Dynamic photos for botulinum toxin: expressions to record

Recording the patient before botulinum toxin is one of the most important photos in the practice, and one of the most neglected. The reason is understandable: the toxin acts on contraction, and whoever takes the photo at rest may think everything has been recorded. But the face at rest says little about the muscle. It is the photo in motion that shows where the patient frowns, how far each eyebrow rises, whether one side works harder than the other, and what the lines looked like before any application.

This page lists the expressions to record, the standard prompts and how to organize the files. The clinical side (muscles, doses, injection points) is not covered here. For the muscle map, see muscle map for botulinum toxin and botulinum toxin: fundamentals.

Why photograph in contraction?

Botulinum toxin reduces muscle contraction, and the result shows up as a decrease in dynamic wrinkles. To compare, the contraction has to be recorded beforehand. There are four practical reasons:

1. Individual pattern. Each patient contracts differently: a broad forehead, a "V" forehead, a glabella in an "11" or an "omega" shape.
2. Prior asymmetry. An eyebrow that rises more than the other exists before the toxin, and must be on record.
3. Reference for the effect. Without the before photo in contraction, assessing the effect is just an impression.
4. Documentation as protection. A prior record of movement protects you in case of a complaint about asymmetry or ptosis (asymmetry after botox).

Which expressions make up the set?

In visits focused on the forehead and glabella, the first three are enough. In visits that include the sides of the eyes, the last two are added. Each has its own details in photo of the forehead raising the eyebrows, photo of the glabella in contraction and photo of crow's feet in a forced smile.

How do I ask for each expression?

The prompt decides the photo. Vague prompts ("make an angry face") produce different expressions every time. Standardize:

• "Relax your face and look at the wall." (rest)
• "Raise your eyebrows as high as you can and hold." (forehead)
• "Frown as if you were concentrating and hold." (glabella)
• "Squeeze your eyes shut, as if soap got in them, and hold." (eyes)
• "Smile as wide as you can, showing your teeth." (smile)

Demonstrate the expression if needed. The patient learns the gesture in one try and repeats it more precisely at later visits. If they cannot isolate the movement (raising only one eyebrow, for example), record the limitation. The logic of rest and movement is in rest photo and dynamic photo.

How do I keep framing and light consistent?

For dynamic photos, the framing is the same as the frontal: whole face, camera at eye level, fixed distance. Diffuse, frontal light without flash keeps the wrinkle from gaining an exaggerated shadow. With light from above, the vertical glabella line and the horizontal forehead lines look deeper; side light creates shadow inside each line. See light for clinical facial photos and shadow on the face.

Hair needs to be away from the forehead. Bangs cover the forehead lines and ruin the photo (hair pulled back in clinical photos). And the patient should have no makeup or concealer on the lines, which fill them in.

What about video?

A short video of 10 to 15 seconds, with the expressions in sequence, complements the photos and shows the full movement, including the moment of maximum contraction and the return to rest. It requires specific consent, as in consent for clinical video, and the technique is in video to assess facial dynamics. From the video you can extract the frame of maximum contraction, which works as a reference photo.

How do I organize the follow-up?

The follow-up is only comparable if the conditions repeat: same prompts, same sequence, same light. The timing of the follow-up photo is the professional's decision, depending on the product and the patient; the organization is in when to take the follow-up photo. Compare rest with rest and contraction with contraction.

Also note what the patient reports. A complaint of "it didn't work" calls for comparing the follow-up contraction photo with the before (failure to respond to toxin).

What should I tell the patient?

Which mistakes should I avoid?

• Photographing only rest.
• Using different prompts between visits.
• Leaving bangs or makeup over the lines.
• Accepting an expression without maximum contraction or without holding it.
• Not labeling the files.
• Keeping movement and rest photos in the same folder without distinction.

The dynamic photo is what gives meaning to the result photo. Whoever records it well can answer, months later, a question that memory cannot: what changed?