Cosmetic Surgery Tips

How Much Botox for Nasolabial Folds

The nasolabial fold is the crease in your face that runs from the outer corner of your nose down towards your mouth. Your muscle tone and skin elasticity are a few of the contributing factors. This area can be prone to sagging as we age, which can give us an older appearance.

Botulinum toxin (aka botox) is a safe and effective way to address sagging skin in this area by temporarily paralyzing muscles used in creating lines and wrinkles. There are two different kinds of botox: onabotulinumtoxinA (also known as Botox Cosmetic) and abobotulunumtoxinB (Dysport). Both last up to 4 months after injection and require repeated injections every 3 months for maintenance.

The question is: how much botox for nasolabial folds? The answer depends on several factors: the skill of your injector; whether you have had previous treatments.

How many units of Botox

How Much Botox for Nasolabial Folds

Botox is the brand name for Onobotulinumtoxin A, a neurotoxin derived from the bacterium, Clostridium botulinum. But Botox isn’t the only botulinum toxin brand. Currently, there are multiple FDA-approved botulinum toxin type A (BoNT-A) brands for cosmetic facial wrinkles including Xeomin, Dysport, Jeuveau, and most recently Daxxify (2022).

A skilled injector can use Botox to treat wrinkles caused by repeated muscle movement. The toxin temporarily freezes the muscle at the injection site — allowing it to relax and smooth out the wrinkles

How many units of Botox

The History of Botox

In the 1970s, scientists used botulinum toxin to treat strabismus (crossed eyes). After this treatment proved successful, Allergan was the first company to license the treatment and brand it Botox.

Since then, there have been multiple FDA approvals of botulinum toxin for a variety of medical conditions:

  • Strabismus and blepharospasm in 1989
  • Cervical dystonia in 2000
  • Glabellar lines (frown lines) in 2002
  • Underarm hyperhidrosis in 2004
  • Chronic migraines and upper lip spasticity in 2010
  • Urinary incontinence in 2011
  • Crow’s feet (lateral canthal lines) in 2013
  • Moderate to severe forehead lines in 2017

Dermatologists and plastic surgeons use Botox Cosmetic to treat facial wrinkles such as forehead lines, frown lines, and crow’s feet.

How many units of Botox are needed for effective treatment?

The number of botox units will vary from person to person and will depend on multiple factors including:

  • specific area being treated
  • individual aesthetic goals
  • gender — men generally need more Botox than women
  • muscle strength
  • metabolism

Botox treatments are minimally-invasive cures for fine lines and wrinkles, without the side effects or risks of plastic surgery. The most popular areas for treatment on the face are the glabella (frown lines), forehead, crow’s feet (around the eyes), and neck.

All units are estimates and the right amount will be determined during a consultation with Dr. Saber, where individual needs and aesthetic goals will be discussed.

HOW MANY BOTOX UNITS FOR 11 LINES (FROWN LINES)?

Frown lines are also referred to as “elevens” and glabellar lines. These vertical lines are found between the eyebrows and are caused by habitual facial expressions where the forehead muscles squeeze inward, i.e. furrowing the brow. Treatment of frown lines is the most common cosmetic use of Botox.

The amount of Botox used in this area can range from 10-25 units.

HOW MUCH BOTOX FOR CROW’S FEET?

Crow’s feet (also called periorbital lines or lateral canthal lines) are wrinkles that branch out from the outer corners of the eyes while smiling or squinting.

Crow’s feet are the second most frequent cosmetic use of Botox. The results here are excellent. The amount of Botox used in this area can range from 4-20 units.

HOW MANY BOTOX UNITS DO I NEED FOR FOREHEAD LINES?

The large facial muscle that overlies the forehead is called the frontalis muscle. When the frontalis muscle contracts, the brow raises and horizontal lines form. During the aging process when collagen and elasticity in the skin diminish, the horizontal lines remain. Botox injections smooth these forehead wrinkles.

The number of Botox units in multiple injection sites can range from 10-30.

HOW MANY UNITS OF BOTOX DO I NEED FOR NECK LINES?

Horizontal neck wrinkles and fine lines are caused by the platysma (neck muscle). It rises from the chest up to the sides of the neck, to the lower face covering the jawline.

When the skin around the platysma loses laxity and volume, the muscle becomes prominent in the form of neck (platysmal) bands. When younger, the bands only appear when the muscle contracts. As we age, the bands become noticeable even when the muscle is relaxed.

The platysma also pulls down the skin of the face and creates the appearance of sagging skin, also known as jowls. This is due to years of active muscle movement in this area. 

Botox targets the platysma, resulting in a smoother and tighter-looking neck. Botox in this region also improves the skin along the jawline for a tighter, more contoured look.

The amount of Botox used in this area can range from 25-50 units.

HOW MANY UNITS OF BOTOX DO I NEED FOR BUNNY LINES?

Bunny lines are tiny creases right below the ridge of the nose, often referred to as nose wrinkles. They appear more pronounced when smiling or laughing but are not normally visible when the facial muscles are at rest.

These creases or wrinkles deepen due to aging. Botox injections on each side of the nose smooth the wrinkles. The amount of Botox in this area can range from 5-10 units.

HOW MANY UNITS OF BOTOX DO I NEED FOR PEBBLE CHIN?

Pebble chin is also known as orange peel chin due to the bumpy and uneven texture of the skin in the area. The dimpling and wrinkling are caused by an overactive mentalis (chin) muscle.

This condition is easily treated with Botox injections which relax the chin muscle. This is considered an off-label use (not approved by the FDA). The amount of Botox in this area can range from 4-10 units.

How many units of Botox

HOW MANY UNITS FOR A BROW LIFT?

A Botox brow lift treats frown lines between the brows AND elevates the height of the eyebrows. Botox injections work by relaxing the underlying muscle between the brows to smooth the skin. This allows forehead muscles to pull up the now-relaxed muscles between the brows, elevating the brows and opening the eyes.

A typical treatment would be 15-30 Botox units.

HOW MANY UNITS OF BOTOX DO I NEED FOR THE CORNERS OF THE MOUTH?

When the corners of the mouth turn down due to aging, a person can appear older. Botox relaxes the depressor anguli oris muscle, responsible for the downturn allowing for a more relaxed expression.

Botox smooths the facial folds and lifts the corners of the mouth. The number of units in this area can range from four to five units per side.

HOW MANY UNITS OF BOTOX DO I NEED FOR SMILE LINES/LAUGH LINES?

Laugh lines or smile lines appear as folds in the skin on both sides of the nose to the corners of the mouth. When younger, the folds appear only when smiling or laughing, then disappear as the face relaxes. Over time, the lines become deep, permanent wrinkles and are present whether smiling or not.

The amount of Botox used in this area ranges from 5-10 units per side.

The doctor-recommended cosmetic treatment for loss of volume and fullness in the face is dermal fillers.

How much does a unit of Botox cost?

Pricing for Botox treatment depends on:

  • geographic area
  • professional expertise – board-certified plastic surgeon or dermatologist versus a licensed injector at a med spa
  • how many Botox units are needed
  • the area being injected

In general, the Botox average cost per unit is $19 to $25 in large cities, and as low as $10 a unit in smaller cities.

If this is the first-time considering Botox injections, a treatment plan will be implemented based on individual needs and the most effective course of action. A personal consultation with an experienced plastic surgeon can help clarify your skin care needs, treatment areas, and treatment options.

What causes unilateral masseter hypertrophy

Treatment of the case above with Botox®:

  • Improved chewing
  • Diminished pain
  • Prevented  jaw from disengaging or clicking
  • Improved facial contour

through a sequence of three injections to the left masseter (25 units in 1 cc of onabotulinumtoxinA = Botox ®/Botox Cosmetic® (Allergan, Inc) with EMG guidance.  Initial treatment resulted in 3 months of benefit with the second injection more durable but still warranting a third injection one year after the second.

Masseter muscle enlargement (hypertrophy) can be accompanied by pain and is often erroneously ascribed to a disorder of the adjacent parotid gland. An excellent review by Fedorowicz et al (2013) identified potential causes to be 

  • emotional stress
  • chronic bruxism 
  • masseteric hyper-function
  • microtrauma

​In some cases the masseter enlargement is thought to arise from a disorder other than work hypertrophy with the absence of a certain type of muscle fiber supporting a cause other than ‘work hypertrophy’ 

  • ​clenbuterol (a bronchodilator with growth-promoting properties prohibited in animal husbandry and sport, used to treat reactive airway disease Thevis 2013) induced hypertrophy
  • overuse of anabolic steroids
  • localised scleroderma
  • facial hemi-atrophy (see: (under construction) Hemifacial Atrophy (Parry-Romberg Syndrome PRS) Romberg Syndrome atrophy in trigeminal nerve distribution )
  • multifactorial origin in combination with a genetic basis
  • benign masseter hypertrophy is also compatible with a rare genetic condition known as hypertrophic branchial myopathy 

Recommendations for evaluation have included

  • Computed tomographic (CT) scan, magnetic resonance imaging  (MRI) scan, or both (considered the gold standard in confirming a clinical suspicion).
  • Ultrasonographic measurement.
  • Muscle biopsy.
  • Morphometric analysis
  • Electromyographic measurement.

Reported treatments include:

  • Use of muscle relaxants
  • Bite adjustments or involve the use of splints on the teeth.
  • Surgical reduction of the jaw muscle
  • Injections of botulinum toxin type A directly into the muscle are other treatment options.
    • The 2013 Cochrane analysis (Fedorowicz 2013) concludes: “Although the use of botulinum toxin injections might appear to have certain advantages over surgery, the authors of this review did not find any high quality studies that evaluated the effectiveness and potential side effects of botulinum toxin type A for the management of benign masseter hypertrophy. Well-designed randomised controlled trials are needed to assess the effectiveness and safety (i.e. side effects) of this intervention.”

Botulinum Neurotoxin Treatment (BoNT)

Although the largest reported experiences with use of BoNT come from the cosmetic use for facial recontouring, it has been used successfully to treat masseter hypertrophy to address pain associated with unilateral enlargement.

A review (Yeh 2018) addressing publications from January 1994 to Feb 2018 emphasized analysis of complications, which overall were considered rare, with the majority appearing with in 2-4 weeks of the injection and disappearing within 12 weeks. 

How Many Botox Units Do I Need?

Although it’s often seen as a cosmetic-only treatment, Botox is actually a medical procedure. Like all medical procedures, the recommended dosage depends on many factors. What works for one patient may not work for another.

Luckily, the question “How many Botox units do I need?” isn’t something you typically need to worry about—your medical provider will prescribe your correct dosage. By speaking frankly with your provider about the results you’re looking for, you can work together to determine exactly how many Botox units you’ll need.

With that said, because Botox is often priced per unit, it can be helpful to know roughly how many units of Botox your visit will require. To that end, we’ve put together these guidelines on the typical recommended Botox unit requirements for popular treatments.

How Botox is Measured

Before we can fully explain how many Botox units you’ll need for any procedure, it’s important to discuss what a Botox unit is.

The active ingredient in Botox is called botulinum toxin type A. It’s a well-understood toxin that is completely safe and effective when injected in small, controlled doses. Don’t let the term “toxin” scare you; Botox has been used in the medical field for decades to treat facial spasms, reduce skin wrinkles, help with TMJ (pain or discomfort in the jaw joint) and more.

However, because the crucial ingredient in Botox is a toxin, controlling the amount used in any given injection is essential. To ensure a high degree of accuracy, professionals use the term “unit of Botox” to refer to the amount of botulinum toxin type A present. One unit of Botox corresponds to a specific amount of the active ingredient—not the total amount of liquid in a vial.

Sometimes, you may read somewhere or see that Botox treatments are measured in “syringes.” Take these guidelines with a grain of salt; Botox can come in vials of 50 or 100 units, so using “syringes” as a measurement isn’t as accurate as using units.

Finally, keep in mind that Botox is a brand name. Several other neuromodulators use the same biotechnology, such as Dysport and Xeomin. These options rely on the same active ingredient, but they can be more or less potent than Botox. As such, the number of units you’ll need may differ. Today, we’re focusing specifically on Botox units.

An Area-by-Area Guide to Botox Units

Now that you understand what a unit of Botox is, it’s time to look at how many units you may need. Once again, keep in mind that these guidelines are rough estimations based on the average number of units used for each treatment area. Depending on several factors (which we’ll touch upon shortly), your requirements may vary.

Here’s the amount of Botox you might expect your provider to recommend for the following treatments:

  • Forehead lines – The long, horizontal lines that can crease your forehead typically take 8 to 20 units.
  • Frown (glabellar) lines – Known as the “11” lines that can appear between your eyebrows usually require 20 to 30 units.
  • Eyebrow lift – When using Botox to bring about a slight lift in the eyebrows, you’ll generally need 2 to 5 units per side.
  • Crow’s feet – These small wrinkles in the corners of your eyes can be smoothed out with about 9 to 14 units per side.
  • Bunny (nasalis) lines – The tiny lines that show up on the bridge of your nose when you smile or wrinkle your nose can be treated with 4 to 10 units.
  • Masseters (jaw slimming) – Your masseter muscles sit between the ear and mouth and can contribute to jaw pain and discomfort. Treating this area (whether for TMJ relief or facial contouring) requires anywhere from 15 to 50 units per side.
  • Lip lines (perioral lines) – known as “smoker lines” 4 units.
  • Lip Flip – 4 units
  • DAO – These vertical lines are located between the corners of the mouth and chin. They can cause a downturned mouth – 2-6 units per side.
  • Mentalis (Dimpled chin) – Reducing the dimples that appear across your chin is possible; all it takes is 4 to 15 units of Botox.
  • Neck (platysmal) bands – Vertical necklines or “bands” that can appear on the neck over time. With 20 to 40 units, you can soften the appearance of these bands while giving your neck a more youthful look.
  • Underarms – Aside from its cosmetic uses, Botox is also indicated as a treatment for excessive sweating (hyperhidrosis). This treatment calls for 100 units.

Factors That Can Affect the Number of Botox Units You Need

As you may have noticed, there’s a substantial gap between the lower and upper limits for many of the above treatments. That’s because every patient is different; it’s hard to know how many Botox units you’ll need until you book a consultation with a medical provider.

Depending on the factors below, your treatment requirements may be at the bottom, middle or top of these ranges—or even beyond them. However, note that the Botox label specifies that the cumulative dose should not exceed 360 total units administered over a three-month span.

Muscle Size and Strength

The most important factor for gauging the required amount of Botox units is muscle size and strength. After all, Botox works by blocking the signals from your nerves that cause your muscles to contract. If the targeted muscles are larger or stronger than average, you may need more units to convince those facial muscles to relax. On the flip side, weaker muscles may require fewer units overall.

Muscle size and strength can differ from person to person for several reasons. Some are due to genetics; others are based on day-to-day habits. For instance, something as simple as regularly chewing gum could cause your masseter muscles to become bigger and stronger. Other facial muscles that are affected by ordinary movements, include:

  • Smiling
  • Frowning
  • Squinting
  • Laughing
  • Pursing or puckering the lips

Age

Your age impacts the size and strength of your facial muscles, but it also plays other roles in determining how many Botox units you’ll need.

As we age, our skin naturally becomes thinner, less plump and less smooth due to volume loss. Wrinkles also become more pronounced over time.

With that in mind, if you receive your first Botox treatment at 65, you may need more units to diminish deeper lines than if you were 25. For this reason, more and more patients are starting Botox treatments at a young age.

Sex

As a general rule, men tend to require more Botox units than women for the same treatments. The reason is simple: Genetically, males tend to have bigger and stronger facial muscles than females.

Of course, there are always exceptions, but we tend to use more Botox with our male patients.

Metabolism

Just as your body’s metabolism processes incoming calories, it also processes Botox. As such, if you have a high metabolism, your Botox treatment may not last as long. To combat the effects of a high metabolism on injected Botox, your provider may suggest using additional units to extend the amount of time between treatments.

Desired Results

Finally, your exact Botox requirements will depend on your cosmetic goals. If you want that ultra-smooth look, you’ll generally need more Botox units to achieve it. If you’d rather maintain a complete range of facial movement, you and your provider might opt for a smaller dose.

While you can use this guide as a baseline, the only way to know exactly how many Botox units you’ll need is to speak with a professional. Your provider will listen to your concerns and goals, ask questions about your health history and present you with different options that suit your needs and budget. Through regular consultation—and a follow-up appointment two weeks after your first injections—these dosages may be adjusted to provide even better results.

At Derma Health Skin & Laser, our amazing staff is here to walk you through the Botox injection process from start to finish. All of our injectors and aestheticians go through advanced education and training to ensure you leave feeling satisfied with your outcome and results.

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