Isn't 40 units of Botox a lot for lines in the forehead?

Question

I received 20 units of Botox on my forehead 14 days ago. I still have total use of my forehead muscles and the wrinkles are still prevalent. I contacted the place I went and they said that I need more, possibly 20 more. Does this sound right?

Andrew Campbell, MD · Answer

20U of Botox for horizontal lines in the forehead seems like plenty. One issue to consider though is that Botox relaxes the muscle that causes the wrinkles, it doesn't always make the wrinkles disappear. Considering you state that you have total use of your forehead, I will assume you have continued muscle motion and that is not the case. I'd recommend you see your provider and have them take a look. If you need additional Botox in the forehead, have them explain why. We don't charge for touch ups on an area that has recently been adequately treated, just something to discuss if they want to charge you.Andrew Campbell, M.D.

Facial Rejuvenation Specialist

Quintessa Aesthetic Centers

Facial Rejuvenation Specialist

Quintessa Aesthetic Centers

Raymond E. Lee, MD · Answer

Thanks for sharing.  Botox in the "forehead" can actually be split into sub areas such as...

Glabella (vertical lines or 11's)  = 20-25 UHorizontal forehead line = 20 - 25 UBrow Elevation = 4-5 U each Brow These are estimates and of course you would want to be seen in person for final recommendation. Best to go to an expert injector and using Botox that was been recently reconstituted.

Janet Turkle, MD · Answer

Hello. Thank you for your question. The amount of BOTOX needed can vary widely from person to person. What you may be seeing are deep creases from long term wrinkling that can be corrected with a dermal filler. BOTOX will not erase those kinds of creases.I would recommend you return to the practitioner you saw and ask them to examine your forehead.You did not indicate what type of injector provided your BOTOX. I would recommend you only see a board-certified plastic surgeon or an expert injector on his/her staff. Understanding facial anatomy and technique is very important. Good luck.

Joel Schlessinger, MD · Answer

When Botox doesn't work despite being given in the recommended usage there are two basic possibilities:  You could be resistant to the effects of it or the Botox you received may NOT have been as described.  There are many places that advertise 'cheap' Botox and give a very inexpensive price per unit.  That often leads them to consider diluting it.  Alternatively, you may just be resistant to the effects.If we have a situation where the normal amount of Botox or Dysport doesn't work (and that clearly does happen), we would either consider more of it or consider switching from one to another (so consider Dysport next time).  Best of luck!

Michael I. Echavez, MD · Answer

In most cases, I would say around 20 units of Botox is what I normally would use to treat the lines across the forehead.  Some people do need more however to obtain the desired effect.  If you had absolutely no effect from the first 20 units to your forehead, I would be hesitant to try more.  If you had some effect from the first 20 units, I would think that adding more would help with the movement you are still seeing.  An examination of you would be needed to try and determine how much more Botox I would recommend.

Jason Emer, MD · Answer

This is difficult to answer without before and after pictures. The amount of Botox needed is variable. Sometimes a combination approach is best for this with Botox combined with fillers and microneedling/prp. I recommend getting a formal evaluation with an expert. Best, Dr. Emer

Monika Soni, MD · Answer

Thank you for your question. Without a photograph this is difficult to answer. However, the amount of Botox need to treat the forehead can vary from person to person. What you may be experiencing are deep creases in the forehead from long term wrinkling. This can be corrected with a dermal filler. Unfortunately, Botox will not erase these creases. I recommend finding an expert injector in your area to determine the best treatment plan for you.

Hardik Soni, MD · Answer

Thank you for your question. Without a photograph this is difficult to answer. However, the amount of Botox need to treat the forehead can vary from person to person. What you may be experiencing are deep creases in the forehead from long term wrinkling. This can be corrected with a dermal filler. Unfortunately, Botox will not erase these creases. I recommend finding an expert injector in your area to determine the best treatment plan for you.

Esta Kronberg, MD · Answer

Everyone is different in the dose of Botox they require. Go back to your injector . Be sure it is past 12 days of treatment.  You want to evaluate if they are fixed creases or moving lines. If still moving then you need more product. Sometimes Dysport works better in some people. So changing to Dysport might be better for you. Also be sure it's not the frown crease moving instead.If the lines are fixed and they are etched creases you may need some filler at this point to decrease the lines. Be sure your office used fresh product on you.

Tianna Tsitsis, MD · Answer

The amount of Botox needed per person per area is quite varied.  It is difficult to say what you consider "total use" of your forehead muscles.  You may be seeing the muscles of your glabellar complex working if you did not treat that (the area between your eyebrows which actually extends upwards to over your eyebrows medially).  You also may be seeing your forehead lines still because they are very deep and they may not go away with Botox.  Over time they should soften and look less deep, but it took years for them to get there and it will take time to help relax the muscles enough for them to ease off.  I would recommend returning to the same doctor that performed the treatment, look at before and after pictures (make sure its been over 2 weeks since you were first injected) and get their opinion while they are seeing you as to how many units they'd recommend.