Not All Botox® Is Created Equal

San Diego plastic surgery -
La Jolla Cosmetic Surgery Centre patient

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 La Jolla Cosmetic Surgery Centre 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 physician 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 got 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.

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 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?”

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 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, 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 injection to best meet your concerns and they will tell you how many units of Botox you will need to attain your desired result.

Diagram A: Recommended units per area:

Table A: Recommendations for Reconstitution and Handling*

* 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.

Table B: Variables Influencing Treatment Plan*

*Data from the Supplement to Plastic and Reconstructive Surgery provided by the American Society of Plastic Surgeons.

Works Cited

Mayo Clinic Staff. "Botox: Is this wrinkle treatment for you?" Mayo Clinic.com 4 August 2006. 16 October 2006. http://www.mayoclinic.com/print/botox/SNOO40/METHOD=print

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

If you're considering Botox, you want to be as educated as possible. You should always do their own research. Friends, family, or co-workers may not be your best source for correct information. If you're well-informed, you can help to ensure the safety of your treatment and your satisfaction with your 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.

Here is some information and guideline for San Diego residents that we at La Jolla Cosmetic Surgery Centre believe is helpful as you research whether Botox is right for you.

What is Botox?

• It is the cosmetic form of botulinum toxin, a natural purified protein, is often referred to by its product name Botox.
• Botox is a simple, nonsurgical, physician administered treatment that temporarily reduces or eliminates frown lines, forehead creases, crow's feet near the eyes and thick bands in the neck.
• Studies have also shown that Botox can also be effective in relieving migraine headaches, excessive sweating in the underarm area and muscle spasms in the neck and eyes.

How does Botox work?

• Moderate to severe frown lines can appear over time due to facial muscle activity.
• Once Botox is injected, it works by blocking the transmission of the nerve impulses in the injected muscles.
• The injected product will then reduce the activity of those muscles that cause persistent lines to form.
• The treatment time is only about 10 minutes and without any recovery time.
• Results will become noticeable within a few days and can last up to 4 months.

Who is a candidate of Botox?

• You may be a candidate if you are interested in treating facial wrinkles in the forehead, between your eyes and "crow's feet" areas.
• If you are pregnant or nursing, you should not receive Botox. It is not known whether Botox can cause fetal harm when administered to pregnant women, or affect reproductive capabilities or be excreted in human milk.

Who should do your Botox treatment?

• Candidates for Botox should only go to an authorized healthcare professional.
• Professionals such as dermatologists, plastic surgeons, otolaryngologists (ear, nose and throat doctors or facial plastic surgeons), or any other physicians that specialize in cosmetic procedures are typically more experienced.
• While Botox is often administered by nurses or other physician's assistants, we recommend that you choose only a licensed physician do Botox injections.
• At La Jolla Cosmetic Surgery Centre only board certified physicians inject Botox. We think our patients should benefit from the greater knowledge and experience of physicians.

What are the side effects of Botox?

• The most common side effects after a Botox injection may be temporary droopy eyelid or nausea.
• There may also be some localized pain, infection, inflammation, tenderness, swelling, redness and/or bleeding/bruising at the injection sites.
• Do not rub or massage the treated areas. This could cause the Botox to migrate to another area of your face.
• We recommend you wait 24 hours after Botox injections to do aerobic exercise or have a massage so that any potential impact to the product migrating from injection sites is minimized.