Botox dilution - How can I find a physician who dilutes Botox 1 cc per 100 unit vial of Botox in Southern California?

How can I find a physician who dilutes Botox 1 cc per 100 unit vial of Botox in Southern California? I've had my masseter muscles injected a number of times by very experienced doctors; sadly, I've had my smile negatively affected a few of those times. I spoke w/ someone at Allergen & the doctors who successfully did my masseters. I was told 1 cc dilution per 100 units was best for masseters because less saline equals less likelihood of spreading. How can I find a doctor who uses this dilution?

Doctor Answers 8

Botox reconstitution

Thank you for your question Allisoncarmen. Botox is a purified protein used to address wrinkles associated with facial expression. It can be placed in the masseter muscle in the lower face to slim down the face and provide a heart shaped appearance. Reconstitution of Botox can be with various volumes of saline. The manufacturer recommends 2.5 cc for a 100 unit vial, giving 40 units/cc. Many doctors use this concentration for the masseter. However reconstitution in smaller volumes is thought to lead to decreased spread. In our office we reconstitute Botox per the manufacturer's guidelines but there is no reason why we cannot reconstitute it using 1 cc. Please consult with a doctor for specific recommendations. Good luck!

Encino Physician
5.0 out of 5 stars 1 review

Doctor who injects Botox in high concentration

Dear Allison:

I understand the rationale behind your question, and personally always inject Botox in this dilution, even though it costs me more in wasted Botox left in the inaccessible portions of the syringe. 

Injecting in multiple locations in high concentration, low on the jawline, and avoiding the deeper risorius muscle will prevent the side effect you describe.

Dr. Ava Shamban in Santa Monica and Beverly Hills will do this for you.

All the best,
Dr. Clark

Sheryl D. Clark, MD
New York Dermatologist
5.0 out of 5 stars 7 reviews

Botox and Masseter

I have been injecting this area for years without any issues at a 2 cc dilution.  I have done 1 cc dilution for areas on the face without any difference. I suggest you see an expert regardless of the dilution. Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 159 reviews

Botox Dilution To Masseters

Botox injection anywhere should be a customized treatment for each individual. There is no "cookie cutter" approach. I often dilute 100U in 1cc when injecting the masseters. The dilution amount I use varies based on the size of the muscle, size of the person's face, etc. There are several safeguards that can be taken to prevent injection or migration to the wrong muscles and alterations in smile. Finding an experienced injector minimizes these risks. Best wishes.

Michael A. Zadeh, MD, FACS
Sherman Oaks General Surgeon
5.0 out of 5 stars 9 reviews

Botox in the Masseter

1cc Dilution is a nicely concentrated dose for precision. I personally use this dosing when I do not want the Botox to spread to surrounding areas.  As for finding someone in your area that is using this dosing; I would ask the doctors who have successfully treated you in the past to treat you, or to recommend someone that they know in your area that can treat you.  You could also ask the doctor that you know to use that dilution the next time. 
I hope this helps!
Dr. Quenby Erickson

Botox for masseters

Look for an expert Botox injector, someone who does thousands of these injection. I use a dilution of 2.5 cc/100 unit vial and have not had a smile complication. The injector just needs to have experience and know anatomy. Check the Allergen website for a provider in your area. 

Dilution of Botox not related to spread

The dilution of Botox is not related to the spread. A clinical study has been done on this which shows different dilutions of the same dose do not have different spreads. This was done by monitoring the effect of Botox on the circumference of anhydrosis (lack of sweating) on the forehead with different dilutions of Botox using the same dosage in each spot (Botox causes muscle relaxation as well as a reduction in sweating). 

The most important factor with avoiding smile changes is to avoid the risorius muscle. This can be done by keeping the masseter injections low (near the jawline) and back (near the ear). 

Gavin Chan, MBBS
Melbourne Physician
5.0 out of 5 stars 2 reviews

Botox and Masseter Muscle

Botox in the masseter muscle is a high level injection and depends both on the amount of Botox placed and injection technique.  Please consult an expert.  Best, Dr. Green

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.