The patient is advised to sit in an upright position in a chair so that the physician can access all areas of the face and determine the surface anatomy. The doctor must be able to identify certain physical landmarks of the face and be able...

to visually trace the direction of facial muscles. The patient may be asked to make certain facial expressions to help delineate the muscle groups.

To minimize the risk of infection, the area is usually cleaned with a nonalcoholic cleanser. It is important to notify the doctor of any iodine of shellfish allergy as this will dictate the choice of antiseptic. You may request, and some physicians always use, an anesthetic cream to decrease the pain associated with injections in the face.

Once the areas are identified, a small needle with the properly diluted botulinum toxin is introduced under the skin and near the muscles that require relaxation (chemical denervation). An image taken from the prescribing instructions for BOTOX® Cosmetic is shown below. It has been modified slightly to show some of the areas that are targeted by the physician. The areas shown in black are those for which the FDA has approved treatment. Areas marked in red are some of the other locations that trained physicians may inject to relax certain other muscles known to cause facial wrinkles. Some doctors may inject other regions of the face to suit the individual needs of their patients. It is important to discuss your specific needs with your physician and ask whether the BOTOX® injection is appropriate for that facial area and if he or she has experience with injection at that site.