Extra Botox Extending Length of Results?

I recently relocated from Scottsdale AZ to Las Vegas and I was disappointed to learn that they regulate the sale and distribution of botox differently. I usually use about 20 units total. From what I've been told (from three drs offices) in Vegas they will not allow you to purchase less than 50 units because you have to purchase the entire vile. When I explained that's much more than I need one place told me that it's ok because using more will make the results last longer. Any truth to this?

Doctor Answers 17

Las Vegas Botox dosage requirements

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I am a physician in Las Vegas who has injected Botox for over 25 years and I know what you are referring to. It's single use vials, and my office does injections in 25 dose increments. My staff or I would be happy to go over how we comply with the state regulations but still allow you to get proper dosing. Do not allow an office to inject 50 units into a spot you only have 20 units normally. This is not effective, and can cause droopiness of the muscles from overinjection.

Dose of Botox

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Physicians should not inject more units of Botox in an area because a governing body set guidelines on the opening of a vial. It is true that if there is too little a dose of Botox, you may get a good immediate result but it won't last long so increasing the units to what is considered reasonalbe should work better, but injecting much more than that which you need, is unnecessary, a waste and might increase the risk of side effects such as effecting neighboring muscles which could create a functional or aesthetic problem.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 39 reviews

"Extra" Botox will NOT extend results; it WILL extend your injector's profits!

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You are getting misleading information and non-factual data on "regulation of sales and distribution." Botox is sold in multi-use vials, and sterile technique ensures that each patient receives fresh, sterile, and non-contaminated Botox regardless of the number of units used.

This is like saying you can only purchase the Costco or Sam's Club mega-size container of anything they sell. Of course, there are plenty of other grocery stores who will be happy to sell you the size and quantity you need or want.

The same is true for physicians' offices that sell Botox. Find a reputable one!

Also, using "more" Botox than necessary for a given area will not extend the duration of paralysis. Once the receptors are "filled" by the Botox molecules, the irreversible bond is made, and the duration of effect is based on how fast (or slow) your body creates new receptors for neuromuscular activation. That is why some patients will see effective results for 6 months or longer, most see results for 3-4 months, and some will note return of muscular activity and wrinkles in as short as 2 months. Accuracy of injection is critical, as is using freshly-reconstituted Botox that has been kept cool in a medicine refrigerator. The information that "using more will make the results last longer" is just plain WRONG! Find a reputable physician's office for your Botox!

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 263 reviews

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Nevada requirement for purchase of entire Botox vial

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This is fascinating. There has been talk in the medIcal community for a few years about potential regulations requiring sale of single dose vials. Restylane and Radiesse are sold in this manner and, after some cases involving transmission of hepatitis, NY considered such a requirement but it was not implemented. I encourage you to contact the state of Nevada to verify the accuracy of the information provided to you before undergoing the procedure.

Does extra Botox extend the length of results?

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I  tell my patients when talking about Botox that we are trying to get the maximum result with the least amount of Botox.  This is  to avoid a "plastic" immobile look.  If you are happy with the results that you have obtained using 20 units of Botox then do not get any more than this.  Extra Botox will not extend the length of results if you have the correct dosage. Furthermore, you may run into difficulties and problems if you use more.  It  sounds as though the physicians you have talked to do not use very much Botox in their practices and do not want to be left with any unused Botox.  I would continue your search. 

Donald M. Brown, MD (retired)
San Francisco Plastic Surgeon

Patients do NOT need to purchase a botox vial

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If you are happy with 20 units of botox, there is no need to purchase a vial of 50. This usually means that the practice you called doesn't do enough botox to "justify" the expense of mixing a vial for one patient (b/c they don't know if they will be able to use the rest and don't want to waste it). I would look for a doctor that will let you get the ammount you want.

Also, more botox may cause problems, such as drooping. So be careful!

Gary Goldenberg, MD
New York Dermatologist

Do I have to purchase the entire vial of Botox?

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Technically, bottles of Botox are single use so they are being technically correct. In point of fact, few physicians use an entire vial on a single patient. However, some states are being very difficult with how they allow physicians to use the vial and Nevada wants people to get a single use vial.

With respect to using more units and getting a longer duration, this is partially true but doubling the dose (from 25 units to 50) will not double the duration and runs the risk of increasing adverse events. Dose is determined by muscle mass and for most women, I use 25 units unless they are marathon runners in which case I use more.

Kenneth Beer, MD
Palm Beach Dermatologic Surgeon

Extra Botox Extending Length of Results?

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WOW! Keep looking for more understanding doctors in Las Vegas, I'm sure there are some. I always adjust the # of units to the patient. 

How many units of Botox do you need?

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There are patients that require 50 units of Botox, but that is relatively uncommon.  If the amount that you usually get is 20 units and you are happy with those results, that is what you should continue to get.  Besides the 50 unit vial, there is also a 100 unit vial that can certainly be used for multiple patients.

If the Botox is reconstituted and drawn out of the bottle in the proper sterile manner, the remaining Botox can remain unused for up to 6 weeks without losing its potency.  Don't let the doctor talk you into more Botox than you need.  Medically, it can result in complications or a frozen look, both of which you want to avoid.

Look for a board-certified dermatologist or plastic surgeon with proper training and experience with Botox injections.

Emily Altman, MD
Short Hills Dermatologic Surgeon

Extra Botox Extending Length of Results?

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Keep looking.  You should find an experienced MD that can give you 20 units of Botox without you having to purchase the entire vial.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 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.