Did I Receive the Correct Amount of Botox?

Question

Hello, I had Botox for the first time and had 14 units between the eyebrows and 6 units in the forehead. I was told less was needed for the forehead because I had more between the brows.

	It is day two and I see nothing. I know this is normal but I am beginning to wonder if I received the correct amount. I am 37 and do not have wrinkles but did not like the way my forehead wrinkled when I squinted in the sun. My PS said my forehead should be smooth like glass and that he did not want to overdo it for the first time. He also said that he prefers a more natural look with more movement than a frozen look. Thanks so much!

Steven H. Williams, MD · Answer

Thanks for your question -
We typically use between 15 - 25 units for the forehead and glabellar region (each).
At two days you're still early.  You usually begin to see results at 4 days with the final effect at about 2 - 4 weeks.
If it seems like you still don't have significant improvement at 2 weeks talk to your injector about a touch-up.
I hope this helps.

Harold J. Kaplan, MD · Answer

Hi Bella Rosella,
Like Dr. Williams, we ordinarily use between 15 and 25 units for both the glabella and the forehead. It sounds like your dosing in the glabella may be ok given the fact you have no lines currently, but the effect you describe on the forehead will probably not be eliminated with 6 units. 
Wait about 7 days and if you are not happy with your results, give your injector a call to return for more. Believe it or not, this MD was probably trying to do you a favor. If he had injected too much on the first visit it could be a lot worse. You can always do a touch-up in the first couple visits to finalize the right dosing for you. Good luck.

Otto Joseph Placik, MD · Answer

You should give Botox at least 3-5 days to "kick in" and at least 2 weeks up to 2 months to see the results.  The Botox package insert typically recommends about 20 units to the frown (glabellar lines).   You've been forming these wrinkles for well over 20 years. They just don't disappear.
Think about this analogy: if you wear your pants all day long and develop wrinkles and creases and then take them off and put them on a hanger, the wrinkles/creass don't immediately disappear. It takes overnight for the wrinkles to soften and some of the worst wrinkles never go away. The same goes for your forehead.
Once the Botox starts working and the muscles relax, it takes time (2 weeks -2 months) for the established lines and wrinkles to soften.  I hope this helps!

Richard W. Westreich, MD · Answer

It is better to do less than more, especially the first time. You describe wrinkling that is dynamic in nature, not resting wrinkles. It is harder to predict the outcome in that situation. Remember, you can always do more Botox. The only way to get less effect is to wait for it to stop working. Give it a few more days.

Daniel Reichner, MD, FACS · Answer

The 20 units that your Plastic Surgeon started with is OK.  I tell my patients that they should expect results in 7 to 10 days.  After two weeks, we recheck new patients and add more Botox if needed.

Kenneth D. Steinsapir, MD · Answer

Dear Bella
The treatment dose you received is in the ballpark and should make a nice difference.  However, BOTOX takes time to take effect.  Generally people are aware that "something is going on" in the first 24 to 48 hours.  However, the effect is much more evident after a week and is maximal at three weeks.  I encourage my patients to come back to the office at three weeks so we can see how their treatment worked for them.  We take the after picture and directly compare this for the patient with the before picture.  This can be very helpful to understand the treatment effect.  
Surprisingly I have some patients who don't think their BOTOX is working until they see the after pictures and then they are shocked that they did not see the effect before.  The issue here is that the treatment effect sets in slowly and the comparison is much more dramatic.  In fact I pioneered my MicrodropletTM BOTOX treatment (you can see this treatment at lidlift.com) by having patients back in follow up and carefully reviewing before and after photos with them.  
So I encourage you and anyone else to go back to the treating physician to look at the before and after photos to understand their treatment effect.  If you still don't see the result then either you did not get what you paid or the difference is insufficient to make it worth your while to be retreated.

Michael A. Persky, MD · Answer

Hi Bella,
"You look marvelous!", to quote our friend Billy Crystal.  Be patient and let the treatment kick in.  Wait at least 10 to 14 days and then have a look at yourself "squinting" in the sun. It sounds like you have a good PS.  You should be fine.
Be well.
Dr. P

Steven Wallach, MD · Answer

Treatment of the forehead and the glabella area varies from patient to patient.  Assessment of what you need is performed during an evaluation.

Christopher L. Hess, MD · Answer

My standard protocol for the glabella is 25 units.  For the forehead I'll use anywhere from 75-100 units.  Unfortunately, 6 units won't do much.  
I hope you paid by the unit.

Stephen A. Goldstein, MD · Answer

I certainly can understand your concerns.  It is important to be patient, as it typically takes between 2-7 days before the action of Botox to kick in.  In terms of dosage, the amount injected is understandable as this was your first injection.  I usually administer about 15 units for a first time patient with mild to slightly moderate lines and furrows in the glabella region.
The amount of Botox used in the forehead region is also titrated, depending upon the patient&rsquo;s degree of wrinkling, etc. If at two weeks, you still do not appreciate the desired aesthetic result, then I would recommend that you return to your physician injector for additional Botox.  Keep track of the total amount of Botox so that you and your physician will know the correct amount required on future injections.
I hope this helps to explain your concerns.

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