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Did I Have Too Much Botox?

asked 3 years ago by cindyc in minneapolis, minnesota
Latest answer by Harold J. Kaplan, MD
Question viewed 3,372 times
Tags: age 45-54, female, risk

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.

22 answers to Did I Have Too Much Botox?

Dosing should be individualized

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... more

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon

www.celibre.com

Not excessive Botox

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.

Kenneth R. Francis, MD
Manhattan Plastic Surgeon

Botox dosage not excessive, you should be OK

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... more

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon

You didn't have too much Botox

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... more

Don Mehrabi, MD
Beverly Hills Dermatologist

Botox doses need to be individualized

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. more

Richard Baxter, MD
Seattle Plastic Surgeon

Average Amount

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... more

Arnold R. Oppenheim, MD
Virginia Beach Dermatologist

Not excessive.

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

Not too much Botox

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

BOTOX

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... more

Daniel Reichner, MD
Newport Beach Plastic Surgeon

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

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

This number of Botox units is fine

I wouldn't worry. The total number of units you received in these areas is within the normal bounds. If anything, the initial number of units you got in the areas you listed is quite conservative. Take care. For more information about Botox, refer to the Web reference link below.

Paul L. Leong, MD
Pittsburgh Facial Plastic Surgeon

idealplasticsurgery.com

People respond to Botox somewhat differently

It is good for you to be tracking exactly how much botox is injected to each area on the face should you wish to make any adjustments in the future. The total number of units you received for each area is generally not considered excessive. Many people can get away with fewer units, though some people need more to achieve the desired effect. Chances are you will be pleased with the effect after 1-2 weeks.

Bryan K. Chen, MD
San Diego Dermatologist

No actually not enough Botox

These initial doses are extremely low and I wonder what the specialty of the the treating physician is......this sounds like an inexperienced injector. The crow's feet area can easily require 12 units on average per side, the glabella can require 25-40 units, and the forehead sometimes needs 15-20 units or so. Of course these numbers can fluctuate a bit but the number of units he/she used on you in the initial visit, are low. You will know for sure in 7-10 days.

William Groff, DO
San Diego Dermatologist

Too much Botox

Cindy, Within the ranges that you give, the only area that I would be concerned about is the crow's feet. That is way more that you should need for this area. The other areas sometimes need higher amounts of Botox. If some of your crow's feet are static wrinkles, then Botox is not going to help those wrinkles. Botox only works on dynamic wrinkles by paralyzing the underlying muscle to prevent the dynamic wrinkles of the overlying skin.

David Shafer, MD
New York Plastic Surgeon

www.ShaferPlasticSurgery.com

Botox units

I usually place about 50 units in the forehead and crow's feet to get the desired effect. That is not to say that some people require more or sometimes less.

Steven Wallach, MD
Manhattan Plastic Surgeon

You did not have too much Botox

To cindyc, Hi! For the forehead, glabella, and crow's feet, I routinely use 75 units, and my patients do not look frozen at all. I use a little more than most plastic surgeons because the result lasts longer with higher doses. I think avoiding the "frozen" look has more to do with the artistry of the injector in knowing exactly WHERE to place the injections than with the number of units. The common error is to inject not enough Botox rather than too much. This happens because... more

George J. Beraka, MD
Manhattan Plastic Surgeon

Amount of Botox

This is indeed about average amount of Botox Cosmetic to cover all these areas, so you should do that fine. The amount itself is just as important as the proper technique and placement of the injections. I think you will enjoy the results of your treatment.

Stella Desyatnikova, MD
Seattle Facial Plastic Surgeon

Looks within normal Botox dosage range

That seems to be within my normal BOTOX dosage ranges. However, each person needs to be individualized. For women, I usually use about 20-25 in the glabella, 15-20 for the crows, about 10 for the brows, and 8-10 for the forehead (if the glabella was done).

Steven F. Weiner, MD
Pensacola Facial Plastic Surgeon

Doses for Botox

In an average woman, I generally inject 20 unit in the forehead, 20 unit for the glabella and 10 units per side for the crows feet. That has work pretty well for my patients. Some patients, in particular male patients require more than what I have listed above. Hope that helps.

Farbod Esmailian, MD
Orange County Plastic Surgeon

Too much Botox?

Hi Cindy, You will be fine. Sometimes patients recieve as much or more Botox than you have without any problems. You need not worry. Let us know how it turns out. Good luck and be well. Dr. P

Michael A. Persky, MD
Los Angeles Facial Plastic Surgeon

Probably not too much Botox

Sometimes, people develop resistance to Botox and its effect may not be as desirable as past injections. Hopefully, the same doctor did your repeat injections and so you have some trust and confidence in his/her abilities. Although rare, this has been observed in some individuals. The amounts you listed seem reasonable and hopefully it was a fresh bottle of Botox, meaning that it was still biologically active.

Hratch Karamanoukian, MD
Buffalo General Surgeon

40 to 50 Botox units on several areas within normal range

There is a general recommendation for the Botox dose but i like to treat each patient depending on the anatomy. 40-50 units for all these areas is not a lot. It seems that you got the high normal for the Botox dose. The result should show in 3 days anyway.