Preparation & honesty of Botox?

I am continually reading botox can't be over diluted. If the person that is preparing it is using more saline then recommended this equals poor results so the client has to pay more for the intended result. This is called what if not over dilution w/ saline?

Doctor Answers 13

Botox preparation

Botox comes as a freeze-dried powder and is reconstituted with saline. Some people use more or less saline based on the area being treated or based on their preference & experience. You should be paying for the results and if you go to a credible expert physician such as a dermatologist, you needn't worry about having an overly diluted product. Bottom line is that you should have excellent results that last about 4 months based on proper injection technique and number of botox units, rather than based on dilution/reconstitution.

Toronto Dermatologic Surgeon
4.8 out of 5 stars 53 reviews

Honesty in Botox

Botox comes in a powdered form and needs saline added to it to be reconstituted.  Depending how much saline is placed in the Botox  vial will determine how diluted the botox is.  For instance 25 Units of botox may be delivered in 0.25 mL, 0.6 mL or 1 mL.  I use different dilutions depending on the effect I am trying to achieve.  This is equivalent to placing a small pizza in 3 different sized boxes (small, medium and large).  You still get the same amount of food it just doesn't fill up as much of the box.  The most important thing is that you get what you pay for.  The term over dilution in my opinion means that you are receiving less than you are paying for.  This is equivalent to having a small pizza delivered with a few slices missing.   I pride myself on being trustworthy and honest with my patients and I believe that why they keep coming back for repeat treatments.  Follow the recommendations of friends and family to help find the honest doctor you deserve. 

Jacob Bloom, MD
Chicago Plastic Surgeon
4.6 out of 5 stars 11 reviews

Preparation and Honesty of Botox

As in all walks of life, there are some people who are less honest or less ethical than others.  The doctor-patient relationship is based on trust.  If you cannot trust your doctor, then it is time to move on and find someone else.  I suspect that there are some injectors out there (not the majority) who cut corners and give fewer units than they say or substitute other products for Botox.  Try to establish a long-term relationship with a reputable doctor who has your best interests in mind.  Don't chase the latest discount or deal because sooner or later you will have problems.

The actual dilution should not matter as long as you are getting the number of units that you are paying for.  A higher dilution might actually give you a stronger effect for a given number of units because more volume is injected, which leads to greater spread and a greater area of coverage.  In my hands, I routinely get great results with less units than others.  This saves my patients money over the long run. I also tell all my patients to return within 1-2 weeks after treatment if results are not perfect.  My goal is to provide natural results and have happy patients without breaking the bank.  

I have been injecting Botox, Xeomin, and Dysport since 1998.  The more you do of something, the better you get at it.  Botox and fillers now represent about 50% of my practice.  


Dr. Ort

Richard Ort, MD
Lone Tree Dermatologic Surgeon
5.0 out of 5 stars 27 reviews

Under dilution

All three botulinum toxins, Botox, Xeomin, and Dysport, have manufacturer recommended dilution techniques.  Over dilution can lead to less results unless the volume injected is proportionally increased.  The objective is consistent results so each doctor will decided on how he/she wants to dilute the product. That said, if the product is injected into the dermis of the skin and not the muscle for fine lines, the dilution is often increased.  

Stuart H. Bentkover, MD
Boston Facial Plastic Surgeon
4.5 out of 5 stars 26 reviews

I am continually reading botox can't be over diluted =not true! It can be diluted #botox #botox application #drmesa #realself100

There is a lot of misconception about Botox "dilution" out there.

The Botox package insert recommends Botox to be diluted in certain amount of fluid. This is considered the "standard" dilution. However doctors can dilute the Botox in a different volume as a off-lable-use.

Diluted Botox is not "bad", "wrong" or a "mistake". When properly used, diluted Botox gives similar or even stronger effects than  "standard" Botox dilution.

In my practice I dilute the Botox in tow ways : One concentrated ("G" concentration) as recommended by the Botox package insert; and one diluted ("M" Concentration- M because my last name "Mesa"). 

The concentrated ("G") Botox gives me a mild Botox effect (only weakens the muscle) while de diluted Botox ("M) gives me a very strong effect (paralyzes the muscle). When I use the diluted Botox, I am able to administer less Botox to the patient to have a very strong effect when compared with "standard" concentrated botox ( a money saving advantage).

In my practice both concentrated ("G") and diluted ("M") Botox have very precise indications. I usually treat my patents with both dilutions to deliver a natural Botox result while promoting  money savings to the patient.

Either when treating with either "diluted" or "concentrated" Botox, patients should paid ONLY for the total number of units of Botox administered. That's why I don't charge Botox  per syringes or per area since every patient is different. 

John Mesa, MD
New York Plastic Surgeon
4.9 out of 5 stars 129 reviews

Excellent question

Dear Luvbotox, i think you have asked an excellent question. yes, its correct that it can be diluted, but its best used at recommended dilutions. The only answer is to consult specialists with integrity and professionalism who will not let this happen.

Bijoy Methil, MCh, MS, DNB
India Plastic Surgeon
4.8 out of 5 stars 5 reviews

Depends on dose

Tequila can be a shot, or it can be diluted in a margarita.
The dose is the same, but the reconstitution is different.
Three of each will get you a DUI despite one being "diluted".
Botox is similar.
There is concentration, and there is the amount (units).

Keith Denkler, MD
Marin Plastic Surgeon
5.0 out of 5 stars 19 reviews

Units, not dilution, determines results after Botox

Hello again, I have updated my answer with a web reference to better answer your question.

Hi luvbotox.  The effect of botox is dependent upon the number of units injected, not the dilution.  If more saline is used, then a larger volume needs to be injected to get the same number of units.  Dilution recommendations from the manufacturer (per vial) is 1:4 but many expert injectors use higher 1:2 or 1:1 proportions to avoid potential problems with diffusion into adjacent tissues and reduce discomfort.  An expert injector will be willing to show you the botox vial and their methods.  Good luck!

Vaishali B. Doolabh, MD, FACS
Jacksonville Plastic Surgeon
4.9 out of 5 stars 33 reviews

Botox preparation

As with everything in live, it is important to see experts for the best and consistent results.
I think that taking chances with your Botox and other treatments for the sake of costs is not a good policy.
It is very reasonable to ask your doctor how she or he reconstitutes Botox and to see the actual vial for yourself. This may help to alleviate your concerns and become more comfortable with your doctor.
I hope that helps and best regards, Dr. Sapijaszko.

Mariusz Sapijaszko, MD, FRCPC
Edmonton Dermatologic Surgeon
5.0 out of 5 stars 13 reviews

Preparation of botox

I think you are questioning how much botox you really get when someone says you are getting a certain number of units. This is an excellent question. If someone charges you for 20 units of botox, but overdilutes it, you may only be getting 10 or 15 units. Even though the apparent "cost per unit" may be less, you will need more "units" to achieve the same effect. You need to trust the integrity of your injector to make sure they are not cheating you by overdiluting the Botox. 

Another option is to see a doctor that charges a fixed price based on the number of areas treated. You are charged a fixed price to treated a particular area regardless of how many units it takes. There are advantages and disadvantages to both pricing models.

I prefer to charge by the number of areas treated. It is my job to figure out how much botox you will need to achieve the results you want. I almost always see patients back a few weeks after their first botox with me. If they need a little more, it is included with the treatment and there is no additional charge. This also allows me to tweak their next treatment to optimize the results. 

Mitesh Kapadia, MD, PhD
Boston Oculoplastic Surgeon
5.0 out of 5 stars 167 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.