Botox Protocol Starter Template

Clinic Name

Medical Director

Protocol Version

Last Reviewed

⚠ Training Use Only: This template is a starting framework for med spa owners to customize with their own protocols. It does not constitute medical advice, clinical guidance, or compliance documentation. All protocols must be reviewed and approved by your medical director. Dosing must be adapted to individual patient assessment. Not a substitute for clinical training.

01 Pre-Treatment Patient Assessment Checklist

Medical History Review

Allergies confirmed (especially albumin/eggs)
No neuromuscular disorders (ALS, myasthenia gravis)
No current infections at injection sites
Medication review completed
Blood thinners / anticoagulants noted
Muscle relaxants noted
Aminoglycoside antibiotics noted
Not pregnant or breastfeeding
Previous Botox treatments documented
Date of last treatment: ___________
Units used previously: ___________

Consultation & Consent

Patient goals and concerns discussed
Realistic outcomes explained
Common side effects reviewed
Bruising and swelling (3–7 days)
Onset timeline (3–7 days, full effect 14 days)
Duration (3–6 months typical)
Rare risks discussed (ptosis, asymmetry)
Consent form signed and filed
Before photos taken (3 angles minimum)
Frontal: neutral expression
Frontal: full expression (raise brows)
Lateral: 45 degree angle

02 Product Preparation Protocol

Reconstitution Standard

Product	Saline Volume	Result
Botox 100U	2.5 mL	4U per 0.1 mL
Botox 100U	4.0 mL	2.5U per 0.1 mL
Dysport 300U	3.0 mL	10U per 0.1 mL
Xeomin 100U	2.5 mL	4U per 0.1 mL

✦ Our clinic standard reconstitution: _______________________

Preparation Checklist

Verify product: name, lot number, expiration
Refrigerated storage confirmed (2–8°C)
Preservative-free 0.9% saline only
Reconstitute gently — do not shake
Draw up using correct syringe size
Label syringe with date, time, units/mL
Use within 24 hours of reconstitution
Record lot number in patient chart

Supplies Needed

30–32G needle

1 mL syringe

Alcohol swabs

Gauze

Ice pack

Topical numbing

03 Standard Injection Zones & Dosing Reference

Injection Point Reference

Zone	Standard Range	Our Protocol	Points	Notes
Forehead (FH)	10–20U	______U	4–6	Horizontal lines. Titrate conservatively to avoid brow drop.
Glabella (GL)	20–25U	______U	5	Between brows. Procerus + corrugators. High-demand zone.
Crow's Feet (CF)	6–12U/side	______U	2–4/side	Lateral orbicularis oculi. Stay lateral to orbital rim.
Brow Lift (BL)	2–4U/side	______U	1–2/side	Lateral brow depressor. Optional add-on. Subtle lift effect.
Bunny Lines (BN)	4–8U	______U	2–4	Nasalis muscle. Often added with glabella treatment.
Lip Flip (LF)	4–6U	______U	4	Orbicularis oris. Caution: affects speech/straws for 2–4 weeks.
TOTAL — TYPICAL FULL FACE		40–60 units (Botox / Xeomin) · 120–180 units (Dysport)

04 Treatment Procedure Checklist

Room Setup & Patient Prep

Treatment bed at 45-degree angle
Good lighting confirmed (overhead + side)
All supplies laid out and within reach
Patient hair pulled back / secured
Makeup removed from treatment areas
Topical numbing applied if requested
Wait time: _______ minutes
Skin cleaned with alcohol swab
Alcohol dried completely before injection
Treatment zones marked if using mapping

Injection Execution

Start with least sensitive zone first
Inject intramuscularly at correct depth
Aspirate if using our protocol: ☐ Yes ☐ No
Apply gentle pressure after each injection
Do not massage treatment areas
Assess symmetry between zones
Patient comfort checked throughout
After photos taken (matching before angles)
Total units used documented in chart
Lot number recorded in patient record

05 Patient Aftercare Instructions

First 4 Hours

Stay upright — no lying down
No touching or rubbing treated areas
No strenuous exercise
No alcohol
No facial massages

First 24 Hours

Avoid saunas and hot tubs
No intense cardio exercise
Sleep on back if possible
Avoid blood thinners (aspirin, ibuprofen)
Gentle cleanser only on face

Ongoing Instructions

Results visible in 3–7 days
Full effect at 14 days
2-week follow-up offered
Next appointment: 3–4 months
Contact us if any concerns

06 Common Mistakes to Avoid

Injecting too high on forehead — risks brow drop and heavy appearance
Over-treating the forehead alone — always balance with glabella
Too many units in one zone — frozen appearance, patient dissatisfaction
Massaging after injection — spreads toxin to unintended muscles

Ignoring asymmetry baseline — always document pre-existing asymmetry
Not checking brow position — assess before treating to avoid ptosis
Skipping the 2-week follow-up — this is where you assess and touch up
Under-documenting — exact units per zone must be in the chart

07 Treatment Sign-Off & Documentation

Provider Name

Provider Signature

Date of Treatment

Total Units Used

Product Lot Number

Next Appointment

Notes / Variations from Standard Protocol