Botox for Frown Lines - How Many Units Are Normal?

I just went to get rid of my frown lines (forehead) they gave me 46 units of Botox, which is equivalent to 2 syringes... does that sound right?  I don't understand the term units, and I don't want to get ripped off.

Doctor Answers 23

Sounds average

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46 units sounds like the average for the area. Give it up to 2 weeks to see an improvement, then return to your injector if you don't see any improvement. Units is the measurement of the actual amount of Botox administered, before it is reconstituted.

Botox for frown lines

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The amount of Botox units placed in the forehead is quite variable depending upon which muscle groups( corrugator versus frontalis) are injected. A large person with thick muscles will require much more  Botox than someone very petite with small muscle structure. 45-50 units seems  appropriate for the forehead

No rip off here

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VJB,

You weren't ripped off!  Trust your surgeon.  I have said this before and I will say it again.  It doesn't do ANY practitioner ANY good to compromise your result.  It's a basic business concept.  A satisfied customer will always come back!

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The amount of Botox required to treat wrinkles varies from individual to individual.

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The amount of Botox required to treat wrinkles varies from individual to individual. In general, I use about 50 units to treat the forehead, glabella, and crow’s feet. Some patients may require more and some less. So, it does not appear that you were overcharged.

Thanks for your question.

Stephen A. Goldstein, MD
Englewood Plastic Surgeon

Botox Units vs. Areas

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It is always preferable to know how many "units" of Botox were used to treat a given area. The pricing is then based on dollars per unit, and you know exactly what you're getting, as well as what you're paying for it, like going to the gas station to fill your tank. A "syringe" means nothing unless you know how many units it contains, and the cost per unit.

I typically use 20 units to treat the "glabellar" frown lines (a.k.a. "11's") between the eyebrows and the root of the nose, and 20 units to treat the horizontal forehead lines. Some patients may require more, or less of a dose, depending on the muscle mass and their sensitivity to the Botox.

25 units is fairly typical.

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For just the frown lines (the corrugator supercilii and procerus muscles), I usually start patients with 25 units. The occasional patient requires more depending on the prominence of the muscles.

"Units" are a standardized dose of Botox, where 1 unit was defined as the LD50 for intraperitoneal injections in mice. The LD50 is the "lethal dose, 50%" which means that 50% of the mice injected with 1 unit of Botox in the abdominal cavity were killed. [And before anyone gets nervous, the LD50 for humans is on the order of 3,000 units--more than a hundred times the dose used in the frown lines!]

In addition, you can't compare treatments by number of syringes or by volume (number of milliliters) since various practitioners reconstitute the Botox to different concentrations. Typical concentrations are 2.5 units/0.1ml, 4 units/0.1ml, and 5 units/0.1ml. I prefer to use 2.5 units/ml so that I can more evenly treat the muscles (10 injection points with smaller doses at each site...but then I also numb the patient first since it is more "shots").

David C. Pearson, MD
Jacksonville Facial Plastic Surgeon

Dose of Botox for frown lines

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Thank you for your question vjb. I understand your concern. Botox is a purified protein used to address wrinkles associated with facial expression. When injected into the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The most common areas of treatment are in the upper face. These include the horizontal lines seen on the upper forehead when one raises the brows, the vertical lines seen between the brows when one frowns (frown lines), and the crow's feet seen around the eyes when one smiles.

It is difficult to make an assessment without a formal exam in the office where I can view the skin in multiple angles and observe wrinkles formed with facial expression. However I hope the information provided here is helpful.

The pivotal studies used 20 units and 24 units (12 units per side) of Botox in the glabella area between the brow and around the eyes to address the frown lines and crow's feet, respectively. These studies demonstrated that the peak results are seen 14 days after the treatment and most people enjoy their results for 3-4 months. At that point, a maintenance treatment is recommended. While some people start to see results as early as the next day, it can take two weeks for full results so patience is important. We have our patients return two weeks after their treatment to assess their results via photographs. At that time additional units may be added if necessary.

Although 20 units is a good standard dose to start with for the frown lines, some people require a higher dose because of higher muscle volume. This is common in mature patients, in those with large bulges from expressive faces, and in men. I find that Botox still works in these cases, just a higher dose is required. I have used up to 40 units in the glabella.

There have not been such studies published for the horizontal lines on the upper forehead. However, in my experience I find that 10-20 units works well in this area. For patients with narrow foreheads a lower dose may be used and those with a broad forehead generally require higher doses. I have also found that the full results in this area are seen by two weeks. Therefore, we have our patients return two weeks after their treatment to assess the results via photographs. At that point additional units may be used if further enhancement is desired.

Dosing of Botox is by the unit. The concentration depends on the reconstitution of the product. The manufacturer recommends reconstituting 100 units in 2.5 mL, giving a concentration of 40 units/mL or 4 units/0.1 mL. The product is withdrawn from the vial into syringes prior to its use. The number of syringes depends on the concentration and the size of the syringes. In my practice I reconstitute the product per the manufacturer's guidelines and use 1 mL syringes. I typically withdraw 20-30 units (0.5 mL to 0.75 mL) in any syringe. So I would likely use two syringes for a total dose of 46 units.

With any injection, there are risks such as pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take special precautions to minimize these risks such as using a painless technique. We also treat bruises with a laser as early as the next day. Bruises usually resolve within two weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take two weeks for full resolution.

After a Botox treatment, I recommend that my patients avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours and not lie down flat for four hours. This is because all of these activities may possibly lead to the movement of the product and consequent side effects such as droopy eyelids as described above. Although there have been no definitive studies shown that these actually occur and some physicians do not provide such aftercare instructions, in the absence of data I err on the side of caution and recommend that my patients avoid such activities.

Please consult with a doctor for specific recommendations. Good luck!

Botox Units

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Botox is an injectable used to lessen the movement of specific muscle of the face in an effort to target wrinkles created by the contraction of facial muscle groups.

The dosing for Botox is variable and based on the desired effect, the amount of current animation, and the strength of the muscles. For new patients, however, the exact dosing is often discovered through a trial and error process. See link below. Some rough guidelines are:

Forehead: 16 units
Crowfeet (around eyes): 8 units per side
Glabella (between eyes): 18 units

For clarification, think of Botox Units as grains of salt dissolved in water. The same number of Units can be put in 1 syringe or many syringes and the same number of Units can be dissolved in 1 ml or 10 ml of water depending on the concentration.

A detailed examination will help delineate your treatment options. Consultation with a surgeon certified by the American Board of Plastic Surgery would be the next best step.

Botox dosing for frown lines

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The correct dosage of Botox is the smallest amount necessary to achieve the desired effect.
I typically use one syringe (25 units) of Botox for the glabellar frown lines.  If this provides insufficient improvement, then a larger dosage of Botox can be used for subsequent injections.  46 units is an unusually large dosage to the glabella for most women, though it is sometimes an appropriate dosage for men (who usually have stronger muscles in this area).  

Ronald Friedman, MD
Plano Plastic Surgeon

Botox for Frown Lines - How Many Units Are Normal

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For the Frown lines it is normal to use between 20 - 30 units of Botox.
Giving more Botox units is of no benefit. It is like filling a 50 litre gas tank with 60 litres. The 10 litres will overflow and serve no purpose.

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.