Is there an advantage or disadvantage to Botox placement within the periosteum?

This surgeon does not know what he/she is talking about.  The good news is that there will be plenty of physicians in your community who actually know where to place the treatment.  Botox does no good at the periosteal level.  The muscles we want to treat insert into the skin not the periosteum.  There is an entire glide plane that separates the periosteal plan from the more superficial muscles of facial expression.  At best, this is a very inefficient way of perform a botox treatment.  At worst is that this product can drift in this plane causing unwanted side effects.

Thank you for sharing your question.  There is no benefit to Botox placement at the periosteum as Botox works best when placed where the nerves meet the muscle, which is more superficial than the periosteum.  The crunch felt during Botox is more commonly related to the connective tissue of a patient and use of a slightly dulled needle. Hope this helps.

 Botox is never placed in the periosteum. 
For the best result, Botox should be injected directly into muscle.

The crunching sound comes from the dulled tip of the needle!  It happens when a dulled needle penetrates a layer of fascia (connective tissue) over lying the muscle. This layer of fascia is thickest in the glabella (i.e. you won't often hear crunching around the crows feet).  On a related note, the Botox needs to be placed in the muscle to work.  if you actually got it inside the periostium, it would not work unless it diffused into the muscle.The needle can be dulled enough to cause the crunching sound by touching it to the glass bottle the Botox comes in,  passing through the rubber stopper, or, worst of all, banging the needle into the bone of your forehead!  I take extra care to always use a sharp needle...not only will it make no noise at all, but a super sharp needle hurts less as well!Great question, and thanks for asking!  Best wishes, MKB

Botox placement requires only superficial cutaneous placement as it selectively migrates to the muscles.  

Thank you for your question hoopermd. Botox is a purified protein used to address wrinkles associated with
facial expression. When injected into the skin it will relax the muscles and smoothen out the overlying wrinkles. Since the wrinkles are caused by muscle movement, the target of the Botox should be muscles. Injecting the product into the bone would require the Botox to diffuse to the muscles and likely yield inferior results. Additionally, the periosteum is rich with nerves and injecting product there will lead to significant pain. Please consult with a doctor for specific recommendations. Good luck!

Hi and welcome to our forum.
Botox should be injected into the offending muscle. On occasion, there is a "pop" as the injecting needle passes through the muscular fascia. This is superficial to the periosteum and the musculature. I inject with a #32 gauge needle which is relatively painless.
Best wishes!

Botox and similar medications work on muscles, not bone, so there is no reason to place it on the periosteum and it is unlikely to work with that placement.

An experienced endotoxin injector would place the botox in the frontalis muscle which is directly superficial to the periosteum, which is a thin layer covering of pericranium over the frontal bone.The frontal bone and its periosteum do not have any effect on the contraction of the frontalis muscle besides acting as insertion for the muscle, so it would not make any sense to inject the periosteum if your objective is to reduce the contractile strength of the frontalis muscle.

Botox (like Xeomin and Dysport) is a medication injected into target muscles of the face to selectively relax them for fewer/softer wrinkles. Since this medication acts where the motor nerve meets the muscle, the muscle itself is the best place for the injection. Injecting the dermis of the skin is too shallow and the periosteum on bone is too deep. I would seek out a doctor who understands this concept for safe and happy outcomes. Safety comes first.