Purpose: Ensure consistent, evidence-based aesthetic outcomes while minimising risks of brow ptosis, asymmetry and unnatural appearance. Applies to all injectors and aligns with Australian clinical governance and safety standards. ^{1 2 3 4}

1. Frontalis - Balancing to Prevent Brow Ptosis

Anatomy & Function: The frontalis elevates the eyebrows and opposes the depressors (corrugator, procerus, orbicularis oculi). Excess dosing in the lower third reduces elevator function and risks brow or eyelid ptosis.

Technique: Inject upper two‑thirds only, spacing 1.5–2 cm with 1–2 U per point (onabotulinumtoxinA‑equivalent). Maintain a 2 cm safety margin above the brow. Use low volumes and perpendicular intramuscular placement to limit diffusion. Reassess at day 10–14 to titrate conservatively. ^{5 6}

2. Glabella -  Safe Corrugator & Procerus Treatment

Anatomy: Corrugator inserts into the skin above the brow; procerus lies midline over the nasal bridge. Supraorbital and supratrochlear vessels run deep and connect to the ophthalmic circulation.

Technique: Standard 5‑point pattern (corrugator ×2 each side, procerus midline). Typical total dose 20–25 U onabotulinumtoxinA‑equivalent. For procerus, inject deep at 90°. For corrugator, superficial at 45°. Maintain midline control to avoid lateral diffusion and brow drop; avoid deep medial placement over vascular bundles. ^{2 7 8}

3. Periorbital (Crow’s Feet) - Micro‑Dosing

Anatomy: Orbicularis oculi encircles the eye; lateral fibres create crow’s‑feet. The zygomatic and temporal branches of the facial nerve pass superficially; the orbital rim demarcates safer zones.

Technique: Use 3–4 lateral points per side, ≥1 cm outside the orbital rim. Dose 4–6 U per side in new/sensitive patients. Deliver micro‑droplet superficial injections angled away from the globe; avoid the inferior fat pad to reduce lid heaviness. ^{6 9 10}

4. Gender & Hyperkinetic Variants - Dosing Logic

Male pattern: Greater muscle mass often requires 20–30% higher total dose, slightly higher placement and broader spread to preserve natural mobility and avoid brow heaviness.

Female pattern: Smaller bulk and arch aesthetics favour micro‑dosing, minimal lower‑forehead points and careful symmetry checks to preserve femininity.

Hyperkinetic variants: Start conservative, review at 10–14 days, and top‑up selectively to correct persistent lines or asymmetry. ^{1 7}

5. Review Window & Quality Monitoring

Review: Standard assessment at day 10–14 for symmetry, function, and patient‑reported outcome. Avoid premature re‑treatment to reduce overtreatment risk and maintain natural expression.

Documentation: Record brand, batch/lot, dilution, exact injection map, total units per site, consent, and aftercare. Trend outcomes per patient to individualise dosing over time.

Regulatory: Significant or persistent adverse events should be recorded as clinical incidents and, where indicated, reported via the TGA DAEN portal. ^{3 4 11}

6. Risk Minimisation & Escalation

Red flags: Eyelid or brow ptosis, diplopia, dysphagia, dysphonia, or breathing difficulty require prompt assessment. Consider ocular involvement and refer urgently if vision is affected.

Actions: Reassure and document onset, dose map and findings; inform the Medical Director; initiate incident process; consider TGA reporting if severe or persistent. ^{4 5}

7. Education & CPD Alignment

Maintain AHPRA registration and annual CPD in anatomy, safe injection techniques, complication management and informed consent. Participate in periodic simulation of adverse event scenarios (e.g., anaphylaxis, vascular complications) and document competencies. ^{1 3 6}

Sources

1. AHPRA (2025), Guidelines for registered medical practitioners who perform cosmetic medical and surgical procedures., viewed 27 October 2025, https://www.medicalboard.gov.au/ ↩
2. TGA, Australian Regulatory Guidance & Therapeutic Goods Advertising Code., viewed 27 October 2025, https://www.tga.gov.au/ ↩
3. ACSQHC (2024), NSQHS Standards: Clinical Governance, Medication Safety & Partnering with Consumers., viewed 27 October 2025, https://www.safetyandquality.gov.au/ ↩
4. NSW Health, Clinical Governance and Patient Safety Framework., viewed 27 October 2025, https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2017_043.pdf ↩
5. Kane MA. Injection anatomy of the forehead and glabella: avoiding complications. Aesthetic Surg J, Kane MA. Injection anatomy of the forehead and glabella: avoiding complications. Aesthetic Surg J., viewed 27 October 2025, https://academic.oup.com/asj ↩
6. Carruthers J, Carruthers A. Botulinum toxin: current clinical applications. Dermatol Surg, Carruthers J, Carruthers A. Botulinum toxin: current clinical applications. Dermatol Surg., viewed 27 October 2025, https://onlinelibrary.wiley.com/journal/15244725 ↩
7. Alam M. et al. Consensus recommendations on botulinum toxin in facial aesthetics. JAAD, Alam M. et al. Consensus recommendations on botulinum toxin in facial aesthetics. JAAD., viewed 27 October 2025, https://www.jaad.org/ ↩
8. Sundaram H., Signorini M. Anatomy and safety for glabellar injections. Aesthetic Surg J, Sundaram H., Signorini M. Anatomy and safety for glabellar injections. Aesthetic Surg J., viewed 27 October 2025, https://academic.oup.com/asj ↩
9. Beleznay K. et al. Anatomical review of periocular injection safety. Plast Reconstr Surg, Beleznay K. et al. Anatomical review of periocular injection safety. Plast Reconstr Surg., viewed 27 October 2025, https://journals.lww.com/plasreconsurg/pages/default.aspx ↩
10. Kane MA. Periorbital dosing strategies for natural outcomes. Clin Aesthet Dermatol, Kane MA. Periorbital dosing strategies for natural outcomes. Clin Aesthet Dermatol., viewed 27 October 2025, https://www.ncbi.nlm.nih.gov/pmc/ ↩
11. TGA, Database of Adverse Event Notifications (DAEN)., viewed 27 October 2025, https://www.tga.gov.au/resources/database/database-adverse-event-notifications-daen ↩