Can botox be mixed with lidocaine 1% instead of normal saline, and what is the difference?

The answer is yes it can, but why would you want to?  Some have adovcated mixing epinephrine into the saline mixture so that the results of the botox may activate quicker, last longer, and stay more concentrated at the injection site.  Either way, I think there is no reason, and the typical use of bacteriostatic is all that is needed and required.  I get excellent results this way.  I wish you the best of luck, Dr. Emer.

I can see no reason for making this mixture. The patient wil still feel the needle stick, which is minimal, but the lidocaine will sting. Mixing with bacteriostatic saline takes the sting out of the injection.

The company recommends that Botox be mixed with saline or sterile salt water.  The lidocaine is in an acidic form and may cause buring upon injection, and I am not sure how the Botox would react to the acidic environment.

There are doctors who choose to mix Botox with lidocaine instead of normal saline but for what purpose I am not certain. The Allergan company who manufactures Botox has recommended the dilution be performed with sterile water or normal saline and most physicians follow these guidelines.

Yes, but let me explain. Botox comes in a powder form in the vial so solution is added to it to make it a liquid and therefore able to be injected. Normally we dilute it with a form of saline. It can be diluted with lidocaine, but just plain lidocaine actually stings very much. So the lidocaine has to be cut with something else too. This means you are putting different solutions into the vial. There is some scientific study to show that diluting with lidocaine may make the results of the Botox kick in faster (this study is being done in Europe, not America), but the results at this point aren't conclusive. The reason it may help is because lidocaine numbs, and therefore numbing the muscle a bit may make it so the Botox neurotoxin can be picked up faster by the nerve endings. At this point, it's best to stick to the standard dilution method until more conclusive research is established. "This answer has been solicited without seeing this patient and
cannot be held as true medical advice, but only opinion. Seek in-person
treatment with a trained medical professional for appropriate care."