Does Botox Have to Be Diluted Before Injecting?

Does Botox Have to Be Diluted Before Injecting?

Doctor Answers 29

Botox powder

Botox is distributed as a powder in a bottle and needs to be reconstituted with saline.  The dilution does not matter since various doctors use different dilutions.  What matters is the number of units injected to achieve the optimal results.  You should be treated by a board certified dermatologist or plastic surgeon to ensure the best possible results.

Toronto Dermatologist
5.0 out of 5 stars 22 reviews

Botox is mixed prior to administration

Botox comes as a freeze-dried powder in a sterile vial which is then mixed by the physician prior to use, with a sterile saline liquid.  Different doctors use different volumes so that the concentration can vary but the number of units delivered per area is the important number to compare from treatment to treatment.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 37 reviews

How is Botox mixed?

Botox is delivered to physician offices as a fine dry powder in sterilized 100 unit vials on dry ice (Botox must be refrigerated).  It must be mixed with normal saline solution prior to injection.  The amount saline used to put the Botox powder into solution varies per physician and on the areas being treated. 

Steven E. Rasmussen, MD, FAAD
Austin Dermatologist
5.0 out of 5 stars 3 reviews

How Doctors use Botox

Of course it must be diluted! It is more correct to say, "It must be reconstituted", since it is sold to doctors as a white powder that is then mixed just prior to using it.  The dilution factor depends on where we are using it on the body. For example, when used in the armpits to treat excess sweating, it is more dilute than when it is mixed for treating facial lines.

Beverly Johnson, MD
Silver Spring Dermatologic Surgeon
4.9 out of 5 stars 7 reviews

Does Botox Have to Be Diluted Before Injecting?

Botox, Dysport and Xeomin all come from the manufacturer freeze dried inside vials.  The freeze dried powder needs to be reconstituted to make the injectible solution.  This is the dilution everyone refers to when speaking about concentartion and unit doses.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 24 reviews

Botox Dilution

I agree with the other docs that it needs to be reconstituted, and that the most important variable is not dilution but total dose.  So you want to make sure you get at least 20 units of botox in the glabella, for example.  But since you can survey a number of docs here in one place, I will give you specifics, since we have done internal studies in our office that have fine tuned our approach.  For the glabella (between the brows) we use a 1 cc dilution.  For the rest of the face, we have tried a 4, 3, and 2.5 cc dilution.  We now stick with the 2.5cc.  The only place I tend to favor dysport is in the crows feet, as it has been disappointing at times when used in other sites compared to botox cosmetic.   And we are currently working with Xeomin to see how it stacks up against Botox right now-it's too early to tell how it will do.

Kevin Robertson, MD
Madison Facial Plastic Surgeon
4.7 out of 5 stars 14 reviews

Dilution of botox

Botox comes to the physician as a dried power.  In order for this to be injected as a liquid it needs to be reconstituted with saline. The amount of saline added various from physician to physician.  What is important for you as a patient to know is not the volume but the number of units injected into each area. 

Donald M. Brown, MD (retired)
San Francisco Plastic Surgeon
5.0 out of 5 stars 8 reviews

Botox Needs to be Diluted Before Injecting

Botox, as well as Dysport and Xeomin are manufactured as a freeze-dried powder. They must be reconstituted or diluted prior to administration.  Although the manufacturers recommend what they consider to be optimal dilutions, different physicians use dilutions that works best for them. 

Anifat Balogun, MD
Seattle Otolaryngologist

Botox injection and its dilution

Yes , Botox is preserved in freezing temprature in small containers ( vial) in powdre form. It need to be reconstituted into liquid form prior to injection , by adding 2.5 ml of steril salt water to a 100 unit vial. This is the conventional, standard and recommended method for Botox preparation. Each one ml of this dilution contains 40 unit of Botox and has been proven to be the most effective way of preparation for cosmetic uses.    F.Mahjouri M.D.F.A.C.S 

Fereydoon S. Mahjouri, MD
Minneapolis Plastic Surgeon
4.9 out of 5 stars 16 reviews

Yes, Botox is Diluted Before Injecting

Dear Wegiddy-

Botox is shipped in a dry powder, and has to be mixed with fluid to make it injectable.  The plastic surgeon mixing it has control of how strong, or dilute, it is.  However, you HAVE to mix it with fluid to give Botox. 

How strong or dilute it is depends on your injector, where it's injected in your face, and your personal reaction to it.  Many plastic surgeons choose to make the muscles between the eyebrows have stronger Botox.  The areas of the crow's feet typically get less Botox units, and so may be more dilute. 

So, yes, Botox needs to be diluted before injection, but the amount of dilution is variable.


Best Wishes,


Roy Kim, MD
San Francisco Plastic Surgeon
4.2 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.