Why do some people get 2 or 3 units of Botox vs. 5 or 10 in certain areas?

My girlfriend says her PS administers just 2 or 3 units to her crows feet & that is the perfect amount for her. My PS explained the standard is 5 units to each side, 20 for "11's", & 20 in the forehead. Do certain people need more or less? Is this is case by case scenario? Also, my facial muscles don't really do the "11s thing" at all, mainly just 3 or 4 forehead creases, but was told it would look odd if I only do the forehead & not 11s? Is this true? Do I really need 20 in my forehead?

Doctor Answers 12

The number of units used will depend on the person’s desired result as well as their individual metabolism and the state of thei

The number of units required for each person will vary; it’s not a “one size fits all” treatment. The number of units used will depend on the person’s desired result as well as their individual metabolism and the state of their wrinkles. Deeper, more numerous wrinkles will require more units than someone whose wrinkles are just beginning to show. Most injectors prefer to inject conservatively at first, as it is easier to add more units later than to fix a bad result from injecting too much.

If you do not have 11 lines, there’s no reason to have Botox done in that area, unless you want to treat the forehead. In which case I always put a little on the glabellar complex to avoid a brow drop as by just treating the forehead you are left with the brow depressor muscles unopposed. I recommend visiting a different board-certified dermatologist for a second opinion.

San Diego Dermatologic Surgeon
5.0 out of 5 stars 66 reviews

Botox units

To explain Botox units u need to know the dilution used to reconstitute the Botox powder in a new bottle of the product used . This has varied since the introduction of this marvelous discovery many years ago & it's approval to be used throughout the world . I rarely use the term units unless a patient is acquainted with this by others , rather use areas of function such as forehead , frown & outer eyes . As mentioned it's a little trial & error to start a pt & follow up in 2 weeks to see your results , often patients don't really know what to look for results & have to be educated . Most times it works the way u want but a little tweak is good if u stay conservative & try not to have the patient dictate against your experience & discretion . Usually u can it it right after 2-3 Rxs but u & pt must have patience! This is based on @15 yrs experience .

Jerrold Gendler, MD, FRCS
New York Facial Plastic Surgeon
5.0 out of 5 stars 1 review

Why do some people get 2 or 3 units of Botox vs. 5 or 10 in certain areas?

Thank you for your question.  Each injector may start with a certain dose per area for new patients.  Botox takes 3-7 days to take effect.  Once the result of the initial injection is seen, patients can follow up approximately one week following their injection for a "touch up" if necessary.  If additional units are required for a certain area, then the injector may decided to treat with the total amount that was used to get the desired effect.  The number of units used also depends on the initial exam of the patient (the number and type of lines present) and the patient's goals.  Botox, just like many things, is not a one-size-fits-all treatment.  The treatment should be tailored to each patient.

Why do some people get 2 or 3 units of Botox vs. 5 or 10 in certain areas?

Hello Petunia83,

Different injectors have different preferences for the amounts to inject.  This is because people can respond differently.  I do have minimums that I recommend in an area because that works for most patients.  But what works for one patient may not be enough of a dose on another.  It also depends on what result you are going for.  For example, some people want to get rid of a resting face they  make but still want motion for expression.  Others want no motion to prevent wrinkles.  This affects how much each person will need.
With regards to whether you have to treat the area between the eyes, in my opinion no.  I have multiple patients who only develop forehead wrinkles so I only treat their forehead.  They don't look strange and continue to come back and refer friends to me which is usually a good sign.  When my patients come in for just the forehead, I start with 10 units but it can take as many as 20 units. 

If you don't feel comfortable with your injector, I would recommend you consult with a few others such as a facial plastic surgeon, plastic surgeon, dermatologist, or oculoplastic surgeon.

I hope this helps and good luck.   

William Marshall Guy, MD
The Woodlands Facial Plastic Surgeon
5.0 out of 5 stars 23 reviews

People can do well with different doses of Botox

People can do well with different doses of Botox.  Some of my patients only get 2 units in their crows feet for a lift.  Others may only get 1 or 2 units in a frown for a troublesome muscle recruiter.
A careful exam and working with your plastic surgeon will come up with an optimal result for each individual.
Doses if Botox can be varied. Most commonly I use 20 in the frown and 5 or 10 units in the crows area. 

Botox Dosing for Crows Feet & Forehead

Thank you for an excellent question regarding dosing for a neuromodulator (Botox, Dysport, Xeomin). 

The number of "necessary" units of any of the neuromodulators is highly individualized based on the strength of your muscles in the area to be treated.  As an international trainer for Allergan (maker of Botox), I am required to discuss FDA "on-label" approved dosages when officially training plastic surgeons or dermatologists.  For example, the FDA approved the use of 12 units of Botox per side for treatment of the crows feet.  Therefore, the clinical trials indicate that a total of 24 units around both eyes will provide the optimal treatment for the majority of patients.  Similarly, the clinical trials for the glabella (area between the eyebrows) show that injecting 20 units in this area is optimal.  The forehead is not an FDA approved area yet, but most advanced injectors place neuromodulators in this location.  The average amount used on the forehead ranges from 8 to 12 units.  Using high doses of Botox in this area can cause eyebrow and / or eyelid drooping.   If the forehead is treated alone (without the "11's"), you may experience eyebrow / eyelid heaviness. 

While the FDA has approved this average dosing, no person is average.  You may need less or more Botox depending on your muscular anatomy.  Please consult or return to an experienced board certified dermatologist or plastic surgeon for further evaluation.  

Best of luck,
Suneel Chilukuri, M.D.
Houston, TX

Suneel Chilukuri, MD
Houston Dermatologic Surgeon
4.8 out of 5 stars 4 reviews

Botox doses

Thank you for your question shortcake83. Botox is a purified protein used to address wrinkles associated with facial expression such as the vertical frown lines seen between the brows when one frowns or the crow's feet seen around the eyes when one smiles. The pivotal studies demonstrated that most people enjoy the results of their treatment for 3-4 months when 20 units are used between the brows for the frown lines and when 24 units (12 units per side) are used for the crows feet. While this is the standard based on studies, many doctors adjust the dosing based on the person, the extent of the wrinkles, etc. On the forehead there are muscles that pull the brow up and others that pull the brow down. If one muscle group is relaxed with Botox but not the other wrinkles may deepen or appear where they were not previously apparent. For this reason I recommend to my patients to have both areas treated. Please consult with a doctor for specific recommendations. Good luck!

Alex Eshaghian, MD, PhD
Encino Physician
5.0 out of 5 stars 1 review

Botox Starting Dose

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: 8 units per side
Glabella: 18 units

Consultation with a surgeon certified by the American Board of Plastic Surgery would be the next best step.


Thank you for your question in regards to Botox.
Each patient differs from the amount of units used. Some people do not need as many as others. Also, depending on the injector and how the Botox was reconstituted will vary the number of units used. If you are only concerned will forehead lines, and not your glabella area than Botox should not be necessary in your 11's. To be sure what is best for you, see two or more board-certified providers in your area for a complete evaluation to make sure you are a good candidate and that it is safe for you to have treatment.
I hope this helps.

J. Jason Wendel, MD, FACS
Nashville Plastic Surgeon
5.0 out of 5 stars 142 reviews

Why do some people get 2 or 3 units of Botox vs. 5 or 10 in certain areas?

Thank you for your excellent question.  In response to your first two questions, yes Botox dosing is dependent on a case by case scenario, as patients with larger muscles, or more active muscles, will typically require higher doses.  Botox is an excellent medication because it can lead to predictable and reproducible results in a very safe and controlled manner.  Areas that you wish to be treated can, while others can be left alone, tailoring the results to your desires.  Be sure to see an ASPS board certified plastic surgeon for an in-person evaluation.   

Nelson Castillo, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 38 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.