Botox Dilution: How to Be Sure You Get the Units of Botox Paid for

As you know Botox dosing is measured in biological units, not weight or volume. An honest provider will give the number of units you are paying for regardless of dilution.
Here are a couple of things to keep in mind: Although the on-label dilution uses preservative-free saline, most experienced injectors use preserved because it hurts less and doesn't seem to affect the potency.
Some experts also use different dilutions for different areas to try and control the spread more precisely, though it is debatable whether this is useful.
The recommended dilution on the label is based on the preclinical studies and so the FDA mandates that the label say that; however, adjustments based on clinical experience are the norm.

Botox dilution has nothing to do with the number of units received and dilution amounts will vary depending on injector preference. We will say that in our experience if you are being sold Botox by the "syringe", then you can almost certaily assume it is being overdiluted or diluted at the high end of the acceptable range.
With regard to how you will know how many units you are getting. I am not sure you will ever know exactly. But regardless of whether your injector is board certified, there are certain medical practices in any area that have a good reputation with lots of referrals and other practices that do not have a good reputation and get very few referrals. The best way to find an upstanding practice that injects what you pay for is to ask around for a practice with a good reputation.

Your best insurance for having a proper dilution of Botox is to go to a top plastic surgeon or dermatologist and have your treatment.
Their reputations are your best guarantee of having the procedure done artistically and effectively.
There is no way you can supervise how much saline a doctor is putting into a Botox bottle. If you are even asking this question, you are in the wrong office.
If you go to an unlicensed practitioner or think you can get top notch treatment for $10 a unit in a spa, or get your Botox on a table with stirrups, be prepared for droopy eyelids, facial asymmetries, short acting Botox, frequent "touch ups" and eventually resistance to the effects of Botox.

If is impossible to know how much you are really getting, that is why you go to someone you trust. The dilution really does not make a difference, but you just need to know how many units you are getting. That is what matters not how the dilution is done. In general, I inject 20 units per muscle area. Doctors charge per unit of botox injected.
This is why you need to get your plastic surgery procedures and injectables performed by a board certified plastic surgeon.

My simple recommendation is to get your Botox done by a Core Cosmetic Medicine Doctor like a board-certified Dermalogist, Plastic Surgeon, Oculoplastic Surgeon, or Facial Plastic Surgeon (ENT) only and avoid the spas, hair salons and mall quick fix places that dilute Botox and may not even be using a legal form of Botox as there is so littel quality control.
I do all the Botox and Filler injections in my office myself and all the dilutions are done with the patient viewing us...and we show them the real Botox bottle as well
Bottomline, know before you go...and in Medicine and in Life, you get what you pay for!

Botulinum toxin comes in a powder, always, and must be diluted. Physicians legally may perform off-label uses, and many use preserved sterile saline to dilute the Botox. The dilutions range from 1 cc to 2.5 ccs or even more. The number of units given is the absolute variable and this is what is discussed at conferences and medical journal articles when describing Botox injections from site to site and from physician to physician.

There is no practical method to measure the botulinum toxin concentration. The end result is the bottom line. Results can be seen in as little as 24 hours but typically take between 3-5 days to take effect.

It is immaterial as to how many units are injected in the area of interest. If you get the desired result then don't worry. If you feel that you did not get the desired result then go back to your physician and ask about the reason for no result. If you continue to have issues then see a physician that charges NOT by units but per site. This way your result is guaranteed and you don't have to worry about how many units were put in.
Regards

The dilution of Botox is not very important. What matters is the number of units used in each area. A skilled Botox injector can also get better results because they treat each patient differently, according to their needs. Rookie injectors sometimes take one day courses then treat all patients with a set pattern. So, when seeking Botox treatment, ask how long the doctor has been using Botox and how often instead of what dilution they use.

Offices vary in how they dilute BOTOX. Some used 1 ml of saline to 100 units of BOTOX. This makes a very concentrate solution. The range typically varies from 1 ml to 4.0 of saline. I generally recommend that offices use a single dilution to avoid confusion unless there is a very good reason for having multiple dilutions.
For example Eye plastic surgeons treating a medical condition called blepharospam may use very concentrated BOTOX solution but a more dilute preparation for cosmetic treatment.
Personally, I don't believe that these are treatments that should be done by nurses. There is a lot of important anatomy that simply is not taught to nurses. If you are not comfortable with your current provider, consider finding an office you can trust regarding what they tell your about your treatment. A cosmetic dermatologist or eye plastic surgeon who actually performs the service is a good place to start.
Finally, there is no reason to believe that using preserved saline is a problem with BOTOX. There is actually evidence that the preservative makes the treatment less stingy.