How Many Botox Injections for 20 Units?

The nurse told me she had given me 20 units, but she only gave me 4 Botox injections. Is that normal?

Doctor Answers 6

Botox injection sites with 20 units

If you had Botox injections for your frown lines, it would be appropriate to inject 20 units into four sites, depending on your muscle movement.  After 12 days, you will know if it was the appropriate dosage for you and you could have more Botox if indicated.

Toronto Dermatologist
5.0 out of 5 stars 22 reviews

There is no normal.

Dear Iselita

There are any number of way to dilute BOTOX. However most standard dilutions vary between 2.5 to 4 milliliters of saline. This produces BOTOX solutions with a concentration range of 25 units to 40 units per milliliter. Rarely an injector may use 1 milliliter of saline to reconstitute a 100 Unit vial of BOTOX. In this circumstance, 20 units of BOTOX would be contained in just 0.2 ml of saline. However, it is unusual for injectors to work with such concentrated BOTOX solutions. However, 0.2 ml of volume could easily be administered in just four injections.

I think what you are really asking is if you are getting less BOTOX than your are being told you are paying for. The answer to this is a resounding maybe. This type of deceptive business practice is very common. After all it is hard for you as a consumer to actually know what you are getting. Here is the clue: How long does your treatment last. Smaller doses of BOTOX wear off much faster that appropriate doses of BOTOX. A twenty unit treatment should provide benefit for at least 2 months. If you only seem to get a couple of weeks of benefit, it is time to find an ethical cosmetic surgeon like Dr. Cohen.

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

The Number of Botox Injections not as Important as the Person Injecting You

The number of actual injections you receive is not as important as making sure the person injecting you is well-versed and well-skilled in what the anatomy of the area you are concerned about and about the product itself. We always recommend going to an office where there is a board-certified dermatologist or plastic surgeon and that either they or someone they trained are injecting you. We will ask you to use your muscles in the area of concern, determine where the proper placement for the toxin should be, then inject the proper amount of toxin to the appropriate areas.

Sometimes we will use 5 injection points and sometimes 3 or 4 or 6, depending on the need – and then we will inject the appropriate amount of toxin into each site. Sometimes you may need 4-5 units into a certain area and sometimes you may need a little more or a little less – that is why going to the proper injector is key.

Find a board-certified dermatologist or plastic surgeon – and enjoy the toxin for what it does to the lines that concern you.

Michael Gold, MD
Nashville Dermatologic Surgeon
4.0 out of 5 stars 18 reviews

It may be fine

Botox can be diluted to different concentrations depending on the physicians preference and the effect that is desired. Overall the most important issue is the total number of units given and the placement of the injections. If you were being treated between the brows for frown lines it may be perfectly normal to receive 4 injections for that area. It would be a little more unusual to only have 4 injections to treat crowsfeet.

However, the bottom line is the end result. Botox can take up to two weeks to fully work. After two weeks, if you are happy with the result, than things are great. If you are not satisfied with the result, a different injection pattern or dose may help.

Hope this is helpful.

Marc Cohen, MD
Bala Cynwyd, PA & Voorhees, NJ

Marc Cohen, MD
Philadelphia Oculoplastic Surgeon
4.8 out of 5 stars 24 reviews

Sounds appropriate for Botox

A total 20 units of Botox Cosmetic injected via 4 injections sounds appropriate. The concentration of the solution would be 5 units per 0.1cc. Most plastic surgeons and dermatologist use concentrations of either 2.5 units or 5 units per 0.1cc. There is no cosmetic difference with the concentration.

Botox Cosmetic takes a little bit of time before you see results. Wrinkle improvement starts within a few days, with maximum aesthetic rejuventation by 2 weeks after injection. Touchup Botox Cosmetic injections are sometimes needed to achieve the best results.

Houtan Chaboki, MD
Washington DC Facial Plastic Surgeon
4.9 out of 5 stars 85 reviews


Yes that is normal depending on the dilution that he/she used.  You can inject more than one unit of botox at a time.  

Hannah Vargas, MD
Kansas City Facial Plastic Surgeon
4.8 out of 5 stars 46 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.