I had 20 units of Botox but it didn't work. How much more do I need? I'm thinking 30-40.

After 20 units my face unchanged. I don't have deep lines but my face looks like an accordion when I raise my eyebrows. I am 47 White male.

Doctor Answers 16


One can not answer y our question without seeing you in person. We don't know exactly where you were injected and what it would take to make an improvement without seeing you in person.

New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Botox dosing male patient

It is difficult to assess without knowing the actual points of injection. That being said I typically use a minimum of 40 units to treat the Glabella in my male patients and an adittional 20 to 40 units to treat the forehead. You should follow up with your injector or consider finding a more experienced injector in your area. 20 units is a very low dose on any male at any age.

Best regards, Dr. P

Barbara Persons, MD, FACS
Bay Area Plastic Surgeon
4.8 out of 5 stars 17 reviews

How long ago

So the first time you have botox it can be expected to take three weeks to work fully. If now is less time than that then give it a chance. 

Otherwise, 20 units is a small dose for a heavy set male forehead but the 20 units aren't wasted. Ask for a top up. For me 35-40 units is often needed in a male forehead that has never had botox before. 

Hope that helps. Adam Goodwin

Adam Goodwin, MBBS, FRCS(Plast)
Manchester Plastic Surgeon
5.0 out of 5 stars 18 reviews

I had 20 units of Botox but it didn't work. How much more do I need? I'm thinking 30-40.

More information is needed to determine if you received enough units. Where exactly was the Botox placed and also how long ago were you injected. Botox can take up to a week to see the full result. 

Lawrence Bundrick, MD
Huntsville Plastic Surgeon
5.0 out of 5 stars 7 reviews

Wrinkles after botox

It is likely that the provider may have only injected the Glabella region and not the forehead.  You likely need injections in the forehead to weaken the Frontalis muscle and get rid of the "accordion" face.  I would address this with your provider who I am sure will be glad to talk with you about further injections.  

Dr ODell

B. Edward O`Dell, MD
Florence Physician
5.0 out of 5 stars 4 reviews

Botox dosing

Hello, and thanks for your question. I cannot answer this without examining you in person or knowing where the Botox was placed. In order to determine the best treatment plan for you, I recommend an in-person consultation with an expert. Best of luck, Dr. Frucht.   

Corey Frucht, MD, PhD
Santa Barbara Dermatologic Surgeon
5.0 out of 5 stars 4 reviews

Botox for forehead wrinkles

More than likely you had Botox injected in the area called the glabella (in the muscles known as the procerus and corrugators), which helps with frown lines - this is the 1st place most injectors put Botox.  Treatment of this area alone is not enough to get rid of forehead lines...Botox in the forehead is needed for this.   I would suggest finding a provider who takes good before and after pictures, who understands your concerns, and who has solid reviews on line.  One other note - not everyone is a candidate for Botox in the forehead, so a thorough evaluation of your facial musculature is essential prior to treatment.

Botox results

Typically Botox dosing for the forehead is 16-20 units at the glabella and 6-10 units into the frontalis. I'm not sure if you had 20 units for both frown lines and forehead lines or whether a total of 20 units was used just on the forehead lines. If the later is the case you should have seen a results. If the prior is the case then you might need more units in the forehead. 

Shaun Patel, MD
Miami Physician
5.0 out of 5 stars 55 reviews

Botox Followup

Thank you for your question. I am sorry to hear about your concerns. It is hard to say if you need additional Botox without knowing the areas injected as well as seeing you in person. If you are unhappy with your results I would recommend to followup with your provider to see if additional treatment is recommended. Best wishes. 

Leonard Lu, MD
Chicago Plastic Surgeon
4.6 out of 5 stars 26 reviews

Botox for Forehead Wrinkles--Add Belotero or Juvederm--Lasers for Anti-Aging--See an Expert

It's difficult to determine without pictures. However, for forehead wrinkles a combination approach is best. Forehead wrinkles need a combination of fillers, botox, lasers and microneedling/PRP for improvement. Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 191 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.