Dr. Cynthia Elliott recently asked:


Every day we get questions from patients asking about the way Botox Cosmetic is prepared and priced, and it is confusing until you understand the difference between dilution and units.

Botox Cosmetic is a vacuum-dried protein powder so it needs to be mixed with a liquid in order for it to be injected. The total “dose” of Botox in each vial is always 100 units but doctors mix different amounts of saline solution (water that has the same concentrations of sodium and chloride as the human body) with each vial depending on the intended use.

In some cases its beneficial to have more units in less liquid or a more concentrated solution. Men, for instance, need almost double the dose of Botox that a woman would need for each area treated, and using a more concentrated dose prevents the formation of ping pong ball-size lumps that would be seen with a larger amount of liquid. On the other hand, a lower concentration is useful when it’s advantageous to have the Botox effects spread out more, such as in the underarm area when used to prevent sweating, or when only a minute amount is needed with each injection, such as around the lips.

The total number of units injected during a treatment determines the degree and duration of effect more than the number of cc (the measurement of liquid). For example, whether a more concentrated or dilute solution of Botox is used, it takes an average of about 20 units to relax a woman’s frown muscles adequately for a full 3-4 months.

Think of it as taking either one 800 mg ibuprofen tablet vs. four 200 mg ibuprofen tablets. One seems like more medicine but the total dose and the final effect is the same with either choice.

There’s a lot of variation in how many units of Botox each person needs depending on the size and distribution of their muscles. In general, most women will need about 60 to 70 units to relax all three main areas (their foreheads, frown lines, and crow’s feet). Men usually need almost double that and I have male patients who get over 150 units with each treatment. Obviously people who are just starting to have moving lines need much less.

So how do you know what you’re paying for when doctors price Botox treatments differently? Doctors sometimes set their Botox prices by the area (frown lines or forehead, for example) instead of by the unit, based on the average number of units they usually use in that area. If as a patient, you have more than the average amount of muscle movement and need more than the average number of units, the provider will either lose money by giving you the number of units you need which is more than you’re paying for or he/she will use less than you need and your results won’t be good.

On the other hand if you have less movement than most people, you’ll be given less units than average with pricing by the area but you’ll have paid for the average number. There’s nothing wrong with paying by the area but you should find out how many units are included in that price.

Another consideration in charging by the unit instead of the area is that there are so many new ways that Botox can be used that only require a few units, and it’s becoming a rarity for me to just treat a single area. I can lift brows, the corners of the mouth, smooth out a dimply chin, decrease smoker’s lines, stop those crinkly bunny lines on the nose or decrease a gummy smile with just a unit or two of Botox in the right places.

An unscrupulous provider may use fewer units than you need with either area pricing or unit pricing and it’s impossible for the patient to know since there may be the same number of injections. The difference shows up later when the relaxation is less than expected or the effects wear off within weeks. In the long run, your Botox treatments become more expensive if you have to have them repeated every 2 months or you may mistakenly believe that you’re just one of those people that are resistant to Botox. Almost no one is resistant to Botox if they get the right amount.

Beware of anyone offering Botox regularly for less than $10 a unit and make sure that he or she is listed on the Botox Cosmetic Physician’s Network website. Many Botox providers offering highly discounted Botox import their Botox at a discount from Canada but the product they’re getting may be as real as a NY sidewalk designer purse or it may be expired. It’s only a matter of time before the next disaster where people who thought they were getting American Botox find out that someone was cutting corners.

Doctors near the top of the Botox website list earn that place because they order so much Botox from Allergan here in the US and they have the most experience using it. Be safe by going with expertise.

Cynthia Elliott, M.D. is a board certified physician in Clearwater, Florida, whose practice is exclusively devoted to aesthetic medicine. She is an Allergan Platinum Level Botox Provider, a speaker for Juvederm, and an aesthetic laser trainer for other physicians. http://www.skinspirations-info.com