One of my friends recently sent me an urgent Facebook message.  She was about to get Botox later that day, and wanted to know if it makes a difference on how “dilute” the Botox is, what the normal practice is, and whether it means anything.  I thought I’d share my answer, in case any of you have the same question.

She lives in the Midwest.  Otherwise, if she lived within about 500 miles of San Francisco, I know she would drive in to get her Botox from me.  But I digress…


How do doctors prepare Botox?

Botox arrives from the manufacturer, as a dry powder.  It is mixed with sterile saline solution in the doctor’s office.  The typical vial has 100 units of Botox.

The Botox Injector has discretion as to how much liquid sterile saline to add.  Typically, it is 2-3 cc, but this varies, depending on injector preference.

Does Botox dilution matter? 


In a thicker muscle, where you want more Botox units, it’s helpful to use a more concentrated solution. Thicker muscles tend to include the muscles between your eyebrows, the corrugator and procerus muscles.

However, in a thinner muscle, such as the crow’s feet area, you will use fewer Botox units.  A more dilute solution of Botox is helpful here, to make the smaller amount of Botox spread evenly over a larger area.  If you look at your crow’s feet, you will see that the area around your eyes physically takes up more space, compared to the thick muscles concentrated between your eyebrows.

How does my Botox injector account for different  Botox dilutions?

Your Botox injector will get the correct number of Botox units for your facial area, and then make it more “dilute” with additional sterile solution.

As an example, for crow’s feet, your injector may withdraw 10 units from the Botox vial, then withdraw some sterile saline solution into it.  You will still get 10 units of Botox, but in more “liquid,” for better coverage.

What are the consequences of Botox dilution?

If you get very dilute Botox, you will need more needle injections and shots.  This is not a big deal in thinner muscles-  in fact it’s preferable to ensure that you will be getting Botox widely dispersed like it should be.

The downside of very dilute Botox is, if you get it injected in a small area, you will end up with slightly puffy bumps in the area, requiring some time to calm down.  It’s no big deal in the long term; the puffiness is from the excess saline solution.

What can I do about Botox dilution and asking for it?

Well, this is the tricky part.  If you have the social skills of James Bond, and a good relationship with your injector, you might be able to navigate the conversation without sounding like a micromanaging d-bag.  But I’m not sure there’s a nice way to question the professional judgment of an injector before he even performs the procedure, without being offensive.

Each professional uses the dilution he/she is most comfortable with administering in a given situation, to get the desired result for the patient.

If you really want to be a part of the decision, you might start with a lengthy track record with the injector, all the charm you can muster, and perhaps a token of appreciation.  Personally, I like fancy chocolates.

A better approach might be to inquire generally about the injector’s procedure, start to finish.  You can always ask about how your injector addresses areas that require less Botox versus more Botox, or thinner muscles versus thicker muscles.  If you’re not hearing the answer that you want, then you should consider finding another injector.

Questions?  Comments?  Want to book a consultation for Botox?  Please contact me at or 415 362 1846.  I have offices in San Francisco and Santa Clara to accommodate you.

PS-  Here’s another interesting article about the down side to getting “stale” Botox.


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