Can You Dilute Botox with Lidocaine 1% ONLY Instead of Normal Saline? Will It Have the Same Effect?

Question

Normally my doctor dilutes 100 units botox with 2.5cc of injectable normal saline but could I dilute the 100 units of botox with 2.5 cc of 1% lidocaine and inject as normal and get the same results?

Andrew B. Denton, MD · Answer

Saline is the specified dilutent.  Lidocaine should not be used as a dilutent.  Not only would it be much more painful to inject but it also might destroy the botox protein.

Michael Bowman, MD · Answer

Most likely the lidocaine would not effect the efficacy of the medicine, however it won't make your injection any more comfortable.  The mild discomfort associated with a Botox injection is due to the needle and the tiny amount of medicine that comes out.  The injection is over and done with before the lidocaine can have any effect.  In fact, the lidocaine may burn more than the saline because it has a lower pH.

	My patients report their injections are pretty much painless just using a cold pack as a topical anesthetic.  If you are having significant discomfort from the injections, I would consider a topical numbing cream like Emla or BLT (benzocaine/lidocaine/tetracaine).  Ask your injector for your options.

	Best Wishes

Choon Kia Yeo, MD · Answer

Yes you can dilute botox with 1% lidocaine and you will have the same effect. However the injection will sting because of the ph in lidocaine and the area will be numb for about 30 minutes. The Botox and normal saline will not sting. The way I inject Botox is gentle, I use a small fine needle, little topical anesthetic and icing and the injection is painless.

Mark Schwartz, MD · Answer

I would strongly recommend that your Botox is diluted with sterile normal saline and not lidocaine. In fact, lidocaine may hurt you more and diminish the effect of the Botox due to its pH. Good luck!

Jo Herzog, MD · Answer

There is no reason to dilute Botox with Lidocaine. Doing this would make the injections uncomfortable.

Benjamin Barankin, MD, FRCPC · Answer

Botox is reconstituted normally with saline, sometimes preserved, sometimes not, depending on the physician. There is actually a mild anesthetic effect to the saline, and the pH is such that there is almost no discomfort with the injection. The lidocaine is much less studied, would hurt more, and is not something I'd recommend for any reason. ~ Dr. Benjamin Barankin, Toronto Dermatology Centre

Steven F. Weiner, MD · Answer

It seems like a theoretical good idea but it is not.  Besides being MORE painful, the ph of the lidocaine might destroy the Botox so you would probably have a lessened effect.

Steven Hacker, MD · Answer

We have been using Botox for over 10 years and we only dilue with normal saline and that is because we know it works. We have tried other dilutents. Pain is not a problem with injection of Botox for our patients. I would recommend injection only by a properly licensed board certified dermatologist or plastic surgeon.

David W. Bray, MD · Answer

The FDA approved way to dilute Botox is with saline. Bacteriostatic saline (with preservative) is most commonly used because it does not hurt as much as some other diluents. Although theoretically Botox would probably still work if diluted with lidocaine, I would not recommend this. If your provider uses bacteriostatic saline and a small (30-32 gauge) needle, the procedure should be very quick and well tolerated with minimal discomfort.

F. Victor Rueckl, MD (in memoriam) · Answer

Strange timing that you ask this question, as an international report just came out talking about the different effects of diluting Botox with lidocaine vs saline. Because lidocaine will stop immediate movement because it numbs, some thought it might actually make a Botox injection more effective. Turns out, not so much. One outcome was that patients thought the Botox hurt A LOT more when only diluted with lidocaine. Plus, the FDA approved way to dilute Botox is with saline. Stick with what works and has been proven to work for a loooooong time.

	"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."

Can You Dilute Botox with Lidocaine 1% ONLY Instead of Normal Saline? Will It Have the Same Effect?

Answers (10)

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