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Paying for Botox by the Vial

A few weeks ago, I had Botox for my crow's feet only, but I was charged for an entire vial of Botox (6 cc's)! I have had this procedure before by the same well known plastic surgeon, and I know only 3 cc's were used. He told me we only needed 3 cc's. I am very upset and have been refused documentation of the amount used.

Is there any way an entire vial of Botox could have been used on my crow's feet? Do other doctors charge for a whole vial if all of it isn't used? Is there something I'm missing?

Doctor Answers 18

No way could a whole vial have been used on your crow's feet

There is absolutely NO WAY a whole vial (100 units) of Botox could have been used up on just your crow's feet. Check back with your doctor, something very fishy is going on there!

Botox by the vial: Purchasing 100 units of Botox

Botox is a trademark of Allergan, Inc. The product is produced in vials of 100 units and requires reconstitution in normal saline prior to use.

Typically, less than 100 units is used on a single patient and thus the method of dispensing is through a multi-use vial.

Using 100 units along the lateral canthus is unusual, but can occur depending on your degree of dynamic rhytids.

Have a frank discussion with your surgeon and this will help clarify the situation and decrease your level of frustration.

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
5.0 out of 5 stars 70 reviews

The amount of Botox used can differ quite a bit

A vial of Botox is actually not necessarily 6cc's. In fact, Botox comes completely dehydrated as 100 units. The amount of saline added to dilute the Botox, so that it can be injected, varies from doctor to doctor. The more saline is added, the "weaker" the Botox becomes, just like when you used to drink Kool Aid and added more water when you started running out, until all you had left was pink water!

The point is, a full bottle is not necessarily 6 cc's. The fact that an entire of bottle of botox (100 U) was used for just your crows feet area seems a bit excessive to me. I have heard of physicians who use an entire vial per patient, as a matter of principle, thinking that the more concentrated the solution they use, the longer the Botox will last.

I hope this helps.

Eric Chang, MD
Baltimore Plastic Surgeon
5.0 out of 5 stars 9 reviews

Cost of Botox

Thank you for your question. Botox is not normally sold by the cc. This is more common for fillers. Some injectors sell Botox by the syringe, but this becomes a very difficult way to compare with units as the injector may reconstitute their Botox differently. I train other injectors on the safe and effective use of Botox (and other injectables). I find that core aesthetic physicians (e.g. plastic surgeons and dermatologists) have a deeper understanding of anatomy and the physiology of facial aging and thus I spend less more time focusing my teachings on assessment and the underlying anatomy. For non-core (e.g nurses, family practice physicians, OB/Gyn), this is not something they get a lot of training in during their medical training. Most of Botox complications that reported is usually due to technique and inadequate assessment. I would strongly recommend that you stick with a board certified plastic surgeon or dermatologist who does a high volume of injectables as part of their practice. You may pay more, but knowledge and experience is vitally important to having a safe and effective result.

As far as a whole vial of Botox being used for the Crow's feet region.... this is too high a dose.

Unusual Case

This is a very unusual case.  I would definitely request to speak to the physician to ask for a clarification. The norm for most offices is to pay based on the amount used or the regions done.

Kris M. Reddy, MD, FACS
West Palm Beach Plastic Surgeon
4.5 out of 5 stars 27 reviews

Botox by the cc is a scam.

The most accurate way of paying for Botox is by the unit. A common popular way to be charged for it is by the area. Both have their pros and cons. Botox by the vial or cc or syringe is not a fair way to measure and charge a patient. As other physicians here say, the fluid volume can vary greatly depending on the dilution your injector uses, and it will be very hard for you to know what is going on. Not fair, I say.

Jessica J. Krant, MD, MPH
New York Dermatologic Surgeon
5.0 out of 5 stars 42 reviews

Botox by vial or by unit

First of all, you did not have 3 cc or 6 cc of Botox - they would be way off the chart.  I assume you are meaning to say 3 units or 6 units were injected in your crow's feet, which is usually about 1/10 of a cc.  In my practice, we charge by the unit so that you know exactly how much Botox you received.   Good luck.

David Shafer, MD
New York Plastic Surgeon
5.0 out of 5 stars 66 reviews

Botox charges

I do not charge botox by the cc's or units, I charge by the region being treated.  This may be as little as 12-15 units or more.

Steven Wallach, MD
New York Plastic Surgeon
4.0 out of 5 stars 22 reviews

Don't pay for Botox by the cc!


Thank you for the great question. Botox comes as a dry powder in a small vial. The doctor then chooses to add a certain amount of sterile saline into this vial to reconstitute the Botox. The amount of saline that added depends on the preferences of the doctor. This is why you should never pay for Botox by the milliliter or CC. It is not the saline then you are buying but how much Botox is in the saline. Before your next treatment, ask your physician how many units of Botox they plan to use. Clarify that you will be charged only for the units of Botox and not for the amount of saline that these units come in.

For more information on Botox or to schedule an iConsult, please visit us online at: 

Pat Pazmino, MD
Miami Plastic Surgeon
4.5 out of 5 stars 68 reviews

Don't pay for Botox by the cc!

It sounds like your physician is trying to hide the number of actual Botox units used by selling it by the CC. This is a common practice to dupe consumers about the amount of Botox that is used.

While you may be able to request your medical records to determine how much Botox was used, it may not help you recover any fees you paid. Our suggestion would be to go to a practitioner that is fair and open with the amount of Botox UNITS that are being injected.

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