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Where Not to Inject

Arch Dermatol. 2002;138:1180-1185.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

THE TREATMENT of hyperfunctional facial lines with botulinum A exotoxin injection is safe, usually effective, and without serious adverse effects. Millions of individual clinical doses have been delivered without major complications. The average lethal dose, at 40 U/kg (eg, 2800 U for a 70-kg person), is orders of magnitude greater than the average dose delivered for glabellar frown lines (15-50 U).¹ Indeed, cosmetic use of botulinum A exotoxin has become routine within dermatology. Initiated by pioneering dermatologists, ophthalmologists, and otolaryngologists during the 1980s, and honed by leaders in dermatologic surgery during the past decade,^2-6 techniques for botulinum injection are now commonly taught in residency and postgraduate education programs. Overall safety and efficacy, however, do not imply that bothersome adverse effects seldom occur. There is understandable reluctance to document these, which are usually mild and time limited.^7-12 Yet adherence to a few simple guidelines can reduce the likelihood that the patient . . . [Full Text of this Article]

WHERE INJECTIONS ARE ALWAYS A PROBLEM

Too Close Above the Middle and Lateral Portions of the Eyebrow

Under the Midbrow and Into the Medial Canthus

Too Close to the Lateral Aspect of the Eyes

On the Upper Cheek

WHERE INJECTIONS ARE OFTEN A PROBLEM
Everywhere at the Same Time

Only Into the Medial Aspect of the Forehead

Directly Under the Lateral Aspect of the Eyebrows

Directly Under the Eyes

On the Upper Lip

WHERE INJECTIONS CAN CAUSE ADVERSE EFFECTS
Too Deep on the Hands for Palmar Hyperhidrosis

Too Deep on the Neck for Platysmal Bands

Too Deep Elsewhere

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