Watered Down Botox - I also get the worst sinus headaches for several weeks after my injections. What could be the problem?

However, that is not what we mean when talking about "watered down" BOTOX.  NO what we mean is you are told you are getting a certain about of BOTOX but in fact you are getting much less.  This is often done by putting in extra saline when reconstituting the BOTOX in the vial.  This means that when the BOTOX is drawn up the 1 ml syringe may only contain 12 units of BOTOX instead of say 25 or 50 units.  Of course if you are paying for 50 units and you are getting 12 units, you are being defrauded.

The headaches you are describing after a BOTOX treatment is suggestive that you are getting BOTOX when you are treated and this type of reaction is reported.  If there has been a noticeable change in the effect you normally get, this is a sign that something is up.  WIth so many doctors providing BOTOX, if you are unsure of your injector, do get a second opinion or simply find a new injector.

Botox has to be diluted. It comes in a powder and the doctor must add liquid to make a solution.  different doctors are comfortable with different dilutions.  The important aspect is for the doctor to inject the right number of units of Botox. The volume of liquid injected will depend on the number of units being injected. All you have to do is ask your doctor how many units they are injecting in the area and if you know the average number of units, you can compare.

Units can vary even more than I list as follows:

Crow's feet - 9 to 15 per side

Glabella (between eyebrows) - 15 - 35

Forehead: 8 - 24
 

There are different ways to reconstitue the Botox with regards to the volume used.  Some surgeons like a smaller volume per unit, so that it is less volume injected, while othere prefer more volume per unit.  However it is reconstitued, the units used should be the same regardless.  It is the physicians duty to inject the required amount of units per area, but whether that is 25u/ml or 20u/ml should be irrelevant as long as the number of units injected is the right amount.

"Watering down" a BOTOX® injection implies that your provider is using less medicine than you are paying for. Although there may be some unethical providers of BOTOX® treatments around, this would be most unusual amongst leaders in this field. Different Specialists that provide BOTOX® may choose to dilute the BOTOX® in a manner that facilitates their technique or the results they want. This refers to adding more saline to the vial of BOTOX® prior to the injection. However, the dose of BOTOX® or the number of units you receive should not be affected by this personalized approach. What should matter is that you feel confident in your provider and they have the credentials and experience to optimize your treatment. Although access to BOTOX® has become far to easy, this is not a treatment that should be performed in a cavalier or hasty manner.

Low grade headaches for 1-2 days after a forehead injection of BOTOX® occurs in about 10-20% of patients and is usually mild and easily managed with over the counter medications. This should not concern you and is likely related to the minor irritation caused by the injections. In fact, BOTOX® treatments have become a highly effective treatment for chronic and severe migraine and tension headache sufferers.

Dr. Mosher

Botox is a freeze dried powder that has to have some fluid added to it in order to be injectable through a needle.  How much we add depends largely upon our training, use and experience.  1cc is common, 4cc is common and even 8cc (for armpits) is sometimes used.  What matters is the dose in units.  1/2 cc of 100 Units/cc is the same dose as 2cc of 25 Units/cc.  Just ask what the dose is, in units, not cc's.  BTW,  cc's and ml's are the same thing.