I have had Botox for a few years and love it. I have changed my location. I have a new person doing Botox, my problem is I have always maintained 22-24 units that has been perfect and on one occasion 28 units. Which was great as well. My problem is this, my new person that is doing Botox has guessed 39 units I was shocked, I told her no.
As previously stated, the amount of Botox used in this area is dependant on the strength of the muscles. Patients with thicker, stronger lateral obicularis oculi muscles (often seen in men) will require more Botox to treat that patients with thinner, less strong muscles (older patients with thin skin and muscles). In general, I have found that 8U (thin, less strong muscles) to 14U per side usually improves crow's feet significantly.
Bev,
I start with 8 units of Botox on each side - placing 1 to 2 units per injection. I will then see the patient back in 2 weeks to determine if additional Botox is needed - this way I can incrementally determine the optimal botox dosage to give the desired results. Once the right number of Botox units has been determined there is no reason to change.
This seems to be a problem in cosmetic medicine, many practitioners (especially non-physician injectors) are worrying more about the bottom line rather that giving the patient the right amount of Botox. See my posts on non-physician owned medical spas and ethics in cosmetic medicine.
Generally, we inject between 5-10 units of Botox on each side for crow's feet. If you had great results with 22-24 units, then you should stick with it. 39 units sounds like too much and may have to do with the lack of skill on the injector's part.
In my practice I use 10 units per side. This is usually a good dose to insure good muscle relaxtion.
Only exception is a male with very deep lines, I might use 15 units per side in this case. I also believe that the injection technique makes a big difference.
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