Need for Additional Botox Dosage?

I received my second dose of Botox for deep furrows from frowning, a year after my first dose. The dose did not take effect at all seven days later. The doctor stated that I may be a "super user" of the Botox, meaning that my body rejected the dose. He gave me an additional dose and it worked. Was this correct, and would I require more than the normal botox dose in the future?

I have no autoimmune diseases.

Doctor Answers 12


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Perhaps the Botox used was not enough, or not mixed properly, or old?  I could not say for sure, but I am glad it worked out.

New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Super user of Botox

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Rest assurred, people that are actually non-responders to Botox are few and far in between. A "super user" of Botox is a term we are not familiar with. The fact that you responded well on the second treatment would imply that your body is not "eating it up" as it was suggested to you. More than likely, you required a higher, proper dose. Secondly, technique and protocols (ex: dilution, storage, etc) are important in ensuring that you are receiving a quality treatment and a quality product.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.4 out of 5 stars 7 reviews

Some people need more

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Some people do require more Botox than others. However, it would be nice to know how many units you were administered at each visit. Also, waiting a year between visits is a bad idea. The Botox wears off after 4 to 6 months. If you wait longer than that for your next treatment, then you are starting over from scratch. In addition to preventing the dynamic wrinkles, the Botox also decreases the stress on your skin and with long-term use will help the static wrinkles from dermal atrophy as well. Just make sure you are going to a well-trained plastic surgeon or dermatologist for your Botox injections. Good luck.

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Don't Believe Your Doc

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I hear this all the time. "I went to doctor X, who's famous, and my botox didn't take. I must be a rejector or super user of Botox." Okay, this doesn't happen. What is happening is that these "doctors" are either diluting Botox so much that it's not effective (so that they can make more money on a vial) or they're just not injecting enough. When you went back he realized the issue and injected maybe the correct amount.

Most Plastic Surgeons don't make any significant money on Botox because we look at it as an adjunct that is needed. We make our livings off of surgery. Other physicians, primary care docs, gynacologists, orthopedists etc., use Botox to make money. So they dilute the vial and inject limited amounts making the vial last longer and make more money.

See a Board Certified Plastic Surgeon and understand how many units of Botox you will recieve.

Everyone is different

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After one year your first dose of Botox was entirely gone. If you have "deep furrows" you must have strong frown muscle action and may well need two syringes of Botox every 4 months or so to lessen them. I once had a male patient who routinely needed 3 syringes in the lines between the eyebrows because his frown function was so powerful.

Botox dosage

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Botox can spread differently each time it is used and so its effect and vary each time. In your case it has sound as if it didn't work at all. I have had Botox personally injected into the Glabellar area at various times, and one time it didn't work for me either. It could have been the way it was injected, the material itself, the concentration, etc. However, it continues to work on me in standard doses.

It is my opinion, that you will not need additional units but ytou can only determine that through trial and error. IF a paitent requires higher than average doses on multiple occasions (not just one time), then I would consider them a "superuser."

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Muscle mass and degree of frowning

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I strongly beleive that people have different botox needs based on several factors. The muscle max and the degree of frowning is a major one. I have seen this many times with males who always require a little more than females.

Hisham Seify, MD, PhD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 19 reviews

Double dose of Botox

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Sometimes it is necessary to touch up a Botox treatment with additional units. Each treatment may be different from the next, as well. So, the same amount of units used for the first treatment might not be fully effective on the second treatment, and the reverse might also be true. At any rate, the amount needed will only fluctuate within a range of a few units.

Some people do need more Botox than others.

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1) I can usually tell by examining the patient, if someone will need more than usual Botox. One can tell by the size and activity of the muscles.

2) Find out the total number of units you received this time, and it should be consistent each time.

3) For the vertical frown lines between the eyebrows, I typically use 25 units for women and 30 to 40 for men. If you use a little more, I think it lasts longer.

4) Exactly where the Botox is injected is just as important as the number of units.

5) Wait a full 2 weeks to see the final result of a Botox injection.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Need for additional Botox

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I suspect that an insufficient number of units was injected or the batch of botox had lost its activity after re-constitution.

You ought to keep a log of many units you receive in which location(s) for future reference.

Bryan K. Chen, MD
San Diego 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.