Retrograde vs spot botulinium toxin facial injection

Ann Chir Plast Esthet. 2021 Jun;66(3):223-233. doi: 10.1016/j.anplas.2020.06.006. Epub 2020 Jul 24.


Background: In this study we have based our research on botulinium toxin injection via targeted neuromuscular end plate zones, specifically in muscles with diffuse distribution of the latter. The muscular surface anatomical variety was also taken into consideration with thorough pre-injection examination of every subject.

Method: With consideration of the facial muscles anatomical variation and neuromuscular bundle distribution, we have applied the method of retrograde botulinium toxin injection on a series of 10 patients on the right side of the face with the left side as a control side, it was injected in a regular perpendicular manner in order to conclude the efficacy of targeted motor end zone injection. Using an auto-injecting syringe, we have delivered 6 Allergan units per zone (frontalis, glabellar lines of corrugator supercilii and orbicularis oculi crow's feet).

Results: On control day 8 we have noticed a more prominent effect mainly on the level of the orbicularis oculi muscle and the corrugator supercilii muscle on 9 out of 10 patients. Nine patients out of 10 needed the delivery of an additional 6 Allergan units per zone on the control side's glabellar lines and crow's feet rhytids. Where 1 out of 10 patients needed the reinjection of the control side on the glabellar lines zone.

Conclusion: The musculature of the face varies when it comes to neuromuscular plate distribution. Muscles with scattered distribution patterns show an optimal response to botulinum toxin injections when delivered in a retrograde manner. This has allowed us to achieve of optimal results while minimizing injection sites and hence pain, the use of lower dosage and hence treatment cost, as well as lowering the unwanted product dissemination to the neighboring mimic muscles.

Keywords: Aesthetic; Botulinum toxin; Esthétique; Injection points; Mode d’injection; Toxine botulique.

MeSH terms

  • Botulinum Toxins, Type A*
  • Face
  • Facial Muscles
  • Humans
  • Neuromuscular Agents*
  • Skin Aging*


  • Neuromuscular Agents
  • Botulinum Toxins, Type A