Do Some Providers Water Down Botox? I Recently Received 60 Units to Remove the 11's and Can Still See Them.

Question

Melissa Chiang, MD, FAAD · Answer

Two possibilities:

	1) The botox worked to paralyze the muscle, but you are seeing the creases in your skin.  Lines that are present when the face is at rest will not go away with botox.  Botox paralyzes muscle, but it does not fill erase the creases in the skin that have resulted from years of frowning.  The paralysis will keep the creases from deepening.  Over time and serial botox injections, lines that are present at rest will often soften quite a bit.  For any remainder, a small amount of filler is an option.

	2) The botox didn't work.  This would be quite unusual.  Sixty units should be enough to see a result, even in someone who has a very well-developed musculature.  

	You should return to your provider to ask his or her opinion of what happened.

Ron Shelton, MD · Answer

All providers must "water down" the botox as it arrives as a powder and must be mixed with sterile saline. The amount of dilution correlates with the amount of liquid placed in the bottle. As the dilution (number of units of Botox per ml. of solution) varies from office to office, it is important that physicians discuss Botox treatment as number of units injected. In this way, it doesn't matter what dilution was used. If you had 60 units from one doctor who initially mixed one cc. of water in the bottle, vs. 60 units from another doctor who used 2 or 2.5ccs of water, the results should be the same as the number of units were the same.

Kenneth D. Steinsapir, MD · Answer

There are certain, lets say red flags out there.

	Areas vs syringes.  If the office will not tell you how many units you are getting.  This is done to keep you ignorant  about the actual dose.  However, knowing the alleged dose allows you to compare office when needed.  These products are measured in units.  BOTOX and Xeomin units are pretty comparable.  On the other hand Dysport requires about 3 times the number of units for a clinically equivalent treatment.

	The advertised price per unit is less than the actual cost of the agent.  A vial of BOTOX cost the doctor about $500 give or take in the United States.  The vial contains 100 units.  So if you are being offered a unit for $5, something is up because no one gives this stuff away for their cost.  It is much more likely that the unit you are getting contains something less than a unit of agent.

	In the United States, the is no independent practice of estheticians or register nurses, or medical assistants.  Physician assistants and nurse practitioners are different.  I personally believe that these treatments are best administered by the physician.  So check with your State.  If the situation is not legal, they may be cutting other corners including how much product you are getting.

Matthew Schulman, MD · Answer

60 units for 11's is completely inappropriate dose. There are 2 possibilities - either your are mistaken on the dosage or the specific toxin used (perhaps it was Dysport) or your doctor has no idea of what he/she is doing and should not be allowed to administer Botox. If your story is correct - that it was 60 units for jsut the 11's (corrugators) then you certainly did not have this done by a plastic surgeon or dermatologist and your "injector" should be reported to the state medical board immediately.

Mennen T. Gallas, MD · Answer

Botox must be diluted in order to get it to an injectable form. The manufacturer has specifications as to how this should be done. It is possible that some providers may not follow these guidelines. Sixty units of Botox seems excessive for the glabella area. However, if your wrinkles are so deep that they are present regardless of muscle activity, it may be that you need a combination of Botox and fillers to achieve the result you desire.

Joseph Serota, MD, FACS · Answer

Sixty units of Botox to treat the glabella region (11's) sounds excessive if the product was dilluted properly. A more standard dose would be 20 units. It may be that the provider injected Dysport, which requires approximately 2.5 - 3 times the dose of Botox.

	It is also important to remember that you will not see the results of your Botox injection immediately. Botox typically begins to work 5-7 days following injection, with results being even better at two weeks.

	Some clients require dual treatment to include Botox and a filler (depending on how deep the 11's were to begin with). Botox gets to the root of the problem, which is the muscle activity causing the creases to form in the first place. Some individuals will still have a crease even after the Botox has taken effect, this can be improved by following up with a filler.

Steven Wallach, MD · Answer

Doctors do dilute Botox differently. I tend to concentrate it more so that I do not use too much extra fluid which may cause the solution to migrate a bit. But I will say that 60 units sounds too much for the one area.

Robert L. Kraft, MD, FACS · Answer

All Botox is reconstituted by the injector.  60 units is an absurd dose for the 11s.  I agree with other posters on the forum that you could have been treated with Dysport or that the dose was diluted (and I'll bet that, if the latter was the case, you were quoted a ridiculously low rate per unit).  You should see a board certified plastic surgeon or dermatologist on consultation and obtain your medical records to insure that you are accurately reporting the dosage and the substance with which you were injected.

Christina Steil, MD · Answer

Yes, some providers do water down their Botox with excess saline so that they can water down their prices.   For the 11 wrinkles,  weak muscle can respond to 15 units, and a strong muscles may need 35 units.  The typical dose is 20-25 units.

	Maybe you were treated with  Dysport.  The dosing with Dysport is usually 2-2.5x more than Botox.  So the average  Dysport dose for the 11's would be 50 units.

Jeffrey Schiller, MD · Answer

Botox comes dry, and we ALL dilute it with saline. Some use 1 cc, some 2, and some use 4 cc. What matters is not the dilution but how many units are put into specific muscles. You can get an adequate dosage using any dilution but the volume injected is adjusted to compensate for the strength of the solution injected. A good injector knows how many units to inject. Some muscles are bigger and stronger and need more units of Botox. If you could still frown then you need more units, although 60 units to the frown lines (glabella) is enough for almost everyone. Some of those "11's" are permanently etched into the skin after many years of wrinkling, and will still be visible even the Botox was strong enough and you cannot frown.

Do Some Providers Water Down Botox? I Recently Received 60 Units to Remove the 11's and Can Still See Them.

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Answers (13)

More Botox Questions

Botox in the Upper Lip Wasn't Effective All over and Didn't Last Long. Should I Have More Injections and Have Them Once a Month?

After Botox for Migraine, Having Difficulty Swallowing, Chewing and Raising my Head from a Bent Position, Why is this Happening?

Is It Safe to Wear a Helmet and Exercise Heavily After Botox?

Is it Okay to Get Botox to Frown Lines Only and Not Forehead as Well?

Can a Bump Emerge a Few Hours After a Botox Injection in the Crows Feet Area?

Where Could I Find a List of Advance Trained Botox Injectors?

WE SEND PRETTY EMAILS

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