Full-Face Botox: Master the Holistic Treatment Approach

Full-face Botox application is a developing technique in aesthetic and therapeutic medicine. Recent studies have shifted the approach from isolated wrinkle correction to comprehensive facial harmonization using tailored dosing and anatomical precision.

This article provides an evidence-based overview of full-face Botox treatments, drawing exclusively from the latest research to guide clinical practice.

Key Takeaways

• Full-face botulinum toxin treatments use different FDA-approved formulations of botulinum toxin type A and type B.
• The depth and dose of injections depend on the specific facial muscle being treated. Injections can be intramuscular, subdermal, or intradermal. Botox is mixed with 1-5 milliliters of saline per 100-unit vial.
• Each facial region requires customized doses ranging from 2 to 30 units.
• Most side effects relate to the injection technique. Mild effects include redness and bruising. More serious complications like drooping eyelids, difficulty speaking, or facial asymmetry occur if the toxin spreads beyond the intended area.
• Full-face Botox should not be used in individuals with myasthenia gravis or amyotrophic lateral sclerosis, during pregnancy or breastfeeding, and in those with known allergies to the product. 

Overview of Full-Face Botox Treatments

Full-face botulinum toxin involves precision neuromodulation across multiple anatomical facial zones. A growing number of BoNTA and BoNTB formulations are commercially available. All available products vary in complexing proteins, molecular weights, excipients, and immunogenic potential.

BoNTs are manufactured as core 150 kDa neurotoxins, which bind variably to neurotoxin-associated proteins to form high-molecular-weight progenitor complexes.¹

In clinical use, full-face Botox injection site, depth, and dosing are area-specific. Deep intramuscular injections are reserved for large, thick muscles (such as the masseter and corrugator supercilii), while subdermal/intradermal injections are preferred for superficial targets.

Full-Face Botox Areas and Anatomical Considerations

Botox administration technique varies based on the area of the face being treated.² Important facial areas treated in the full-face Botox before and after photos you see include:

Upper Third (Forehead, Glabella, and Crow’s Feet)

Treatment of the upper third of the face targets the frontalis, corrugator supercilii, procerus, and orbicularis oculi muscles. 

The frontalis is highly variable across patients and requires conservative dosing (15-20 units) delivered at least 1-2 cm above the orbital rim to prevent brow ptosis. Lateral points should not exceed 2 cm from the lateral eyebrow to avoid over-elevation

In the glabellar complex, dynamic frown lines result from hyperactivity of the procerus and corrugator supercilii. Deep, intramuscular injections (12-20 units total) at 3-5 standardized sites help prevent static rhytids. Avoid diffusion to the levator palpebrae superioris, which may result in blepharoptosis.

For lateral canthal lines, BoNT targets the superficial orbicularis oculi. A total of 6-12 units per side, injected intradermally and 1-1.5 cm lateral to the canthus, smooths crow’s feet.

Midface and Nasal Region

Botox in the midface and nasal region modulates the nasalis and levator labii superioris alaeque nasi (LLSAN) muscles. These muscles contribute to dynamic nasal lines (“bunny lines”) and excessive gingival display (“gummy smile”).

The nasalis muscle, a superficial dilator of the nostrils, is targeted with 2-4 units per side, administered intramuscularly at the mid-nasal dorsum. 

For correction of a gummy smile, 2-4 units per side should be injected into the LLSAN muscle. Precise placement, approximately 1 cm lateral to the nasal ala, reduces upper lip retraction without impairing perioral animation.

Lower Third and Perioral Complex

In the lower third of the face, Botox is used to support orbicularis oris, depressor anguli oris (DAO), and mentalis muscles.

Perioral lines arise from repetitive contraction of the orbicularis oris, a circumoral sphincter muscle. Intradermal injections of 2-3 units along the vermilion border reduce vertical rhytides.

However, you need to be cautious with the procedure because overtreatment risks lip flattening. Dermal fillers may be used adjunctively for structural support.

To correct oral commissure descent due to hyperactivity of the DAO muscle, inject 4-10 units subdermally, approximately 1 cm lateral and inferior to the mouth corners.

Cobblestone chin, caused by overactive mentalis, is managed with two intramuscular injections totaling 10 units. Injection should be placed 1 cm below the mental sulcus to avoid lower lip ptosis.

Platysma and Jawline Contouring

Targeted Botox into anterior and posterior platysmal bands relaxes its depressor effect and improves jawline definition. The procedure recently received FDA approval following trials demonstrating statistically significant improvements using onabotulinumtoxinA (26-36 U).³

In addition, as seen commonly in East Asian practice, Botox injection to the masseter muscle combats hypertrophy and refines facial contouring. A recommended dose of 25-30 U per side, administered in both superficial and deep planes, mitigates “paradoxical bulging.” 

Deep placement below the line from oral commissure to tragus, and at least 1 cm posterior to the anterior masseter border, protects against chewing weakness.

When volumetric prominence over a wide mandibular angle is partly glandular, superficial Botox to the parotid, administered at a dose of 20-30 U, can reduce glandular volume. 

Full Face Botox vs. Full Face Fillers

Full-face Botox and filler products serve complementary functions. The Global Aesthetics Consensus Group recognizes combined BoNT‑A and hyaluronic acid (HA) filler treatments as standard practice for panfacial harmonization.⁴

In areas where muscle activity is influenced by volume loss, lower doses of botulinum toxin are recommended to modulate rather than fully inhibit movement.

A multicenter clinical study of combined BoNT‑A and HA fillers over six months demonstrated a 96.5% satisfaction rate at three weeks (92.9% at six months).⁵

Further real-world data reveal that sequential full-face treatments (BoNT + fillers + skin boosters) consistently outperform monotherapy. Combining a full-face Botox and filler yields synergistic benefits:

• BoNT‑A reduces muscle movement, which permits more precise filler placement with smaller volumes and reduces microextrusion.
• Fillers restore volume in areas where tissue loss is the primary contributor to aging signs (e.g., cheeks, nasolabial, and marionette folds).

Clinical consensus supports administering filler first, followed by BoNT‑A, either within the same session or spaced by 1‑2 weeks. 

Dosage Guidelines and Unit Mapping for Full-Face Botox

BoNTA is reconstituted by adding 1-5 mL of preservative-free 0.9% NaCl to a 100-unit vial.⁶

Lower dilution (e.g., 1 mL/100 U) results in a more concentrated solution, ideal for deeper muscles like the masseter where diffusion must be controlled. Higher dilutions (e.g., 2.5 mL/100 U) allow greater spread and are preferred for superficial targets like the frontalis.

However, individual target area dosing demands a detailed understanding of facial anatomy. 

In addition, the treatment efficacy depends not only on appropriate full-face Botox units but also on the injector’s ability to assess muscle mass, function, and dynamic lines in both repose and motion. 

Full-Face Botox Outcomes 

Full-face Botox treatments, when executed with anatomical precision, provide clinically validated aesthetic and functional outcomes. The following outcomes have been reported in the literature:²

• Reduction in dynamic rhytids (e.g., forehead lines, crow’s feet, and glabellar lines)
• Improved facial symmetry, especially in cases of unilateral hypertonicity or asymmetry
• Softening of perioral aging signs, including barcode lines and oral commissure descent
• Lift in specific areas such as the brows (chemical brow lift) or jawline (Nefertiti lift)
• Refinement of lower facial contour, particularly with masseteric and DAO modulation
• Improved skin texture and pore size (when applied intradermally via microtoxin techniques)
• Reduction in facial flushing and seborrhea, through Botox’s effect on acetylcholine-mediated glandular activity

Safety Profile of Full-Face Botox and Contraindications

BoNT-related complications are largely technique-dependent. The most frequently encountered reactions are erythema, edema, injection-site pain, ecchymosis, and headaches and migraine. Additional mild reactions include anxiety, vasovagal episodes, paresthesia/dysesthesia, and allergic responses, which require post-procedure monitoring.

More serious adverse events are due to unintended diffusion of BoNT into adjacent musculature. These include:²

• Blepharoptosis (1-5% incidence)
• Eyebrow ptosis or asymmetry
• Unnatural facial expression
• Difficulty in eye opening
• Functional disturbances in articulation or mastication, especially when treating lower facial muscles

Other systemic and less common adverse outcomes include nasopharyngitis, sinusitis, blurred vision, gastrointestinal upset, voice alteration, limited oral aperture, and muscle stiffness or atrophy.

BoNT is also contraindicated in the following clinical contexts:²

• Myasthenia gravis and Lambert–Eaton myasthenic syndrome
• Amyotrophic lateral sclerosis (ALS)
• Pregnancy and lactation
• Known hypersensitivity to botulinum toxin or its excipients, including cow’s milk protein in abobotulinumtoxinA

Other relative contraindications include:

• Unrealistic patient expectations
• Body dysmorphic disorder (BDD)
• Keloidal tendencies or hypertrophic scarring
• Active infection or dermatologic disease at the treatment site
• Localized motor weakness such as Bell’s palsy

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FAQs

How Many Units Are Needed for Full-Face Botox?

A range of 50-180 units has been used in clinical reports for full-face Botox.⁷ The exact dosage, however, depends on the specific Botox product used, the facial areas being treated, and the severity of the condition being addressed.

How Much Does Full Face-Botox Cost?

According to the American Academy of Facial Esthetics, providers charge between $10-$30 per unit.⁸ Since full-face Botox treatments require using 50-180 units, the cost for a full-face Botox can range between $500 and $5,400. 

How Long Does Full-Face Botox Last?

Full-face Botox generally lasts 3-4 months. However, results can vary, with some patients experiencing effects for 4-6 months, while others may notice a shorter duration of around two months.⁹

References

1. Inoue K, Fujinaga Y, Watanabe T, et al. Molecular composition of Clostridium botulinum type A progenitor toxins. Infection and immunity. 1996;64(5):1589-1594. doi:https://doi.org/10.1128/iai.64.5.1589-1594.1996
2. Hong SO. Cosmetic Treatment Using Botulinum Toxin in the Oral and Maxillofacial Area: A Narrative Review of Esthetic Techniques. Toxins. 2023;15(2):82. doi:https://doi.org/10.3390/toxins15020082
3. Yi KH, Lee JH, Lee K, Hu HW, Lee HJ, Kim HJ. Anatomical Proposal for Botulinum Neurotoxin Injection Targeting the Platysma Muscle for Treating Platysmal Band and Jawline Lifting: A Review. Toxins. 2022;14(12):868. doi:https://doi.org/10.3390/toxins14120868
4. Sundaram H, Liew S, Signorini M, et al. Global Aesthetics Consensus. Plastic and Reconstructive Surgery. 2016;137(5):1410-1423. doi:https://doi.org/10.1097/prs.0000000000002119
5. Molina B, David M, Jain R, et al. Patient Satisfaction and Efficacy of Full-Facial Rejuvenation Using a Combination of Botulinum Toxin Type A and Hyaluronic Acid Filler. Dermatologic Surgery. 2015;41(Supplement 1):S325-S332. doi:https://doi.org/10.1097/dss.0000000000000548
6. Dover JS, Monheit G, Greener M, Pickett A. Botulinum Toxin in Aesthetic Medicine: Myths and Realities. Dermatologic Surgery. 2018;44(2):249-260. doi:https://doi.org/10.1097/DSS.0000000000001277
7. D’Emilio R, Rosati G. Full‐face treatment with onabotulinumtoxinA: Results from a single‐center study. Journal of Cosmetic Dermatology. 2019;19(4):809-816. doi:https://doi.org/10.1111/jocd.13130
8. Budgeting for Botox-AGD Impact – AAFE – American Academy of Facial Esthetics Blog. AAFE – American Academy of Facial Esthetics. Published 2015. https://facialesthetics.org/budgeting-for-botox-agd-impact/
9. Smita Ramanadham M | WO, Tuesday N 12. How long does Botox last? American Society of Plastic Surgeons. https://www.plasticsurgery.org/news/blog/how-long-does-botox-last