Each patient should be individually treated.  The amount of BOTOX utilized the injection sites and the areas injected vary significantly from patient to patient.  Fronto-temporal headaches alone are the most standard. 

Dilutions and Needles:

I use a 2 cc dilution. That means that the full 100 Units in a vial are going to be distributed through a 2 cc volume.  Remember not to shake the vial or you'll get a lot of bubbles.

I usually use the large 2 inch #20 needle to draw up the BOTOX into the tuberculin type syringe first then change needles to the #30 1/2 needle.  I use 30 or 40 units in each syringe.  Thus:

I may use three - six syringes on a given patient.

Sites of Injection:

As mentioned above this is going to be highly variable from patient to patient.  A general template for frontal headaches is shown in the cartoon below:

Note the black circle above the pupil.  Never inject directly above the pupillary line,, or you risk eyelid ptosis.  Similarly, do not inject near the eyebrow laterally or you will get eyebrow ptosis.

Use an arching pattern rising high up on the forehead.  The center midline green circle indicates the injection site in the proceris.  Others use two injections.  I generally use one with 4-5 units. See PowerPoint Presentation or more details

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