Legit Botox? Was my Latest Experience Kosher?

From a (resident) physician to expert physicians. visit w/ board certified plastics doc Explicitly voiced: - frequent comments from others re: looking "worried" - tension in corrugator's when stressed w. painful contraction - lateral brow lift & to avoid "spock" look. My concerns - quoted me 60u (usu need 40) - didn't see vial or dilution, just 3 syringes - painful injections - injected VERY high on frontalis IN HAIRLINE! - didn't inject lateral frontalis, just orbic orculi sound kosher?

Doctor Answers 8

Botox experience

It's impossible to know if you had legitimate Botox or not, without seeing the vial that was used.  It would be important to know exactly what areas you had treated.  You mentioned forehead and eyes.  If the horizontal forehead lines, the frown lines and the crow's feet were all treated, then 60 units would not be an unusual amount.  It's also difficult to comment on your pain issue without knowing more details, as normally, Botox injections are not very painful.  

San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 18 reviews

?Kosher Botox

Even when you see the vial you don't know what the dilution was. However, at least you know that it was botox. I always draw from the vial in front of the patient. If you trust the doctor then you should trust that it was Botox. They might have gone high on the forehead if you have a small forehead to avoid flattening of the brow or droop of lid. Most of us are more cautious about staying high when using Dysport as it has more travel. As far as the pain goes:If the Botox was diluted with saline or water that was sterile but not bacteriostatic it will burn.  60 units is reasonable but if you are a resident I assume that you are fairly young so it does sound like a bit on the higher side

Jo Herzog, MD
Birmingham Dermatologist
5.0 out of 5 stars 18 reviews

Botox and efficacy

It's very difficult to answer your question without first seeing you in person to understand what happened and see the results. If you've consulted and had treatment with a reputable and well-trained injector, you should be in good hands.

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 221 reviews

Botox in forehead

Injecting Botox is not a painful process and it would be difficult to fully assess why you had such a negative experience without knowing more details.  With regard to the amount of product you received and its placement, every patient is different and some people require more Botox and in different areas than others.  I tend to be conservative with my treatment of the forehead as I do not like to have patients with a static or frozen forehead appearance but would rather give them a natural appearing result with the minimum amount of Botox needed.  You can always add a little more at the two week mark if needed for touch up.

I would wait two weeks and then return to your injector to assess your results and ask any further questions you may have.

Best Regards,

Jacque P. LeBeau

Jacque P. LeBeau, MD
Pensacola Facial Plastic Surgeon
5.0 out of 5 stars 26 reviews


It's important to ask questions, know your physician well and start conservatively.  It's also OK to look at the bottles and see the expirations...these are all normal.  Take photos before and after as well..Dr. Boxrud 

Cynthia Boxrud, MD
Santa Monica Oculoplastic Surgeon
5.0 out of 5 stars 6 reviews

To answer your concerns directly

My concerns

- quoted me 60u (usu need 40) ..... no wrong or right answer and each inkector knows what works for their own analysis.

- didn't see vial or dilution, just 3 syringes ..... worth asking to see this everytime imo

- painful injections .... no need with LA creams and cold packs

- injected VERY high on frontalis IN HAIRLINE! .... normal in my practice

- didn't inject lateral frontalis, just orbic orculi sound kosher? .... sounds kosher to me unless you want a dropped brow!

kind regards

Dominic Bray, MBBS, FRCS
London Facial Plastic Surgeon
4.9 out of 5 stars 169 reviews

Pain with Botox injections

A lot has been said about duress already regarding the placement of the Botox and legitimacy of the product.

I will simply address pain with injections. I have an extensive Botox practice, having treated over 2,000 patients over the last few years. I take patient comfort seriously.

We have gone through various regiments to minimize discomfort.

Today, the best we have found is the application of a topical anesthetic that is custom-made for our office. It includes benzocaine, lidocaine tetracaine and phenylephrine.

This is applied with sufficient time to allow it to be effective.

Next, we'll use the absolute highest quality needles made. They're made by a company called Turumo.

Very fine, sharp needles are very easily damaged.

I never allow more than three or four injections with any one needle.

A full facial Botox treatment will usually require four to six needles at minimum.

Patients will often complain of a crunching sound from injections from other providers. This is what happens when a damaged needle tip is used for repeat injections.

Never, never, never use the same needle to inject skin that is used to draw the Botox from the vile with. Pushing a needle through the rubber plunger to obtain the Botox from the vile grossly damages a fine needle.

This is technique, technique, technique, technique as well as using the best equipment and being patient.

Botox should not need to be painful. At all.

There's always room for improvement, and I'm all ears if my technique can be improved.

I feel like I have come close to mastering painless Botox injections.

Check out the reference below.

Best of luck,

Mats Hagstrom, M.D.

Mats Hagstrom, MD
San Francisco Plastic Surgeon
4.8 out of 5 stars 18 reviews

Botox or not?

Without being the injector, I would hae no idea what was injected for you.  Best to ask you doctor that injected you. Botox can take about a week to work.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 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.