Does the Number of Botox Units Used Depend on the Severity of the Wrinkles?

Hi! I am starting to notice wrinkles on my forehead and in between my brows. Right now they are in between fine lines and wrinkles. I want to do something to stop them before they become more pronounced. I am considering Botox injections.

I have called several inquiries and some places charge by the unit and some places charge by the area. Does the number of units used depend on the severity of the wrinkles? If it does then it would be more economical to pay by the unit. But if it doesn't depend on the severity then it might be better for me to pay by the area. Thanks!

Doctor Answers 12

Know the number of units to compare

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Comparing costs for Botox treatment can be confusing for the very reasons you mention; if the charge is by the area, you don't know how much Botox is being used. The amount used depends upon the size of the muscle that is causing the wrinkles, so for someone with more wrionkles that often means a more active muscle but not always. The botox works on the muscle underneath the skin trather than filling in the wrinkles like dermal fillers (Restylane, Juvederm). There are some general guidelines, such as men typically require a higher dose, and somewhere around 20 units is typical for the vertical lines between the eyebrows. But you really need to have this determined by the medical professional who is doing the injections.

Seattle Plastic Surgeon
4.9 out of 5 stars 59 reviews

Botox and units

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I do not charge per unit. I charge based upon the area I treat. Some regions do require more "units" than others, and some patients may require  more Botox than others.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Start by finding a Botox doctor you can trust.

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 Tips on picking a Plastic Surgeon for Botox or for cosmetic surgery:

Answer by George J. Beraka, MD
Manhattan Plastic Surgeon
1) Is the surgeon a member of the American Society for Aesthetic Plastic Surgery? Members usually do a lot of cosmetic surgery.

2) Did you sense a commitment to excellence in the office. Did the surgeon spend a lot of time with you? Someone who rushes through the consultation may rush through the surgery.

3) Were you treated as an individual? Did the surgeon present you with a surgical plan tailor made for you?

4) Plastic surgeons have to have a good eye and meticulous technique. Did the surgeon show you A LOT of before and after pictures, and did you love the results?

5) Talk to other doctors you know. Established plastic surgeons have a reputation in the community, good or bad.

6) Ask to speak to a patient who has had the procedure you want. You are looking for a surgeon who does a lot of what you want. Many patients are eager to share their experience. Privacy is preserved by having the patient call you.

7) If you are having breast augmentation, ask if the surgeon has a large inventory of different size and shape breast implants available in the operating room. A surgeon who does a lot of breast surgery will have an inventory. This way, the final implant choice does not have to be made in advance.

8) With office surgery, make sure the surgical facility is ACCREDITED. Very important safety assurance.

9) Make sure the anesthesia is given by a BOARD CERTIFIED ANESTHESIOLOGIST. Another very important safety factor.

10) Make sure the office has trained nurses available for hands-on post operative care. This can really speed recovery.

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

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Area vs. unit pricing for Botox?

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Hi Arhmt9. If you are consumer doing price comparisons for Botox then pricing by the unit is the easiest way to compare. We would encourage you to find out how many units are injected when you decide on a practitioner regardless of the manner in which they charge - unit or area. In this way you will be an informed consumer.

In reference to the amount of units necessary, you will need less Botox if you have less muscle mass and milder wrinkles. For the area you reference, the typical patient requires 20 units, but it sounds like you may need less than this number.

Regardless of whether you decide on a practice that is charging by the unit or area, the most important factor to our patients is the desired outcome. Price is certainly part of the decision, but as you can see from these forums, there are a lot of practitioners that are not highly skilled at injecting Botox. This is why word of mouth is always the best way to choose a practitioner. Good luck.

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

Don't choose Botox injectors based on price

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Sometimes the artist is more important than the quality or volume of his paint. Botox injection is an acquired skill. If you are judging injectors based on price, that may not be the best approach. Ask friends and trusted physicians for a good referral. Your more likely to be satisfied with the results and the patient care. Places that lure you in based on price tend to come and go and use that as their only means of attracting clients. Think about it and make the right choice.

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

Units of Botox

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There are a few factors that most physicians weigh when deciding how many units of Botox to use. Some physicians are more comfortable giving higher numbers of units which may increase the duration of effectiveness, especially in areas with very strong muscles.

Cost is a factor, and some physicians do charge by the area and others by the unit, and some incorporate both area and units in determining the cost from treatment to treatment. Botox treatment is very much an art and a science. Depending on the doctor’s experience, the treatment is either significantly or mildly different than the manner in which another physician would treat the same patient.

You will have to see a physician in consultation in order to be examined and get a better idea of the plan of treatment and its cost.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 39 reviews

Botox is a Medication

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Botox is a medication and like other medications the effective dose will depend on many factors. One Botox molecule blocks a single muscle receptor. Therefore, the amount of Botox you require will ultimately depend on the number of receptors that need to be blocked – or the size of the muscle. In addition, the effectiveness will also depend on how effective each Botox molecule binds to and blocks the muscle receptor. In some individuals, Botox is not effective in binding to the muscle receptors and they are considered non-responders and may require much higher doses to achieve a comparable response. Injection technique is also very important. This is why it is so important to understand the anatomy of the facial muscles. If the Botox is injected into the wrong places then it will take more Botox to achieve the same results.

My personal approach to Botox injections is to always start with a lower dose. I explain to my patients - like other medications - it is better to start with a lower dose, document precisely the number of units and location of injected Botox. We photograph every patient before and after injections and recommend 2 week follow-up for new patients to determine if additional Botox is needed to achieve the desired results. Once we determine the best dose for you, this is documented for all follow-up visits.

I recommend that you seek consultation with a Board Certified Doctor who understands these principles.

Daniel Reichner, MD
Newport Beach Plastic Surgeon
4.9 out of 5 stars 51 reviews

Number of Botox Units

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The number of units required is directly related to muscle bulk/strength of muscle contraction. Because men typically have more facial muscle bulk, they typically require more units than women. Whether your provider charges per unit (as I do) or per area, it is important for you to find out and make a note of how many units were used and where, for future comparison. It is most important to find an injector you are comfortable with - preferably a qualified and experienced dermatologist, facial plastic surgeon or oculoplastic surgeon.

Bryan K. Chen, MD
San Diego Dermatologist

6 of one...

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I have seen both approaches to this issue, and neither is right or wrong.

I charge by the area. I dont care how many units are used, as long as I get the cosmetic result desired. I guess if you look at it that way, you might save some $$$ if you pay by the unit. As long as you get the result you want. You may find however, that it is not that much a difference.

Don't go to practices that make you be the doctor.

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Dear Ahrmt9

There are a lot of common practices out there that make absolutely no sense. They exist because the offices offering them have no idea of what works-they have nothing to offer. So they let you practice medicine on yourself by telling them how much BOTOX you want or where to put it (or in the parlance of the street, what area you want treatment). Lets backup and ask if either of these approaches make any sense.

Isn't it logical that your treating doctor should know better than you how much BOTOX you need and what parts need treatment?

The only reason to charge a premium for services is if you are going to provide them. So if the office you go to for BOTOX, no one is telling you or advising you about what you need, then they are truly only offering just the commodity (i.e. a squirt of BOTOX). However, this is an injustice because how should you know how much BOTOX you need and exactly where it should be put?

In Los Angeles, some offices are actually offering a "unit of BOTOX" for less than the actual cost. Believe me when I tell you that these offices are not charities. This can only mean that there is less BOTOX in the syringe then they claim.

In my office, I charge by the service. I have a patent pending microdropletTM BOTOX method that consistently produces a forehead lift. I charge a premium for this service which usually requires 33 units of BOTOX. However, I have some patients who need much more BOTOX and they pay for more and get more medication.

I recommend that you find an office where you are being treated by the doctor, and where the doctor can talk to you about what you need and why. You should be told exactly how many units of BOTOX you will be receiving. If the office won't tell you or tells you that they only treat by area or syringe, find another office. If the office tells you that their technician, or trained aesthetician will be doing the service, find another office. If you have been going to the office for awhile but the treatment no longer lasts as long as it once did, find another office. The good news is that this service is so popular, it is very easy to find an ethical office with a caring physician who performs a premium services. You will pay more for this type of care but peace of mind is worth this premium.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 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.