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

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.

A typical starting dose for botox to the glabellar area (between the eyebrows) is 25 units. This is for Botox Cosmetic (onabotulinum toxin) and Xeomin (incobotulinum toxin). Dysport is dosed differently (higher). 50 units for Botox Cosmetic or Xeomin is too high as a starting dose.

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.This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.