Dr. Alexander Landfield
Board-Certified Neurologist & Medical Director
One question I receive frequently at Rani Beauty Clinic in Renton, WA, is how do you decide how many units to use? The answer involves far more nuance than most patients realize, and I want to pull back the curtain on this decision-making process.
The assessment begins before I pick up a syringe. When I evaluate a patient for Botox, I am analyzing several factors simultaneously. Muscle mass and strength vary dramatically between individuals. A patient with strong corrugator muscles (the muscles that create frown lines) may need 25 units to achieve the same result that 15 units would achieve in someone with weaker muscles. I assess this by asking you to make various expressions and observing the force and pattern of your muscle contractions.
Facial anatomy is not symmetrical. Almost everyone has some degree of asymmetry in their facial muscles. One eyebrow may sit higher than the other. One side may have a stronger frown pattern. Recognizing and compensating for these asymmetries is essential for a balanced result. I may use different unit counts on each side to achieve visual symmetry.
Your aesthetic goals directly influence my dosing. A patient who wants to soften lines while maintaining significant movement receives fewer units than a patient who wants maximum smoothing. Neither approach is wrong. They are different aesthetic preferences, and my job is to understand yours and deliver accordingly. I always ask what result you are hoping for before determining my plan.
Age and skin quality factor into my calculation. Younger patients with dynamic lines (visible only during expression) typically need fewer units because we are preventing rather than treating. Older patients with etched static lines (visible at rest) may need Botox combined with other treatments, as Botox alone cannot erase lines that have become permanent creases in the skin.
Treatment history matters significantly. First-time patients are always treated conservatively at our clinic. I would rather use slightly fewer units and bring you back for a touch-up at two weeks than overtreate on your first visit. For established patients whose response I know well, I can be more precise with initial dosing because I have data on how their muscles respond.
The interaction between muscle groups is something my neurology background helps me understand deeply. Relaxing the frontalis (forehead) without adequate treatment of the glabella (frown area) can cause the brows to drop. Treating the crow's feet without considering the underlying orbicularis oculi can affect the eye shape. These interactions require understanding the face as an integrated muscular system, not a collection of isolated treatment zones.
I also consider what is NOT in front of me. Medications, hydration status, stress levels, and even the time of day can subtly affect muscle tone and treatment response. A thorough intake ensures I have the complete picture.
My personal philosophy: I believe in precision over volume. Using exactly the right number of units in exactly the right locations produces superior results compared to using more product less precisely. Every unit I inject has a purpose and a target. This intentional approach is what produces results that look natural rather than overdone.
The two-week follow-up is not an afterthought. It is an integral part of my treatment process. Evaluating how your muscles responded to the initial treatment provides data that refines future treatments. Over time, I develop a precise understanding of your individual response that allows for increasingly optimized results.
