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Treating Botox Patients With A Small Forehead

We were recently asked an interesting question about treating botox patients with small foreheads. This is a fairly common scenario so we wanted to set out the special considerations new injectors should be aware of here.

Aesthetics specialist, registered nurse prescriber, practice owner and Harley Academy clinical trainer, Shantel Noble has some great advice for you...



There is an increased ptosis risk when treating botox patients with small foreheads. This is due to injectors not having a safer distance between the lower frontalis muscle fibres and the treatable area.

What is the best approach for a botox patient with a small forehead?

When treating a smaller forehead, place your injection points safely above the 2cm rule. If this means along the hairline or within the hair then so be it.

Be conservative with the dosing upon first treatment; stick to the lower end. You can increase once your patient’s muscles become a little more predictable for you, from experience.

Consider all other ptosis risk factors the patient may also have to further determine your dose.


Please give us your top 3 tips for treating these types of patients…

  1. Assess other risk factors alongside the forehead size, such as frontalis hyperactivity, hooding, low set eyebrows or increased skin laxity above the eyes. This can help you to determine whether to treat the forehead at all or whether a smaller or larger dose can be used. Patient selection is key, so ensure you assess them thoroughly.
  2. If you do decide to treat, continue to stick to the 2cm rule, ensuring your injection points are at the very least 2cm above the orbital rim.
  3. Do not determine forehead size based upon eyebrow positioning. Some patients may have microbladed (tattooed), drawn-on or otherwise cosmetically altered eyebrows. Therefore, for accuracy, it’s best to ascertain the size of the forehead by palpating the orbital rim.



If you’re a doctor, dentist, nurse or midwife interested in learning how to safely administer cosmetic botulinum toxin, we have a range of Botox and Dermal Filler training courses for you to choose from.

Whether you’re a total novice wanting to find out more, a beginner looking to dip their toe into the waters of aesthetic medicine, or an intermediate – or even advanced – practitioner wanting to obtain our widely-respected, Ofqual-regulated Level 7 Diploma qualification in injectables, we can help.

Download our prospectus or simply give us a call so we can answer any questions you may have.

Make getting #HarleyTrained easier with the help of our head of student recruitment; book a call with Deneal Basi today. He knows our roster of leading aesthetics training courses inside and out, so can help you to find your perfect match.