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Is 45 Units of Botox Too Much?

I have always gotten 10 units on my forehead. although it didnt remove every line it looked smooth when my muscle was relaxed & lasted 3 months. i went 2 a new doctor becaue mine is out of town for 3 weeks and he insisted on 45 units! I'm only 26. there's only two small lines 2-3inches long that show up with no muscle movement? Is this outrageous amount?

Doctor Answers (28)

45 units for a 26 year old?

+2

  I am not sure that any of the experts who answer this question can truly know what is right for you.  I do agree that 10 units is way too low. 


Saint Petersburg Oculoplastic Surgeon
4.5 out of 5 stars 47 reviews

Amount of Botox Varies from Patient to Patient

+1

The amount of botox needed to treat vertical frown lines varies from patient to patient and depends on several variables. These include patients aesthetic goals and the strength of their underlying glabeller muscles.

In the vast majority of patients , 46 units of botox would be more than enough to adequately treat vertical frown lines. Patients don't usually see a response for 2 to 3 days following injection. This response continues to improve for 5 to 7 days following the procedure.

Rarely, vertical frown lines are still present after adequate botox injections. This occurs when deeply etched frown lines are tethered to the deeper structures.  Under these circumstances, injectable dermal fillers may be necessary to adequately treat the problem.

If you’re concerned about vertical frown lines, consultation with a physician with experience treating this type of problem is appropriate. This physician should be able to outline a plan that's appropriate for you.

Richard J. Bruneteau, MD
Omaha Plastic Surgeon
5.0 out of 5 stars 90 reviews

Botox Dosing

+1

The average dose for treating the frontalis muscle (horizontal forehead lines) is 15-20 units to achieve a measurable response.  The average dose for treating the glabella (11's) is 20 units.  45 units is not unusual in treating both areas of the forehead, but would be a very large dose to treat the frontalis muscle alone.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
5.0 out of 5 stars 38 reviews

Botox and small forehead lines

+1

The amount of Botox required depends on the strength of your forehead muscles.  10 units may be appropriate for you since it has worked in the past.  45 units would be too much for your forehead since it would probably cause drooping of your eyebrows.  Perhaps he was going to treat your frown lines as well?  Hopefully, you are being treated by an experienced injector.

Martie Gidon, MD, FRCPC
Toronto Dermatologist
5.0 out of 5 stars 17 reviews

How many units of Botox are enough?

+1

no one can comment on what is best for you without examininig you in person. I evaluate my patients by seeing their lines at rest and with muscle contraction. I also examine the mass of the affected muscle with contraction and get a sense as to how many units they will need. Smaller muscle mass gets the lower end of the spectrum, and larger gets the higher amount, but first-time patients that I treat do not get the highest amount the first treatment.

If you have two lines between 2 - 3 inches, and if the lines are not too far apart from one another, then botox insertions can be placed in between the lines and placed about 2/3 of an inch apart to allow for the 1 cm. of diffusion. Conceivably, then, 10 units might be enough, however, there are some physicians that will not treat the forehead without treating the area between the eyebrows to allow for lifting since the treatment of the forehead may drop the forehead.  There is a good possibllity that if your lines are not too obvious, that the treatment can be done without the glabella and if the 4o+ units are injected throughout the forehead you might not like your "frozen" appearance. It's only a few weeks that your doctor is returning, why don't you wait to be more comfortable with the treatment, even if this new doctor has a great reputation?

Ronald Shelton, MD
Manhattan Dermatologist
5.0 out of 5 stars 32 reviews

Too much Botox

+1

well, a larger dose might give you a more dramatic change if injected over a more broad area, that can be everything from more wrinkle reduction and a pleasing result to too much weakening and a falling of the brows. There is no right or wrong dose though as what is needed to achieve an effect can vary from patient to patient.

Julio Garcia, MD
Las Vegas Plastic Surgeon
4.0 out of 5 stars 6 reviews

45 Units of Botox too much?

+1

You are 26 years old and 10 units of Botox seem to work for treatment of your glabellar lines.

Most likely you have a very minor wrinkle problem and therefore I would stick with the 10 units.

45 units sounds almost too much even for the treatment of  the glabellar lines, frontal lines, crow's feet. and  bunny lines and I'm not sure that you have these lines.

I would wait for the  Dr who first treated you.

Always make sure that you are being treated by an experienced, Board Certified Dermatologist or Plastic Surgeon.

Eugene Mandrea, MD
Chicago Dermatologist
4.5 out of 5 stars 4 reviews

When is too much Botox too much?

+1

As other panel members had suggested, it is difficult to make a judgement without knowing if you received treatment to the forehead in addition to the frown lines (glabella area) which are considered two separate treatment areas. 

Oftentimes, patients confuse the two areas.  A general rule of thumb is that horizontal lines are related to forehead movement whereas the vertical lines ("11's") are glabellar in nature.  This is important when knowing a patient's goals and treatment plan.

With regards to forehead treatments, for your age and history of responding well to 10 units, it is unusual to require more than this.  We believe forehead treatments should be conservative and allow for movement of the eyebrows as well. 

The below link will offer more information on forehead dosing.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 6 reviews

Too much Botox

+1

45 units seems a little high to me given your age but 10 units seems way low (at lease for the corregator muscles that create the scowl lines)   

You question raises the important issue of continuity.  It's important to establish care with a doctor for filler and Botox.  It's very difficult to see patients who have been to many doctors and had a little Botox here, a little Dysport there, a little Restylane here and a little Juvederm there.  You get the picture.  Patients who shop around for the lowest price may not get the best care if there is lack of continuity. 

Find a doctor you like and stick with him/her.

Lisa Lynn Sowder, M.D.

Lisa L. Sowder, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 48 reviews

Botox dosage

+1

In treating the forehead, crow's feet, and the "11" lines of the corrugator muscles, I usually place about 40-50 units.  However, a 26 year old is a bit young unless there is significant premature aging.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 18 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.