I read that Botox is purchased by doctors in a powder form. And that the Botox is diluted such that one doctor may give lower concentration botox then another. If this is true, how can i be sure that the doctor doesnt dilute my treatment more than it should be?
Does Botox Concentration Vary from Doctor to Doctor?
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Doctor Answers 26
Units count Not dilution
Botox comes in an airless vial with a film on the sides (the Botox)> It is then reconstituted by the physician or nurse. The dilution is placed into the vial and can very between 1-10 cc. Obviously the 10 cc product is 1/10th as strong as the 1 cc product. However, they equalize out when it is injection time. The physician using 10 cc dilution is going to put in 10 times as much as the physician uising the 1 cc dilution when he is putting in say 5 units,.
I attended an advanced Botox course about 2 years ago. One skilled physician used the 10 cc dilution and the patient was left with large blobs where the Botox went. I asm sure the patient got an excellent result. The other physician used the dilutions I use, which varies depening on the area. The patient had only small bumps. I am sure his patient got equally good results.
Personally, I like to use a more dilute Botox in areas where I want diffusion (forehead, crow's feet )and more concentrated Botox in areas I want precision (glabella, lateral brow lift, DAO).
What might be important is to be sure that the Botox is from Allergan. For awhile Allergan was encouraging us to show the patient the hologram on the vial. If you are picky you might ask to see the invoice from Allergan to ensure that the Botox came through normal Allergan channels. I would be a bit worried otherwise even if it was an Allergan vial. ( Perhaps, the vial sat on a dock someplace at room temperature and then was refrozen. I doubt whether there would be harm, but the Botox might not work.
In sum, dilutions and amount of Botox is not the issue but units. Thinking of it, its not even that, but your results.
The reputation of the doctor is paramount
Doctors can "water down" the Botox, without increasing the commensurate amount injected, or use Botox that is old.
Signs of this are when the Botox appears to go away quickly, or frequent "touch-ups" are necessary when the initial dosage was not adequate. Botox should also be administered in a medical setting, not a party or carnival environment.
While it may not seem to be a big deal to return frequently for repeat injections, there is some evidence that frequent low doses of Botox increases tolerance to the injections, and the Botox loses its effectiveness over time.
A reputable doctor will inject a strong amount of Botox in the right muscles. He is not worried about the economics of how many units he is saving on by watering down the Botox. His reputation is more important to him.
Pay by the Unit, Treat by the Area, or Find a New Saloon!
The concentration of Botox may vary from one doctor's office to the next, depending on the preference of the individual physician. Some may choose a concentration of 4 units per 0.1cc, down to 1 unit per 0.1cc, all dependent upon the volume of saline that is mixed into the 100 unit Botox vial supplied by the manufacturer. Assuming the doctor knows the relevant anatomy and the proper dosage, the concentration doesn't matter when it comes to achieving the desired treatment response.
Most patients have specific areas they want treated, and shouldn't be expected to know the proper dose. However, there is only one truly ethical way of communicating the dose received, which is to tell the patient how many units were administered. Doctors and offices may choose to price the Botox at a different cost per unit, depending on desired profit margin, office location, promotions, etc. Since Botox is a drug, it is inappropriate to fail to make note of the dosage administered to a patient in the medical record. Why would Botox be any different than an antibiotic or blood pressure medication in this regard?
Like a saloon in the wild west, the cowboys may not care if the whiskey is watered down as long as they still get drunk. If the Botox treatments are effective, patients may not care whether they are being charged by the area or by the unit. However, the only way to know for sure what you are actually getting, is to know the number of units per treatment, and the cost per unit. Then, you can compare one saloon (oops, Doctor's Office) to the other ones down the street.
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Have this question answered prior to deciding on a provider.
This is a very common question about Botox.
Botox does come in a powder form. In order to inject Botox you must first reconstitute it into a liquid form. A sterile isotonic saline solution is used. This is where patients may become confused because it is within the proper guidelines to reconstitute the Botox with different volumes. It is best to have your treatment done by an experienced well-trained provider who uses a consistent reconstitution. In my office we adhere to the guidelines of the Consensus Recommendations published by the Journal of Plastic and Reconstructive Surgery, the journal of the American Society for Plastic Surgeons. The consensus panel agrees, “that a range of dilutions and injection volumes is acceptable and depends primarily on the preference of the practitioner. In general, dilution should minimize the likelihood of affecting neighboring muscle groups. Anecdotal and published reports also suggest that volume may influence duration, the greater the volume, the shorter the duration of effect.”
In my office, we have set a standardized policy for reconstitution. Every injector uses that same standard to insure quality and consistency in outcomes. This is a key factor in choosing who does your Botox treatment. Using a standard insures outcome-based quality. We use a standard dilution of 50 units per 1cc, which will fill the Botox 1 cc syringe. We quote our patients‘ treatments in units; never in cc or volume. Therefore, you know exactly the cost of your treatment based on the units you have received.. You can obtain a list of board certified plastic surgeons by visiting www.surgery.org. This is the website for the American Society for Aesthetic Plastic Surgery, a member group of board certified plastic surgeons who specialize in cosmetic or aesthetic plastic surgery.
The most important decision you make about any medical aesthetic treatment is the choice of your physician.
Botox concentration usually doesn't matter
Although there are recommended dilution parameters, there is no set standard. The main thing that matters is how many units you have received. If both doctors give you 20 units for example, then it does not matter how they diluted it.
The next important thing is outcome. If you are getting the outcome you are looking for, then the dilution is not important again. The last important thing is cost. If they price per unit, then again the dilution does not matter. If they price per area and you are getting good results at a competitive fee, then the dilution does not make a difference.
The best thing to do is look for a board certified physician who is experienced in botox injections and ask your friends, family and other physicians. Word of mouth about the outcomes an office has is the best way to find a reputable office to work with.
Be careful of places that advertise rock bottom prices that sound too good to be true - they usually are. Those are the places you have to worry about how diluted the botox is, and if you are getting the correct number of units to have an effective treatment.
Make sure you go with someone you trust. Botox is not a flu shot.
Although there is a recommended dilution, many qualified physicians use slightly different dilutions. The key is getting what you pay for and that is based on the actual units that are injected. Some doctors inject based on volume, however in those cases it is not clear to the consumer how much botox they are actually getting. Paying for it by the unit is the most clear way to measure what is actually being used. Also, alway seek an experienced person who understands the science as well as the art of achieving an attractive and wrinkle-free result. The goal is not to simply "freeze" the wrinkles. It is to soften them while allowing acceptable expression so you don't look like you've had botox.
Botox concentration - depends on how you mix it
A fresh Botox bottle has 100 units of Botox and is diluted with 5 cc or 6 cc of solution. When it is diluted to 5 cc for example, each cc (ml) contains 20 units. So 5 cc of diluted Botox contains 100 units of Botox.
So, if you see the doctor mix the Botox, ask the amount of dilutent (the number of cc's so you can calculate the numer of units in each cc injected.
Botox Concentration and Freshness Can Vary - Find Physician You Can Trust
It makes no sense to price Botox "per area". Pricing "per area" means one of two things - either (1) a physician is injecting the same number of units of Botox into a given treatment area in every patient, say the forehead, whether the patient is a young woman with few lines and wrinkles or a mature gentleman with a large forehead and significant wrinkles; or 2) the doctor injects a varying number of units into the treatment area depending on the needs of patient, but charges everyone the same amount for that area. In this latter scenario, the gentleman with deep lines on the forehead might be getting more Botox and a much better deal than the young woman with early signs of aging.
Here are a few questions to ask that might help you find a Botox physician who can provide you great treatments with consistent results:
- Do you charge for Botox by the unit or by the treatment area?
- How many years have you been injecting Botox ?
- Do you always use freshly reconstituted Botox?
- How many Botox patients do you see each month?
Botox dilution is not so important.
I agree that you ought to keep track of the number of units that is being injected to a certain area. If not, when you go to a new provider, you may end up paying for more units than you need, or find the injections to be less effective because you did not receive an adequate number of units.
While the number of units is more relevant than dilution, even more important is whether the injector knows what he or she is doing. I suggest you look into the credentials of whoever will be treating you.
It can vary
A doctor can vary the concentration, the amount and the location that Botox can be injected.
All of these factors should be something that an experienced Botox administrator should be able to explain. In addition they should have rationale behind why they have injected in a particular location, with a particular concentration and in a particular amount.
It can be helpful to ask how many total units of Botox you've gotten. Keep track of it yourself between treatments and especially if you transfer providers.
I hope this helps.
Steven Williams, MD
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.