20 units of Botox were not effective on my glabellar lines. Any concerns about touching up with 25 units, 2.5 weeks later?

Dec. 27 was my first experience with Botox. I was given ~20 units, which the doctor injected into six total spots, starting at the 11s and working up and out. Over two weeks have passed, and there is little to no improvement. Is it too soon to go for a touch up? If the timing is fine, does 25 units seem like a reasonable amount?

Doctor Answers 16

When can additional Botox be added if 11s are still there?

The dose depends upon which toxin was used. Dysport tends to require about 2 1/2 times the number of "Botox units." 20 units of Botox is typically adequate for this area but depending upon the muscle volume it's not uncommon to require more. You should be fine with the addition of additional units at this point if you still have too much movement.

Stephen Weber MD, FACS

Denver Facial Plastic Surgeon

Denver Facial Plastic Surgeon
4.9 out of 5 stars 129 reviews

Botox Touch Up

There can be many variables, but when I personally get Botox or when I inject my patients I begin with 20 units and touch up with another 5-10 units after 10 days.  I do not think this is a problem in the normal healthy adult patient.

Joe Niamtu, III DMD
Cosmetic Facial Surgery
Richmond, VA

Joseph Niamtu, III, DMD
Richmond Oral & Maxillofacial Surgeon
4.5 out of 5 stars 12 reviews

Filler Might Be Recommended

Although there is no danger to adding additional units to the glabella, a total of 45 units is a larger than typical amount used in that area. I would advise waiting up to 4 full weeks to make sure that the 20 units are not working. Adding anadditonal 10-15 units may be more appropriate than 25, depending on the strength of your glabellar muscles. The repetitive motion of those actively moving muscles are what has caused the lines to form between your brows, and botox helps to diminish that muscle activity, preventing and furthering worsening those lines. If your lines are very prominent when you are at rest without frowning, is it unlikely that adding more Botox will help. A dermal filler such as Restylane or Juvederm may be more effective in reducing those “static” lines that are present all the time.

H. Michael Roark, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 16 reviews

Botox Touch up

In my experience in average frown lines, Botox will work well with a dose of 10units provided it is injected on the right position of the involved muscles. Rarely, a higher dose is required for those patients with massive and strong muscles. 
Since this is your first experience, drug resistance is out of the question.
If these are permanent frown lines, you will need concomitant injection of fillers.
However, if you are looking for a touch up, 2 weeks is just about the right time for you, either with the same dose or lower. 

Somyos Kunachak, MD
Thailand Facial Plastic Surgeon
4.7 out of 5 stars 17 reviews

Botox touch ups

As long as there is good technique and experience on the injector's part, there is no concern with injecting more botox units to get the desired effect at 2 weeks. Twenty units is a standard starting dose, and it is common to add more toxin at 2 weeks to even things out or to get so stronger effect. I have safely used twice the standard dose in the glabella for men or in people with strong glabellar muscles. Everyone is different, which is why I stronger suggest seeing an experienced physician injector.

Ramona Behshad, MD
Saint Louis Dermatologic Surgeon
5.0 out of 5 stars 6 reviews

Botox Touchup

There shouldn't be a problem with a Botox touch-up 2 weeks after the initial injections.  The amount of Botox needed for a touch-up is really dependent on how much you are wrinkling after the initial treatment.  

Eugene Kim, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 59 reviews

Botox and results.

20 units of Botox is a good standard dose. It is also a good starting point for someone who was never had anything in the glabellar region before. I often try to differentiate what to expect in terms of 11's deepening while you frown versus 11's at you see when you're not frowning at all. Botox may not help much with static lines, that is to say the lines that you see when you Are not frowning. For this I often use fillers in conjunction with the Botox.

If you still feel like you have a lot of frown movement after a couple weeks,  you can always add more Botox. I would also make sure that you go to a place that is well qualified to do Botox injections. People will dilute Botox differently at different places and the technique is important so that you are injecting the correct muscles to get the desired result. If you still see movement at the frown region, then you can always add more Botox to soften these lines.  

Young R. Cho, MD, PhD
Houston Plastic Surgeon
4.8 out of 5 stars 37 reviews


Our typical dosage is 25 units per area-(unless the wrinkles are more pronounced and deeper) you should be able to go back for additional units at this time.  Your PS can determine how much would be effective. 

Edward J. Bednar, MD
Charlotte Plastic Surgeon
4.8 out of 5 stars 125 reviews

20 units of Botox were not effective on my glabellar lines. Any concerns about touching up with 25 units, 2.5 weeks later

You may have been under dosed, If you have very strong muscle movement to start, you will require more units of Botox to see full result, scheduling a follow-up consult with your provider would be best 

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 496 reviews

20 Units of Botox

Dear Astridt1, Botox is extremely popular and reliable. Twenty units was a very satisfactory dose for your glabella. It typically takes 5-7 days to start to see the result. We would not consider a touchup until two weeks have passed by as it should have certainly taken effect by then. Occasionally, there can be a bad vial which doesn’t have the potency. The other reason for the non-effect is it is possible the product was not injected directly into the muscle. Different practices vary on touchup charges. You should have a good understanding of that before you have your first dose. Certainly, time wise though in answer to your question, it would be appropriate to touch up now. I don’t know that an increase in the dose to 25 units is necessary. I have never heard of a patient being resistant to Botox. More likely, it is one of the two causes I mentioned above. Robert D. Wilcox, M.D.

Robert D. Wilcox, MD
Dallas Plastic Surgeon
4.1 out of 5 stars 22 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.