Crow's Feet (Periorbital Lateral Lines) Anti-Wrinkle Injection Policy

Published:

November 4, 2025

1. Purpose

Provide a safe, evidence-based framework for botulinum toxin type A (BoNT-A) treatment of lateral canthal (“crow’s feet”) lines, consistent with Australian medical governance and current clinical consensus. ¹

2. Scope

Applies to AHPRA-registered practitioners performing or supervising anti-wrinkle injections to the periorbital lateral lines. ¹

3. Governance (Australia)

Requires a face-to-face prescriber consultation, compliance with TGA advertising restrictions, and record keeping per NSQHS clinical governance standards. ¹

4. Anatomy & Injection Mapping

Crow’s feet form from orbicularis oculi overactivity. Consensus technique: three injection points per side, approximately 1–1.5 cm lateral to the canthus, at superficial/intramuscular depth avoiding the orbital rim. ⁴

5. Dosing (Evidence-Based)

The FDA-approved onabotulinumtoxinA label recommends 12 Units per side (24 U total) for lateral canthal lines, divided across multiple injection points and adjusted for anatomy and muscle strength. ⁵

6. Contraindications

Defer treatment in pregnancy, breastfeeding, active skin infection, or neuromuscular disorders; review medication and allergy history before injection. ²

7. Informed Consent & Risks

Discuss realistic outcomes (softening not removal), possible bruising, asymmetry, or eyelid ptosis from diffusion, and the requirement for repeat dosing every 3–6 months. ¹

8. Post-Treatment Care

Remain upright for at least four hours, avoid touching, massage, exercise, or heat exposure for 24–48 hours; review at two weeks for treatment assessment. ²

9. Adverse Events & Management

Eyelid ptosis may be treated with apraclonidine 0.5% drops and documented review. Bruising is typically self-limiting; advise patients to report visual changes immediately. ⁶

10. Documentation & Audit

Record prescriber, injector, product name, batch number, expiry date, dosage, injection sites, and consent. Audit results annually and maintain at least 20 hours of CPD per year. ³

Sources

AHPRA, Guidelines for Cosmetic Medical and Surgical Procedures., viewed 30 October 2025, https://www.ahpra.gov.au/News/2025-09-02-New-guidelines-for-cosmetic-procedures.aspx ↩
Queensland Health, Beginner's Guide to Cosmetic Injectables., viewed 30 October 2025, https://www.health.qld.gov.au/newsroom/news/beginner-friendly-guide-to-cosmetic-injectables ↩
ACSQHC, NSQHS Standards – Medication Safety., viewed 30 October 2025, https://www.safetyandquality.gov.au ↩
Ascher B et al., International Consensus Recommendations on the Aesthetic Usage of Ready-to-Use AbobotulinumtoxinA (Alluzience), Aesthetic Surgery Journal, 44(2):192–202., viewed 30 October 2025, https://academic.oup.com/asj/article-abstract/44/2/192/7231033 ↩
U.S. Food and Drug Administration (FDA) (2024), BOTOX® Cosmetic (onabotulinumtoxinA) Prescribing Information – Lateral Canthal Lines, viewed 30 October 2025, https://www.accessdata.fda.gov/drugsatfda_docs/label/2024/103000s5316s5319s5323s5326s5331lbl.pdf ↩
Bernardini FP, Skippen B, Croasdell B, Cerón Bohórquez JM, Murray G, Sayed K, Walker L, Hartstein MEManagement of Severe Botulinum-Induced Eyelid Ptosis With Pretarsal Botulinum Toxin and Oxymetazoline Hydrochloride 0.1, Complications in Medical Aesthetics Collaborative (CMAC) Study Group, 47(5):699–702., viewed 30 October 2025, https://pubmed.ncbi.nlm.nih.gov/36943792/ ↩

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.