CATEGORY AUSTRALASIAN DENTIST 47 CLINICAL dimensional anatomy rather than simply identifying surface landmarks. The needle tip should reach the target muscle – not merely the target location. A – Angle of injection The angle at which the needle enters the skin influences both accuracy and safety. Perpendicular injections are appropriate in many areas where muscles are relatively superficial and broad. However, other regions require a more oblique approach to improve control or accommodate local anatomy. Needle angle also affects the final position of the needle tip and therefore the location of toxin deposition. Small changes in angle can alter which muscle fibres receive the product. Every injection should be deliberate, with the angle chosen according to the anatomy being treated rather than habit alone. S – Support Your non-injecting hand is just as important as the one holding the syringe. Providing gentle support to the tissues during injection improves both accuracy and patient comfort. Stabilising the skin reduces movement, allowing the needle to be placed more precisely within the intended muscle while helping to minimise discomfort during treatment. Support can also influence where the botulinum toxin travels. By applying gentle traction or compression to the surrounding tissues, clinicians can help guide the product towards the target muscle and reduce its spread into adjacent muscles. In anatomically sensitive regions, thoughtful tissue support may also assist in directing the toxin away from underlying foramina and important neurovascular structures. Support should therefore be viewed as more than simply stretching the skin. It is an active part of injection technique that improves control, enhances precision and contributes to safer, more predictable outcomes. A systematic approach reduces risk No injection technique can completely eliminate complications. Individual anatomy varies, products differ, and biological responses remain unpredictable. However, complications become far less frequent when clinicians adopt a consistent approach to treatment planning. Before every injection, pause and ask yourself: S – Am I injecting slowly? A – Do I understand this patient's anatomy? L – Am I in the correct tissue layer? A – Is my needle angle appropriate? D – Have I selected the right drug, dose and dilution? S – How can my non-injecting hand improve support, precision and control? D – Dose, drug and dilution Dose is only one part of the equation. A common misconception is that more units automatically produce better or longer-lasting results. In reality, successful treatment depends on selecting the appropriate dose for the individual patient's muscle strength, facial proportions and treatment goals. It is equally important to remember that botulinum toxin units are not interchangeable. Each formulation is manufactured using its own proprietary biological assay, meaning the labelled units are specific to that product. For this reason, clinicians routinely administer a higher numerical dose of abobotulinumtoxinA (Dysport) than they would with incobotulinumtoxinA (Xeomin) or prabotulinumtoxinA (Nuceiva), despite achieving comparable clinical outcomes. Understanding these differences is essential when changing products or interpreting published literature. Dilution also deserves consideration. Although dilution does not alter the total biological activity administered, it changes the volume delivered and may influence injection precision, tissue spread and ease of administration. The clinician should think beyond units and instead consider the relationship between drug, dose, dilution and anatomy. Conclusion Botulinum toxin complications are rarely caused by a single mistake. More often, they result from a series of small decisions that collectively influence where the product is deposited and how it affects facial movement. The SALADS framework provides a practical mental checklist that encourages clinicians to think beyond injection points and dosing charts. By considering injection speed, anatomy, depth, angle, drug selection and functional support before every treatment, practitioners can reduce complications and achieve more predictable, natural outcomes. After all, successful cosmetic injecting is not about how quickly the treatment is completed. It is about how thoughtfully it is performed. u To watch our SALADS botulinum toxin complications lecture, please sign up to our Foundation course at www.dermaldistinction.com
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