JMISKO Surgical Design

Not all botulinum toxins ("Botox") are created equal...

Botox,officially known as BOTOX® Cosmetic...there are so many advertisements and specials out there that our heads spin. As the consumer, you need to educate yourself. Here is some information that we at JMISKO surgical design md believe you can use to help guide yourself through the ads and specials flooding the market.

#1 Many doctors and self-proclaimed Botox “experts” offer discounted Botox because the product they provide is manufactured in other countries without supervision, without restrictions and without FDA approval. Allergan’s BOTOX® Cosmetic is the only FDA-approved product for distribution in the United States. Check to see if your office does participates in Allergan's Brilliant Distinctions Program, question where the Botox is coming from if not!

#2 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 inject Botox, the practitioner must add saline to the vail in order to achieve a liquid/injectible form.

As you can see in Table A (see below), the more saline (in mL) that is added to the Botox vial, the less active units that will be present in each 1/10 mL extracted into the syringe. Some refer to this is as the dilution process, we use the more correct terminology “reconstitution”. So now while each practice received the same product from the manufacturer (that is if they are purchasing FDA approved products), when they reconstitute the Botox 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 pandemic within the United States.

Please 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 $250-400 per area treated. We constantly hear from new patients that Botox treatments from other centers did not seem to work as well or they believe the product does not work. Then after receiving Botox from JMISKO surgical design md they are amazed at the difference proper dilution and technique make.

So...botox buyers beware! If prices seem too good to be true there is a reason for that and like Paul Harvey always says, now you know the rest of the story...

Diagram A: Recommended units per area:

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Table B: Recommendations for Reconsitution and Handling*

Diluent (saline) added to Botox vial	Resulting dose/ Units per 0.1 (1/10th) 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