95
Botox Injection Technique
John R. Burroughs and Richard L. Anderson
A half-inch 32-gauge needle (Air-Tite Products) minimizes injection
discomfort. In the periorbital areas we inject in an oblique manner to
the skin to lessen the chance of deep injections or even injury should a
patient suddenly move. Pinching upward or gently rubbing the adjacent
skin during injection minimizes patient discomfort by distracting the
patient during the injection and “confusing” the sensory sensation of the
injection (Figure 95.1). We recommend premarking the areas to be
injected, and utilizing bright lighting and wearing magnification
fi to avoid
injury to eyelid vessels. We seldom use topical anesthetics, and some
suggest a reduced duration of effect in patients treated with topical
anesthetic prior to injection.1 We inject into the subcutaneous tissue
planes to avoid the underlying muscle and neurovascular structures. This
reduces patient discomfort and lessens the risks of bruising and deep
dissemination. In general the injections can be given obliquely or per-
pendicular to the skin, but in the orbicularis areas it is critical to inject
at as flat an angle as possible because of the thinness of the eyelid skin
and to point away from the eye. It is also helpful when injecting the lower
orbicularis areas to put the skin on stretch, which helps with placing the
Botox in the subcutaneous plane. Botox must be avoided in the central
upper eyelid to prevent ptosis and over the inferior oblique in the lower
eyelid to avoid diplopia.
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304 J.R. Burroughs and R.L. Anderson
Figure 95.1. Pinch technique during oblique injection of corrugator. This
descreases discomfort and avoids neurovascular structures and bleeding.
Reference
1. Sami MS, Soparkar CN, Patrinely JR, Miller LM, Hollier LH. Efficacy
fi of
botulinum toxin type a after topical anesthesia. Ophth Plast Reconstr Surg
2006;22:448–452.
