Does the Number of Injections Have Anything to Do with Botox Results?

I recently moved from LA to Dallas and was ready for my 2nd Botox treatment. The laws are different here, and you don't have to be a doctor or nurse to inject.

In LA, I was injected with 28 units for lines across the forehead and the ones between my eyes. She only needed to inject me in 8 places or so. I was super happy with the results! My face looked more open and fresh. Two days ago in Dallas, I went to a "Derm Spa" and the esthetician used 25 units, but "poked" me all over the place! My forehead looked like major hail damage! Seriously, like 20 injection sites, and I don't think she even got the area between my eyebrows! I have a small bruise, but at least the redness and bumps went down. Why is there such a huge difference? Is it possible she did it wrong? Is it safe for me to go back for the lines between my eyebrows?

Doctor Answers 17

The number of injection sites is highly variable between different injectors...

whether more units are injected in fewer sites or fewer units are injected into more sites really is a matter of personal's the total number of units used and where they are placed that makes the difference...certainly 25-28 units sounds reasonable...if you don't like the results, you should see a physician injector...a dermatologist or plastic surgeon would be optimal choices...and you can go back for more...just wait a week or two between sessions

Las Vegas Dermatologist
4.6 out of 5 stars 9 reviews

Do not have your injections of botox from the lady down the street

Generally the standard dose of Botox to treat the vertical creases between the eyebrow is between 15 to 20 units.  Either you are not being injected in the correct areas or the Botox is old and and not as effective. Sounds very unusual.

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 19 reviews

Number of Botox injections and amount of fluid are not important.

It can be hard to understand whether Botox is being done properly because it really is an art. How much to put and where to put it are best decided by a board-certified dermatologist or plastic surgeon. Because of the different dilutions used, the actual fluid volume injected is not necessarily directly relevant to how many units were placed in a given spot. Additionally, because Botox spreads to a small degree, the same effect can be achieved in a few different ways with varying numbers of injections.

The best bet is to go to a board-certified dermatologist or plastic surgeon and not a "skin spa" where chances are, it's not one of the four "core aesthetic specialists" running the show.

Jessica J. Krant, MD, MPH
New York Dermatologic Surgeon
4.7 out of 5 stars 41 reviews

The amount of units is important for best results with Botox

Botox is measured in units and not in the number of injections.  Is is always best to have Botox injected with an experience doctor of nurse.  Before you considering going back or going elsewhere for retreatment, you need to wait 14 days for your first Botox  injection to take affect.  Should you require more Botox, the injector will know  then if it has worked successfully in the initial target area. 

David A. F. Ellis, MD
Toronto Facial Plastic Surgeon
3.5 out of 5 stars 8 reviews

The right number of Botox injections


There is no perfect number of Botox injections. Each treatment should be individualized for the patient, their anatomy, and their aesthetic goals. Typically the patient needs to the three injections in the area of the crows feet. The number of injections in the four head may vary depending on the effect the patient wishes to create the Botox. The majority of my patients enjoy erasing the central brow lines but leaving enough animation in the lateral brow to not completely remove all facial motion. This will create a youthful looking brow and will avoid a frozen for an appearance.

Pat Pazmino, MD, FACS
Miami Plastic Surgeon
4.7 out of 5 stars 101 reviews

Botox injection styles will vary

In the situation you described, we would not necessarily state that one procedure was better than the other. The first concern would be how are the results? If the results are good, the second question we would have is how comfortable the procedure was for the patient. If we can get the same results with less injection sites, we will, just because it's easier on the patient.

If you're not happy with the results or not excited about being "poked" so many times again, we would recommend asking around for a different and experienced practitioner.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.3 out of 5 stars 6 reviews

Research the individual who will be performing your Botox treatment

Although there is no standard number of units or number of injections per site, it is wise to consult with a board certified plastic surgeon prior to your next treatment. Unfortunately, many health care assistants do not have the same training and experience as board certified plastic sureons. I would recommend seeing out a board certified plastic sureon who can appropriately evaluate your anatomy and administer and monitor the appropriate amount of Botox to achieve your desired results.

David A. Robinson, MD
Munster Plastic Surgeon
4.7 out of 5 stars 42 reviews

If you were not totally happy, I would seek out a plastic surgeon to do your Botox

Whereas there are certainly non-physician injectors that do a great job with Botox and fillers, a physician, especially a true plastic surgeon, has much more training and experience and may have a different opinion about what exactly would be best for your face. There is a reason for those California laws!!!

Caroline H. Chester, MD
Nashville Plastic Surgeon

Sounds a bit unconventional, but if it worked well again...

There are different ways to do things and still get good results. If 10 days post treatment you are again happy with the result, then the second provider found a different way to get a good result. If not, you may want to find a different injector for next time.

Twenty injections for just the forehead sounds like a lot. Closer to ten is more conventional. The glabella (between eyebrows) usually requires 5-7 in my hands.

It is always wiser to have your treatments done by the most experienced and highly trained individual you can find. Hope this helps.

Bruce K. Barach, MD
Schenectady Plastic Surgeon
4.6 out of 5 stars 13 reviews

Injection techniques for Botox

Botox can be constituted in varying dilutions and all are equally effective based on the absolute quantity of botox injected.

There are varying techniques for injection depending on the experience and overall practice emphasis of the practitioner. In any case, the botox injections should be based on the severity and overall distribution of the wrinkles.

After injection, it is possible to inject more botox to correct any residual wrinkles.

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 94 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.