BOTOX Off-Label

Off-label uses of BOTOX and dermal fillers refer to treatments not specifically approved by the FDA. Despite lacking FDA approval, qualified injectors have safely and effectively used these treatments for years, ensuring pleasing aesthetic results through careful application and expertise in off-label usage.

What does FDA-approved mean?

FDA-approved signifies thorough analysis by the U.S. Food and Drug Administration, confirming safety and efficacy for a specific condition or use, outweighing potential risks.

What does off-label use mean?

Off-label use refers to the utilization of an FDA-approved product or treatment for purposes not specified in its approval documentation. While the FDA regulates approval, healthcare professionals can prescribe treatments for any medical or cosmetic purpose. Educated injectors prioritize patient safety and optimal outcomes.

Are injectables used in an off-label manner?

Yes, dermal fillers and neuromodulators are frequently used off-label due to the extensive range of potential applications. While manufacturers seek narrow FDA approvals, injectors may also substitute FDA-approved products with similar effects. Off-label use is acceptable if the product has demonstrated safety and desirable outcomes.

Following is a list of common and effective off-label injectable treatments

Off-label Dermal Filler Uses:

  • Upper Eyelid Hollows: Adds volume for a youthful appearance.
  • Lower Eyelid Hollows (Tear Troughs): Disguises dark circles and “bags” for a refreshed look.
  • Ear Lobes:Plumps and smoothens wrinkled and stretched lobes.
  • Oral Commissures (Corners of the Mouth):Corrects downturned corners.
  • Pre-Jowl Sulcus:Fills hollows between cheek and chin for a smoother jawline.

1. Gummy Smile Correction with Botox

A gummy smile, characterized by excessive gum exposure when smiling, can be discomforting. Dental and cosmetic experts advocate for an ideal smile with minimal gum display. Botox injections can address this by relaxing hyperactive lip muscles and reducing gum exposure during smiles. This simple procedure offers temporary results lasting three to four months.

2. Jawline Contouring (TMJ and jaw slimming)

Botox injections into the masseter muscle can sculpt the jawline by relaxing overactive muscles, reducing the appearance of a square jaw. At Aesthetic Envy, we specialize in jawline contouring and facial slimming, offering treatments popularized by celebrities like the Kardashian sisters.

In addition to cosmetic enhancement, these injections effectively alleviate pain from TMJ disorder, teeth clenching, and grinding by inducing muscle atrophy over time. This results in a slimmer, more oval-shaped jawline, providing both aesthetic and therapeutic benefits. The effects typically last four to six months, offering long-lasting results.

3. Bunny Lines Treatment

Botox injections effectively target bunny lines, the wrinkles that form on the sides of the nose during smiling or facial expressions. These lines, visible on the nasal bridge during laughter or nose wrinkling, can be smoothed out with Botox injections, providing a more youthful and refreshed appearance.

Off-label Neuromodulator Uses

  • Vertical Lip Lines: Smooth lines for a hydrated look.
  • TMJ and Headache Relief: Relieves tension in jaw muscles.
  • Oral Commissures:Prevents drooping outer mouth corners.
  • Dimple Release:Relaxes chin muscles, causing dimples.
  • Pre-Jowl Sulcus:Fills hollows between cheek and chin for a smoother jawline.
  • Nose Lift:Elevates the nose tip to prevent dipping.
  • Brow Lift:Shapes and elevates lower brows.
  • Lip Flip:Increases upper lip size.
  • Gummy Smile Treatment:Reduces excessive lip lifting when smiling.
  • Face Slimming:Reduces masseter muscle projection for a slimmer appearance.

4. Neck Bands Treatment

Botox injections effectively target neck bands caused by the platysma muscle, reducing their appearance without surgery. By relaxing the muscles, Botox smooths out both vertical neck cords and horizontal lines, rejuvenating the neck for a more youthful look.

5. Lip flips

Lip flips are a cosmetic procedure designed to enhance the appearance of the upper lip, creating the illusion of increased fullness. This involves the strategic injection of Botox into the muscles responsible for upper lip movement, prompting a subtle upward flipping motion.

6. Chin Dimples Treatment

Botox injections effectively relax the muscles responsible for chin dimples, smoothing out divots or an “orange peel” appearance on the chin.

7. Orbicularis Oculi (Brow Lift)

A brow lift can be achieved with minimal Botox units and precise technique, targeting the muscle near the eye to prevent downward contraction, resulting in a lifted brow. Skilled injection is vital to avoid complications.

8. Orbicularis Oris (Smokers’ Lines and Lip Lift)

Injecting small units of Botox into the orbicularis oris muscles surrounding the mouth erases perioral rhytides (smoker’s lines) and enhances lip fullness, often paired with filler for optimal results.

9. Lower Face Muscles (Multiple Corrections)

Botox targets lower face muscles to address various concerns like downturned mouth corners, marionette lines, chin dimpling, and neck bands, restoring a youthful appearance. Precise injection by a skilled provider is crucial to avoid complications.

10. Acne Treatment with Botox

Botox injections for acne control block acetylcholine in the skin, reducing oil production and bacteria growth, leading to fewer breakouts and clearer skin. Intradermal injections can also decrease sebum production and minimize pore enlargement for adult acne treatment.

11. Jelly Rolls

What Are Jelly Rolls?

Jelly rolls refer to tense muscles under the eyes, often caused by frequent squinting or smiling. Under-eye BOTOX relaxes these muscles, reducing or eliminating the jelly roll appearance by stopping muscle movement. This safe and effective treatment offers lasting results, surpassing the efficacy of over-the-counter skin care products.

Why Is Under-Eye BOTOX an Excellent Treatment for Jelly Rolls?

Under-eye BOTOX effectively treats jelly rolls by relaxing tense muscles and softening their appearance. By stopping muscle movement it diminishes the jelly roll when squinting or smiling. This safe and lasting treatment provides superior results compared to over-the-counter skin care products, requiring maintenance every four to six months.

12. Botox for a Wide Nose/Flared Nostril Botox

People have varied opinions on the ideal nose shape. Traditional nose surgery (rhinoplasty) used to be the primary solution for those unhappy with wide nasal bases and flaring nostrils. However, non-surgical options like Botox are gaining popularity.

Can Botox Fix a Wide Nose?

Botox can address a wide nose by targeting the muscles responsible for pulling the nostrils sideways and the nose tip downward. Unlike surgery, Botox alters muscle activity, not bone structure, resulting in a slimmer nose appearance.

Who Is a Good Candidate?

Men and women in good health seeking to correct nostril flaring and a drooping nose tip are ideal candidates. Botox offers a non-invasive alternative with minimal recovery time, but candidates should have realistic expectations.

Procedure Details

After skin cleansing and topical anesthesia, a medical professional injects Botox into specific muscles using a thin needle. The procedure is brief, typically lasting under 30 minutes, and requires no downtime.

Where Do You Inject Botox for a Wide Nose?

Botox is injected into muscles such as the dilator naris posterior and depressor septi-nasi to address nostril flaring and a drooping nasal tip, respectively.

Results and Duration

Patients typically notice slimmer noses and lifted tips within a week of treatment, with results lasting 4-6 months. Maintenance treatments can extend the duration of results.

Side Effects

Common, short-lived side effects may include redness, bruising, swelling, and discomfort. When administered by skilled professionals, Botox for a wide nose is safe.


For individuals dissatisfied with their nose shape, Botox offers a subtle yet impactful solution. Contact Dr. Kasturi at Aesthetic Envy to explore how Botox can help achieve your desired look.


The nose plays a crucial role in facial aesthetics, contributing to overall harmony. A drooping nasal tip can disrupt the facial balance. At Aesthetic Envy in Sacramento, we offer a non-surgical nose tip lift with Botox to enhance facial symmetry and attractiveness.

The nasal tip’s appearance greatly influences overall nose aesthetics. While a slight droop is common, it can detract from facial harmony. Correcting minor imperfections like a downward tip is achievable without surgery. Dr. Kasturi at Aesthetic Envy performs non-surgical nose lifts using Botox injections.


Botox doesn’t directly lift the nose tip; rather, it relaxes muscles, pulling it downward. Acting as a neuromodulator, Botox blocks nerve signals, relaxing targeted muscles for 3-4 months. To lift the nasal tip non-surgically, Botox targets the depressor septi-nasi muscle near the septum’s base. Complete results may take up to two weeks as the muscle relaxes, allowing the nasal tip to rise slightly.

14. DAO/Down Turned Lip

What is the Depressor Anguli Oris (DAO) Muscle?

The Depressor Anguli Oris (DAO) muscle, located in the lower face, aids in mouth downturn or frowning. Linked to mouth corners and the lower jaw, it collaborates with other facial muscles. Aging weakens it, leading to a perpetual frown, tired appearance, and marionette lines. Over time, it contracts, causing jowls. Botulinum toxin injections can counter these aging effects, restoring a more youthful look.

Can Botox treat a downturned mouth?

Botox effectively treats a downturned mouth caused by overactive depressor anguli oris muscles, lifting mouth corners. This condition, visible at rest, creates a sad or tired appearance. Botox restores facial symmetry by relaxing these muscles and erasing fine lines and wrinkles.

Can you Botox the Depressor Anguli Oris?

Yes, Botox can be used on the Depressor Anguli Oris (DAO) muscle. This treatment, known as DAO Botox, targets the muscle responsible for a downturned mouth and marionette lines. Although off-label, it’s gaining popularity for its effectiveness. Expert injectors, like Dr. Kasturi, ensure precise injections into the DAO muscle, avoiding unwanted spread and maintaining facial harmony. While not FDA-approved, when performed by experienced professionals, DAO Botox offers significant benefits. However, caution is advised when seeking treatment from less experienced injectors due to the risk of adverse effects associated with off-label use.

What does Botox in DAO do?

Botox in the Depressor Anguli Oris (DAO) muscle relaxes it by blocking neurotransmitters, preventing excessive muscle contraction. This relaxation helps alleviate a downturned mouth, reducing the appearance of frown lines and wrinkles. By targeting the DAO muscle, Botox lifts the corners of the mouth, restoring a more neutral or upward facial expression. This treatment counters the downward pull of the muscle, providing a subtle lift and enhancing facial symmetry, ultimately contributing to a more youthful and refreshed appearance.

How does Botox work with facial DAO muscles?

During a consultation with Dr. Kasturi, discuss your medical history and aesthetic goals for DAO Botox. Precise injections tailored to your facial anatomy are crucial. Avoid blood thinners prior to treatment to reduce bruising risk. Dr. Kasturi applies numbing cream before marking injection sites. Injections take 15-30 minutes with minimal discomfort. There’s no downtime; patients can resume regular activities immediately. Risks are minimal under an experienced injector. Common side effects include swelling, bruising, and redness, typically resolving within days.

How many units of Botox for DAO?

The required Botox units for DAO treatment vary based on facial anatomy and mouth downturn severity. Generally, 4 units per side are used, accounting for asymmetry. Dr. Kasturi assesses your needs during consultation for a tailored estimate.

How long does DAO Botox last?

DAO Botox typically lasts 3-6 months, with full results visible within 2 weeks. Maintenance appointments every 6 months can prolong the effects.

What does Botox do to DAO muscles?

Botox injected into the DAO muscles blocks neurotransmitters, relaxing the muscles. This action lifts the corners of the mouth, counteracting the downward pull that creates a perpetual frown. It restores a youthful appearance by reducing the appearance of tired or upset expressions.

Side Effects

Common, short-lived side effects may include redness, bruising, swelling, and discomfort. When administered by skilled professionals, Botox for a wide nose is safe.

15. Lip Flip:

A lip flip is a non-invasive cosmetic procedure using small doses of neuromodulators like Botox or Xeomin to enhance lip shape, creating a fuller appearance. It involves relaxing specific muscles around the mouth subtly flipping the upper lip upward.

What to expect?

Treatment takes 10-15 minutes with minimal discomfort and temporary side effects like swelling or redness. Results become fully visible within 2 weeks and last up to 4 months. While off-label, injectables like Botox gain FDA approval over time. Optimal outcomes depend on the injector’s expertise. At Aesthetic Envy, Dr. Kasturi, a double board-certified surgeon, performs these procedures for safe, natural-looking results.

Schedule A Consultation

Unlock your journey to radiant beauty and rejuvenation. Call us at 916-333-4906 to schedule your personalized consultation at our medical spa today!

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