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Does Botox Concentration Vary from Doctor to Doctor?

I read that Botox is purchased by doctors in a powder form. And that the Botox is diluted such that one doctor may give lower concentration botox then another. If this is true, how can i be sure that the doctor doesnt dilute my treatment more than it should be?

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concentration units

Knowing how much Botox is actually being injected

The only way to know for sure how much Botox is being injected is to have a trusted relationship with your physician or injector. The amount of Botox dilution is not set in stone. While there are manufacturer recommendations, the dilution rate is a matter of preference and may vary somewhat from practice to practice. The important issue with Botox is the total number of units being injected. Only when you know the total number of units injected will you be able to compare the strength... more

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Harold J. Kaplan, MD

Los Angeles Facial Plastic Surgeon

Units count Not dilution

Botox comes in an airless vial with a film on the sides (the Botox)> It is then reconstituted by the physician or nurse. The dilution is placed into the vial and can very between 1-10 cc. Obviously the 10 cc product is 1/10th as strong as the 1 cc product. However, they equalize out when it is injection time. The physician using 10 cc dilution is going to put in 10 times as much as the physician uising the 1 cc dilution when he is putting in say 5 units,. I attended an... more

Arnold R. Oppenheim, MD

Virginia Beach Dermatologist

The reputation of the doctor is paramount

Doctors can "water down" the Botox, without increasing the commensurate amount injected, or use Botox that is old. Signs of this are when the Botox appears to go away quickly, or frequent "touch-ups" are necessary when the initial dosage was not adequate. Botox should also be administered in a medical setting, not a party or carnival environment. While it may not seem to be a big deal to return frequently for repeat injections, there is some evidence that frequent low... more

Brent Moelleken, MD

Beverly Hills Plastic Surgeon

ASAPS ASPS

Pay by the Unit, Treat by the Area, or Find a New Saloon!

The concentration of Botox may vary from one doctor's office to the next, depending on the preference of the individual physician. Some may choose a concentration of 4 units per 0.1cc, down to 1 unit per 0.1cc, all dependent upon the volume of saline that is mixed into the 100 unit Botox vial supplied by the manufacturer. Assuming the doctor knows the relevant anatomy and the proper dosage, the concentration doesn't matter when it comes to achieving the desired treatment response. Most... more

Athleo Louis Cambre, MD

Los Angeles Plastic Surgeon

ASAPS ASPS

Have this question answered prior to deciding on a provider.

This is a very common question about Botox. Botox does come in a powder form. In order to inject Botox you must first reconstitute it into a liquid form. A sterile isotonic saline solution is used. This is where patients may become confused because it is within the proper guidelines to reconstitute the Botox with different volumes. It is best to have your treatment done by an experienced well-trained provider who uses a consistent reconstitution. In my office we adhere to the guidelines... more

Dan Mills, MD

Orange County Plastic Surgeon

ASAPS ASPS

Botox concentration usually doesn't matter

Although there are recommended dilution parameters, there is no set standard. The main thing that matters is how many units you have received. If both doctors give you 20 units for example, then it does not matter how they diluted it. The next important thing is outcome. If you are getting the outcome you are looking for, then the dilution is not important again. The last important thing is cost. If they price per unit, then again the dilution does not matter. If they price per area and... more

Bahram Ghaderi, MD

Chicago Plastic Surgeon

ASAPS ASPS

Make sure you go with someone you trust. Botox is not a flu shot.

Although there is a recommended dilution, many qualified physicians use slightly different dilutions. The key is getting what you pay for and that is based on the actual units that are injected. Some doctors inject based on volume, however in those cases it is not clear to the consumer how much botox they are actually getting. Paying for it by the unit is the most clear way to measure what is actually being used. Also, alway seek an experienced person who understands the science as well... more

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Amir M. Karam, MD

San Diego Facial Plastic Surgeon

Botox concentration - depends on how you mix it

A fresh Botox bottle has 100 units of Botox and is diluted with 5 cc or 6 cc of solution. When it is diluted to 5 cc for example, each cc (ml) contains 20 units. So 5 cc of diluted Botox contains 100 units of Botox. So, if you see the doctor mix the Botox, ask the amount of dilutent (the number of cc's so you can calculate the numer of units in each cc injected.

Hratch Karamanoukian, MD

Buffalo General Surgeon

Botox Concentration and Freshness Can Vary - Find Physician You Can Trust

Physicians reconstitute Botox with different amounts of saline solution, which means that the number of units of Botox you receive per cc of the solution that is injected may vary from practice to practice. For this reason it is important for consumers to understand how many units of Botox are being injected into a given treatment area, and to select a physician who prices Botox by the unit. It makes no sense to price Botox "per area". Pricing "per area" means one... more

Doctor's Website

Michael Law, MD

Raleigh-Durham Plastic Surgeon

ASAPS ASPS

Botox dilution is not so important.

I agree that you ought to keep track of the number of units that is being injected to a certain area. If not, when you go to a new provider, you may end up paying for more units than you need, or find the injections to be less effective because you did not receive an adequate number of units. While the number of units is more relevant than dilution, even more important is whether the injector knows what he or she is doing. I suggest you look into the credentials of whoever will be treating... more

Bryan K. Chen, MD

San Diego Dermatologist

It can vary

A doctor can vary the concentration, the amount and the location that Botox can be injected. All of these factors should be something that an experienced Botox administrator should be able to explain. In addition they should have rationale behind why they have injected in a particular location, with a particular concentration and in a particular amount. It can be helpful to ask how many total units of Botox you've gotten. Keep track of it yourself between treatments and especially if you... more

Steven H. Williams, MD

San Francisco Plastic Surgeon

ASPS

The art and science of Botox injections.

Elaine, I agree with the posted answers that affirm that the skill and judgment of the treating physician (or injectionist ) is the most important factor, not necessarily how the Botox® is mixed or diluted. What are most important to you are safe and successful outcomes. Within the package insert the FDA recommends specifically how Botox® should be reconstituted; however, there is leeway and flexibility with ‘off labeled’ deviations, which rely upon the medical... more

Stephen A. Goldstein, MD

Denver Plastic Surgeon

ASAPS ASPS

See a doctor you trust for Botox injections

Botox should be thought of as a treatment not a product. The important issue is the skill of the doctor doing the treatment. That skill includes: The judgment of where to inject The dose (the amount of Botox) The concentration (how dilute the fluid is that is injected). It is perfectly reasonable to ask the doctore to explain how he or she is designing your treatment and why. It is also fine to ask the doctor how many units of Botox you are being givin in a treatment. In terms of... more

Marc Cohen, MD

Philadelphia Oculoplastic Surgeon

Botox- Getting bang for your buck

Units, not concentration, are the fundamental measure that should determine the cost of your treatment. There are many other factors that may result in a treatment providing a much better effect despite equivalent units. Improper or lengthy storage of Botox will result in a loss of effectiveness. Syringes with dead-space will result in Botox left in the syringe after the injection. Improper injection technique is quite common, particularly if the clinician lacks a clear idea of where the... more

Michael Kreidstein, MD

Toronto Plastic Surgeon

ASAPS ASPS

Ask your doctor how they prepare their Botox

Elaine, Offices charge for Botox in two ways - either by "area" or by "unit." It is my feeling that charging by "area" is disingenuous since the office can dilute the Botox by whatever ratio they want and the patient never actually knows how much Botox they have received. There is also the possibility of cross-contamination between patients since the office is using the vial over and over again for several patients. The alternative way of charging for Botox is by the "unit." Botox is... more

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David Shafer, MD

New York Plastic Surgeon

ASPS

Botox Concentrations

The short answer is YES the concentration will vary from doctor to doctor depending on how much saline is added. Botox is shipped in a vial with 100 units and it must be reconstituted with saline. Allergan recommends using 2.5 cc saline to reconstitute the Botox. This is the concentration that I use in most cases. The most important number is units of Botox which should not vary even with different concentrations. So if you use 40 units of botox in your forehead - this will not change... more

Daniel Reichner, MD

Newport Beach Plastic Surgeon

ASPS

The doctor should give you an honest answer

Each office can mix the Botox as they see fit. Some make 20 unit syringes, others 25 units per syringe. Other mixtures can also be done. Just ask and you should get a straight answer from an honest doctor.

Richard P. Rand, MD, FACS

Seattle Plastic Surgeon

ASAPS ASPS

The concentration of Botox cosmetic is less important than the actual number of units injected

Botox cosmetic is one of the most common cosmetic procedures performed in the United States. At this time, the only FDA approved form of Botulinum toxin is manufactured by Allergan. The standard vial contains one hundred units of Botox Type A in an undiluted form (powder form) prefilled in a vial. Before use, a physician must constitute the Botox using sterile saline. After dilution, the physician must calculate precisely the strength (or units) administered per amount injected. At the... more

Raffy Karamanoukian, MD

Los Angeles Plastic Surgeon

Botox Concentration, It's the Number of Units, Not the Dilution

Hi Elaine, It is not the dilution of Botox that affects it's potency, but the number of units and it's proper placement. It is important to choose your Botox injector carefully. Not only has Botox been "watered down" by unethical practioners, clinics, and medispas, but there have been despicable characters injecting bogus Botox (in particular from an Arizona lab TRI that manufactured a "Botox for use in experimental animals only") that has resulted in hospitalizations... more

Michael A. Persky, MD

Los Angeles Facial Plastic Surgeon

Know your units

When giving Botox, the number of units is the important common denominator. Botox is supplied in a vial of powder of 100 Units which must be reconstituted with salt water. Though the dilution can be different, the common denominator which is the same is the number of units used.

D.J. Verret, MD

Dallas Facial Plastic Surgeon

Botox concentration does vary from doctor to doctor.

To Elaine09: Ther are 3 things that make for a good result with Botox: 1) Using enough of it. This means the NUMBER OF UNITS injected in an area. For example, for the vertical wrinkles between the eyebrows in a woman, I use 25 units. The concentration of Botox in the syringe can vary, and that's alright. What matters is how many units end up in your skin. If not enough is used, you may get a good result in the short term,but it won't last 4 months. 2) Injecting it in the right place. ... more

George J. Beraka, MD

Manhattan Plastic Surgeon

ASAPS ASPS

Botox is diluted by the physician

The physician mixes the Botox powder with saline to give a certain concentration of Botox. Depending on the amount of saline used, there may be more or less units of Botox per unit of fluid. If higher volumes of saline are used, you would need a higher volume injected than you would if lower volumes of saline are used to mix the Botox. The dilution is less important than the total units given. However, with large volumes, the Botox will likely diffuse or spread out in a larger area... more

Jordana Gilman, MD

New York Dermatologic Surgeon

Yes it can

Botox concentrations can vary by the different treating physicians. Some dilute it more but will usually inject more. I personally like to keep it fairly concentrated so I can inject a lower volume and keep it in a focused area so that it doesn't spread out.