Treatments · Treatment guide · Injectables
Botox and neurotoxin in your clinic: records, dosing and aftercare
How a clinic documents and runs neurotoxin treatment: the injection record, consent and screening, what the label says about dosing, and the aftercare sheet clients need afterwards.
- Labeled upper-face total
- 64 units (20 glabella, 20 forehead, 24 crow's feet)
- Units are product-specific
- Not interchangeable with other toxins
- Re-treatment
- Not evaluated more often than every 3 months
- Off-label areas
- Masseter, brow lift, lip flip, chin, bunny lines
What to record
Record the product by brand (units differ between products), the lot number and expiry, the dilution, the units by area, and the injection sites on a face diagram. Note the assessing prescriber as well as the injector. Consent to treat the forehead is not consent to treat the masseters, so the areas and units belong on the record before the treatment, not after.
A touch-up is a separate, dated entry. Recording it separately keeps the original treatment and the correction distinguishable when you review a patient's history.
Consent and contraindications
Name the product brand, the areas, and the planned units. State that the effect is temporary, list the common effects (pain, redness, swelling, bruising, headache, asymmetry), the less common ones (eyelid or brow drooping), and the rare serious one: spread of toxin effect causing difficulty swallowing, speaking, or breathing, which needs immediate care. Add an off-label disclosure where you treat outside the approved indications.
In most provinces neurotoxin is a prescription drug, so the form also records who assessed and ordered. Confirm your requirements with your regulatory college.
Screen for these before you treat
- Pregnant, trying to conceive, or breastfeeding
- Neuromuscular condition such as myasthenia gravis or Lambert-Eaton syndrome
- Allergy to a botulinum toxin product or its ingredients
- Infection, cold sore, or skin condition at the injection sites
- Botulinum toxin treatment in the last 3 months
- Antibiotics, blood thinners, or other interacting medication
- An event, dental work, or surgery in the next two weeks
Botox treatment protocol: dosing by area
BOTOX Cosmetic is dosed in product-specific units. The labeled doses below come from the U.S. prescribing information our unit calculator uses, and they are fixed reference doses rather than values to scale by a strength category. A qualified injector still individualises treatment after assessing anatomy, prior response, goals, contraindications, and adjacent muscle activity.
- Glabellar lines: 20 units.
- Lateral canthal lines (crow's feet): 24 units.
- Forehead lines: 40 units, treated together with glabellar lines (20 units in each area).
- All three upper-face areas at once: 64 units.
- Platysma bands: 26, 31, or 36 units depending on whether one or two vertical bands are treated per side.
- Masseter slimming, brow lift, lip flip, chin dimpling, and bunny lines are off-label. Planning ranges for those come from expert consensus literature, not the label, and should be documented as off-label.
Course of treatment
Effect duration varies by indication, dose, anatomy, and prior response. The prescribing information states that the safety and effectiveness of dosing more frequently than every three months have not been clinically evaluated, so plan the return visit around that and around the client's response, not around a fixed number of visits a year.
Book a review visit so any touch-up is a dated, documented decision rather than a quiet top-up.
Aftercare you send
The most searched Botox aftercare question is what not to do. Answering it in writing, with the reasons, gets more of it followed. The sheet also carries the one thing that must not be missed: difficulty swallowing, speaking, or breathing, or widespread weakness, means emergency care. Timings such as how long to stay upright or avoid exercise differ between injectors, so the sheet leaves room for yours.
Running this in Zdrovia
In Zdrovia, neurotoxin units are recorded by area, lot, and expiry as you chart, so vial reconciliation stops being a monthly spreadsheet. Attach the aftercare sheet to the service as its post-visit instruction and it reaches every patient through their portal or by message.
See how Zdrovia is set up for med spas.
Frequently asked questions
How many units of Botox for the upper face?
The FDA-labeled upper-face combination is 40 units for the forehead together with the glabella (20 in each) and 24 units for crow's feet, totalling 64 units. Off-label areas use separate literature-based ranges and need assessment by a qualified injector.
How often can neurotoxin be repeated?
The prescribing information states that dosing more frequently than every three months has not been clinically evaluated. Duration varies with dose, anatomy, and the individual's response.
Is masseter Botox on-label?
No. Masseter slimming is off-label. Document that it was explained to the patient and that they agreed, as the consent template does.
What should Botox aftercare cover?
What to avoid in the first hours and days, what is normal (small bumps, mild redness, occasional bruising), when the result develops, when to book a review, and the symptoms that mean call the clinic or seek emergency care.
Related
- Charting injectable treatments properly
- Injectable inventory: lot and expiry
- Photo consent form template
- All treatment guides
This guide summarises published figures and common documentation practice for clinics. It is not clinical or legal advice. Dosing, depth, and device settings are decisions for the treating practitioner, the manufacturer's instructions, and your medical director's protocol, and scope of practice varies by province and profession. Confirm anything you rely on with your regulatory college.