How Much Botox Is Too Much?
Botox and Dysport contain botulinum, and since they are drugs, proper dosing might vary. Some patients and doctors seem to believe one goal is to completely reduce muscle activity so there seems to be a “frozen” appearance.
Others believe that results should be more subtle, leaving some muscle function that allows basic expression, (ie, appearing interested or surprised when you ARE actually interested or surprised).
So the dose of Botox or Dysport can be calculated depending on what one considers the best goal.
We doctors serve 2 simultaneous roles. One the one hand more units creates more effect and costs the patient more money.
On the other hand using fewer units saves the patient money but may not produce enough of the result.
So for example, 10 units of Botox in the forehead may be all that one patient needs or wants but 4 times that amount might be desirable in a different patient with more muscle activity.
PS: you can always receive more….but, of course, once in, we cannot take it back! (Donn R. Chatham, MD, Louisville Facial Plastic Surgeon)
In treating the forehead, crow’s feet, and the “11” lines of the corrugator muscles, I usually place about 40-50 units. (Steven Wallach, MD, New York Plastic Surgeon)
Botox dosing for forehead
There is no one “correct” botox dose as you must take into account a person’s muscle activity, muscle thickness and what level of decreased motion is wanted. (Thomas A. Lamperti, MD, Seattle Facial Plastic Surgeon)
With experience I find myself injected fewer units, not more
Botox treatments can be more or less aggressive and the “right” amount depends on the amount that creates the look you want.
Medicine is both an art and a science. You need to find the doctor that is a good fit for your sense of what looks good and stick with him or her. (Daryl K. Hoffman, MD, San Jose Plastic Surgeon)
The dose of 45 units of Botox to the forehead alone would seem excessive to me. Both forehead and glabella together could amount to 45 units.
There is another product similar to Botox called Dysport. The dosing of Dysport usually requires 2.5 to 3 times more units compared to Botox to get the same effect. (Steven Svehlak, MD, Los Angeles Plastic Surgeon)
Botox Quantity in Forehead and Glabella
It appears that even other physicians don’t understand this concept, 45 units of Botox is 45 units of Botox. Dilution plays no part in the number 45, only in how much liquid it takes to give you 45 units. Treating both the forehead and glabella with a total of 45 units is pretty typical.
If only one or the other were treated, that would be quite a bit more than typical (about double). A total of 45 units for both areas would give most people a “full” result. 10 units total would produce very little result in most people; probably no noticeable result if it were spread out between both glabella and forehead.
The size of wrinkles is not all that relevant in determining dosage. The size of your muscle and how much movement you want to eliminate are the relevant points. Zero movement is best if your only goal is no wrinkles.
However, the goal is not really no wrinkles, it is too look good now and keep looking good in the future. So, typically, I aim for subtle but noticeable movement, not enough to make wrinkles, but enough to have expression.
Once the wrinkle is there, it is never possible to 100% get rid of it. (Louis W. Apostolakis, MD, Austin Facial Plastic Surgeon)
How much Botox someone needs to acheive a good result is based on the size of the muscles being treated and the experience of the doctor to determine how many units will relax those muscles.
The number of units is a universal way of describing the strength of your treatment regardless of the way in which it is diluted. Treating the forehead without treating the “11” area (glabella) can cause droopy or heavy brows, because once the forehead muscles are weakened, there is nothing left to hold the brows up.
It is not unusual to treat the glabella with 20-30 units and to treat the forehead with 6-12 units. (Brett S. Kotlus, MD, MS, New York Oculoplastic Surgeon)
Ten units is not enough to completely treat a forehead. However 45 unit seems high. (David A. Bray, Sr., MD, Los Angeles Facial Plastic Surgeon)