Botox: safe injection points for crow’s feet (lateral canthal lines)

Crow’s feet, medically referred to as lateral canthal lines are commonly treated with botulinum toxin (Botox®) to reduce their prominence. However, different aesthetic clinicians have different injection approaches, and it is vital to understand the impact that a few millimetres of differentiation with have on the risk to the anatomy and the results you can achieve.

Dr Tim Pearce recently explored the correct Botox injection points for crow’s feet (lateral canthal lines) and safe Botox injection points for smile lines (lateral canthal lines), but in this blog, he discusses some additional injection points that aesthetic clinicians may consider when treating crow’s feet with Botox – explaining the good one, the bad one, and the downright ugly one which has no place in aesthetic medicine. You must understand the anatomy so you can avoid complications and create the best results for your patients.

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Are you using the correct injection points when treating crow’s feet?

Dr Tim has chosen to highlight three different injection points in his discussion below (as you can see from the illustration) for treating crow’s feet. Two of these injection points are commonly carried out and one is more effective than the other, but one of them is certainly not appropriate for aesthetic medical indications. Can you work out which?

The first injection point to discuss, the middle of the three, is certainly appropriate for aesthetic medical indications to reduce activity for crow’s feet formation. Looking at the anatomy, we can see why; the injection point is placed where the strongest part of the orbicular oculi muscle resides. When you are treating lateral canthal lines, this point probably delivers the biggest ‘bang for your buck’, notes Dr Tim. He recommends the placement of four units of Botox at that point for significant effect.

However, if you venture a few millimetres on either side of that injection point, you will experience very different results, and this is where greater anatomical understanding will help.

Once you go more lateral, which is often seen with newer injectors, explains Dr Tim, (they do this to be safer), it results in missing the orbicularis oculi muscle entirely. By injecting at this point, your needle will be somewhere over the temporalis muscle instead. This is not going to achieve much for the patient, perhaps a small amount of atrophy of the muscle at the temple, if you were to inject deep enough, he postulates.

Moving on to the third injection point under discussion, the medial point; this is more appropriately used in the oculoplastic specialty, not aesthetic medicine. It is used by ophthalmologists to treat patients who suffer from blepharospasm where the muscle is continuously contracting. Depth is very important. Anyone who is injecting this area will have a very good knowledge of the anatomy, making sure that they are above the orbicularis oculi muscle, or perhaps just touching it, but certainly not on the other side, going through the fat and into the orbital membrane. Placement there would mean injecting directly into the orbit where the lacrimal gland or the levator palpebrae muscle could be adversely affected. This injection point should be avoided by those practising aesthetic medicine if they are attempting to treat lateral canthal lines.

Knowing your anatomy and the impact of your injection points cannot be underestimated in aesthetic medical practice, concludes Dr Tim. Download Dr Tim Pearce’s 26 essential injection patterns for botulinum toxin.

Dr Tim is always keen to hear about the experiences of his followers and guide newer practitioners with educational content. So, if you have any questions, case studies, or discussion points for him, you can find Dr Tim Pearce on Instagram.

Aesthetics Mastery Show

Use these Botox injection points for Crows Feet. Botox Anatomy Training

Dr Tim says:

“Understanding the precise injection points and depth is crucial in aesthetic medicine, especially for treatments like botulinum toxin around the eyes where we have lots of sensitive anatomy. Injecting at the correct point yields optimal results, particularly for lateral canthal lines. Injecting too laterally may miss the target muscle, while injecting too medially risks complications. In this episode I discuss the best injection points for lateral canthal lines to use on your patients.”

Watch the full Aesthetics Mastery Show here.

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BOTOX (Botulinum Toxin) eLearning Courses

If you want to increase your confidence in botulinum toxin injections, or learn how to avoid and handle complications, Dr Tim Pearce offers two comprehensive courses that are highly rated by our delegates:

• BOTOX® Foundation Course
• Botulinum Toxin Complications Mastery

Both give CPD and certificates on completion.

In addition, browse our FREE downloadable resources on complications.

3D anatomy learning experience movement

In the next few weeks, Dr Tim Pearce is going to be launching something amazing that involves an incredible 3D learning experience for injectors, a community of clinicians on the same mission as you to help you achieve your goals, and exclusive online access to him and his team, to help you become a pro injector. Be the first to join the movement by joining the priority waiting list.

Botox® is a registered trademark of Allergan Aesthetics plc.

Dr Tim Pearce eLearning

Dr Tim Pearce MBChB BSc (Hons) MRCGP founded his eLearning concept in 2016 in order to provide readily accessible BOTOX® and dermal filler online courses for fellow Medical Aesthetics practitioners. His objective was to raise standards within the industry – a principle which remains just as relevant today.

Our exclusive video-led courses are designed to build confidence, knowledge and technique at every stage, working from foundation level to advanced treatments and management of complications.

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