability for any loss, injury, or damage arising from the unauthorised use, reliance upon, or misinterpretation of this material.