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How to Inject Daxxify - From consent to Injection

Updated: Feb 20, 2023


Information and more information



There is, as yet, little practical or real-life experience in using Daxxify, a new, longer, acting form of Botulinum toxin to relax the muscles of the upper face.

The main concern for aesthetic use is the prolonged duration of action meaning side effects, such as brow and eyebrow droop, will potentially last the same amount of time.

As with the shorter-acting brands of botulinum toxin, such as Botox, there is no antidote. But at least their side effects will wear off in two to three months, if you are unlucky, and not six.

Daxxify has yet to be released. But I suspect anyone contemplating using it in their practice will face increased insurance premiums, even though drooping or asymmetrical face areas, after relaxing them with a potent neurotoxin, are well-recognised effects.

However, even these temporary outcomes could lead to negligence claims of not taking due care.

Extended paralysis, as yet, is not well recognised in aesthetic case law.

And if this happens, it could lead to a surge of new claims, especially if the practitioner fails to advise the patient about the negative impact of a longer-acting poor aesthetic outcome.

Patients opting for Daxxify will need material risks clearly delineated to demonstrate indisputable understanding, rather than using just a form, with wordy fine print and a signature, to defend that the patient had gone through a process of "informed" consent.

In the case of injecting Daxxify, timing is everything and allowing a period of reflection on material risks, which have been explicitly defined, is vital.

This should include the following rare but material consequences such as:

  • Emotional distress and unhappiness.

  • Inability to talk properly.

  • Blurred or impaired vision.

  • Complete paralysis of facial muscles

  • Facial disfigurement (albeit temporary, this could lead, for example, to psychiatric damage).

  • Loss of earnings if unable to drive or speak.

Keeping injections within the licence may become even more critical.

How to inject Daxxify

I suggest using Daxxify in the following way:

Information and more information

As a rule, the more information is given to a patient before a treatment, the better, and written in a way that is understandable and free of medical jargon.

Cooling off period

Allowing time to contemplate a treatment defends against a claim of factual causation.

Valid consent

Well-documented and valid consent as to the material risks and potential side effects.

With a particular focus on longevity and the impact that will have on the patient's life should they sustain a poor result and the adverse effect this could have on their mental health.

For consent to be valid, it must be voluntary and informed, and the person giving consent must have the capacity to make the decision. See the addendum for a brief overview of consent.

In addition, each patient should be offered a reasonable alternative, including the option of not undergoing the treatment. Aesthetic treatments, after all, are not essential or life-saving.

Risks need to be explicit and accurate based on the current literature or, ideally, your own results.

Comprehensive facial muscle assessment

Assessing the glabellar complex in conjunction with the frontalis muscle is paramount.

In addition, the detection of risk factors for brow ptoses, such as age and involuntary frontalis activity to maintain brow position, is vital.

An initial trial injection with shorter-acting botulinum toxin

This should achieve the desired results without brow or eyebrow droop and facial asymmetry.

Record of injection pattern with a shorter-acting Botulinum Toxin

A meticulous dosing pattern with a conventional, short-acting form of botulinum toxin.

A record of the angles and depths of needle insertion.

Bone contact should be avoided to prevent the toxin from diffusing under the tissue layers.

Comprehensive photographic evidence of injection points with distance markings from the eyebrow and the lateral forehead.

Abiding by the central safety zones.

This pattern is to be repeated with precision, including depth and direction, when using Daxxify.

Consider ultrasound-guided injections in high-risk zones.

Ultrasound can be used to determine the thickness of the tissue layers. It can give the injector an indication of the depth of needle insertion, both in the intramuscular and subcutaneous planes.




Daxxify is undoubtedly an exciting and new addition to the aesthetic practitioner's list of treatments. However, the stakes are high not only for the patient but also for the injector.

Ensuring that the practitioner is competent, properly trained, experienced and skilled will become even more essential in this rapidly evolving medical field.




The provision of comprehensive information before a procedure is contextually and universally known as "informed" consent. However, this term has not been acknowledged or pervades the English Courts of Law; the preferable description is "valid consent".

The "valid" approach to consent is to tell a patient about the risks and benefits of treatment and ensure that they fully understand. Quintessential to this discussion is whether material risks have been discussed based on the patient's unique values and beliefs.

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