Patients often come to my office with concerns regarding excess frown lines (called glabellar lines), forehead lines (I think of them as the surprised lines), or smiles lines (crows feet). Neurotoxins such as Botox or Dysport can be quite effective to soften or completely remove some of these excess wrinkles.
The method I use for injection is applying a numbing cream on the skin and then using a very small needle. This generally makes the injection process pretty easy for the patient.
The next question really is how much? In the company literature on Botox, the recommendation is 25 units for injection in 5 locations for the frown lines. However, my opinion is that this often results in an overly frozen look of the upper face, as well as a noticeable dropping of the central eyebrows. Certainly, the wrinkles have disappeared for frowning. However, the downside is mark of an overly injected person who does not look as natural. We will often use 15-20 units depending on how much muscle mass you have. For example, patient who has been regularly treated at 4 months intervals will require less than someone who has never been treated before, as their much would be more active and larger.
