The M Word

Are you ‘Tox Curious?’

One of the most common questions people ask me is, “How much Botox do I need?”  Let me first say that unless you have muscle spasm causing unbearable twitching or frequent, horrible migraines or severe jaw pain from clenching or overactive bladder or…  wait there are more than TWENTY medical indications of Botox and I DIGRESS…  No one NEEDS cosmetic Botox/Dysport/Xeomin (neuromodulators for wrinkles) but we of course WANT them to prevent dynamic wrinkles that make us look and feel stressed.  So to get back to the question of an appropriate dose of Botulinum Toxin A for cosmetic purposes, that depends on the location and strength of the muscles in question.  Big, strong muscles need more, thus men typically need more than women for the same facial expressions because of greater muscle mass.  And, while a lower dose may weaken and soften movement, it may take quite a bit to make a muscle be completely still.


I usually expect to inject 50-80 units if someone wants to address their crows feet, frowny “11’s” and upper brow horizontal lines.  For example, this client received 50 units of Botox to get this excellent result:
Assuming that the goal is to make a muscle really not move, here are some guides for how much to expect to “need” broken down by area of the face:

Crows Feet 10-15 units per side. (20-30 units total)
Upper Forehead Horizontal Lines (8-15 units)
“11’s” (20-40 units)

Note that while Botox and Xeomin units are exactly equivalent, because Dysport units are smaller, it requires about 3 times as many units to get the same effect.  This is why Dysport costs roughly a third as much per unit as the other products. So 20 units of Botox is equivalent to 60 units of Dysport. In our office, we generally just talk about neurotoxin dosing in “Botox units”.

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