Botox is an FDA-approved neuromodulator for treating frown lines, forehead wrinkles, and crow’s feet. In order to earn that FDA approval, a standardized dosing and injection protocol was established and applied consistently across clinical trials. This standard approach aims to deliver the intended result: a noticeable reduction in moderate to severe wrinkles lasting an average of 3–4 months.
Now that we understand the foundation of standard Botox dosing, let’s explore how we tailor dosing to meet individual patient needs.
Dosing by Treatment Area
Several factors influence Botox dosing, but the two most important are muscle size and muscle strength. Here’s how that applies across the most common treatment areas:
Frown Lines (Glabella)
These are the muscles responsible for creating the “elevens” between the eyebrows. They’re typically strong and can vary significantly in length. While 20 units is often sufficient for many people, patients with especially long or strong glabellar muscles may require a higher dose to see optimal results. Underdosing in this area not only reduces effectiveness and longevity but can also cause visible muscle bulging at the edges—definitely not the look we’re going for.
Crow’s Feet (Lateral Canthal Lines)
Most patients respond well to an average of 12 units per eye. However, as with any treatment, muscle strength and size must be assessed individually. Some patients request treatment for smile lines that extend down their cheeks, but this isn’t advisable. Those muscles are essential for smiling and mouth movement, and treating them can cause unnatural results.
Forehead (Frontalis)
The forehead is the most recently FDA-approved area and also the most variable in terms of dosing. Let’s take a quick look at the anatomy: the frontalis muscle is responsible for lifting the brows and creating horizontal forehead lines. It’s shaped like two seashells extending from the brows to the scalp and plays a key role in facial expression.
Importantly, the frontalis is the only elevator muscle in the upper third of the face and directly opposes the glabellar muscles, which pull downward. This is why experienced injectors rarely treat the forehead without also treating the frown lines—doing so can lead to brow heaviness and hooded eyes.
Dosing in the forehead varies based on muscle structure and how much a patient uses their forehead to keep their eyes open. Over the years, I’ve treated foreheads with as little as 4 units and as many as 40. The goal is always the same: smooth lines, maintain a refreshed look, and ensure the results last 3–4 months.
Special Cases in Botox Dosing
Some patients don’t fit neatly into standard dosing guidelines and this is why customized Botox plans are essential. If a patient wants to erase their “elevens” with just 5 units, it simply won’t be effective. While some individuals may get by with 15 units, they are the exception. A skilled injector knows how to deliver the right dose—avoiding both under- and over-treatment—to achieve a natural, youthful look without the “frozen” effect.
Realistic Expectations & Budget Considerations
Sometimes patients arrive having been previously treated with “just 20 units all over”—frown lines, forehead, crow’s feet, and even a lip flip. While that might sound like a budget-friendly miracle, the reality is that underdosing multiple areas often results in poor outcomes: the effects don’t last, lines persist, and facial symmetry can be compromised.
Botox is an investment, and it’s smart to be budget-conscious. However, stretching a small dose across multiple areas often ends up costing more in the long run due to short-lived results and the need for more frequent treatments. If budget is a concern, we recommend treating one area at the correct dose every three months instead of under-treating several areas at once.
At Forever Young Medical Spa, we understand that every person’s skin is unique, and we tailor our services to meet your needs. Whether you’re seeking a more defined jawline or smoother neck skin, we’re here to help.
Call (805) 895-6710 or book your FREE virtual consultation today to learn how we can help you look and feel your best.
At Forever Young Medical Spa, we are committed to providing the highest level of care, ensuring that each patient receives a safe and effective treatment tailored to their specific needs. Let us help you achieve the results you deserve!
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