Nervous About Trying Botox...

I have consulted with a plastic surgeon, who has suggested the following: 1. 24 units for crows feet. 2. 15 units for a brow lift. 3. 16 units for horizontal forehead lines. I would like to carefully try Botox to see if it right for me and am not sure which procedure to start with. 2 & 3 seems "conservative" enough but I am very concerned about eyelid drooping!! Is there anything about the dosage or which procedure to do that you could recommend?

Doctor Answers 17

Nervous About Trying Botox...

Best to be conservative first and then follow up 2 weeks later for a touch-up...

And yes, you are right to be concerned about eyelid drooping, which is a rare, but unfortunately, known complication of Botox...

Good luck.

Dr Markarian

Botox anxiety

Make sure your doctor knows what he/she is doing.  Have him/her take photos of the wrinkles you do not like, start with a smallish dose and make sure you follow-up in a month or so.  Your doctor will want to see what sort of effect the dose he/she used had on the areas treated.  Botox effect is dose related but also very individual.  Close follow-up is important.  Eyelid drooping is a real bummer but really rare and also temporary. 

Lisa Lynn Sowder, M.D.

Lisa Lynn Sowder, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 73 reviews

Apprehension with Botox Treatment for Facial Wrinkles

Hi 660418anon in Montreal,

It's completey normal to have a certain level anxiety with any cosmetic treatment, including non-surgical facial enhancements such as Botox Cosmetic. Botox has been used for years for the treatment of facial wrinkles. Eyelid drooping is very uncommon, temporary, and treatable.

Plastic surgery is elective to improve one's appearance. No reason to jump in all at once. Start slowly, and increase treatments as desired. You'll appreciate your improved appearance. Best of luck.

Dr. C

Houtan Chaboki, MD
Washington DC Facial Plastic Surgeon
4.9 out of 5 stars 85 reviews

Botox results are dependent on injector technique

Botox results are more dependent on the experience and the technique of the injector than on the actual units used. The placement of the injections is crucial. When the glabella is injected, gentle pressure below the injection site prevents the inadvertent downward spread of the Botox and is useful in preventing a droopy eyelid.  The Botox should be injected very superficially when used for a brow lift, also to prevent drooping. As far as the forehead goes, Botox can sometimes cause brow drooping if used in a patient that is prone to this condition. An experienced injector will sometimes choose not to inject in the forehead in certain people.

Richard Weiss, MD
Newport Beach Oculoplastic Surgeon
5.0 out of 5 stars 5 reviews

Botox is safe if you have an experienced physician

Botox has a huge safety margin. The number of units is not so important as much as the experience of you physician.

Botox ist ein sehr sicheres Arzneimitte mit einem großen Sicherheitsprofil. Die Anzahl der Einheiten ist nicht so wichtig wie die Erfahrung des Arztes. Spezialisierte Dermatologen haben im allgemeinen viel Erfahrung mit dieser Behandlung.

Robert Kasten, MD
Mainz Dermatologic Surgeon

The only way you will know if you like botox is if you try it.

Botox or Dysport do great in most patients but the only way you will know if you like it is if you try it.  Let you doc recommend the amounts per area. Cost is roughly $300 for the forehead; $500 for the forehead and frown lines; and $675 for the forehead, frown lines and smile lines on the sides of the eyes.  Sincerely,

David Hansen,MD

David Hansen, MD
Beverly Hills Dermatologic Surgeon
4.7 out of 5 stars 43 reviews

Why not start conservatively with you first Botox treatment?

Botox has been used for a couple of decades for cosmetic use and has a very good track record for safety.  When talking with a patient trying Botox for the first time, I often suggest starting conservatively -- pick the area that concerns you the most and have it treated.  For many people this is the glabella (between the eyebrows where I usually use 25 units).  From your photos, I see activity in the forehead muscles, and this is also a popular place to treat (I routinely use 25 units in women and 35 in men).  The most common adverse reaction that I see is bruising, which is most common in treating the crow's feet.

Jonathan Sonne, MD
Naples Facial Plastic Surgeon
4.0 out of 5 stars 4 reviews


You should feel comfortable with the doctor before having Botox.  As for the units, it really depends upon what you are having treated.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Botox and avoiding eyelid droop

(Please see the  link to an easy-to-read book on Botox I wrote, and the links to Botox videos that follow the end of the text below...)

People who already have a slight hooding of the upper eyelid skin should be concerned about further droop if the forehead is treated with Botox, as the muscle of the forehead is used to help lift up the eyebrow/eyelid complex. Many people have forehead lines because their forehead muscle is constantly contracted to provide this lift for their lower eyelid they have naturally. If the Botox is used to smoothen the forehead lines by weakening the muscle, then the lids will drop. Therefore, it is very important to do the glabella (between the eyebrows) injection first which helps lift the forehead slightly. The units seem reasonable, although without seeing you it is impossible to say if you should start wtih less units for the forehead, and the placement of the insertion sites would have to be higher rather than lower to prevent the eyebrow complex from lowering. This is a different drop than a true eyelid droop caused by Botox injected too low on the forehead over the eyebrow near the vertical line that is over the pupil. In this region the Botox can diffuse and affect the levator that holds up the eyelid. This can be avoided with good technique and listening to post-operative instructions not to bend over and exercise for several hours after treatment.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 38 reviews

There are very few problems that may arise after a Botox treatment.

I read your concern, and I think your plastic surgeon has suggested realistic dosages of Botox for the areas to be treated. The likelihood of a temporary eyelid droop is 2% or less. Bruising may occur around your crow's feet in 10% of injections.

I hope this is helpful for you.

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 421 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.