Confused About Units of Botox Received Previously Vs. New Recommendation, Am I Missing Something?

4/11 in Texas I got "10 units Botox in 1 syringe, 7 for forehead/glabella, 3 for frown lines at $25 a unit=$250, dilution ratio 4:1. Saw results I was pleased with (didn't know what to expect for 1st time but definitely improved) for 5 months. 10/2011 MD -recommends 20-25 units for forehead/glabella and 20 (total) for both frown lines so 40-45 total 'units'. Cost around $575. See everywhere that current recommendation is the norm. Confused by what what given in TX. What am I missing?

Doctor Answers 11

Botox dose in units varies from doctor to doctor

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I am surprised to hear you had five months duration of effectiveness from the 10 units total of botox that was used to treat the glabella and forehead when four months is the norm with greater number of units used.  I would expect a markedly diminished result and a less than average duration from that treatment. Something just doesn't make sense and I certainly can't comment on what was done in the past in another practice. The current treatment seems more typical but those units might be more than average for a forehead treatment and I would be concerned about a forehead drop pushing down the eyebrows. Placement is important and if you're happy with the current provider than you should stay with them if possible. 

Manhattan Dermatologic Surgeon
4.9 out of 5 stars 39 reviews

How Many Units of Botox do I Need?

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Hi Donna.  Your research is pointing you in the right direction.  The number of units of Botox is pretty standard at around 20.  We find we use less in the forehead, but it depends on the patient.  A ballpark of 40 units for glabella and forehead is about right and that is what the second injector is recommending.

We are not sure how you would have achieved a 5 month result with only 10 units of Botox and also $25 per unit seems pretty high so that does not make sense either.  Is it possible that you had the right number of units injected in TX but just remember the numbers wrong?  Good luck with the second round of injections, it sounds normal.

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

What the cost does not tell you about your Botox injector.

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All physicians pay the same price to purchase Botox from Allergan. Therefore, the price a physician charges to inject Botox has more to do with how much profit the doctor wants to earn than how much talent and/or skill they have. I am a highly experienced platinum level Botox injector as well as the highest level Radiesse injector and am a member of the medical education faculty (physician trainer) for Radiesse, yet I charge less for Botox than a new, inexperienced physician in my area. That is because I can make it affordable for more of my patients while still making a profit.

Mitchell Schwartz, MD
South Burlington Dermatologic Surgeon
4.4 out of 5 stars 13 reviews

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Botox units & pricing

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The proof is in the pudding: if u got results & are happy with them, u have received the corect amount. Usually the total dose for the "11 ' frown lines is 12-25 units, depending on the particular patient. However , I do have a couple of patients that receive only 6 units total. Any higher doses, for them, lead to abnormal looks! In ur case, maybe u misunderstood the number of units used. Bottom line: you are happy with the results,[ & the total price is very reasonable]. 

Khaled El-Hoshy, MD
Detroit Dermatologic Surgeon

What amout of Botox is needed for forehead and glabella

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The amount of Botox needed for forehead, glabella or any other area primarily depends on what amount of muscle mass is being treated.  If your corrugators (muscles that pull the eyebrows together to make a frown or the famous "11's") are very strong or over-developed, you may need more units.

I agree that $25 per unit is extraordinarily high.  The cost on the East Coast is usually around $14-15 per unit.  I normally start with 5 units into the procerus (on the nasal bridge, between the eyes) and another 10-15 units in the glabella, depending on the size of the muscles.

The forehead needs about 12-15 units as well.  One big consideration is whether the patient is using the forehead to lift the eyebrows, as commonly happens when there is redundant eyelid skin that is hooding the eyes.  In that case, forehead treatment with Botox must be done extremely cautiously so as not to impede this pulling up by the forehead.  If that happens the eyelids may feel heavy.

Most importantly, there are no hard and fast rules about how many units an area requires.  It is all individual and requires a thorough evaluation with the patient both at rest and making facial expressions, such as squeezing the eyes shut, wrinkling the nose, raising the eyebrows, etc.

Emily Altman, MD
Short Hills Dermatologic Surgeon

Botox dosing needs to be individualized

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There must be some miscommunication as the dose you reported having received the first time is far too low to have done very much. The range of 20-25 units for the glabella and 20 for the crow's feet (10 on each side) is typical. The dilution ratio would not affect this, only the total dose in units.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 59 reviews

Confused About Units of Botox Received Previously Vs. New Recommendation, Am I Missing Something?

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Botox and the amounts of units used can vary significantly with individuals and between MD's performing the Botox injections.  IMHO, 10 units doesn't seem like the correct dose for what you describe as being treated (the first time) while the second dose is more likely.  Perhaps a miscommunication somewhere.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

What you are missing is that there is no norm.

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$25 per unit is top dollar and you should get very good service for this cost.  The other injector is charging about $12 per unit.  This is a common price point for ho-hum injectors.  Top people get top prices.  Personally, I think there is a huge difference in how these treatments are performed.  FInding that right person in your new market can be a challenge.  With BOTOX, more is not necessarily better.  You could end up with a densely frozen forehead.  Good luck and sorry about the confusion.  Look on by website and learn about microdroplet BOTOX.

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

Botox dose ranging study

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The Carruthers (the Docs who brought the cosmetic use of Botox to us) have done several dose ranging studies that were reported at our national dermatology meetings. The average dose for females was 25units in the glabella area.The low dose they used was 20. It may be that there was some misunderstanding of the dose you recieved in Texas. I my many years of injecting Botox I haven't had any patient with define gabellar lines get by with only 10 units.

Ann Lott, MD (retired)
Lincoln Dermatologist

Botox dosage

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The price of 25 dollars a unit is exorbitant and the number of units used for those areas is extraordinarily low. Average per unit cost is 12-14 dollars. Average number of units for glabella is 20-25. Average for forehead is 12-20. These doses are if areas are done individually. If both forehead and glabella are done together you don't usually need the full dose for both areas. 45 units for the forehead area is a bit high if it is your first time with that dose. I would recommend a lower forehead dose- you can always add more, but too much will be too much for 4 months! Of course make sure you are seeing a board certified dermatologist or plastic surgeon.

Jacqueline Calkin, MD
Sacramento Dermatologic Surgeon

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.