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Did I Have Too Much Botox?

I have had Botox several times. I just turned 50 and it has worked well in the past. Two weeks ago, I had the following injections that did not really do the trick:

Forehead -  8 units (very few wrinkles on forehead)

Glabella - 15 units (pretty deep 11's)

Crow's Feet - 10 units (5 each side)

Total units: 33

Two weeks later I had additional injections for further correction:

Glabella - 9 units (24 total)

Crows - 12 units (22 total)

Eyebrow Lift - 2 units (had not done this before)

Total units in 2 weeks: 56

This seems to me like a TON of Botox. I was a bit nervous, but was assured by the doctor that this was not excessive; average or slightly above, but not excessive. He explained some patients get upwards of 70 units for correction without the frozen appearance. I trusted him; but sit here and wonder what I will look like in 7 days. Any feedback appreciated.

Doctor Answers (22)

Not excessive Botox

+2

Cindy,

The amount of Botox that you describe is not a TON.  It is the usual amount for treating these areas combined.  The initial treatment amounts were less than the usual amount required for the stated areas, which explains why you needed retreatment.


Manhattan Plastic Surgeon
4.5 out of 5 stars 31 reviews

Botox dosage not excessive, you should be OK

+2

The amount of BOTOX you received is not excessive.

In my office, the majority of my patients receive a microdroplet BOTOX treatment of 33 units of BOTOX. However some patients have bigger muscles and indeed need more BOTOX. Typically these will be 48 units, 66 units and for the big boys (and some big girls) 100 units.

It is totally appropriate to try with a smaller dose of BOTOX at first and then increase the dose based on the response. After all, why pay for more BOTOX than you actually need. Generally, I like to wait a full three weeks before deciding on more treatment but this varies with the doctor.

It is important to have a follow up with your treating doctor 2-3 weeks after your treatment and have an after photo. Also discuss with the doctor what you like and don't like about your treatment so that this information can be used to modify treatment in the future.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
5.0 out of 5 stars 16 reviews

You didn't have too much Botox

+2

Thanks for your question.

To start, let me give you some normal unit ranges for most Botox injections for the forehead, glabella, and crows feet.

Forehead - 10-25 units

Glabella - 16-25 units

Crows feet - 6-12 units per side

Eyebrow lift - 2-4 units per side

I know that it might seem like a lot of Botox was injected into you, but in someone with moderate to severe wrinkles in these areas, the total amount may approach 70-75 units. While most patients wishing to get injected in the three main areas (forehead, glabella, crows feet) usually get around 60 units (20 for the forehead, 20 for the glabella, and 18 for the crows feet), the total amount you received should be fine; especially if we take into account that the first round of injections did not seem to work well (perhaps some of it being inactive or not reaching its target).

Hope this helps.

Don Mehrabi, MD
Beverly Hills Dermatologist
5.0 out of 5 stars 1 review

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Botox doses need to be individualized

+2

In general, the amount you had is not excessive especially since you have been having Botox for a while. Some people begin to develop a tolerance and need more over time. Some experts believe that having Botox too frequently, as in injections too close together rather than every several months, contirbutes to this tolerance. My impression is that 15 units for the glabella and 5 units for each side for crow's feet was on the low side to begin with so I am not surprised that you needed more.

Richard Baxter, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 23 reviews

Dosing should be individualized

+1

We're sure you feel much better about your situation after reading the many responses from panel members. Your first treatment may have been quite conservative; however, it is much easier to add more units than to have too much on board initially wherein there is nothing to do to remedy the situation.

If you don't see much value in the lateral brow lift, you may want to ask about using a more therapeutic dose. Typically, we uses 5 units of Botox to this area on each side to provide a subtle, natural lift in this area.

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

Average Amount

+1

This is certainly not a "ton" of Botox, but an average amount. There is also nothing wrong with a two week touch up. Next time, knowing your reaction to the prior amount of Botox, your physician will have a better guide to what is the appropriate amount for you.

In fact, the only place I would quibble with the amounts, would be on the lateral brow lift, and there I think you could have used an extra couple of units not less. In addition, I like the fact that your physician only placed eight units in the forehead. It is better to give fewer units in this area, and then add, than give patients a brow drop or that zombie expressionless face seen so often. Less Botox is especially advised. for those with a narrow forehead.

By the way, we are going to be interviewing a woman who was in the laboratory group that first isolated Botox. This lady, who worked with Drs. Schantz and LaManna back in the mid-40's at Fort ( Camp) Detrick, will be a guest on our radio show. Should be interesting. E mail me for details.

Arnold R. Oppenheim, MD
Virginia Beach Dermatologist
5.0 out of 5 stars 7 reviews

Not excessive.

+1

A total of 20 to 25 units of botox for the glabella or the crow's feet is not excessive. Some people need less, some people need more depending on the amount of muscle contraction you have and the desired degree of correction.

Jonathan Hoenig, MD
Beverly Hills Oculoplastic Surgeon
5.0 out of 5 stars 32 reviews

Not too much Botox

+1

At one sitting many patients can receive up to 30 units for the crow’s feet and 35 units for the glabella. You did not receive too many units in terms of the safety of Botox. It may be difficult to figure out the correct dose for next treatment if you keep adding more Botox. Sometimes, if you’re unhappy with the results, it is better to let it all go away and start fresh with a higher dose next treatment rather than to continue to add more only a few weeks later.

Ronald Shelton, MD
Manhattan Dermatologist
5.0 out of 5 stars 31 reviews

BOTOX

+1

Cindy

I am assuming that you are going to the same doctor and the botox concentration and technique are the same as you have had in the past. I have injected botox into thousands of patients and I occasionally find that a patient will need more botox to get the same results that they got the last time.

That being said, 56 units is not really a lot of botox for all the areas treated. I will typically use 40 to 60 units at one sitting for the same areas. The other issue is the length of time between botox injections - you will typically need less if the interval between injections is shorter.

Daniel Reichner, MD
Newport Beach Plastic Surgeon
4.5 out of 5 stars 9 reviews

Fifty units of Botox is a very average amount to start with.

+1

Many patients benefit from Botox for treatment of dynamic wrinkles of the forehead, glabella (11's), crow's feet, and droopy brows.  Fifty units of Botox is a very average amount to begin with.  Some patients may require more on their second treatment.

Sanjay Grover, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 99 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.