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

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.  

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 

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.  

Without knowing more about you and your particular situation or seeing before and after pictures in animation, it is difficult to give specific advice.  However, 20 units is a good starting dose and is good for most people.  However, some people do require higher dosing and it is okay to re-dose after 2 weeks for further effect.  One also needs to make a distinction  between static lines and dynamic lines.  If the lines or creases are there at rest (when you are not animating) then Botox will have little effect.  The Botox will have the best effect on lines that appear when you animate or frown.  If the lines are static (always present) then you may need filler (such as Juvederm) as well as the Botox.  Over time, with several treatments of Botox, even static lines improve greatly, but not with just one treatment of Botox.Good Luck. 

20 units is a fairly typical dosing of Botox (comparable to 50 units of Dysport) in the glabellar area (11's).  If it was used in both the glabella and forehead (horizontal lines), your result is likely to be underwhelming. Botox is a medication, which has a minimum necessary dose for patient satisfaction.  Under treating with Botox, Dysport, or Xeomin invariably leads to dissatisfaction.

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. 

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.

It’s
possible that the Botox is working however if you had a “crack” in the glabella
or very deep 11’s it might be necessary to also add filler. The Botox will inhibit
the contraction of the muscles but not fill in a depression. Either way it’s
best for you to go back to your doctor to see what the next best step is.

I will often see patients back at two weeks to see if they require more botox if it was not effective.

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.