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Does a Vial of Botox Come Pre-mixed?

I have heard Botox has to be mixed each time it is used. Is this true, or does it come pre-mixed? Thanks.

Doctor Answers (21)

Botox does not come pre-mixed


As answered by my colleagues before me, Botox comes as dried powder that must be kept refrigerated. The vial contains either 50 or 100 units. It is reconstituted in normal saline prior to your treatment. There is no set volume of saline that is used. It is up to the individual provider. It ranges from 1-6 milliliters(cc). I personally use 2 mls based on my own personal experience, and after talking with many of the experts here in the US and in other countries.

With that being said, it is important to realize that it is the number of units used and not the volume or concentration that determines the cosmetic effect. So, when looking for a physician, look for a physician who charges by the unit and not by the area or by the cc. If they are charging by either of the last two, you are probably not getting your money's worth.

Austin Dermatologist
5.0 out of 5 stars 3 reviews

Does a Vial of Botox Come Pre-mixed?


Botox does not come premixed and must be constituted with bacteriostatic saline preservative-free to be used on frown lines.  Different physicians use different dilutions to inject the compound into your wrinkles.  At our clinic, we use 4.25cc of saline so that 0.1 cc has 2.5 units of Botox solution.  This works for most applications to treat the various areas of the face.

Thomas Guillot, MD
Baton Rouge Plastic Surgeon
5.0 out of 5 stars 6 reviews

Botox comes as a powder and needs to be reconstituted.


Each vial of Botox needs to be prepared for injection by adding fluid. Different offices use different dilutions, all of which are potentially valid. There are pros and cons for using different dilutions, but the key is really how many UNITS are being injected into an area, not how many cc's or vials. See a well-reputed board certified dermatologist or plastic surgeon, and make sure you feel comfortable and know exactly what you are paying for.

Jessica J. Krant, MD, MPH
New York Dermatologic Surgeon
4.5 out of 5 stars 40 reviews

Botox has to be reconstituted


Botox comes in a sealed hologram vial (bottle) in poweded form.  The nurse or doctor usually has to reconstitute it before it can be used for injecting. Proper reconstitution is very important successful results.

David A. F. Ellis, MD
Toronto Facial Plastic Surgeon
4.5 out of 5 stars 2 reviews

Mixing Botox


Botox does not come premixed and the mixing parameters varies from office to office.  Typically, a vial of botox is sufficient for 2 to 3 patients.

Kris M. Reddy, MD, FACS
West Palm Beach Plastic Surgeon
4.5 out of 5 stars 20 reviews

Botox bottles do not come premixed



Botox is a powerful and effective medication used to relax muscles and alleviate the wrinkles caused by them. Botox comes to the doctor's office as a frozen powder in an empty bottle. Your doctor will then add a small amount of saline water to the Botox to help resuspend it. This mixture is what the doctor will inject into your treatment areas.

Pat Pazmino, MD
Miami Plastic Surgeon
4.5 out of 5 stars 55 reviews

Botox does not come pre-mixed


Botox does not come pre-mixed. Botox comes in a powder form and is shipped in a small glass vial. It is then mixed with Saline before use. It does not have to be mixed each time it is used, but 100 Botox units are mixed at a time.

Our patients normally have between 20 units and 60 units injected so in many cases a portion of the vial remains for the subsequent patients.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 6 reviews

Botox does not come pre mixed


Botox is stored in a cold environment and has no liquid in it when the manufacturer delivers it.

We generally use a minimal dilution as I think more concentrated Botox allows us to use fewer needle sticks.  Others dilute it more, but my concern is that higher dilutions may not last as long.

Darrick E. Antell, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 19 reviews

Botox is mixed the first time it is opened

It is mixed every time it is first opened. The same bottle has enough units of Botox to treat two to three cosmetic units. This rarely is all done on the same patient, and more commonly provides doses for two or three patients.

Ronald Shelton, MD
Manhattan Dermatologist
5.0 out of 5 stars 33 reviews

Each bottle needs to be mixed by the doctor's office


Botox comes from the manufacturer as a dry powder in a small vial. It needs to be reconstituted to its active form by the office using it. The concentration can vary depending on how much saline is added to the 100 unit vial.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
5.0 out of 5 stars 52 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.