Obtaining 1:1 Ratio for Botox?

Question

How exactly do you obtain a 1:1 ratio for Botox? Is that meaning 10 ml of saline to dilute the 100u vial or 1ml of saline? I am so confused.

Otto Joseph Placik, MD · Answer

It is my guess that you are referring to 1 unit per .01cc. This is accomplished by adding 1.0 cc of saline to the vial of botox containing 100 units.

Eric M. Joseph, MD · Answer

Botox comes as a white powder at the bottom of the vial, and this contains 100 units of Botulinum toxin, Type A. I typically reconstitute the vial with 4 cc of saline, so a 1cc syringe contains 25 units.
You should always ask your doctor how many units you're getting, since that will affect your outcome.
Where did you hear the phrase: "1:1 ratio with Botox"?
I hope this helps.

Richard Baxter, MD · Answer

The reason for your confusion is that you are asking the wrong question. Regardless of how much saline is added, it is the number of units not the volume or dilution that matters most. Some practitioners may intentionally use confusing terms to disguise the amount they are using. Keep in mind also that units are a biological activity assay, not a weight measure.

Benjamin Barankin, MD, FRCPC · Answer

Every physician uses a different amount of saline to reconstitute/prepare their Botox. I use a 1:1 ratio (although physicians wouldn't really use this terminology), so I put in 1cc of normal saline into the 100unit vial of Botox.

Steven Wallach, MD · Answer

I am not sure what you are asking.  But, more importantly it is the amount of units of Botox that are injected that makes a difference.

Francisco Canales, MD · Answer

I am not even sure what a 1:1 ratio means in relation to Botox. You should find out the number of units being injected and not worry about the exact dilution. Whether Botox is diluted in 2.5 ml or 4 ml of saline is irrelevant if you are getting 25 units of either dilution. Some patients feel "they are getting more" because "my doctor used a whole syringe." Again, a whole syringe of very dilute Botox may be the same as half a syringe of more concentrated Botox. I would recommend strictly discussing Units of Botox and price per unit.

Arnold R. Oppenheim, MD (retired) · Answer

Dilutions can range signficantly. The Allergan recommendation, in the package insert, calls for a 2.5 cc dilution. However, this does not mean we physicians follow this. Just as most of us do not follow the recommendation for unpreserved saline ( this has little benefit from what I can figure out; it merely means the BOTOX does not last as long and hurts a little bit more since the preservative, benzyl alcohol, has some anesthetic qualities. I did have a patient who broke out in a strange, non-urticarial (hive) rash after injections...probably allergic to the benzyl alcohol, so perhaps their recommendation might be attributed to this problem.
    Anyway, frequently I employ  a 1 cc dilution (maybe that is why the term 1:1 ratio is bandied about). Dr. Katz usually uses a 4 cc dilution. If we each  inject 5 units,  my BOTOX might be more "potent", but Dr. Katz is injecting five times more volume.  So, it all depends on units. Although I have never been asked for this, it might be a good idea to request a copy of the sheet we employ in writing down the number of units at each site, especially if you are moving or switching physicians. 
   Incidentally, we discussed this issue this week on our show on www.blogtalkradio.com.

Anifat Balogun, MD - Account Suspended · Answer

Dear Aging Gracefully TN,
I am not sure where that term comes from. Physicians tend to use a dilution ratio that works best for the results they are working to facilitate in their patients. The most common dilution of saline added to a vial of Botox is 2.5ml or 4ml.
What you really should focus on, is the number of units you need to acheive the results you are looking for, and what the cost per unit is.
The "1:1 ratio of Botox" is not relevant.
Good Luck.

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