# Neurotoxin placement maps — dose · dilution · where the needle goes

> **DRAFT learning aid (renders in Obsidian).** Typical consensus doses — **NOT a protocol**.
> Most aesthetic uses beyond the glabella are **off-label**. Units are **product-specific and never
> interchangeable**. Confirm every dose in the current **SmPC / Ficha Técnica (CIMA)** before use.
> Companion to `toxins.md` (taxonomy/mnemonics) and `neurotoxin-map.xlsx` (sheets
> **03 Unit Equivalence**, **04 Reconstitution/Dilution**, **12 Volume on a 1 mL syringe**).
>
> **Mnemonics for these doses → `mnemonics.md` §1** · recall deck (spaced repetition) → `recall.md` (`#flashcards/toxins`).

---

## 0. The one rule

**Think in UNITS first → then convert to mL → then to syringe marks.** Never copy a *volume*
across products. The number of units for a zone is fixed by the muscle; the *volume* that carries
those units changes with the product and the dilution.

---

## 1. The two unit families (this is where people get hurt)

| Family | Products (INN → brands) | Numeric relation | Standard conc | Glabella dose |
|---|---|---|---|---|
| **IU-type** | onaA *Botox/Vistabel* · incoA *Xeomin/Bocouture* · letiA *Letybo* · praboA *Jeuveau/Nuceiva* | ~**1:1** among themselves (working approx, **not** identical potency) | **4 U / 0.1 mL** | **20 U** |
| **Speywood** | aboA *Dysport · Azzalure · Alluzience* | **~2.5–3 Speywood U = 1 IU-type U**; liquid **~5× more concentrated / mL** | **20 Speywood U / 0.1 mL** | **50 Speywood U** |
| **Own scale** | daxiA *Daxxify* (DU) · relaA *Relfydess* (own U) | **no validated conversion** | Daxxify 4 DU/0.1 mL · Relfydess 10 U/0.1 mL | Daxxify **40 DU** · Relfydess **50 U** |
| **Type B** | rimaB *Myobloc/Neurobloc* | **never** convert to type A | 500 U/0.1 mL | not for aesthetics |

**The Speywood trap:** at standard dilution Dysport/Azzalure/Alluzience are **20 U/0.1 mL** vs
Botox's **4 U/0.1 mL** — 5× more concentrated. A glabella point is **10 Speywood U = 0.05 mL**,
i.e. **half the volume** of a Botox point. Inject the same *volume* as Botox and you 5× the dose.

---

## 2. Dilution → what lands in 0.1 mL

Reconstitute with **preservative-free 0.9% NaCl**. Swirl (don't shake). Use within the label window.

| Product (units) | Vial | + saline | → per **0.1 mL** |
|---|---|---|---|
| **IU-type** — Botox / Xeomin / Letybo / Jeuveau | 100 U | **2.5 mL** | **4 U** |
| ↳ *concentrated* (masseter, calf, big muscles) | 100 U | 1.25 mL | 8 U |
| ↳ *dilute* (fine lines, superficial "microtox") | 100 U | 4 mL | 2.5 U |
| **Dysport** (Speywood) | 300 U | 1.5 mL | **20 Speywood U** |
| **Dysport** (Speywood) | 500 U | 2.5 mL | 20 Speywood U |
| **Azzalure** (Speywood) | 125 U | 0.63 mL | 20 Speywood U |
| **Alluzience** — RTU liquid (Speywood) | 125 U / 0.625 mL | **none** | 20 Speywood U |
| **Relfydess** — RTU liquid (own units) | 100 U/mL | **none** | **10 U** |
| **Daxxify** (DU) | 100 DU | 2.5 mL | 4 DU |
| **Myobloc** — RTU liquid (type B) | 5000 U/mL | none | 500 U |

---

## 3. Reading a dose on a 1 mL insulin (U-100) syringe

A U-100 syringe is marked **0–100 = VOLUME** (100 = 1.0 mL, each small mark = **0.01 mL**).
Those marks are **not toxin units**.

```
 0    "5"        "10"                              "50"                          "100"
 |----|----------|----------------------------------|----------------------------|
0.00 0.05 mL   0.1 mL                             0.5 mL                        1.0 mL
      ▲            ▲
      │            └─ IU-type 4 U point  (0.1 mL = 10 marks)
      └────────────── Speywood 10 U point (0.05 mL = 5 marks)
```

- **IU-type @ 4 U/0.1 mL:** 1 U = 0.025 mL → **4 U = 0.1 mL = the "10" mark**.
- **Speywood @ 20 U/0.1 mL:** **10 Speywood U = 0.05 mL = the "5" mark**.
- **Relfydess @ 10 U/0.1 mL:** 10 U = 0.1 mL = the "10" mark.

---

## 4. Special cases — read these before you switch product

| Product | Format | Units | Glabella (label) | Watch out |
|---|---|---|---|---|
| **Relfydess** (relaA, Galderma) | **RTU liquid** 100 U/mL | own potency U | 50 U = 5 × 0.1 mL | Own units — **no** conversion to onaA/Speywood. **Not** the same as Alluzience. |
| **Alluzience** (aboA, Galderma/Ipsen) | **RTU liquid** 200 Speywood U/mL | Speywood | 50 Speywood U = 5 × 0.05 mL | Speywood units = same scale as Dysport/Azzalure. Don't add saline. |
| **Innotox** (Medytox) | RTU liquid | local U | — | **Grey-market** in EU/US; ~1:1 claimed but unverified. Not authorised. |
| **Daxxify** (daxiA, Revance) | powder → 2.5 mL | DU | **40 DU = 5 × 8 DU** | Own DU; **long duration ~6 mo** → unwanted effects last longer too. |
| **Myobloc/Neurobloc** (rimaB) | RTU liquid 5000 U/mL | type B U | not aesthetic | Type B — **never** convert to type A; low pH = stings; therapeutic use only. |

---

## 5. Placement maps (ASCII)

Legend: **●n** = injection point n. Diagrams are schematic (front view unless noted); labels are the
numbered list under each. Doses are **IU-type / Speywood**. Glabella also lists Relfydess (relaA) and
Daxxify (DU) since those carry aesthetic labels; other zones use IU-type or Speywood only.

### 5.1 Glabella — frown (procerus + corrugators) · **deep IM, needle ⟂**
```
        ●1
    ●2      ●3
   ●4        ●5
  ‾‾‾‾      ‾‾‾‾
  brow      brow
```
- **1** procerus — midline, at the frown "X".
- **2,3** corrugator **head** — just above the medial brow.
- **4,5** corrugator **tail** — on the mid-pupil line, keep **≥1 cm above the orbital rim**.

| | total | per point |
|---|---|---|
| IU-type | 20 U | 5 × **4 U** = 0.1 mL |
| Speywood | 50 U | 5 × **10 U** = 0.05 mL |
| Relfydess | 50 U | 5 × 10 U = 0.1 mL |
| Daxxify | 40 DU | 5 × 8 DU |

**Danger:** lateral corrugator too low / lateral / superficial → seeps to **levator palpebrae → eyelid ptosis**. Stay high, medial to the mid-pupil line, ≥1 cm above the rim.

### 5.2 Forehead — frontalis (horizontal lines) · **superficial/mid, small aliquots**
```
  ●1   ●2   ●3   ●4   ●5   ●6
 ─────────────────────────────
  \______ brow line ______/
```
- One row across the **upper** frontalis, **≥2 cm above the brow** (4–8 points).

| | total | per point |
|---|---|---|
| IU-type | 6–15 U | 2–3 U (4–8 pts) |
| Speywood | 15–40 U | ~6 U |

**Danger:** **never treat the frontalis without the glabella** — unopposed depressors drop the brow. Stay high (brow ptosis if too low); a heavy lateral dose → **Spock/Mephisto brow** (soften with 1–2 U in the lateral tail).

### 5.3 Crow's feet — lateral orbicularis oculi (per side) · **very superficial (intradermal)**
```
   rim
    |   ●1
 (eye)  ●2
    |   ●3
       lateral →
```
- 3-point vertical fan, **~1.5 cm lateral to the orbital rim**, outside the bony margin.

| | per side | per point |
|---|---|---|
| IU-type | 12 U | 3 × 4 U = 0.1 mL |
| Speywood | 30 U | 3 × 10 U = 0.05 mL |

**Danger:** stay **lateral to the rim**. Too anterior/low → **zygomaticus** (lip droop, asymmetric smile); keep ≥1 cm from the lateral canthus; too deep/medial → rare diplopia.

### 5.4 Bunny lines — nasalis (per side) · **superficial**
```
    \    /
   ●1    ●1
     \  /
    nose
```
- One point high on **each upper lateral nasal sidewall** (nasalis).

| | per side |
|---|---|
| IU-type | 2–5 U |
| Speywood | 5–10 U |

**Danger:** keep it **high** on the sidewall — drift down/lateral hits **LLSAN** → lip/smile droop.

### 5.5 Masseter — jaw slimming / bruxism (per side) · **DEEP IM, to muscle**
```
  tragus
  ·········
  : ●1  ●2 :
  :  ●3 ●4 :
  :   ●5   :
  ·········
  angle  jaw
```
- **Safe box = lower masseter:** below a line **tragus → mouth corner**, above the **mandibular border**, between the muscle's anterior/posterior borders. Have the patient clench to outline it first. Space points ~1 cm.

| | per side | technique |
|---|---|---|
| IU-type | 20–40 U | 3–5 pts; many use **concentrated 8 U/0.1 mL** (100 U + 1.25 mL) → ~0.25–0.5 mL/side |
| Speywood | 50–150 U | 3–5 pts |

**Danger:** stay **low and posterior**. Too high/anterior/superficial → **risorius/zygomaticus** → asymmetric smile; too superficial → paradoxical bulging. Inject to muscle, then withdraw slightly.

### 5.6 Lip flip — upper orbicularis oris · **very superficial, at the vermillion border**
```
   ●1  | |  ●2
  ●3  cupid  ●4
  ‾‾‾ upper lip ‾‾‾
```
- 4 micro-points on the **upper vermillion border**: 2 at the cupid's-bow peaks, 1 each lateral. `| |` = philtral columns.

| | total | per point |
|---|---|---|
| IU-type | 2–4 U | ~0.5–1 U × 4 |
| Speywood | 4–8 U | ~1–2 U × 4 |

**Danger:** **cap ~4–6 U total.** More, or too lateral (corners), → **oral incompetence** (straw/speech/whistling). Tiny superficial aliquots only.

### 5.7 DAO — depressor anguli oris, downturned corners (per side) · **deep, near the jawline**
```
   ◡ corner
    \
     ●1
  ___\___ jaw
```
- One **deep** point ~1 cm **lateral** and slightly **below** the oral commissure, down on the mandibular border (DAO belly).

| | per side |
|---|---|
| IU-type | 2–5 U |
| Speywood | 5–10 U |

**Danger:** keep it **low and lateral** on the jaw. Too medial/superior → **depressor labii inferioris / orbicularis** → asymmetric smile, lower-lip weakness.

### 5.8 Mentalis — chin dimpling / "pebble chin" · **deep, low on the chin apex**
```
  ‾‾ lower lip ‾‾
     ●1  ●2
    \  chin  /
     \______/
```
- 1–2 points **low** on the chin prominence (pogonion), deep into the mentalis apex.

| | total |
|---|---|
| IU-type | 4–8 U (1–2 pts) |
| Speywood | 10–20 U |

**Danger:** stay **low**. Too high/superficial → **depressor labii** / oral incompetence, lower-lip droop.

### 5.9 Gummy smile — LLSAN, "Yonsei point" (per side) · **superficial/mid, tiny dose**
```
     nose
    ( ●● )
  ●1  ||  ●1
     ala
```
- One point per side, **~1 cm lateral to the ala** in the nasofacial groove (LLSAN / LLS / zyg. minor convergence).

| | per side |
|---|---|
| IU-type | 1–3 U |
| Speywood | 2–5 U |

**Danger:** **very small doses.** Overdose → long/flat upper lip, asymmetry, trouble elevating the lip. Symmetry is critical — dose both sides identically.

### 5.10 Platysmal bands — neck (per band) · **superficial/subcutaneous, pinch technique**
```
  jaw ‾‾‾‾‾‾‾‾‾‾‾‾
   ●1     ●1
   ●2     ●2
   ●3     ●3
   ●4     ●4
  (band) (band)
```
- **Grasp** each visible band; inject **serially** down it — ~2 U/point, ~1–1.5 cm apart, 4–6 points/band.

| | per band | total session |
|---|---|---|
| IU-type | 10–40 U (~2 U/pt) | commonly ≤ 60–100 U |
| Speywood | — | ~25–80 U total |

**Danger:** don't over-dose or inject **deep/medial near the larynx** → **dysphagia, neck weakness**. Respect total-dose caps; pinch the band and stay subcutaneous.

---

## 6. See also
- `toxins.md` — INN ↔ brand map, name-decode, mnemonics.
- `neurotoxin-map.xlsx` → **03 Unit Equivalence** (ratios + basis), **04 Reconstitution/Dilution**
  (full per-product recon + storage + errors), **12 Volume on a 1 mL syringe** (units ↔ mL ↔ marks,
  per brand and per zone), **11 AEMPS/CIMA Spain** (what's authorised here).
- `panorama.md` — cross-catalog hub.

**Sources for the label doses above:** Relfydess EMC SmPC 100710 · Alluzience EMC SmPC 13798 ·
Azzalure/Dysport Ipsen labels · Daxxify FDA PI (761127) · Bocouture/Letybo/Nuceiva SmPCs ·
Carruthers et al. consensus. Verify the current version before clinical use.