Botox injections. 50 units for between brows? (Photo)

I had a consultation with a doctor for Botox injections. Between the brows. I think I mostly have a "1" not an "11". See photos. She recommends 50 units! Isn't this way too much? I did purchase a groupon. I'm thinking maybe she just wants more money. Please advise. Thank you.

Doctor Answers 31

Botox to glabella

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Thank you for your question.I would ask what product the doctor is injecting. In my experience some clinicians who use Dysport typically use 50 or more units in a treatment area. If they are using Botox it should take a max of 25 units.  Is this a board certified PS? Good luck.

Greensburg Plastic Surgeon
4.7 out of 5 stars 83 reviews

50 units Botox® is too much as a first glabella treatment, but similar neurotoxins are measured differently

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Thank you for your question. You submitted a photo, and you state you visited a doctor using a Groupon, and asked the physician about improving what you describe as a number “1” as opposed to a number “11”. You want to improve the area between the brows, and the doctor recommended 50 units of Botox® so you ask if that is too high, and if the doctor is trying to make more money off you.

I can give you some ideas of how this area is handled, with or without a Groupon. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I’ve been in practice in Manhattan and Long Island for over 20 years. I, my colleagues, and my specialty were among the first doctors to administer Botox® to patients, and so I’ve used Botox® for patients since 1993.

First understand what it is the concept of Botox®, which is a neurotoxin, with other neurotoxins in the same category like Dysport®  and Xeomin® . When it comes to the number of units, you may want to be specific whether or not it was Botox®, because the name Botox® is used generically like Kleenex®. It might be that your doctor was suggesting Dysport®. For the glabella area as is your concern, 50 units is not a typical starting dose.

One very important thing to establish is choosing a doctor you can have a long-term relationship with when considering Botox® treatment. People will often try Botox®, and do it in different discounted ways, but for many people it will be disappointing experience. If you are going to have a long-term relationship with a physician, I doubt you are going to get the best doctor for you by virtue of a discounted method. Given that Botox® is the #1 non-surgical cosmetic procedure, this strategy may not be ideal for you.

The glabella is actually 2 sets of muscles called the corrugator, and procerus muscle. These muscles contract and cause that line to form. If that line is always there, even when you are relaxed, it is called a static line. It is very important to understand this line may not significantly improve with the first treatment of Botox®. I always tell my patients the skin is like folding paper or creasing a shirt, so if you iron a shirt, and crease it over and over, those creases will stay - it’s the same thing with Botox®.  What’s different is when you relax, the body will form collagen at the deeper levels of the skin so the lines will improve, but they improve with time.

Clearly, there is a need for better communication when referring to other injectable neuromodulator such as Dysport®  where the units are different than Botox®. You have to be sure you are speaking specifically of Botox® versus Dysport® . Typically, I would not exceed at 25 units for the glabella, especially for someone who is getting it for the first time. It’s my approach in my practice to be conservative with the first treatment, and routinely I will see patients after 2 weeks to reevaluate if they need more. With Botox®, you can add more, but if you do too much, you can’t undo it, so a stepwise approach to dosing gets the patient the outcome at the right dose, and gives them the best value for the longest period of time. This requires some work, and having someone come in for more than just one transaction.

I think that you need to get another opinion, or at the minimum contact the doctor to get the specifics. Ask why the doctor wants to do 50 units. This is a field where so much miscommunication occurs, or lack of communication. I make it a point to spend a lot of time with my patients, take their photos, show them on the screen what I see, and have them see it to evaluate so we are both on the same page with a good understanding.

Again, if you are speaking about Botox®, 50 units do seem like a lot. Contact the doctor to get some clarity as to whether it is Botox®, Dysport®,  or any other product, and ask what the follow-up will be like after you get this treatment. You have to find a doctor you are comfortable with, and I think price is probably the least effective way of finding the right doctor for you. I hope that was helpful, I wish you the best of luck, and thank you for your question.

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Amiya Prasad, MD
New York Oculoplastic Surgeon
4.4 out of 5 stars 80 reviews

Botox for forehead scowl lines

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I agree with you in that to treat the Glabellar area typically requires 17.5 to perhaps a maximum of 27.5 units. You can use the other units elsewhere but I cannot imagine more than that amount in that area.

Scott Trimas, MD
Jacksonville Facial Plastic Surgeon
5.0 out of 5 stars 20 reviews

Units of Botox

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Hello ~ In general the area that you want treated should take 20-25 units of botox. If your injector is using another product, Dysport, it could take 5-60 units. It would be a good idea to clarify which neurotoxin is being used. Good Luck!

50 units of Botox

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Thank you for your question.  Allergan the manufactures of Botox recommend 20-25 units for 1 area.  From my own personal experience injecting, I feel that this is generally an appropriate amount. It is important to have your Botox injected in an office where a Board Certified Plastic surgeon over sees the treatments to make sure that you achieve maximum benefits. 

Michael Sullivan, MD
Columbus Facial Plastic Surgeon
4.9 out of 5 stars 112 reviews

50 Units for Botox in Glabella

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Well 50 units for Botox in your Glabella does seem like a lot. Have you had Botox before? And did you respond to it differently? Also is the injector using Botox or Dysport? Because with Dysport it is typical to use 50 units. Please be sure you are seeing a Board Certified Professional before going further.
Thank you for your question.

Botox dosing

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Is it Botox or Dysport that your injector is using? They are different and require different units to achieve result.  Using a groupon for a neurotoxin is not a good idea.  I would consult with a board certified PS/derm.

Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 517 reviews

50 units

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Thank you for your question and photographs.  50 units of Botox cosmetic to treat only the glabella for the "11s" you are concerned with does seem to be quite a large dose.  Be careful to select an injector who is experienced and certified to perform any injectable procedure.  Best of luck.

Frown lines and Botox

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Using Botox for treating the "11s" or the "1" as you describe, should be adequately treated with 20 U of botox.  50 U seems excessive. However, if you are treating any other areas, you may utilize a full 50 units.  In general, groupon is not a great way to seek medical treatments...

Roxanne Sylora, MD
Orlando Plastic Surgeon
5.0 out of 5 stars 19 reviews

Botox for glabellar frown lines.

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Botox results are directly proportionate to the dose of botox delivered.  Results can be seen with even a small amount of botox (only a few units), but more profound and longer lasting results are seen with higher doses.  50 units is fine.

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