Seven-Site Facial Contouring with Botulinum Toxin Alone: A Practical Framework

More aesthetic patients now ask for changes in facial contour: a smaller face, a sharper jawline, and less sagging. Botulinum toxin (BoNT) is best known as a treatment for wrinkles, but it can also be used for modifying facial contour. With BoNT alone, a wide face can be made narrower, a heavy lower face can be made lighter, sagging on the jawline can be reduced, and a short chin can be corrected. Many physicians already do this, but each site is taught and studied on its own. This review brings the sites together under the name "contouring BoNT". It describes seven sites: five muscles (masseter, temporalis, platysma, depressor anguli oris, mentalis) and two salivary glands (parotid, submandibular). The seven sites work in three ways: reducing the volume of a muscle or gland, removing a downward pull so that the face looks lifted, and relaxing an overactive muscle that changes the shape of the chin. All three serve one goal that patients describe in their own words: a smaller and lifted face. For each site, the review explains what it does to the contour, who is a good candidate, who needs caution, the published dose range and the authors' practice, and which neighboring site changes when the target is treated. It explains which sites are checked together and how each is examined. Two safety points specific to contouring-the immunogenicity of large repeated doses, and salivary gland treatment-are discussed separately. The framework provided is a checklist for assessment, not a rule stating that every patient needs all seven sites to be treated.