Understanding Botox® Reconstitution [With Chart]

When deciding how to reconstitute Botox®, many providers now prefer to use a larger volume of saline. In this article, we take a look at the reasons why this is so, address patient concerns, and provide a handy Botox® reconstitution chart to guide your own decision-making.

How to Reconstitute Botox®: Accuracy vs. Efficacy

Botox® has revolutionized the medical aesthetics industry in the last 20 years. A quick, relatively painless intervention, Botox® injections to the face provide a safe way to improve the appearance of worry, frown and laugh lines, and crow's feet.

Cosmetic use of botulinum involves far lower doses than other medical procedures where it is indicated. As a medical professional, you want to provide the patient with the smallest possible effective dose while at the same time ensuring accuracy to achieve safe, effective outcomes.

As a result, many practitioners have chosen to increase the amount of sterile saline used to reconstitute Botox® because the larger volume can make it simpler to calculate the number of units being delivered to each dose point.

Nevertheless, patients and practitioners have questioned whether this is both safe and the most effective way to deliver Botox® and other neurotoxin treatments to where they are needed. Let’s take a look at the facts.

Administering Botox®

Botox® and similar products are usually supplied by manufacturers in vials of 50 or 100 powdered dosage units. It must be reconstituted with saline for subcutaneous injection. Improvements are usually visible within a week.

Reconstituted Botox® is typically injected into areas of the face where fine muscles cause the skin to wrinkle and acquire lines over time. Most often this is the areas around the sides of the eyes (canthal lines) and between the brows (glabellar lines), although it has also been used to reduce wrinkles around the nose and chin.

According to Allergan, the recommended dosing per treatment for the most commonly affected areas is:

Calculating Dosage and Dilution

The standard recommended dose from Allergan for Botox® at each injection site is 4 units. This can be achieved using the following reconstitution ratios:

Improving Dosing Accuracy

Increasing dilution to an extent may make it simpler to administer Botox® and other products accurately. A commonly prescribed dose of 20 units is typically delivered through four small injections. A dilution for a 100 unit vial with 2.5ml saline means each site would be injected with 0.1ml reconstituted saline, rather than 0.04ml with a 1.0ml dilution.

The 0.1ml volume makes it simpler for the practitioner to read measurements and control each injection dose across the required area. It also means less of the active Botox® dose is lost to the small “dead space” in all hypodermic needle hubs, which becomes more significant in the very small volumes used in cosmetics.

Dosage readings can be further simplified by using syringes that hold smaller volumes. Many injectors prefer to use .3ml or .5ml syringes because the smaller volumes feature dosage markings that are further apart. This makes it easier to decipher to the naked eye, while also providing more control with the small plunger movements.

Maintaining Safety

Some patients and practitioners have raised concerns about whether using increased Botox® dilutions is safe. In fact, safety is increased because while the same overall Botox® dose is maintained, the larger volume is easier to control precisely in the syringe. This makes it easier to avoid overdosing at individual injection sites.

Maintaining Efficacy

Some practitioners have also expressed concern about botulinum spreading further in tissue with larger volume injections. While migration risk does increase when more fluid is injected, many practitioners feel that this is outweighed by the benefits of improved dosage control and placement when dilution is moderately increased to 2.5ml.

Addressing Discomfort

Botox® treatment is not painless, and patients may worry that increased fluid in injections will increase discomfort and raise the risk of ecchymosis (purple discoloration) or even bruising.

Pain, discoloration, and bruising are largely associated with needle design and injector technique. The introduction of improved ultra-fine “invisible” needles has helped reduce patient discomfort and minimize potential side effects.

Smart Dilutions, Smart Injections

Along with increased Botox® dilutions, better syringe and needle designs, including reduced needle dead space and clearer graduation markings, have helped improve dose accuracy and eliminate waste.

As a leading supplier of specialty hypodermic needles and syringes, Air-Tite Aesthetics plays a critical role in making treatment more effective, comfortable, and profitable.

Read how to select the correct needle when injecting Botox® by clicking the box below.