Revealed! BOTOX Off-Label Uses - The Bend Magazine

Revealed! BOTOX Off-Label Uses

Botox is known for its magical ability to smooth wrinkles, but is that all?

By: Angelica Jackson, Halcyon Med Spa

Botox is known for its magical ability to smooth wrinkles. Lately, more people are using it as a preventive measure to avoid deep, static rhytides (facial lines that you see even when your face is at rest). Once those lines are deeply formed, it takes multiple modalities to reverse unwanted lines.

Given the widespread popularity of Botox, it may surprise you to learn that until recently, the only on-label indications for Botox were for the glabellar complex, (the 11s) and the lateral canthal rhytides (crow’s feet)! An on-label treatment means that the FDA has cleared a drug for a planned use. FDA-approved prescription drugs are often prescribed by clinicians for off-label indications/uses beyond what the FDA has approved. It was not until 2017 that the FDA awarded approval for on-label indication for the frontalis muscles that cause horizontal rhytides, or wrinkles on the forehead. Needless to say, Botox has been used to treat forehead lines for quite a while now.

Before we go any further, let’s sum up the on-label vs. off label uses.


  • Glabellar complex (the 11s)
    Lateral canthal rhytides (crows feet)
    Frontalis rhytides (horizontal forehead lines)


  • Masseter (TMJ and jaw slimming
    Orbicularis Oris (brow lift)
    Orbicularis Oris (smokers lines and lip lift)
    Gingival smile (reduce visible gums in smile)
    Vertical rhytides on nasal bridge (bunny lines on nose)
    Lower face muscles (multiple corrections possible)

Regardless of whether your treatment is on- or off-label, Botox should only be administered by trained medical professionals with advanced degrees and a profound understanding of your complex facial anatomy.  Be certain of the credentials held by your injector, and if you’re not sure, don’t be reluctant to ask. A licensed injector with prescriptive authority will be able to address any adverse reactions you may have to the the drug. For even more peace of mind, ask to see before/after photos of past clients. As with any cosmetic medical procedure, the most important criteria is confidence in knowing that your provider has a mastery of the technique.

Off label, explained

Masseter (TMJ and jaw slimming)

Botox injections into the jawline for conturing and treatment of TMJ are common in our practice. Jawline contouring and facial slimming were popularized by the Kardashian sisters and have become mainstream. Injections in the large muscle of the jaw, the masseter, will help treat pain from Temporalmandibular Joint disorder (TMJ), clenching and teeth grinding.  This injection causes that large muscle to atrophy. Over time, the masseter is used less and the square jaw softens into a softer oval shape, resulting in a slimming appearance.

Orbicularis Oculi (brow lift)

In a like manner, a brow lift can be done with just a couple of units of Botox and the correct technique.  By injecting a muscle that pulls down near the eye, this muscle will no longer contract, thereby allowing the brow to lift freely. If not performed by a clinician with advanced anatomical training, patients risk complications like a drooping eyelid. Only a skilled injector should place the neurotoxin into the target muscles.

Orbicularis oris (smokers lines and lip lift)

Popularly known as a lip lift, small units injected into the orbicularis oris that encircles the mouth can erase perioral rhytides (smoker’s lines), creating the appearance of a fuller lip. Paired with filler, patient-satisfaction is very high for this procedure.

Gingival smile (reduce visible gums in smile)

In the same way, over-active mid-facial muscles that cause a gingival smile, also known as a gummy smile, are very effectively treated. Botox relaxes the targeted muscles to produce a smile that stops right above the teeth. Personally, I use Botox to treat this concern on my own face and am very satisfied with the effect.

Vertical rhytides on nasal bridge (bunny lines on nose)

Bunny lines on the nasal bridge can be seen when laughing, wrinkling the nose or mid-sneeze.  The can be treated quite easily with Botox.

Lower face muscles (multiple corrections possible)

Normal muscular contractions in the lower face cause a pulling action. They pull down at corners of your mouth, worsen marionette lines and chin dimpling, and cause unsightly bands on the neck. The result is a falling appearance associated with aging.

The lower face muscle sets that contribute to a patient’s particular facial aging concern are complex. Only a skilled injector should place the neurotoxin into the target muscles. A mistake could cause complications like a crooked smile.

Avoid risk

Despite it’s magical ability to turn back the clock on wrinkles, Botox injection is a medical procedure and should be taken seriously to avoid complications. Many people do not realize only a Medical Doctor, Physician Assistant or Nurse Practitioner can legally prescribe your number of units for injection. These medical providers have prescriptive authority. This is also why it’s so hard to get a price over the phone. Each individual face must be assessed to determine a treatment cost. Never buy Botox on Groupon and be wary of discount Botox parties. Unfortunately, in our practice I see many clients who require correction from improper neurotoxin placement. Not only do these individuals experience distressing consequences, they end up spending more money.

Don’t be afraid to ask questions and make sure you can see your injector draw up the product so you know what you’re getting. Look for that hologram on the Botox label and if you don’t consult with a medical provider prior to injection, your injector may be practicing outside of the law.  Be careful, you don’t want to be a guest on Botched.


Angelica Jackson is a Board Certified Physician Assistant and Master Injector at Halcyon Med Spa.  

PA Jackson completed her Master Degree of Physician Assistant Sciences at St. Francis University and was trained in Medical, Surgical and Cosmetic Dermatology.  She has received an award for her artistic skill in injecting from RealSelf. She remains at the forefront of medical cosmetic services through continuing education and training by leaders in the field, including Dr. Prather of Westlake Dermatology in Austin, Dr. Arthur Swift, Plastic Surgeon who performs testing for Botox and Juvederm, Dr. Runels, the inventor and trademark holder of the Vampire Facelift and Facial, and Dr. Chopra, Beverly Hills Plastic Surgeon to the stars.

Halcyon Med Spa is solely owned and operated by Dr. Lonnie Schwirtlich. All medical services are performed by Heather Orr, a Family Nurse Practitioner and Angelica Jackson, a Board Certified PA trained in Dermatology and an Allergen Master Injector.