Treatment guides
How many units of Botox for the forehead? (And the 11s and crow’s feet)
There isn’t one number for the forehead. It’s a range we set after watching your forehead move. The one standardized dose is for the frown lines between the brows: 20 units of Botox, per the Botox Cosmetic label. Your forehead and crow’s feet are dosed to your muscle strength, your sex, and how much movement you’d like to keep. We start low, and we’ll add more at two weeks if you’d like.
What a unit is, and why the label’s number isn’t your number
A unit is the label’s measure of dose, and every brand defines its own. Xeomin’s label says its units “cannot be converted into Units of any other botulinum toxin,” per the Xeomin prescribing information. The randomized trial that compared the brands in frown lines used 3 Dysport units for every Botox unit and dosed Xeomin 1 to 1, per Rappl and colleagues, 2013. So 60 units of Dysport and 20 units of Botox can be the same treatment. When comparing unit counts, always ask which brand.
The 20 units for frown lines is the dose on Allergan’s label, the one its trials used, per the Botox Cosmetic prescribing information. It’s the number we anchor on, but it isn’t the number everyone gets. A label dose is set for a study population, and your muscles may need more or less.
Botox at our Arlington Heights office is done by a nurse in a treatment room, and your dose is set at your consult.
What can move your unit count up or down
Four factors matter, listed here in order of importance.
Muscle strength. The nurse will ask you to frown, raise your brows, and squint, while watching how deep the lines get and how fast they form. A forehead that folds into deep creases needs more than one that barely moves. Heavier muscles need more units.
Sex. Men need more units than women on average, for the same reason: bigger muscles. Onset was also slower in men in the head-to-head trial.
How much movement you want to keep. A softened forehead that still moves takes fewer units than one that barely moves. If you’d like to keep some brow movement, we’ll dose with that in mind.
Age. Botox works less well in older muscles. In Botox’s trials, 39 percent of patients 65 and older responded at day 30, against 83 percent of those under 65, per the label. That doesn’t automatically mean more units. It usually means a softer result, which we’ll discuss before treatment.
What moves a Botox unit count, and which way
| Factor | Fewer units | More units |
|---|---|---|
| Muscle strength | Lines that vanish when you relax | Deep creases from a strong muscle |
| Sex | Women, on average | Men, on average |
| The look you want | Softened, still expressive | As still as possible |
| Areas treated | One area | Forehead plus the 11s plus crow's feet |
| Brand | Botox or Xeomin, dosed 1 to 1 in the trial | Dysport, about 3 units per Botox unit for the same effect |
Why the forehead and the 11s travel together
The frown muscles pull your brows down. The forehead muscle pulls them up. They’re in a tug of war all day, and if you relax only the forehead, the frown muscles win and the brow drops. That’s why a forehead conversation almost always includes the 11s, and why the total count for “just my forehead” is often two areas, not one.
It’s also why we dose the forehead conservatively. In the label’s forehead-line trials, brow drooping showed up in 2 percent of patients and headache in 9 percent. A heavy brow lasts as long as the treatment does, which can be months.
Why we start low and see you again at two weeks
Botox takes a few days to start and about two weeks to reach full effect. The American Academy of Dermatology puts onset at “within 3 to 7 days,” per its botulinum toxin FAQs, and in Botox’s trials 74 percent of patients had responded by day 7.
At day 14, we check your result. If your forehead still moves more than you wanted, adding a few more units then is easy. Taking units out isn’t possible, so we start light and adjust at two weeks rather than risk a heavy brow for three months.
This is also why we recommend booking at least two weeks before an event or photos.
Crow’s feet, and the areas the label doesn’t cover
Crow’s feet are dosed per side, and the two sides aren’t always equal. Many people squint harder or sleep on one side, so the nurse doses each side to its own movement.
Botox Cosmetic is approved for frown lines, crow’s feet, forehead lines, and platysma bands in the neck, per its label. A brow lift, bunny lines, a lip flip, the masseter, and the chin are off-label. Off-label means the manufacturer didn’t run trials there, so the counts for those areas come from clinical practice rather than a label. If you’re weighing brands as well as units, Dysport vs Botox covers what differs.
When forehead lines need something other than Botox
Some forehead lines aren’t made by movement anymore. If a crease is there when your face is relaxed, toxin will soften the motion that made it, but the crease will still be there. For static lines, we’ll recommend other options at your consult.
And some “forehead lines” are really a heavy, tired brow with slightly loose skin above the eyes. More units would make that worse. For mild laxity and crepey skin around the eyes, Forma radiofrequency skin tightening is often a better fit, with no needles and no downtime.
How often we’ll see you for Botox
You’ll typically come back every three to four months, when movement returns. The Botox label says dosing more often than every three months “has not been clinically evaluated,” and in the trials the share of patients still responding fell from 80 percent at day 30 to 48 percent at day 90 and 25 percent at day 120. Individual results vary, and your count can change as the nurse gets to know your face.
Your questions, answered
How many units of Botox do men need for the forehead?
More than women, on average, because the muscles are heavier, and the head-to-head trial also found slower onset in men. There’s no fixed men’s number. The nurse watches your forehead move and doses to it, and the label’s 20 units for frown lines is the anchor the nurse works from. You can expect the forehead and the 11s to be treated together.
Can you get too much Botox in the forehead?
Yes, which is why we dose conservatively. The forehead muscle is what lifts your brows, so over-treating it leaves the brow heavy and the eyes tired. In the label’s forehead trials, brow drooping showed up in 2 percent of patients. It wears off with the rest of the treatment, but that takes months. That’s why we start light and add more at the two-week check if you need it.
How much is Botox per unit?
The per-unit price on its own isn’t a useful comparison. Each brand defines its own unit, and the head-to-head trial dosed Dysport at about 3 units per Botox unit, so a lower per-unit price can be the same total. What drives cost is the number of areas, the dose your muscles need, the brand, and whether a touch-up is included. It’s more helpful to ask what your treatment costs than what a unit costs, and we’ll go over that at your consult.
How often do I need forehead Botox?
Usually every three to four months, once movement comes back. The Botox label says dosing more often than every three months hasn’t been clinically evaluated, and in the trials 48 percent of patients were still responding at day 90 and 25 percent at day 120. It’s best to book two weeks ahead of any event you’d like it settled for.