by Clare Tobias, RN, LE
How long do you feel like your Botox lasts? Did you know that the number of units of Botox is directly related to the quality of your results and to the longevity of your treatment? While we all know that Botox is temporary, a dose adjustment could be the key to getting your desired duration out of each treatment. At beyond|AESTHETICS in Camarillo and Ventura, we like to educate our patients about their treatment options, including Botox dosing, so they are empowered to get the best results possible.
What is a unit of Botox?
A Botox unit is the amount of biologically derived clostridium botulinum molecules needed to produce a desired effect.
As an analogy: You need a certain amount of drug to cause the desired outcome. For example, if you take 400mg (2 tablets) of ibuprofen you will have pain relief for 4-6 hours. Taking 600 mg (3 tablets) of ibuprofen may provide relief for 6+ hours, but taking 200 mg of ibuprofen (1 tablet) might not give any pain relief or for a minimal amount of time.
Botox comes in a vacuum sealed vial in aerosolized powder form, meaning it has to be reconstituted before it can be injected. The amount of sterile saline used as the dilutant varies from practice to practice ranging from 0.5 ml to 10 ml. Commonly, injectors use 1.0 ml to 2.5 ml to achieve desired results.
Relative to other injectable neurotoxins: the type of toxins that are mass available for cosmetic use in the US currently are type A. Type B is used for medical purposes and many other strains are being studied for different uses and durations. When comparing Botox to other toxins on the market, it’s like comparing the dose of Aleve to Advil… they aren’t the exact same drug even though they treat the same conditions. The easiest example is between Botox and Dysport. 20 units of Botox equals 50 units of Dysport.
The dose you receive will be measured in units and the dose prescribed varies from person to person based upon their individual needs. In our practice, 1 unit is roughly equal to 0.01mL of liquid volume, so 100 units would be 1 mL.
How is Botox dosing determined?
Botox is FDA approved to treat the frontalis (forehead), glabella (frown), and orbicularis oculi (around the eye) muscles. However, there are many off-label applications. Check out our April blog about other areas we commonly treat with Botox.
The FDA recommended dose for these three areas is 64 units total, but a well-trained provider can recommend a customized dose based upon your specific concerns, anatomy and muscle movement.
FDA dosing of Botox is as follows:
- 20 units for frown lines
- 20 units for forehead
- 24 units for crow’s feet
The prescribed dose depends largely upon the targeted muscle’s strength and size. Your provider will recommend an appropriate dose based upon a full assessment completed during your consultation. If it is your first time getting Botox, we recommend a two-week follow up to assess muscle movement and make any adjustments if necessary.
Botox begins working within 24 hours after administration and can take up to 14 days for full effect.
Why do I still have lines after my Botox Treatment?
There are two primary reasons you still notice some fine lines and wrinkles, even after Botox treatment:
- Accessory muscle use: When certain muscles are relaxed with Botox, other muscles, referred to as accessory muscles, may be recruited to make the undesired expression lines. It’s not that the botox is not working, but non-treatable accessory muscles are to blame. The best example of using accessory muscles is in the crow’s feet area. When applying Botox we are only treating the circular muscle around the eyes. Treating the muscles in the cheek when trying to soften crow’s feet is not a good idea because, at worst, it may lead to an unnatural looking smile and at best, it looks good but only lasts a very short amount of time due to the size and strength of those muscles. If a patient has deeply etched lines around the eye, the cheek muscles may continue to push the skin of the eye area together and make visible lines.
- Static Lines: Botox will only prevent the muscle from contracting, stopping your face from making more or deeper lines. If there is a deep line to start, Botox won’t immediately erase it. Other skin treatments may be necessary for optimal results and your injector will educate you about the different options.
Why is proper Botox dosing so important?
Typically, medications are dosed based upon patient weight, however with Botox, dosing is determined relative to FDA recommendations while taking into consideration the strength of each muscle and the patient’s goals.
Less is not always more! When it comes to Botox, just like any other medication, if not properly dosed, Botox could wear off sooner than expected leaving you with unsatisfactory results and it can end up costing you more overall.
Botox should last 3-4 months in FDA approved areas. If you notice your muscle movement is back to baseline before this period, it could indicate the dose needs to be increased.
Staying on a 3-4 month schedule with your Botox is extremely important for long term results. Botox works by temporarily paralyzing the targeted muscle, so once that muscle activity returns to baseline those wrinkles will start to form again. Keeping your results maintained is also important for an overall refreshed and natural look. Our patients who subscribe to the b|A Botox Membership take advantage of a 3-4 month treatment schedule and get all the perks of being a member.
How much Botox will I need?
Again, Botox dosing varies from person to person, but there are some self-assessment steps you can take to get an idea of your need for treatment in certain areas.
Take a look in the mirror:
- Make your “mad” face. If you have deep-set lines in your glabella (between your eyes right above your nose), you may need the FDA recommended dosing for your frown lines.
- Make your “surprised” face. If you have deep-set lines across your forehead, you may need the FDA recommended dosing in your forehead.
- Now make a BIG smile. If you have deep-set lines around your eyes, you may need the FDA recommended dosing in your crow’s feet.
Check out our staff dosing blog to get an idea how much proper Botox dosages can vary. Keeping these points in mind when you get your next Botox treatment can help improve your expectations and result in a much better outcome. Contact us with any questions or to schedule your appointment!