Best dosage for botox when performing cosmetic surgery

Botulinum toxin Type A

This article gives doses in milliliters of reconstituted solution as opposed to ‘units’ of BTX-A. One ml syringes are recommended ) allowing doses of 0.025 ml to be given safely. Always keep an eye on the hub of the syringe and the volume used while injecting. The doses recommended relate to the experience of the cosmetic surgeon,with thousands of patients undergoing repeated cosmetic treatments over six years.

Botox and Dysport are both reconstituted to give an equal effect per ml. 0.1 ml BTX-A refers both to Botox (reconstituted with 2.5 ml) and Dysport (reconstituted with 3 ml). The difference in concentration is because a vial of Dysport is stronger than a vial of Botox (although the price per vial is equal), and so requires greater dilution for effect. Allergan (Botox) and Ipsen (Dysport) have developed different individual ‘mouse units’ of concentration.These are not interchangeable and refer to different quantities.

A vial of Botox contains 100 (Allergan) units,whereas a vial of Dysport contains 500 (Ipsen) units.Measurement of dose per site in units could therefore be hazardous in countries where both products are available.

Measurement in volume allows the practitioner to get a ‘feeling’ for the different doses per site. The practitioner can observe a treatment in volume as opposed to having to convert volume to units during treatment e.g. 0.1 ml to a site can be observed, rather than thinking ‘this is 4 units Botox’ or ‘16.6 units Dysport’. With practice, the concentration can be adjusted to modify the effect of treatment further.

Think in vol/ml solution and not units/BTX-A when injecting a patient.This allows good control and safety as one eye should always watch the volume gauge.

2.5 ml to Botox correlates with 3 ml to Dysport,giving equal doses per 0.1 ml injected.

0.1 ml Botox (4 Botox units) = 0.1 ml Dysport (16.6 Dysport units)

Botulinum toxin Type B (NeuroBloc)

NeuroBloc was launched in Europe in March 2001 for the treatment of cervical dystonia. It is presented in a ready-to-use solution and can be stored for 2 years if refrigerated. It is available in three vial volumes (containing 2,500, 5,000 and 10,000 units) and each vial contains a slight overfill.

Although it is effective for 12–16 weeks in the treatment of cervical dystonia, at concentrations equal to that of Botox (i.e. one unit Botox = 50 units NeuroBloc), its duration of action for cosmetic use in the cosmetic clinic was six weeks. Current trials with this new product are examining the effect of increasing concentration on duration of action.

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