Not All Botox is Created Equal

We all hear so much about Botox, officially known as BOTOX® Cosmetic. There are so many advertisements and specials out there that our heads spin. But as the headline says, not all Botox is created equal. So as the consumer, you need to beware. Here is some information that we at Forever Young MedSpa believe you can use to help guide yourself through the media maze.

Not all Botox is Created Equal!

Unfortunately, Botox 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 vacuum-dried neurotoxin complex.  In order to be able to inject these active units of Botox, a practitioner must add saline to get it in “liquid form.” This process enables the Botox to be extracted from the vial into the syringe.

There are 100 units of Botox in every vial. As you can see in Table A (see below), the more saline (in mL) that is added to the Botox vile, the less active units that will be 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 received 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.   Unfortunately, over diluted BOTOX is an epidemic in South Florida.

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.   

You may think you are getting a “good dose” of Botox because the practitioner is injecting a large amount, but don’t confuse the units of saline with the units of actual Botox.  In other words you may get a large syringe and only have received half or less of the amount of Botox units you need.   Most Cosmetic Centers that inject properly charge from $13.00 to $17.00 per unit of Botox or $250-300 per area treated.   We constantly hear from new patients that Botox treatments from other centers did not seem to work well and they believe the product does not work.  Then after receiving Botox at Forever Young MedSpa they are amazed at the difference proper dilution and technique make.

So buyers beware!   If prices seem to good to be true there is a reason for that and now you know the rest of the story…

Diagram A: Recommended units per area:

Table B: Recommendations for Reconstitution and Handling*

So if a center dilutes their Botox with 8.0mL of saline you would only receive 1.25 units of Botox per 0.1 mL injected vs. the proper dose of 4.0 units per 0.1 mL injected.   In other words you're receiving mostly saline.   Now you know why some centers price their Botox so low and why all Botox injections are not created equal...