Are "units" of Botox/Dysport marked on the syringe? Is it possible that they could inject more than what they thought they had?

Question

Injector says she injected 1.5 units of dysport on each side of my upper lip, now food/liquid is falling out of my mouth, I have very little chewing motion. cannot use my upper lip to slide food off a spoon, can't use a straw to sip. Could 1.5 units cause this or is it likely she injected a more? I asked for filler, she said it's not the norm to put filler there. When I asked about side effects, I was told "some people may have a problem pronouncing certain letters afterwards, but that's all."

Martin Jugenburg, MD · Answer

Thank you for your question. Botox is drawn up by the injector. Treatments in the upper lip can initially cause disruptions with eating and drinking. Allow 2 weeks for the Botox to settle. If you have any further questions please contact your injector to discuss. Best,

James Bonaparte, MD, MSc, FRCSC · Answer

Hi there, I'm really sorry to hear about your trouble. I will answer your first question before getting to some recommendations. First off, Units is a very specific unit we use to measure these products. A unit of Botox is different than a Unit of Dysport, this is a just a guide but 1 Unit of Botox is about the same as 4 Units of Dysport. So, 1.5 units of Dysport would be VERY low. However, none of these medications are approved in Canada for injection in the upper lip and if it was done, its considered "off label." In the past, I tried injecting Botox into the upper lip for fine lines. From my perspective, it wasn't very effective. Even worse is that it was not uncommon to get complications, similar to what you mention. Dysport/Botox/Xeomin all work by preventing muscles from working. So, if it ends up causing strong weakness in your upper lip you will have trouble pronouncing words and in some cases, unable to keep liquid in your mouth, which is obviously a big deal. Now, confusing all this, is the that amount of liquid injected does not indicate how many "units" were injected. For example, you can have 5 Units mixed in 1ml of water or 10 ml of water. In both cases its 5 Units, but one there was more injected (cause there was more water!) Make sense? So, the amount injected won't tell you much unless you know the concentration. Often, Filler is injected into the upper lip to help smooth the lines. I'm not sure where you had this performed by my advice would be to see the individual who did the injection and discuss it with them. Remember, stay positive, the good thing about these products is that they are temporary so it will go away. Given the small dose, it will likely resolve quickly, but there is no guarantee. I hope things work out for you and if you have any questions feel free to message me. Dr James P. Bonaparte, MD, MSc, FRCSCOtolaryngology - Head and Neck Surgerypracticing in Facial Plastic and Reconstructive SurgeryOttawa, Ontario, Canada

Kimberly Finder, MD · Answer

Botox and Dysport both reduce muscle motion. They're both measured by the unit, but one unit of Botox activity is about equal to 3 or 4 units of Dysport activity. They arrive to the doctor as a powder and we add saline to the bottle to make a liquid, so each doctor needs to be aware of the concentration to know how much to draw into their syringe of choice. Your question mentions an injector, which makes me think you were injected by someone other than a physician. Botox or Dysport can be used off-label for reducing upper lip lines quite effectively, but I consider this an advanced use of Botox/Dysport and it should only be done by someone very familiar with facial anatomy and muscle function. 1.5 units of  Dysport would be an exceedingly small dose, very unlikely to give the profound effect you describe. Perhaps Botox was used by accident (its easy to get confused if syringes are pre-dawn since both are a clear liquid). Or, perhaps unfamiliarity with the anatomy meant an unintended effect, as even small deviations in placement can affect the wrong muscles around the mouth. Fortunately, Botox/Dysport will wear off. Be sure to seek the most experienced physician for your injections, one who has done thousands (or tens or thousands of injections!).

Chad Robbins, MD · Answer

Sorry to hear this, it sounds like she obviously gave you too much although 1.5 units doesn't sound like much.  She may have used less diluent to reconstitute the vial which would make it more concentrated.  I use filler all the time in lips and lip borders for fine lines .  She may not have been trained with fillers or using them in lips and didn't know how to.

Steven Wallach, MD · Answer

Both can achieve the same results but their unit dosage is different.  Dysport is usually 3X the units of Botox.    The syringes are not marked for units, but the injector should know the approximate dilution so that they can inject appropriately. 1.5 units sounds more like botox for a low dose injection IMO.

Thomas M. DeWire Sr., MD (retired) · Answer

Koremins,Botox and Dysport are delivered as a lyophilized (freeze-dried) powder that is kept frozen until use. The units of biological activity are not the same between Botox and Dysport, and the actual concentration of the material to be injected is determined by how much saline is used to reconstitute the product and how many units of biological activity are in the vial.  Thus the markings on the syringe do not have much to do with the dosing, as it is the dilution factor that determines that, along with understanding the difference in the dosing of Botox versus Dysport.  I do not usually use Botox in the lips, as no matter how precise you inject, there is always an element of lip weakness and potential asymmetry that is introduced. Fillers are often used in the lips, to highlight the margin of the lip and to fill vertical lines, but not every contour or motion issue can be corrected.  The Botox will eventually wear off over coming months, but this may give you an idea if you wish to go back to that particular source. Outcome of Botox treatments generally is related to the experience and skills of the practitioner doing the injection, and requires an intimate understanding of the mechanism and dynamics of facial motion.  Offering procedures that cause problems with diction and enunciation are likely ones that should be avoided. I hope that this helps.

Robert Savage, MD (retired) · Answer

Usually the units are not marked on syringes when these products are injected.Also the units used for the same effect is different dysport versus botox.The number of units per ml or cc also varies depending what dilution of saline is used to reconstitute the powder.

Are "units" of Botox/Dysport marked on the syringe? Is it possible that they could inject more than what they thought they had?

Answers (7)

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