How many units of Botox will I require and where should the placement of injections be to avoid unwanted side effects? (Photo)

I am a 35 year old female and just discovered a fine vertical line in between my eyebrows. It's my first wrinkle and I want it gone. I want to be sure that I don't look frozen after my treatment and I also want to be sure to avoid a droopy eye side effect. How many units should I get injected and where should those be done? I met with 3 different plastic surgeons and they all gave me different answers. Needless to say I don't know whom to believe. Thanks.

Doctor Answers 9

How many units of Botox will I require and where should the placement of injections be to avoid unwanted side effects

Thank you for your question. The amount of Botox used in the glabella ranges from12-30 units.  Looking at your photos, and without an examination,i would prob recommend 20 units.  Consult with a board certified plastic surgeon. Best wishes.

What amount is the right amount of botox

The question you ask is a good one. Some patents want the "11's" to not exist, others do not mind having a little motion. The opinions that you received related to personal experience and clinical evaluation. On clinical evaluation one is able to assess muscle mass and strength. This makes a difference in the quantity of Botox needed to achieve your aesthetic result. To arbitrarily give a specific number without a clinical exam is to invite an error in your ultimate outcome. Generally, based on your region of interest, most patients require between 16 and 26 units in my practice. Hopefully this is helpful to you.
Be healthy and be well,
James M. Ridgway, MD, FACS

James M. Ridgway, MD, FACS
Bellevue Facial Plastic Surgeon
5.0 out of 5 stars 78 reviews

Botox Injections for Glabella

Most women have 5 points that are injected in this area of the face. 15 to 25 units of Botox is commonly used.  Depending on each individual patient, if the muscles are thick and strong a higher dose may be used and if the muscles are thin and weak a lower dose may be used. The dose chosen also depends on how relaxed the patient wants the muscles to be. A higher dose will relax more and last longer than a lower dose. To help avoid the side effect of eyelid drop, do not touch the area injected for at least 4 hours after injection.

William J. Schweitzer, MD, FAAD
Westlake Village Dermatologist

20 units of Botox

I would treat these vertical frown lines with 20 units of Botox. That should be enough to relax the muscles that cause these lines without freezing you. A follow up visit 2 weeks later would be a good time to determine if any more was needed, which, I would imagine wouldn't be more than 2-4 units. Injections should be targeted at the procerus and corrugator muscles - muscles which are responsible for pulling the eyebrows down and inward. You'll find that this treatment can give your eyebrows a slight lift as well and most people are very pleased with the outcome.

Luis Soro, DO
Fort Lauderdale Dermatologic Surgeon
5.0 out of 5 stars 13 reviews

Botox for Seattle patients

I typically treat the glabella and procerus muscle groups with 25-30 units of Botox - this gives most patients 3-4 months of treatment duration - sometimes longer. Botox results are technique related, and avoidance of 'side effects' like eyelid ptosis is really important - choose a provider with a lot of injection experience.

How many units of botox?

It is not uncommon to get three different opinions when visiting 3 different doctors, and in fact, depending on the number of responses you get to your question, you will likely get several different answers on this site as well.  In general, for the area you would like to have treated 20-30 units is usually enough and will not make you look frozen.  The first time you get Botox you will likely need less and you may need more as time goes by.  The beauty of Botox is that if you do not like the results, it will wear off in about 90 days, sometimes a little longer, sometimes a little sooner depending on each individual. My best advice is that you go to someone who has been doing Botox for a number of years, preferably a plastic surgeon, facial plastic surgeon or dermatologist.  Best of luck with your injections!

Jeffrey A. Sweat, MD
Sacramento Plastic Surgeon
4.9 out of 5 stars 37 reviews

Botox for Frown Lines

In my hands, I would start with 15-20 units of Botox or Xeomin. Some people require more but you can always add more later.  Usually Botox in the glabella is given as five separate injection points.  You might not need the one central injection to treat the procerus muscle since I don't see an obvious horizontal line on your upper nose area.  I would let your doctor determine the amount and the actual injection sites.  Botox in the glabella is usually a "home run" in terms of results. 

Richard Ort, MD
Lone Tree Dermatologic Surgeon
5.0 out of 5 stars 22 reviews

Botox for the frown lines - how much and where

It's impossible to give you an exact number of units without seeing you in person, full face, moving and at rest.  The number of units and placement of the injections depends on the brand of botulinum toxin used (Botox Cosmetic, Dysport or Xeomin in the USA), the strength of the muscles, the presence of volume loss in the forehead and brow, and the goals of the patient.  Treating the glabella (the localized area causing the frown movement) can range from 15 - 50 units of Botox depending on the patient.  My patients tend to prefer what we call 'actress doses' that reduce the movement but don't take it away completely.  The next question is whether or not to include forehead treatment.  In someone with strong forehead muscles, treating the glabella alone may cause a tell tale central smoothness with lines and movement above and on each side or the so called 'jack nicholson' or 'spock' overly arched eyebrow.  On the other hand, if the patient relies on the forehead to keep the brows raised, taking away that movement can drop the brows making them look straight and heavy (less likely in a 35 year old than a 50 year old).  When it comes to botulinum toxin, less is more --  you can ask your physician to start with the lowest dose she thinks will be effective and return in 2-3 weeks for followup and additional treatment as needed.  (It takes a good 1 - 2 weeks to see the full effect of any botulinum toxin injection.)  Regardless, find a physician with whom you feel comfortable.  Ultimately, trust is key in any doctor-patient relationship.

Heidi A. Waldorf, MD
New York Dermatologist
5.0 out of 5 stars 9 reviews

Botox great results with different units

Treating patients with Botox is not about the units but rather about creating stunning results without much risks. 20 units and 30 units will give a great results but with 30 units the results will last longer and one can also create nice eyebrow lift.
Remember, it is not about the number - it is all about great results.
I hope that helps

Mariusz Sapijaszko, MD, FRCPC
Edmonton Dermatologic Surgeon
5.0 out of 5 stars 11 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.