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

Question

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.

Barbara L. Persons, MD, FACS · Answer

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

Mark Rayman, MD - Account Suspended · Answer

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.

Leonard Lu, MD · Answer

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.

Jason Emer, MD · Answer

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.

Nelson Castillo, MD · Answer

Thank you for sharing your question. Unfortunately without an in-person examination it is difficult to offer definite advice but you should have seen some improvement in your wrinkle appearance with 20 units of Botox and I would voice your concerns with your injector.  You may require additional units but ensure that your injector has the experience to appropriately treat your forehead areas of concern.

Adam Goodwin, MBBS, FRCS(Plast) · Answer

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

B. Edward O`Dell, MD · Answer

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

Dr ODell

Corey Frucht, MD, PhD · Answer

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.

Shaun Patel, MD · Answer

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.

Sanjiv Kayastha, MD · Answer

Each  patient is unique and the amount of Botox required to achieve the intended result varies. An average patient requires 30 to 60 units of Botox to treat the  forehead. Discuss your concerns with your injector.

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

Answers (16)

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