What is the recommended dosing of botulinum toxin (Botox (onabotulinumtoxinA), Dysport (abobotulinumtoxinA), Xeomin (incobotulinumtoxinA)) for common therapeutic and cosmetic indications?

The recommended dose of botulinum toxin varies widely depending on the indication, the specific toxin product used, and the individual patient’s characteristics, so a precise dose cannot be given without more clinical detail; however, typical dosing ranges for the most common therapeutic and aesthetic uses are as follows. For cosmetic treatment of glabellar lines with on‑abotulinumtoxinA (Botox) the usual regimen is 20 units total, administered as 4‑5 injection sites of 4 units each; for the same indication with abobotulinumtoxinA (Dysport) a dose of 60‑80 units (≈3‑4 times the Botox dose) is typical, and with incobotulinumtoxinA (Xeomin) 20 units is standard. For cervical dystonia the usual total dose of on‑abotulinumtoxinA is 200‑300 units per session, divided among the affected neck muscles (often 25‑50 units per injection site). For upper‑limb spasticity (e.g., elbow flexors, wrist extensors) clinicians commonly use 100‑200 units per limb, not exceeding 50 units per individual muscle, with a maximum cumulative dose of about 400 units per session and no more than 600 units within a 3‑month period. For focal hyperhidrosis of the axillae, 50‑100 units per axilla (total 100‑200 units) of on‑abotulinumtoxinA are typical, injected intradermally in a grid pattern. For blepharospasm and hemifacial spasm, total doses of 25‑30 units per eye (distributed in several sites) are common. Across all indications the guiding principle is to start with the lowest effective dose, titrate based on clinical response, and avoid exceeding the product‑specific maximum total dose (generally 400‑600 units for on‑abotulinumtoxinA per 3‑month interval). Contraindications include pregnancy, known hypersensitivity to the toxin, and active neuromuscular junction disorders such as myasthenia gravis; patients should be screened for these conditions before injection. If a patient does not respond adequately or experiences intolerable side effects, alternative botulinum toxin formulations (e.g., switching from Botox to Dysport with appropriate dose conversion) or adjunctive therapies such as oral antispasmodics, physical therapy, or occupational therapy may be considered. In all cases dosing must be individualized, performed by a trained clinician, and the patient should be monitored for adverse effects such as localized weakness, dysphagia, or systemic spread.