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

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?

Doctor Answers 10

Lidocaine is not necessary for Botox treatments

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

Roanoke Facial Plastic Surgeon
5.0 out of 5 stars 10 reviews

Diluting Botox with 1% Lidocaine

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.

Choon Kia Yeo, MD
Honolulu General Surgeon
4.3 out of 5 stars 6 reviews

Botox and Lidocaine

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!

Mark Schwartz, MD
New York Plastic Surgeon
5.0 out of 5 stars 23 reviews

Diluting Botox with Lidocaine

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

Jo Herzog, MD
Birmingham Dermatologist
5.0 out of 5 stars 18 reviews

Diluting Botox with lidocaine

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

Benjamin Barankin, MD, FRCPC
Toronto Dermatologic Surgeon
4.8 out of 5 stars 50 reviews

Can you dilute Botox with Lidocaine instead of Saline

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."

F. Victor Rueckl, MD
Las Vegas Dermatologist
4.6 out of 5 stars 17 reviews

Lidocaine actually hurts when injected before the numbing kicks in so don't use for Botox dilution

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 F. Weiner, MD
Panama City Facial Plastic Surgeon
4.7 out of 5 stars 41 reviews


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.

Andrew B. Denton, MD
Vancouver Facial Plastic Surgeon
4.7 out of 5 stars 70 reviews

Dilute with normal saline

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.

Steven Hacker, MD
West Palm Beach Dermatologic Surgeon
5.0 out of 5 stars 4 reviews

Don't dilute Botox with lidocaine

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.

David W. Bray, MD
Alexandria Dermatologist

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.