Anti-wrinkle and filler face map template (injection mapping chart)

This template is for UK aesthetics practitioners who want a record of exactly where each treatment went on the face: every anti-wrinkle (botulinum toxin) or filler injection point with its dose or volume, depth and technique, and, for microneedling, the zones treated and the needle depth used in each. Practitioners often search for this as a “Botox face map”; the chart works the same way whatever product you use. It covers the assessment you do before treatment (symmetry, muscle movement, existing findings) and the chart you complete during it, in the order you do them, and sits alongside a full treatment record.

Why each section exists

The baseline assessment records what the face looked like before you touched it. Asymmetry is common and often goes unnoticed by the patient until after treatment, when they start looking closely. A note that the left brow already sat higher, backed by a photograph, prevents a normal feature being blamed on your technique. The same goes for previous filler, scars and existing lumps.

The dynamic assessment is there for anti-wrinkle treatment. Recording which lines are present at rest and which appear only on movement explains your plan and your dosing, and gives you something to compare against at the review appointment.

The microneedling table does the same job for a treatment with no injection points. Depth usually varies by zone (thinner skin around the eyes, for example, is commonly treated more superficially than the cheeks), so recording depth and passes per zone, with any serum applied, is what makes the next session in the course repeatable and explains any zone that reacted differently.

The injection point table is the heart of the map for injectables. For botulinum toxin, record units per point and the reconstitution dilution; for filler, record volume per point or per area, the depth and whether you used a needle or a cannula (with the entry point for a cannula). This level of detail makes the treatment repeatable, makes a review meaningful, and gives a precise account if an outcome or complication is ever questioned. It also matters in an emergency: if a patient reports signs of a vascular problem, knowing exactly which product was placed where, and at what depth, supports fast decisions. Insurers expect this detail for injectables, and the direction of England’s planned licensing scheme for non-surgical cosmetic procedures points the same way.

The template

Print this alongside a face diagram (front view, plus a profile view for the jawline, chin and nose), mark each injection point on the diagram with its number, and record the detail below.

Patient and visit details

Patient name: ___________________________

Date of birth: ___________________________

Patient reference / record number: ___________________________

Date of treatment: ___________________________

Treatment performed: ___________________________

Treating practitioner: ___________________________

Prescriber (if different): ___________________________

Linked consent form and version: ___________________________

Photo references (before at rest / before on movement / after): ___________________________

Facial zone reference list

Use these codes on the diagram and in the tables. Always record left and right from the patient’s point of view.

Code	Zone	Code	Zone
Z1	Forehead	Z9	Nose
Z2	Glabella (between the brows)	Z10	Perioral lines
Z3	Brow, left / right	Z11	Lips: upper, lower, border
Z4	Crow’s feet (lateral canthal lines), left / right	Z12	Marionette area, left / right
Z5	Temple, left / right	Z13	Chin
Z6	Under-eye / tear trough, left / right	Z14	Jawline, left / right
Z7	Cheek / midface, left / right	Z15	Masseter, left / right
Z8	Nasolabial area, left / right	Z16	Neck / platysma

Baseline assessment

Facial symmetry at rest (note any existing asymmetry of brows, eyelids, mouth, cheeks or jaw): ___________________________

Previous treatment in these zones (product, date, any complication): ___________________________

Scars, lumps, pigmentation or other findings (mark with letters A, B, C… on the diagram): ___________________________

Patient’s stated concerns and goals: ___________________________

Dynamic assessment (anti-wrinkle treatment)

Zone	Lines at rest (none / mild / moderate / marked)	Lines on movement (none / mild / moderate / marked)	Notes

Injection points

Point	Zone	Product	Batch number	Expiry	Dose (units) or volume (ml)	Depth	Needle / cannula, gauge, entry point	Notes
1
2
3
4
5
6
7
8

Toxin reconstitution (diluent and volume): ___________________________

Microneedling zones (if applicable)

Zone	Needle depth (mm)	Passes	Serum or product applied (and batch)	Skin response / notes

Device and cartridge / needle configuration: ___________________________

Total units / volume used: ___________________________

Product wastage (amount and reason): ___________________________

Observations and immediate outcome

Observations during treatment, including capillary refill checks where relevant, and any immediate reaction or complication with the action taken:

---

---

• Written aftercare given for this treatment
• Patient told how to reach the clinic urgently, including out of hours
• Review appointment date: ___________________________

Practitioner sign-off

I confirm that this face map is an accurate, contemporaneous record of the assessment and treatment above.

Practitioner signature: ___________________________

Print name and qualification: ___________________________

Date: ___________________________

Using it in practice

Take photographs at rest and on movement before you mark anything, then complete the baseline and dynamic assessment with the patient in the chair, so they can see and agree what you are recording. Mark injection points as you go. Use one row per point, or one row per area for a filler technique where points are not practical, and keep separate rows for separate batches. A top-up or review treatment gets its own new map rather than extra marks on the old one, so each visit stands on its own.

The map is a record, not a substitute for anatomical training. Plan injections using the technique and safety guidance from your training, and keep your complication protocols to hand: for filler, that includes recognised guidance such as the Aesthetic Complications Expert (ACE) Group’s guidelines on vascular occlusion. Pair the map with the right consent, for example the anti-wrinkle consent form, the dermal filler consent form or the microneedling consent form, and send the matching aftercare, such as our anti-wrinkle aftercare sheet or dermal filler aftercare sheet.

AesthetiClinic has this built into the treatment record: you chart injection points on a face front, face profile, lips or body diagram, or on one of the patient’s own photos, and record the product, quantity, batch, expiry, needle or cannula and depth against each point. Signing the record locks the map, and the mapped products feed the record’s product lines. See the features page. Every free document is in the template library.

This template is provided as a starting point for UK aesthetics practice. It is not legal or medical advice. Review it with your insurer and, where relevant, your prescriber before use.