Botox areas of the face: why, how and for whom, area by area

This atlas answers three questions, area by area: why is this area treated, with which toxin, and for whom? It is based on the official product labels and on medical publications, with no promise of results. It complements our general page to understand botulinum toxin and does not replace a consultation.

The eleven areas of the atlas

Each area has its own "why and how" page, built on the same outline: the muscle involved, what the toxin does and does not treat, the approval status, who it is for, onset and duration, and risks.

The upper face:

• Forehead lines: the frontalis muscle, approved for some type A toxins.
• Frown lines: the creases between the eyebrows, the only area approved for both families of toxins.
• Eyebrows: lifting the tail of the eyebrow, off-label.
• Eyelids: an area that is protected, and why.
• Crow’s feet: the lines at the corner of the eye, approved for some type A toxins.

The mid and lower face, and the neck:

• Bunny lines on the nose: off-label.
• Gummy smile: when too much gum shows on smiling, off-label.
• Lips and lip flip: off-label.
• "Orange peel" chin: off-label.
• Masseter and jaw: off-label in France.
• Neck and platysma bands: approved in the United States, off-label in France.

How does botulinum toxin work on an area?

Botulinum toxin is injected into a muscle. It blocks the release of a chemical messenger, acetylcholine, at the junction between nerve and muscle, by cleaving a protein called SNAP-25¹. The injected muscle receives fewer signals and contracts less, locally and temporarily. The effect wears off as the nerve endings recover their function¹.

This explains what the toxin can do, and what it cannot. It softens lines that deepen when a muscle contracts: frowning, raising the eyebrows, squinting when you smile. It can also change the balance between opposing muscles, as in the eyebrow lift. On the other hand, it does not add volume, does not tighten the skin and does not act on lines caused only by skin quality. Each page states these limits for its area.

Approved or off-label: what difference does it make?

A medicine is approved for specific indications, written in its official label, called the summary of product characteristics (SmPC). For aesthetic use, all type A botulinum toxins marketed in France carry the "frown lines" indication; some also cover crow’s feet, others forehead lines^2,3,4,5,6,7. All these indications share the same condition: moderate to severe lines whose severity has an important psychological impact, in adults^2,4,5.

The other areas of the atlas are not in any French label: nose, gummy smile, lips, chin, masseter, neck, and eyebrow lift^2,4,5. An injection in these areas is an off-label use. In practice, the label then gives no dose, no timeline and no efficacy data for the area: the doctor relies on published studies and expert consensus, whose level of evidence varies from one area to another. Your doctor should tell you so.

The status may differ from one country to another. For example, in October 2024 the FDA approved a type A toxin for neck bands in the United States; this approval does not apply in France¹⁰. Each page shows the status of its area in a dated table.

Which toxin for which area?

Two families of botulinum toxins are now approved for aesthetic use in the European Union. Long-acting toxins (type A) have been used for aesthetic purposes in France since 2003³. The short-acting toxin (serotype E) has been approved in the European Union since 15 July 2026⁸, for a single indication: frown lines in adults¹. As of 29 September 2026, the date of the latest update consulted, it had no entry yet in the French public medicines database³.

Outside the European Union, its status differs. It was approved in Canada on 22 June 2026, for the same indication¹¹.

In practice:

• Frown lines: both families are approved^1,3.
• Crow’s feet and forehead: some type A toxins only^2,4,5,6.
• All other areas: no toxin is approved in France.

The two families do not have the same profile: one works faster and for a shorter time, the other more slowly and for longer. Neither is better than the other, and no trial compares them directly. The short-acting toxin gives you an additional choice for frown lines, to be made with your doctor. To find out more, see the page on the new botulinum toxin and what sets it apart.

Is it right for me? Questions common to every area

Whatever the area, some rules are shared. The approved indications concern adults^1,2. The labels contraindicate injection in case of allergy to the toxin or to a component of the product, a generalised disorder of the muscles and of the junction between nerve and muscle (myasthenia gravis, Lambert-Eaton syndrome), or an infection at the injection site^1,2,4,5. Treatment is not recommended during pregnancy or breastfeeding^1,2. Injection is not recommended in people with a history of swallowing difficulties^1,2.

Age matters too, with no single rule. Several type A toxins are indicated only in adults under 65^4,5,6, one up to 75⁷, and for others data are limited beyond 65². For the short-acting toxin, only 7% of trial patients were 65 or older, with lower response rates¹.

Finally, how much the lines bother you is part of the indication: this is not a routine procedure. Your doctor will assess the area at rest and in motion, your medical history, your treatments and your expectations.

What happens during a session?

The toxin is injected into the muscle, at a few points, by a qualified and experienced doctor¹. Doses are expressed in units, but the units of one product are not interchangeable with those of another^1,2: this is why this site never gives a dose. The name and batch number of the product injected should be recorded, for traceability^1,2.

With a type A toxin, one label provides for a review one month after the first session if no improvement is seen, and for a second session to be considered only in the absence of side effects². Sessions are at least 3 months apart^2,4. For the short-acting toxin, the label provides for occasional use; a new injection less than 6 weeks after the previous one has not been evaluated¹.

Onset and duration, in brief

For the approved areas, the labels give precise benchmarks:

• Long-acting toxins (type A): first effects usually within 2–3 days, up to one week; peak effect between week 2 and week 4; usually lasts 3–4 months, up to 6 months depending on the product^2,4,6,7,9.
• Short-acting toxin (serotype E) (frown lines only): first effects from 8 hours, peak effect around day 7, lasts 2–3 weeks¹.

For off-label areas, the labels give no timeline. The pages concerned report what studies show when they exist, and say so when no reliable data could be found.

What are the risks, whatever the area?

The labels describe injection-site reactions: pain, swelling, redness, a small bruise¹. Headaches are common with some toxins². A severe allergic reaction can occur very rarely^1,2. Each area then has its own risks: a drooping eyelid or eyebrow in the upper face, a changed smile in the lower face, for example. They are temporary and detailed on each page.

The labels also point out that the effect of the toxin can, rarely, spread beyond the injection site: any difficulty swallowing, speaking or breathing requires immediate medical attention^1,2.

If something unexpected happens after an injection, our second atlas, devoted to problems after a botulinum toxin injection, covers the same areas and explains, problem by problem, what is happening, how long it lasts and when to see a doctor.

What the toxin does not treat: when to think of something else

Botulinum toxin acts on a muscle, and only on a muscle. Many requests about the face are therefore not a matter for it, and saying so is part of honest information.

• A line visible at rest, without any movement, is mostly related to the skin: the toxin softens it less than a line that deepens with movement.
• A loss of volume (cheeks, temples, lips) cannot be corrected by relaxing a muscle.
• Excess skin, heavy eyelids, under-eye bags or sagging of the lower face call for other approaches.
• A gummy smile caused by the shape of the jaw, or a wide jaw caused by the bone, does not depend on a muscle.

In these situations, other treatments exist, medical, surgical or dental depending on the case. This site does not cover them, because it is devoted to botulinum toxin: talk to your doctor, who can refer you. Each page of the atlas states, in its first section, what the toxin does not do in that area.

Questions to ask your doctor

Before an injection, whatever the area, these questions will help you decide with full information:

1. Is this area approved for the product you are offering me, or is it an off-label use?
2. Which toxin will you use, and why this one?
3. What result is reasonable in my case, and after how long?
4. How long should the effect last?
5. Which side effects should I watch for, and whom should I contact if they occur?
6. Do my medical history, my treatments or a pregnancy plan raise any issue?
7. What alternatives exist for what I want to correct?

The answers to these questions are yours: they depend on your face, your health and your expectations, and only a doctor who examines you can give them.