We all hear so much about BOTOX®, officially known as BOTOX® Cosmetic. There are so many deals and specials out there that our heads spin. But not all BOTOX® is created equal. So as the consumer, you need to beware. Here is some information that we at La Jolla Cosmetic Surgery Centre & Medical Spa believe you can use to help guide yourself through the media maze.
Not All BOTOX® Is Created Equal!
Unfortunately, the BOTOX® you get at one practice may not be exactly what you get at another. Clostridium botulinum toxin type A is supplied in a manufacturers’ vial containing 100 units of the vacuum-dried neurotoxin complex. In order to be able to inject these active units of BOTOX®, a physician must add saline to get it in “liquid form.” This process enables the BOTOX® to be extracted from the vial into the syringe.
Why is Botox diluted?
There are 100 units of BOTOX® in every vial. As you can see in Table A (see below), the more saline (in mL) added to the BOTOX® vial, the less active units present in each 1/10 mL extracted into the syringe. Some may refer to this is as the dilution process, but it is actually called “reconstitution.” So now, while each practice gets the same product from the manufacturer, when they reconstitute it to make it possible to inject, they can add saline at the recommended standard or they can add more saline than recommended.
Table A: Recommendations for Reconstitution and Handling**
|Diluent (saline) added to BOTOX vial
(0.9% sodium chloride injection)
Units per 0.1 (1/10) mL
|1.0 mL||10.0 U|
|2.0 mL||5.0 U|
|2.5 mL||4.0 U*|
|4.0 mL||2.5 U|
|8.0 mL||1.25 U|
* Approved dose is 4 units per 0.1 mL at each of the 5 injection sites for a total dose of 20 units in 0.5 mL.
** Data from the Supplement to Plastic and Reconstructive Surgery, provided by the American Society of Plastic Surgeons.
Beware of Bargain Botox
With this in mind, you should be cautious when practices offer BOTOX® at bargain prices. Everyone pays the same price to get the product from the vendor (Allergan). So how can prices vary so much? That’s where the “reconstitution” question becomes very important. Below, Diagram A illustrates the recommended starting doses of the frequently injected areas.
Diagram A: Recommended units per area:
You may think you are getting a “good dose” of BOTOX® because the physician is injecting a large amount, but don’t confuse the units of saline with the units of actual BOTOX®. Physicians who add more saline than suggested by the manufacturer (or such organizations as the American Society of Plastic Surgery) are giving you a less effective injection of BOTOX®. So no matter where you go for BOTOX®, always ask this question: “What is your reconstitution ratio?”
Botox Pricing By The Area
Also, many facilities quote a price based on a particular area. Now, besides your “reconstitution question,” you need to ask, “How many units do you inject in that area?” And that begs the next question—what is their definition of an “area.” For instance, a practice may advertise $99 per area, but may be actually breaking up the crow’s feet area into two areas when in most practices, it is considered one area.
So buyers beware! At La Jolla Cosmetic Surgery Centre & Medical Spa, we charge by the unit for BOTOX®, so you only pay for the exact number of units you receive. Also, we follow the American Society of Plastic Surgery (ASPS) guidelines on “reconstitution,” so you are assured of the efficacy of the product. Our doctors will discuss with you which areas on your face should receive injections to best meet your concerns, and they will tell you how many units of BOTOX® you will need to attain your desired result.
Table B: Variables Influencing Treatment Plan*
|Aesthetic goals||Development of overall treatment plan|
|Region(s) to be injected||Dose, injection sites, retreatment interval|
|Gender||Usually higher doses for men; aesthetic goals|
|Muscle Mass||Higher doses for larger muscles|
|Ethnicity||Aesthetic ideals, skin thickness, functional anatomy|
|Skin Thickness||Higher doses may be needed for thicker skin|
* Data from the Supplement to “Plastic and Reconstructive Surgery” provided by the American Society of Plastic Surgeons.
If you’re considering BOTOX®, you want to be as educated as possible. You should always do your own research. If you’re well-informed, you can help to ensure the safety of your treatment and your satisfaction with the results. You need to be aware of exactly what is being used in your treatment, whether the person administering your treatment is qualified, and last but not least, if you are even a candidate for BOTOX®.
- Goldwyn, M.D, Robert M. Consensus Recommendations on the Use of Botulinum Toxin Type A in Facial Aesthetics. Supplement to Plastic and Reconstructive Surgery® Volume 114 (2004): p.1S-19S