Is it normal procedure to mix Botox with .9% alcohol water?

Question

I was injected with BOTOX that was mixed with sterile water containing .9% alcohol. It stung very bad, and now I'm left with red marks all over my temples thgat look like burns or bug bites. Is this normal procedure to mix BOTOX with alcohol?

Jonathan Kulbersh, MD · Answer

It is standard practice for Botox to be mixed with a 0.9% saline solution. This solution quite often contains benzyl alcohol as a preservative. It is up to your doctor whether they want to use a saline solution with no preservative or with benzyl alcohol. There are no reported negative side effects when using a saline solution with a preservative, and in fact there can be benefits such as a slight anesthetic effect and a longer shelf life. It is normal for Botox to sting a little when being injected, and those “bug bites” are normal too. They should disappear quickly.

Nelson Castillo, MD · Answer

Thank you for your question and I am sorry to hear of your botox injection side-effects.  Botox is mixed with 0.9% normal saline (salt-water) which can have an alcohol as a preservative.  Be sure you are being injected by a board certified plastic surgeon for the safest results.

Cameron Chesnut, MD, FAAD, FACMS · Answer

Botox is meant to be reconstituted with 0.9% saline, NaCl. Saline comes preservative free or as the standard formulation with benzyl alcohol as a preservative, which is likely what you saw. You do have to be carful about who you are choosing to inject you and making sure they are using real Botox, but saline is cheapand even someone trying to cut corners wouldn't substitute here. Like the airlines say, if you see something, say something. Any reputable physician doing the right thing will be happy to educate you about the process from reconstitution to injection.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question missmoo007. I am sorry to hear about your situation. Botox is a purified protein used to address wrinkles associated with facial expression. The manufacturer recommends reconstituting a 100 unit vial of Botox with normal saline. However many doctors use preserved saline, as we do in our office. Preserved saline is normal saline with a small amount of benzyl alcohol. This preserves the shelf life of the Botox, minimizes the risk of infection, and provides for a more comfortable experience for the patient. Please follow up with your doctor for specific recommendations. Good luck!

Benjamin J. Cousins, MD · Answer

Thank you for your question. I am not familiar with alcohol water. Botox is
mixed/re-constituted with 0.9% Normal saline (salt water). On the bottle of
Normal saline it states "each ml contains sodium chloride, 9mg. May
contain HCL or NaOH of PH adjustment. Sterile, nonpyogenic". It best to
use an experienced injector that is a Board Certified Plastic Surgeon or
Dermatologist. Best of luck.
Benjamin J. Cousins MD
Board Certified Plastic Surgeon

Jo Herzog, MD · Answer

I mix my Botox with normal saline 0.9% and it has preservative benzyl alcohol in it. This is a common procedure and I would consider it the standard of care.

Tal T. Roudner, MD, FACS · Answer

Botox should be reconstituted with sterile normal saline, it should not contain alcohol in the mix. You could be confusing it with 0.9% NSS. Different solutions have different effects when injected and so may sting more then others.Make sure you are been treated by an experienced board certified doctor.Good luck!

Daniel Calva Cerqueira, MD FACS · Answer

It is likely that your doctor reconstituted Botox with preserved saline. The standards for Botox is to be reconstituted with PRESERVATIVE-FREE 0.9% Sodium Chloride. This is also the only way that the FDA approved the reconstitution of Botox.  Some or most practices also use 0.9% Sodium Chloride with a preservative, which is benzyl alcohol.  This is not the standards set by Botox Cosmetic, not is it approved by the FDA.  However, many doctors use preserved saline, and over the years, it is clear that the results are the same.  There are also many studies published on this topic, in reliable journals, and all found the practice to be safe.There are a few advantages to using preserved saline to reconstitute Botox.  1) It increases the shelf life of the product once reconstituted2) Has the capacity to kill pathogens3) Provides a mild anesthetic effect (which has been demonstrated on clinical studies)Therefore, I would not be worried.  Hope this helps.

Laxmeesh Mike Nayak, MD · Answer

I suspect there is a miscommunication here. In the vast majority of practices, Botox is reconstituted with 0.9% saline. That saline is preserved, very commonly, with benzyl alcohol.If that is what you had injected, rest assured that it is the standard of care.

Steven F. Weiner, MD · Answer

The industry standard is mixing Botox with preserved saline. The saline is 0.9%. The preservative is Benzyl Alcohol. The preservative makes the injection more comfortable. I don't think it was mixed with that high a strength of alcohol. I would discuss with your doctor. There is a 0.5% allergy risk to the Benzyl alcohol and to test that, a small injection of the saline without Botox can be placed in your forearm. Reactions are immediate.

Is it normal procedure to mix Botox with .9% alcohol water?

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