Is 45 Units of Botox Too Much?

A person have always gotten 10 units on their forehead. although it didnt remove every line it looked smooth when my muscle was relaxed & lasted 3 months. They went 2 a new doctor becaue mine is out of town for 3 weeks and he insisted on 45 units! They are only 26. there's only two small lines 2-3inches long that show up with no muscle movement? Is this outrageous amount?

Doctor Answers 30

45 units for a 26 year old?

  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. 


Saint Petersburg Oculoplastic Surgeon
4.9 out of 5 stars 114 reviews

Excessive Botox

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 units

45 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.

45 Botox units for forehead

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.

Amount of Botox Varies from Patient to Patient

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.

Botox Dosing

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.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.8 out of 5 stars 81 reviews

Botox and small forehead lines

The amount of Botox required depends on the strength of your forehead muscles.  10 units may be appropriate for you since it has worked in the past.  45 units would be too much for your forehead since it would probably cause drooping of your eyebrows.  Perhaps he was going to treat your frown lines as well?  Hopefully, you are being treated by an experienced injector.

Martie Gidon, MD, FRCPC
Toronto Dermatologist
5.0 out of 5 stars 20 reviews

How many units of Botox are enough?

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?

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 37 reviews

Too much Botox

well, a larger dose might give you a more dramatic change if injected over a more broad area, that can be everything from more wrinkle reduction and a pleasing result to too much weakening and a falling of the brows. There is no right or wrong dose though as what is needed to achieve an effect can vary from patient to patient.

Julio Garcia, MD
Las Vegas Plastic Surgeon
4.7 out of 5 stars 21 reviews

45 Units of Botox too much?

You are 26 years old and 10 units of Botox seem to work for treatment of your glabellar lines.

Most likely you have a very minor wrinkle problem and therefore I would stick with the 10 units.

45 units sounds almost too much even for the treatment of  the glabellar lines, frontal lines, crow's feet. and  bunny lines and I'm not sure that you have these lines.

I would wait for the  Dr who first treated you.

Always make sure that you are being treated by an experienced, Board Certified Dermatologist or Plastic Surgeon.

Eugene Mandrea, MD
Chicago Dermatologist
4.6 out of 5 stars 5 reviews

When is too much Botox too much?

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.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.5 out of 5 stars 8 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.