How Many Botox Units for Horizontal Forehead Lines?

Dear Cabbie02
I am not a big fan of injecting BOTOX into the forehead. The muscle up there, the frontalis muscle is the only elevator of the eyebrows. This means that any BOTOX injected into the frontalis muscle will drop the eyebrow position.
Yes one can certainly create a glass smooth forehead (Think Marcia Cross) but the price is a fall in the eyebrow position. The aesthetic price is very high because one gets this frozen forehead and a drop in the eyebrows that screams: MY FOREHEAD IS FROZEN BY BOTOX.
However, is there an alternative? The answer is absolutely: Microdroplet BOTOX. This is my patent pending method where tiny microinjections of BOTOX are place between the skin and the muscles of facial expression that insert into the skin along the eyebrow, root of the nose and the crows feet area.
This provides a degree of control over the placement of BOTOX that has not previously existed. The muscles responsible for pulling the eyebrow down and furrowing the eyebrow and glabella can be precisely targeted.
With the eyebrow depressing muscle treated in this fashion, the tug of war between the eyebrow lifting muscle and the eyebrow depressing muscles shifts to favor the brow elevator, the frontalis. This means that the frontalis muscle does not need to work so hard.
The eyebrow comes up and at the same time the lines in the forehead diminish without a bit of forehead freeze. This is one of the most popular BOTOX treatments in Los Angeles- the actors love it because they retain facial expression while at the same time having a very natural improvement in their appearance.

The typical forehead and 11's will require about 40 units for treatment. The forehead by itself could be treated with 20 units.  The crow's feet can require 5 to 10 units. It depends on the the size of the face and the muscular strength.

From 5-15. I tend to not be an aggressive heavy forehead line injector. It is easy to over do it and leave somewhat flat eyebrows which is not aesthetically pleasing until the botox wears off.

A great injector can do a lot with a few units, it really depends on the skill and experience of the injector. As far as what is possible with your specific anatomy, it would be best to consult a board certified plastic surgeon with injection experience who can provide an accurate idea of what kind of results you can expect.

Thank you for your question.  Botox for the forehead requires careful assessment of the brows and eyes.  Most people with strong horizontal lines across the forehead have them because of anatomically low brow, deep set eyes or heavy lids.  Injecting Botox into the forehead may do a good job reducing them, but if done so with too large of a dose will cause a very uncomfortable downward heaviness on the eyes.  A good practitioner will approach your treatment with this in mind, and will also inject the muscle group at the brow (glabella) to provide needed counterbalance while relaxing those horizontal lines.  In my practice, patients with this presentation will be assessed, and injected on the more conservative side in the forehead (about 8-14 units) while also treating the glabella, and asked to follow up in 2 weeks. At that point, a few more units may be added if warranted.   

There is no absolute number of units of Botox a patient should receive to treat a specific number of forehead wrinkles.  In our practice, the range of units that we use can vary from four to thirty-four, but this does not really tell the story. Not merely the dosage of Botox, but the placement and number of injections in which muscles, and which portions of the muscles, needs to be individualized to the anatomy and aesthetic goals of each patient.The treatment of forehead wrinkles with Botox injections is really a double-edged sword.  Many patients have the transverse wrinkling of the forehead that they see, because they have brow ptosis, i.e., the soft tissue of the brow has descended to some degree, and the patients need to fire their frontalis muscles on a virtually continuous basis to elevate the overlying soft tissue, so that their field of vision, especially on upward gaze, is not diminished.  This activity causes wrinkles to form in a direction perpendicular to the vector of pull of the paired frontalis muscles.However, when a physician injects Botox into the frontalis muscles underlying these wrinkles, he is causing a weakening of those muscles, and thus a diminution of their ability to elevate the ptotic soft tissue of the brow.  Inject too much Botox in the wrong places, and you will have actually exacerbated, or, in some cases, caused, brow ptosis in your patient.In our practice, we make a point of first supporting the brow by injecting Botox in the periorbital muscles whose vectors of pull naturally counteract that of the frontalis muscle.  Once we have done this, we are extremely deliberate, precise, and conservative, in both the dosing, and the placement, of Botox injections in the forehead.  Remember too, that in addition to causing ptosis of the brow, it is also possible to cause ptosis of the upper eyelid by injecting Botox in the wrong anatomic location, or at the wrong depth, in the inferior portion of the forehead.  Botox injection of the forehead is an extremely useful tool to achieve subtle improvements in the upper third of the face of both men and women.  But, like any powerful tool, its indications, limitations, complications and side-effects must be well-understood by a physician who is experienced with the procedure, knows how to avoid the problems that can result, and is prepared to address any possible untoward effects that might arise