Botox dosing is the part of an aesthetic visit clients have the least visibility into. You're told a number, you're billed, the needles happen, and two weeks later you see the result. By then it's locked in.
Here's how I think about it.
Why the smallest effective dose is usually the right call
Three reasons:
1. You can always add more. You cannot remove it. Botox is metabolized over 10-14 weeks. Once it's in, it's in. Over-dosing on visit one means living with too-frozen for a quarter of a year.
2. Movement preservation matters. A face that can express is a face that looks like itself. The visible signal of "too much Botox" is loss of expression, not absence of wrinkles. Conservative dosing keeps your face moving in proportion to what you'd want.
3. It's better medicine. The dose-response curve for Botox is not linear above a certain threshold. Beyond the effective dose, more product doesn't make the result "better" — it makes the result "more frozen."
The two-week check
When you come in for a first-time Botox visit, I dose conservatively and may ask you to come back at the two-week mark for a check. If something needs more — your glabella didn't soften enough, your forehead is asymmetric — I add at the two-week check based on individual results.
We discuss this in your consultation and decide together. Most clients don't need the touch-up. Some do. The model means we get to the right dose for you specifically.
Counter-examples (when higher doses are clinically warranted)
There are anatomical situations where higher doses are correct on visit one:
- Masseter Botox (jaw-slimming): 25-50 units per side is typical. Lower doses don't produce the muscle atrophy needed for the result.
- Hyperhidrosis (excessive sweating): therapeutic doses for axillary or palmar treatment are 50-100 units total.
- Severe glabellar lines in long-time Botox patients who tolerate higher doses without losing movement: clinical judgment on visit two or three.
These are exceptions, not the rule.
How to tell if your previous injector over-dosed you
If, after your last Botox visit, you couldn't lift your forehead at all for 10+ weeks — that was an over-dose. If your eyebrows dropped or one side felt heavier than the other — that was an over-dose or a placement issue. If friends commented that you looked "off," not "refreshed" — that's a sign.
None of this is permanent. Botox metabolizes; the muscle returns. The lesson is for next time — find someone who'll dose for movement, not for change.
Professional recommendation
If you've never had Botox and someone wants to start you at 40 units, that's a flag. Ask why. Ask what the dose-response logic is. Ask if there's a two-week check.
Or book a consult and I'll walk you through it.