摘要

Objectives: To share practical clinical principles for advanced BoNT-A injection techniques in the upper face, focusing on prevention and management of adverse events (AEs). Introduction: Botulinum toxin type A (BoNT-A) is widely considered the safest procedure in aesthetic medicine; however, optimal outcomes require strict anatomical knowledge, dosing accuracy and complication-prevention strategies. Materials / method: Evidence-based safety concepts derived from the literature were integrated with a long-term personal clinical practice experience. Particular attention was given to injection planning for the forehead, glabella and periocular regions, considering muscle dynamics, brow morphology and patient-related risk factors (age, laxity, prior blepharoplasty). Results: In personal practice, chemodenervation has been performed since 1998 (13,428 treatments until december 2025; maximum 38 treatments in a single patient). Eyelid ptosis represented the most relevant AE (1.3%). Key preventive measures included avoiding forehead overtreatment, maintaining injection points ≥2 cm above the eyebrow, and adopting a “two-step approach” in elderly or flat-brow patients. Updated dilution protocols and standardized dosing strategies contributed to a reduction of eyelid ptosis rate from 1.3% to 0.3% in the most recent series Conclusion: AEs related to aesthetic BoNT-A are typically temporary with complete recovery. Safety can be further improved through conservative dosing, precise anatomical targeting and staged treatment protocols, particularly in high-risk patients.