Is 45 Units of Botox Too Much?

  I am not sure that any of the experts who answer this question can truly know what is right for you.  I do agree that 10 units is way too low. 

How  much Botox someone needs to acheive a good result is based on the size of the muscles being treated and the experience of the doctor to determine how many units will relax those muscles. The number of units is a universal way of describing the strength of your treatment regardless of the way in which it is diluted.

Treating the forehead without treating the "11" area (glabella) can cause droopy or heavy brows, because once the forehead muscles are weakened, there is nothing left to hold the brows up.  This may be why the new doctor suggested more units to the glabella.  It is not unusual to treat the glabella with 20-30 units and to treat the forehead with 6-12 units. 

The dosing for Botox is variable
and based on the desired effect, the amount of current animation, and the
strength of the muscles. See link below. Some rough guidelines are:



Forehead: 16 units

Crowfeet: 8 units per side

Labella: 18 units45 units for just the forehead seems excessive. 



Consultation with a surgeon
certified by the American Board of Plastic Surgery would be the next best step.

Unfortunately, I would have to see a photo at least of your wrinkles to give you a better estimate. 10 may be suitable if your wrinkles are very minor.

The amount of
botox needed to treat vertical frown lines varies from patient to patient and
depends on several variables. These include patients aesthetic goals and the
strength of their underlying glabeller muscles.

In the vast
majority of patients , 46 units of botox would be more than enough to
adequately treat vertical frown lines. Patients don't usually see a response
for 2 to 3 days following injection. This response continues to improve for 5
to 7 days following the procedure.

Rarely,
vertical frown lines are still present after adequate botox injections. This
occurs when deeply etched frown lines are tethered to the deeper
structures.  Under these
circumstances, injectable dermal fillers may be necessary to adequately treat
the problem.

If you’re concerned
about vertical frown lines, consultation with a physician with experience
treating this type of problem is appropriate. This physician should
be able to outline a plan that's appropriate for you.

The average dose for treating the frontalis muscle (horizontal forehead lines) is 15-20 units to achieve a measurable response.  The average dose for treating the glabella (11's) is 20 units.  45 units is not unusual in treating both areas of the forehead, but would be a very large dose to treat the frontalis muscle alone.

no one can comment on what is best for you without examininig you in person. I evaluate my patients by seeing their lines at rest and with muscle contraction. I also examine the mass of the affected muscle with contraction and get a sense as to how many units they will need. Smaller muscle mass gets the lower end of the spectrum, and larger gets the higher amount, but first-time patients that I treat do not get the highest amount the first treatment.

If you have two lines between 2 - 3 inches, and if the lines are not too far apart from one another, then botox insertions can be placed in between the lines and placed about 2/3 of an inch apart to allow for the 1 cm. of diffusion. Conceivably, then, 10 units might be enough, however, there are some physicians that will not treat the forehead without treating the area between the eyebrows to allow for lifting since the treatment of the forehead may drop the forehead.  There is a good possibllity that if your lines are not too obvious, that the treatment can be done without the glabella and if the 4o+ units are injected throughout the forehead you might not like your "frozen" appearance. It's only a few weeks that your doctor is returning, why don't you wait to be more comfortable with the treatment, even if this new doctor has a great reputation?

As other panel members had suggested, it is difficult to make a judgement without knowing if you received treatment to the forehead in addition to the frown lines (glabella area) which are considered two separate treatment areas. 

Oftentimes, patients confuse the two areas.  A general rule of thumb is that horizontal lines are related to forehead movement whereas the vertical lines ("11's") are glabellar in nature.  This is important when knowing a patient's goals and treatment plan.

With regards to forehead treatments, for your age and history of responding well to 10 units, it is unusual to require more than this.  We believe forehead treatments should be conservative and allow for movement of the eyebrows as well. 

The below link will offer more information on forehead dosing.

Botox and Dysport contain botulinum, and since they are drugs, proper dosing might vary. Some patients and doctors seem to believe one goal is to completely reduce muscle activity so there seems to be a "frozen" appearance. Others believe that results should be more subtle, leaving some muscle function that allows basic expression, (ie, appearing interested or surprised when you ARE actually interested or surprised).     So the dose of Botox or Dysport can be calculated depending on what one considers the best goal.     We doctors serve 2 simultaneous roles.      One the one hand more units creates more effect and costs the patient more money.      On the other hand using fewer units saves the patient money but may not produce enough of the result. So for example, 10 units of Botox in the forehead may be all that one patient needs or wants but 4 times that amount might be desirable in a different patient with more muscle activity.        PS:  you can always receive more....but, of course, once in, we cannot take it back!

If 10 units gave you good results, jumping to 45 units may be excessive for you. Make sure your physician is listening- your physician should never "insist" on using more Botox than you are requesting, especially if you have a history of injections and know how much you need! If you feel you are being pushed into more than you want, get another opinion. Good luck!