Botox - Units, Effectiveness, Dilution - What's the Story?
Alan M. Engler, MD - New York Plastic Surgery and Aesthetics
What’s the difference between Botox and Dysport?
Well, depending on who you talk to, either a lot or very little.
Botox is, of course, better known. It’s been around for years and is actually one of the most consistently effective non-surgical treatments available. It targets those pesky frown lines and grooves on the forehead, between the eyes (the “11” lines), at the sides of the eyes, and nearly anywhere else on the face. It works by weakening the muscles that, when contracted, cause the lines in the first place. Weaken the muscles, you can’t frown as much, and the lines either disappear completely or, at least, are softened. Treatment typically lasts from about 6-9 months, depending on many factors.
Botox is actually botulinum toxin A (there’s a botulinum toxin B, but we’re not going to talk about that – yet). However, there are TWO versions of botulinum toxin A: onabotulinumtoxinA (which goes by the trade name of Botox, and is manufactured by Allergan) and abobotulinumtoxinaA (which goes by the trade name of Dysport, and is manufactured by Medicis).
So, Botox and Dysport are two versions of essentially the same thing. They are injectable treatments that relax muscles. Each comes in a vial that contains a freeze-dried powder that gets reconstituted (mixed with sterile saline) to form a liquid that can be injected.
Here’s where it starts to get tricky, because there are a lot of variables. When considering an injection, you need to know two things: how many units are being injected, and how old is the solution? Some people have been dissatisfied with the level of correction they’ve achieved, but there may be some simple explanations.
The first issue is how many units will be used. Botox is available in bottles of 50 or 100 units, so there’s a certain degree of flexibility. Most people need about 50 units (or, at least, they could benefit from that amount!) depending on how deep the lines are, how thick the muscles are (larger muscles require more botulinum) and how much correction is desired. Some people share a 50 unit vial if they just want a bit. In general, it takes about 20-40 units to get a nice correction between the eyes, 5-15 units at the sides of the eyes, and 10-40 for the forehead. One person can easily use 50 units; larger people or muscles, or a greater degree of correction, may require up to 100 units.
Dysport is packaged differently – it comes in a vial that contains 300 units. However, you generally need more units of Dysport to provide the same degree of correction as compared with Botox. Most people think it’s about 2 to 2.5 units of Dysport per unit of Botox. That means that 300 units of Dysport is ABOUT equal to 120–150 units of Botox.
But you can reconstitute the product (whether Botox of Dysport) with varying amounts of saline. Putting 4 cc’s into a 100 unit vial makes it 25 units per cc; putting 2 cc’s in makes it 50 units per cc. Putting 3 cc’s into a 300 unit vial of Dysport makes it 100 units per cc, which is then the equivalent of 40-50 units of Botox.
Confused? You don’t really need to be. What you need to know is how many UNITS you’re getting – not how many areas are being “treated” (what does “treatment” mean?), or how many “syringes” are being used (how strong is the solution?) or how many “injections” you’re getting. It’s all about the UNITS.
The next issue is how long the reconstituted product lasts after the saline has been added. Unless it’s being made up fresh for each patient, you have to know how old the product is when you actually get it. Botox, for example, says that any product not used should be discarded after 24 hours; the Dysport, packaging says that any product not used should be discarded 4 hours after reconstitution. Studies have actually shown that Botox can last a lot longer than that (up to several weeks) but it’s one of the factors to take into account if you’re considering these treatments.
For that reason, in my office we ONLY use product within the recommended time periods and, in general, make it up fresh for each patient or treatment.
One more issue is how similar the treatments are, assuming an equivalent number of units is used. There is a some disagreement over this. It has been reported that, when compared with Botox, Dysport works faster and spreads out (diffuses) more evenly. There are many possible factors involved in this, including how much saline is used to reconstitute the product (ie, how dilute it is) but this is a feature that has not yet been fully elucidated.
In summary, Botox and Dysport are excellent and equally effective treatments for facial lines, particularly between the eyes, at the sides of the eyes, and on the forehead. There are some differences, and some people prefer one versus the other, but both work well. If you’re interested in these treatments, ask your doctor the following two questions: (1) How many units am I getting, and (2) When was the product reconstituted?
I hope that this helps, and good luck,
The only thing that matters is how my many units of BTX-A you get
1. The "unit" is a standard dosage measure for the various formulations of BTX-A. Each manufacturer [for example Allergan:BOTOX®, Ipsen:Dysport, Merz:XEOMIN® has their own highly standardized, proprietary methodology for determining a standard dosage unit for their product.
For this reason, it is not possible to compare or translate "units" of one formulation [for example, units of BOTOX®] into units of another formulation [for example, units of Dysport®]. Each formulation of BTX-A is a unique medication, with a unique diffusion profile in various tissue, and unique immunological properties.
The amount of saline used in the reconstitution [not "dilution"] of the various formulations of BTX-A does not seem to make any practical difference to outcomes in the volume ranges commonly used in clinical practice. The amount of saline is simply a matter of the individual physician's convenience and preference. The volume of saline in which your BTX-A is dissolved does not matter much [if at all] -- the only thing that is really important is how many units of the BTX-A formulation are administered. And of course, the location and depth of the injections is important, as is the interaction between the various treated areas, and diffusion of BTX-A into adjacent non-treated areas.
As you can see, administration of BTX-A is not a simple thing, and is highly dependent on the expertise, experience and judgement of the physician who is taking care of you.
Units of the various neurotoxins are not the same. You should be treated by a physician that you trust who gives you results you like.
Is Botox Diluted So Injectors Can Charge More?
Whenever I'm told by a patient "Botox does not work on me..." I suspect this is what happened.
There are MANY ways an unsuspecting patient can be short-changed and over charged for Botox
- the Botox is outdated and no longer active or as active
- the Botox is NOT Botox (it came to the country from either Canada or other unknown sources (Federal crime) and you are being injected with an unknown
- while you are TOLD you are getting X number of active units, you may be getting less. (By over diluting the original 100Unit vial, an injector can discount her charges but make a lot more money - similar to serving dilute drinks in a bar)
- your injector is not as experienced as they say and your results will be mediocre or poor.
OR a combination of ALL of the above.
Read the link below and you will know everything you need to know about Botox treatment.
Peter A Aldea, MD
BOTOX units are the actual amount of product
It’s not a question of dilution. Units are the actual amount of product. The solution can be diluted to different amounts, but the number of units will be the same. That’s how you determine whether the amount of BOTOX given was correct.
Botulinum toxin is in units
i unit refers to the dose that would kill 50% of the mice injected with it. i vial of Botox contains 100 mouse units. In the two studies used for the FDA approval of Botox 20 units of Botox was used at 5 sites with a 2.5cc dilutiom. I presently use 24 uits and it last 6 months,With Dysport a total dose of 50 Units of DYSPORT™
is divided in five equal aliquots of 10 Units each, should administered to affected muscles to achieve clinical effect. In reality because of greater spread Dysport will work just as well when 3 sites are injected.
Botox and Dysport are diluted but not to charge more
All Botox and Dysport must be reconstituted by adding sterlie liquid with the powder. To compare different treatments you need to know how many units were used, not the number of ccs of fluid. The doctors may charge per cosmetic area treated or the number of units used. Dysport uses a different number of units than Botox so you can't compare them easily, especially since different doctors use different dilution formulas (as an example some use 2, others 2.5 and other 3 times the number of Dysport units to one unit of Botox). Most Botox and Dysport only last up to four, maybe very slightly more, than four months. Some patients have been able to retrain themselves not to frown when the botox wears off so they don't see the wrinkles until more months go by but the muscle when examined is able to move so we know the Botox wore off.
What is important is the number of units of botox injected, not the volume which can vary from physician to physician. It is very unlikely you had 800 units injected around the eyes and in the forehead. The success is truly dependent on the experience and technique of the individual physician.
Most Practioners Charge Per Unit of Botox
Most practioners whether they are surgeons or dermatologists charge for Botox on the basis of the number of units injected. I think you may have misunderstood the amount of Botox injected by Derma2 as the cost to him/her would far exceed what you where charged unless they were into patient welfare.