Happy Friday, friends!
Today, we're sharing our interview with Dr. Babak Azizzadeh on Botox dosage. Several readers have written in with questions, and Dr. Azizzadeh was kind enough to make time to provide us with answers. We spoke about a ton of interesting things, including:
- Body dysmorphia
- How the number of Botox units needed varies by gender and age
- How Botox is priced per unit
- If there are any risks from injecting too much Botox
If any of those topics piqued your curiosity, we highly encourage you to read on to learn more.
A bit more about our illustrious interviewee: Dr. Babak Azizzadeh is a board-certified plastic surgeon who specializes in facial nerves. He is currently a professor of surgery at University of California at Los Angeles, as well as the director of the Facial Paralysis Institute. He also serves as the Western Regional Director of the American Academy of Facial Plastic and Reconstructive Surgery. If you're interested in seeing Dr. Azizzadeh as a patient, you can find him at the CENTER for Facial Plastic & Reconstructive Surgery in Beverly Hills.
Now, onto the interview. We hope you enjoy it, and learn something new!
How many units of Botox do most people end up needing? Does it vary by age/skin type/other factors? If so, how does it vary?
Dr. Azizzadeh: The units of Botox most people need depend on the regions that we are injecting. Most patients get somewhere between 30 to 50 units. However, this can vary depending on how far along they are in the aging process, so age does matter to a degree. Skin type does not have that much impact. But, fair-skinned individuals typically develop thinner skin and have more wrinkles around their eyes and forehead areas as they age. Gender is another factor. Men typically need more units in the area between the eyebrows due to having stronger muscles.
What is the highest number of units of Botox you have given a client in a single session? What was the outcome?
Dr. Azizzadeh: We can give Botox in larger doses, depending on what area we are injecting. In some men, we have used up to 150 units. Some of our migraine patients get up to 200 units. Overall, Botox at these dosage levels has excellent outcomes for our patients.
Do you place limits on the amount of botox you are willing to give people? Why/why not?
Dr. Azizzadeh: We want to utilize Botox when it is needed. Some patients come in wanting Botox, but they don't need it. Other patients come in not wanting a lot of Botox, but they need a lot of it. The limits are very dependent on the patient. With that said, Botox sessions should be limited to every 2 ½ to 3 months. If people come in constantly for touch-ups, they can develop antibodies and become resistant toward Botox, making it ineffective."
Are there any risks to using a high amount of Botox?
Dr. Azizzadeh: Botox toxicity is rare. It is a condition that I have not seen at my practice. The risk for Botox toxicity is low as long as injectors follow the recommended guidelines. If Botox is injected into unintended muscles, it can cause droopy eyelids and smile asymmetry. The Botox injection site has more of an impact on negative side effects than the amount of Botox being used.
Have you ever had to discuss limiting Botox due to concerns about body dysmorphia with any of your patients? What was the outcome of your discussion?
Dr. Azizzadeh: Body dysmorphia is a significant issue in aesthetic medicine. There have been times when I have recommended against Botox for certain patients because they did not need it. However, body dysmorphia is less common among Botox patients than it is with patients who get revision rhinoplasties or repeated facial procedures.
Do some areas of the face require more units of Botox than others? Why?
Dr. Azizzadeh: Yes, there are several regions of the face that require more Botox. For example, we use almost double the amount of units for the masseter muscles than we do for the area between the eyebrows. Botox in the masseter muscles helps to narrow the jawline and improve the effects of TMJ (Temporomandibular Joint) disorders. We also utilize Botox in the platysma muscles of the neck, which also requires more units than crow's feet or the forehead area.
How much does Botox cost per unit? Why do you price it this way?
Dr. Azizzadeh: Botox pricing varies from doctor to doctor. What it's utilized for and the experience of the injector plays a role in how much it will cost. Typically, Botox costs $10-$25 per unit. At my practice, we price it around $22 per unit. I am very experienced at giving Botox to patients that results in a natural-looking outcome with minimal to no complications.
What areas of the face are best treated with Botox, and what areas of the face are best treated by other interventions, such as fillers?
Dr. Azizzadeh: Botox is extremely effective for crow's feet, forehead lines, the lines in between the eyebrows, improving eyebrow position (brow lift-like outcome), the platysma muscles on the neck, and the masseter muscles. It is not very effective for volume restoration, such as laugh lines, the area under the eye, and tear trough deformity. For those areas, you will need to use fillers. For fine lines and skin discoloration, instead of Botox, we utilize medical-grade skincare, PRP injections, and laser resurfacing for those regions. Patients with significant laxity of tissue, jowls, neck fullness, facial fullness, will require deep plane facelifts and neck contouring to achieve their desired outcomes.
Many thanks to Dr. Azizzadeh for joining us for this interview.
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