Mapping botulinum toxin injection sites and automated unit totalization in orofacial harmonization: a session-based web module for standardized, traceable clinical imaging

Objective: To develop and describe a standardized photographic protocol and a session-based web module for traceable clinical image documentation in orofacial aesthetics, integrating spatial mapping of botulinum toxin injection sites and automated unit totalization. Methods: Methodological study of protocol and system development. The module provided real-time capture validation, session-structured logging, and structured export to the clinical record. A two-phase pilot study was conducted: Phase 1 (n=20 sessions; two operators) assessed session time and capture conformity, including final recapture (retake requested after capture completion); Phase 2 (n=20 sessions; one operator) assessed total time and intra-session recaptures (retakes triggered by nonconformity). Landmark annotation reliability was estimated using ICC(2,1) and RMSE on normalized facial landmark coordinates. Optional metric calibration (px→mm) used a physical reference (caliper). Results: In Phase 1, median session time was 13 min (IQR 10.8–16.3), with 0/20 final recaptures; total dose ranged from 40–91 units (U). In Phase 2, total time ranged from 20–50 min (median 31; IQR 25–40), and intra-session recaptures ranged from 0–20 (median 9.5; IQR 5–10). Agreement of normalized coordinates was high in x (ICC_x=0.958; 95% CI 0.910–0.970) and moderate in y (ICC_y=0.758; 95% CI 0.604–0.810), with normalized RMSE_total=0.0301. Conclusion: The protocol and session-based web module enable standardized, traceable session-level documentation, supporting longitudinal image standardization and auditable quantitative analyses in orofacial aesthetics.