How common is it for doctors to sell Botox in cc's instead of units? How much does Botox cost per cc of Botox vs. per unit of Botox?

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 of two things - either (1) a physician is injecting the same number of units of Botox into a given treatment area in every patient, say the forehead, whether the patient is a young woman with few lines and wrinkles or a mature gentleman with a large forehead and significant wrinkles; or 2) the doctor injects a varying number of units into the treatment area depending on the needs of patient, but charges everyone the same amount for that area. In this latter scenario, the gentleman with deep lines on the forehead might be getting more Botox and a much better deal than the young woman with early signs of aging. Botox can make a big difference for most people, but getting the best results depends upon finding an experienced injector who uses freshly reconstituted Botox, and who varies the amount of Botox that is administered according to each patient's individual needs.

Botox should be priced by unit, because the unit determines the level of efficacy. Whether I dilute 10 units in 0.1 cc or 1 cc, it still only has 10 units of effectiveness, albeit spread over a different volume.

A "unit" delivers a certain amount of relaxation. A unit can be delivered in 0.01 cc or 0.025 cc or even 0.05 cc, depending on how Botox is reconstituted.

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.

It is more common to advertise Botox per unit, rather than by cc's. It can be measured by cc's, but the amount depends on how much solution is added to reconstitute the Botox.In Toronto, Botox ranges from $12-$15/unit.

Units are basically the exact amount of Botox administered, before it is reconstituted. Botox can be reconstituted at different concentrations, therefore CCs is not as accurate.

Botox is supplied by the manufacturer as a dry powder in a vial, then the doctor adds saline fluid to turn it into a liquid prior to doing the injection. The concentration of the Botox in the vial will vary depending on how much fluid is added. However, the total number of units in the vial will stay the same. If you ask your doctor how many units are being injected rather than just the volume of fluid, you will know how much Botox was actually injected.

The charge structure for botox injections can be extremely confusing. Although most practitioners charge for the total number of botox units administered, some charge by the syringe or by the number of areas treated. This can make comparing the price of botox injections difficult. In most cases, comparisons can be made by translating syringe areas into units. For example how many units per syringe is an appropriate question to ask. When these comparisons are made the price is usually between $10 and $16 per unit. The cost of botox, not only reflects the product cost, but the skill and experience of the injector as well. For this reason it's important to be careful when the pricing seems too good to be true.

I personally think the only way a doctor should charge for Botox is by the unit. The only way to legally purchase Botox in the United States is per unit. Meaning, most doctors purchase a 100 unit bottle of Botox from Allergan - the only make and distributor of Botox in the U.S. The bottle requires 'reconstitution' in order to be used properly. This means that the doctor has to add saline (salt water) into the bottle in order to create a solution of Botox that can then be injected. If you add, for instance, 4 cc (milliliters) of saline into the bottle, you then get a solution that has 25 units per cc. If you add 10 cc of saline into the bottle, you get a solution that is 10 units per cc. Most doctors use a 1 cc syringe to inject Botox. Unfortunately, one syringe in one office is not equivalent to one syringe in another office. Using our examples note above, one syringe in the first office would be equivalent to 25 units of Botox. In the second office, this would be equivalent to only 10 units of Botox. So changing the dilution of Botox can significantly effect the amount of Botox that is actually being given in one syringe. The only measurement that really matters when it comes to controlling unwanted muscle movement is how many units were used. This is also the only consistent factor between offices. So from a patient's perspective, you should only be concerned about how many units are being used in your particular situation. In the San Diego area, Botox can range in price from $8.00 - $17.50 per unit. There shouldn't be any difference in the effectiveness of one unit of Botox from one office to another. Charging patients by the unit of Botox used is a much more transparent method than charging them by the number of syringes used or areas treated. This is the only way for patients to reliably compare apples to apples when it comes to Botox use.

If a physician is selling you CC's of Botox he/she is almost certainly trying to deceive you. There are two common ways to offer Botox in today's market, one is by the unit and the other is by the area. Measuring in CC's is deceiving because a CC of diluted Botox does not tell you how much actual Botox is in the dilution, rather it tells you more about how much saline was used. Purchasing Botox in anything other then the "unit" cost will usually lead to paying more for the product. If you know how many units are being injected, you can easily judge how it compares to another practice. Understand though that this pricing information has nothing to do with the amount of skill necessary to create good outcomes and you should always seek out experienced, well trained Botox injectors.