We occasionally read or hear about watered down Botox or Botox that has been overly diluted. Sometimes these articles or hearsay are based on a few misconceptions or misunderstandings that do not clearly define what "watered down" Botox means. At Peach, we hope to dispel the myths and shed some light on the murky subject of dilutions, solutions and mixtures of the product. In the following article, we will explain what it means when Botox is "watered down."

To help define exactly what we are referring to and where the watered down concept emerges from, let's review what the product is, how it’s sold and how the service is performed to get a better understanding.

FACT: Botox comes to the clinic from the manufacturer in a frozen powder, not a liquid.

Yes. This comes as a surprise to many patients. Medical professionals have to add saline to the powder in order to activate it and be able to inject it into a patient. We cannot inject a dry powder into the muscle.

MYTH: Mixing it with saline "waters down" the Botox.

Every medical professional offering Botox MUST add saline to the powdered Botox before administering it to a patient. Using this solution of these two items (one liquid and one powder) is the way medical professionals inject Botox into the muscle. When a medication is injected, is it first prepared in a solution form to administer intramuscularly (IM). Every provider will make a solution of the medication Botox with the saline in order to get the prescribed drug dilution required for the injectable medication. This is necessary practice. Now, there are different opinions on what amount of saline should be used. Botox comes in 50 unit and 100 unit vials. Some the of the common quantities of solvent used are 1 ml, 2 ml, 2.5 ml, 3 ml and 4 ml.

The amount of saline mixed with the Botox powder will determine the conversion rate. At Peach, we use a 1.0 ml for each 100 unit vial of Botox. Regardless of how much saline a medical professional uses, the conversion rate must be correct in order to determine how much Botox to inject and how much it costs. Meaning, it needs to be the same formula across the board and should be reflected in the same formula for calculating the cost to the patient.

What is a conversion rate?

If a provider introduces 1 ml of saline to the powdered Botox, then how do they know what 1 unit of Botox is? What if they use 2 ml of saline to one vial of botox? 3 ml? Well the following list shows what constitutes 1 unit of Botox when using 1 ml, 2 ml, and 3 ml.

  • If you use 1 ml saline per 100 units of powdered Botox, then your Botox unit is equal to 0.01 ml of the liquid.
  • If you use 2 ml saline per 100 units of powdered Botox, then your Botox unit is equal to 0.02 ml of the liquid.
  • If you use 3 ml saline per 100 units of powdered Botox, then your Botox unit is equal to 0.03 ml of the liquid.

So what is watered down Botox?

Consider the following example: A medical professional mixes the Botox powder with 2 ml of saline. The medical professional considers 0.01 ml of the Botox mix as 1 unit of Botox. Therefore, they charge the patient for every 0.01 ml of the liquid that gets injected into the patient.

When the medical professional injects 0.01 ml of liquid into the patient, is the patient getting 1 unit of Botox?

The answer is no. The patient is only receiving 1/2 a unit of Botox but being charged for the full unit. If the patient pays for 30 units, they would have only received 15 units of Botox.

This is an example of watering down the Botox.

If this chemistry lesson is a little too much to take in, we offer a fun analogy for you here:

A bar sells 100 year old scotch. A shot of this famous Scotch costs an arm and a leg but it’s delicious! Patrons come back every time they try this Scotch and become regulars. Now the barkeep knows that when the scotch runs out, he will not only have unhappy customers but he will lose money. Therefore, he does something sneaky and unethical; he puts water in the 100 year old scotch. Most people buying the 100 year old shot of scotch for the first time can’t tell its been watered down, and shell out the same amount of money for the less potent shot the previous patrons received. So did the newer customers pay more for less? Yes.

What is wrong with watering down the Botox?

First, you are robbing clients of what they actually paid for. Second, the patients will not get the results that they expect even if they paid the correct amount.

Our recommendation is to ask questions and don't be shy to ask your provider to share his/her dilution rate with you. If you would like to learn more about diluation rates, feel free to email us. We are always excited to educate patients about the services they receive.

Photo by klenova/iStock / Getty Images
AuthorOscar Bueno