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What's the Maximum Amount for 11s?

I am trying to get rid of my 11s between my eyebrows. So far I have recieved 50 botox units. 20, then 15 and 15. all a week apart. Things have softened but still have quite a bit of movement. Dr. just keeps telling me that I have strong muscles and havent met my theshold yet. At what point do I just give up? how much is too much?

Doctor Answers (22)

What's the Maximum Amount for 11s?

+3

You have received a lot of Botox for your 11s.  Either you do not respond to Botox, which is rare, or something else is going on.  Can you still frown?  If so, I would consider seeing a different physician and seeing whether you get a better response with his injection technique.  If you cannot frown, then the Botox is working, you may just need fillers in addition.


Beverly Hills Oculoplastic Surgeon
4.5 out of 5 stars 13 reviews

Inadequate response from Botox - causes

+3

There are several causes of your problem.

First, your corrugator muscles are broad based, i.e. .completely over the eyebrow, so those fibers will need to be relaxed as well.

Second, the wrinkles you have are very well established and it will take some filling material to fill in the wrinkle in the mean time.  Patient expect the "11's" to be gone, but Botox will not always eliminatedecades of sun damage and wrinkling.

Third, you are actually refractory to Botox, rare but possible.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 92 reviews

What's the Maximum Amount for 11s?

+2

As you can read from the previous expert posters, 50 units is a maximum for the "11"s. Try adding a HA filler to the creases. Otherwise I would be extremely careful to have any additional botox to this area. i also recommend calling Allergan cosmetic to address this issue with their clinical experts and scientists. Call 1-800-433-8871.   from MIAMI 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.5 out of 5 stars 62 reviews

Maximum Amount of Botox

+2

50 units is certainly a full dose of Botox if it is being used for between the eyebrows only. Assuming the Botox was properly reconstituted and stored before being injected, you should wait at least 3 to 4 months before considering additional treatment. You may also be "recruiting" different muscles in your forehead to move your eyebrows and therefore Botox might be doing its job. You can discuss this with your doctor. You might also want to consider trying Dysport next time to see if it works better for you.

Mitchell Schwartz, MD
South Burlington Dermatologic Surgeon
5.0 out of 5 stars 8 reviews

Find someone else to do your Botox

+1

Generally the standard dose of Botox to treat the vertical creases between the eyebrow is between 15 to 20 units.  Either you are not being injected in the correct areas or the Botox is old and and not as effective. Sounds very unusual.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 9 reviews

Botox Responsiveness

+1

A dose of 50 units of Botox (Allergan produced) in the glabella should have some degree of efficacy as far as minimization of movement (assuming that you are receiving the real product, properly reconstituted, and properly administered).  Please understand that very deeply etched lines will not disappear with Botox alone.  However, I have seen an occasional patient who is poorly responsive to Botox, yet responds to Dysport (Medicis produced).

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
5.0 out of 5 stars 32 reviews

Botox for the glabellar "11s"

+1

You state that you have had weekly additions to the botox number of units in the glabella. During an examination for this concern, I evaluate if the muscles are moving, not if the creases are still there!  If you are not able to move the muscle then you need no more Botox for now.  There may be continued improvement of the creases as time progresses and the muscle is no longer able to make the skin fold like an accordion.  YOu have probably develoepd these creases from years of crinkling the frown muscles and for some patients, the creaes are deep and need many months of muscle relaxation for the lines to improve. Sometimes botox takes more than two weeks to show its maximal onset of effectiveness and it may be unwise to add units before this time.  If two weeks after Botox the muscles are still moving then additional units may be needed, and for some hypertrophic muscles, mostly in men, but I have seen some women with this as well, 50 to 60 units are needed, but not much more, and again, this is not common.  If the muscles are relaxed, and you don't want to wait months for continued improvement then a filler can be added but it should only be Juvederm Ultra or Restylane.  Thicker products have compromised circulation in this area and caused complications.  

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

For 11's dual therapy with Botox and Fillers.

+1

I like to "nuke" the 11's for a new patient.  Using a HA filler like Juvederm or Restylane along with the Botox can give you a running start.  Fillers work for a long time when done in concert with Botox, because the muscular action isn't "milking" the filler out of the area.  Unit wise, 20 plus 15 plus 10 sounds like a lot.  Watch your brow position, as extravisated Botox can cause problems in adjacent muscles!

Ritu Chopra, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 9 reviews

Maximum Amount of Botox for Frown Line?

+1

Hi Avion.  It sounds like you have more than enough to relax the muscles in this area.  Even if you had extremely developed muscles, 50 units is a lot and should have done the trick.  

If you cannot animate (move or contract) the muscles that cause the frown, then you do not need more Botox and your injector needs to think more about a dermal filler like Restylane.  If you are not able to move the muscles and your injector has not already suggested a dermal filler like Restylane, then you may need to start looking for a new injector as this is a fairly common issue.

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

Botox and a 2 week touch-up

+1

I would wait 2 weeks before adding botox after the initial injection, as it can take up to that long to see the full effects of the botox.  Usually 20-30 units is sufficient in the glabella but in a man with strong muscles (or woman), more may be needed.  However, you have had A LOT of botox added into that area.   If you cannot move those muscles, the wrinkle there is a wrinkle at rest and will not be fully corrected with the botox (which works better for the dynamic wrinkles which are more evident during movement).  Some injectors will (carefully) do a little filler in this area to help with the #11 lines if they are still present after botox but this area can be difficult to obtain perfect results with fillers as well (depending on how deep the wrinkle is).  

Some people do develop antibodies to botox and botox is not effective.  If you are getting that many units and still able to move those muscles, I would wonder about antibodies,  I would also question the injector as to why he/ she has continued to add more units without waiting the full 2 weeks to see the initial results. 

Amy A. McClung, MD
Austin Dermatologist

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.