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

How do you know if you are getting the actual number of units (Botox) that you are paying for, when should you notice results and can you tell if the Botox has been diluted? Also, recently at a local MedSpa in Fresno California, I paid $440 for Botox..the nurse left the room for more than a few minutes to get the product and then when asked about "dilution" of the product, advised that there is a "range" of the amount of saline (hopefully preservative free)she uses to dilute the dry form. Is this true, if so, what is the range. Of all the research I've done on the prescribing information, no where does is say to use "anywhere from" 1.0 mlto 2.5 ml. It says to use 1.25ml for a 50 unit vial and 2.5 for a 100 unit vial. Should this nurse be using less than either of these?

Doctor Answers 21

Botox dilution for best results

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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.

Seattle Plastic Surgeon
4.9 out of 5 stars 59 reviews

2.5 cc per 100 unit bottle of Botox is the usual dilution. Avoid bargain prices when it comes to Botox.

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Botox can be diluted from 2-3 cc per 100 unit bottle and that is acceptable. Only your doc will know the exact amount of units you get. It takes about 1 week to get the full affect of botox and should last about 3-4 months on the average. Sometimes it works better than usual and sometimes it may not seem to work as well as usual.

It can vary alittle sometimes. Don't go to the cheaply advertised Botox places because they may not be giving you what you need or paid for. You are also paying for the skill and expertise of the doc.

David Hansen, MD
Beverly Hills Dermatologic Surgeon
4.7 out of 5 stars 46 reviews

See a reputable board certified physician to get best Botox results

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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!

Rod J. Rohrich, MD
Dallas Plastic Surgeon

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Dilution of botox

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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.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 39 reviews

Botox dilution

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Typically, botox is diluted with 1 to 3 cc's of saline, depending on the injector's preference and the areas being treated.  The more concentrated the solution, the more exact the treatment and the less the diffusion or spread.  What is important for you is not the dilution, but the number of units being used.  The effectiveness and cost of the treatment is determined by the number of units injected.  You should have your treatments with someone you trust, preferably a board certified dermatologist or plastic surgeon who is accountable to their medical licensing college.  To whom is a nurse working at a med spa accountable?

Martie Gidon, MD, FRCPC
Toronto Dermatologist

Botox dilution can vary

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As answered many times on Real Self, the dilution can vary. While the official recommendation from Allergan is to dilute Botox with 2.5 cc of unpreserved saline, nearly all physicians (including myself) stray from this recommendation. Dilutions differ: I personally use a 1 cc dilution in places where I do not want Botox to stray and 2-2.5 cc where I want diffusion.

Thus, the dilution does not matter. What may matter is such factors as where the Botox is obtained, how long it has been in the frig (or even whether it has been in a frig at all), whether it has been drawn up properly, etc.

It is my contention, and from reading my colleagues' answers to this question, that there is superior quality control in a dermatologist or plastic surgeon's office than one obtains in a so-called medi-spa whether run by say a gynecologist or an entrepreneur.

There is a certain amount of trust involved, going beyond the topic of dilution. Are you being charged for the actual number of units that are being placed? In other words, if 18 units are in reality being placed into the glabella, are you being charged 25 units by a less than scrupulous injector. An entrepreneur, or for that matter a gynecologist, dentist or neurologist, has opened up their spa as a business enterprise: to extract as much profit from their customers ( not patients) as possible. Messing around with units, dilutions etc. can lead to greater profits.

The vast majority of dermatologists and plastic surgeons are doing these procedures as a natural outflow from their core ethos: making people look better. The above mentioned business men or physician/businessmen have entered our field to make a buck.

Sure, we all appreciate that dermatologists and plastic surgeons are better at performing Botox injections due to the years of familiarity with the muscle, nerve and vascular structures of the face. There is no argument there. I thought I would advance, another reason that you are better off in the hands of not only physicians, but physicians whose motivation and skills are most likely to give you a good and honest result.

Arnold R. Oppenheim, MD
Virginia Beach Dermatologist

Dilution of Botox

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With regards to the dilution of Botox, it can vary, however, only a skilled injector can properly calculate the ratio. I would highly recommend seeking a dermatologist or surgeon that has years of experience and whom is board certified.

Nissan Pilest, MD
Irvine Dermatologic Surgeon
4.6 out of 5 stars 23 reviews

Botox dilution - determining the right dilution - seeking the right doctor

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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.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 195 reviews

Botox dilution can vary

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I completely agree with the others that in receiving treatments like Botox, you are best off going to a board-certified core cosmetic physician (dermatologist, plastic surgeon). Having said that, the dilution can vary for certain areas in which you are being injected. For example, it would be perfectly reasonable to dilute more for forehead injections where you may want a little more diffusion and less so for the glabella (area between the eyebrows) for a greater effect.

The problem is, you cannot possibly know the dilution this nurse used for your injections unless you were either watching her or did it yourself! Also, the dilutions can vary based on clinical experience and injector preferences and many experienced injectors do not strictly follow the guidelines set forth by Allergan.

The big question is are you happy with the outcome? If not, I would certainly recommend what everyone else is saying that you are better off being treated by a board-certified physician who will at the very least held to a certain standard of ethics.

Ritu Saini, MD - Account Suspended
New York Dermatologic Surgeon

Botox Dilution

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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.

Farbod Esmailian, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 88 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.