How to Reconstitute Anti-Wrinkle Injections

By Florence Goulbourne

Fox Pharma stocks a wide range of anti-wrinkle injections, including Botox, Bocoture, Dysport, Azzalure and Alluzience. Prior to injection, all neurotoxins must be reconstituted as they either arrive freeze dried (Dysport) or vacuum dried (Botox). Therefore, saline must be added in order for the toxin to be suitable for injection. Reconstitution is defined as restoring to a former condition by adding water, while dilution is the thinning of a liquid, this can often be a point of confusion for patients who are concerned that they are receiving a ‘diluted’ version of the treatment. So how do you reconstitute anti-wrinkle injections?

What are anti-wrinkle injections?

Anti-Wrinkle Injectables work to prevent static wrinkle and line formation by stopping the signal between the nerve and muscle. The decreased movement in the muscle limits expression lines, creating a smoother-looking complexion.

What’s the difference between Botox and anti-wrinkle injections?

Botox is one of the most popular brand names for anti-wrinkle injections and has become synonymous with toxin treatments, however there are many other toxins on the market. Anti-wrinkle injections utilise a botulinum type A neurotoxin complex to reduce muscle movement in the intended treatment area.

How long do anti-wrinkle injections take to work?

Anti-wrinkle injections typically take around a week to work, although some patients may see results more quickly or more slowly dependent on their metabolism and the frequency of previous treatments.


What should I use to reconstitute anti-wrinkle injections?

You should always use bacteriostatic normal saline as the diluent to reconstitute anti-wrinkle injections. Using sterile water can result in the client experiencing a burning sensation and great discomfort during treatment. Non-preserved saline was originally the approved saline for reconstitution, however as non-preserved saline burns more with injection, in recent years preserved 0.9% saline as the preferred diluent

What ratio should I use?

You can reconstitute a 200 Unit vial of BOTOX using 6 mL of 0.9% non-preserved saline solution and mix the vial gently. Draw 2 mL from the vial into each of three 10 mL syringes. Complete the reconstitution by adding a further 8 mL of 0.9% non-preserved saline solution into each of the 10 mL syringes and mix gently.

A standard ratio would be 1 ml of preserved saline : to one vial of Botox (100 units) or 1 ml of preserved saline : to one vial of Dysport (300 units). Always refer to the individual brand’s reconstitution chart.

Tailoring Reconstitution

When performing treatments such as addressing hyperhidrosis under the arms, some practitioners may prefer a higher ratio of saline to Botox to create greater diffusion, while other areas such as glabellar lines may require a more precise and concentrated approach.

Practitioners may find it easier to reconstitute all of their vials 1:1, by adding 1cc of bacteriostatic saline into a 100u vial of Botox. This formula will yield 1 unit of saline for every 1 unit of Botox. (There are 100u in 1 cc or 1mL).

Through further counter reconstitution within their syringe, practitioners can create various reconstitutions, allowing them to diversify the number of units injected into a specific treatment area. For example, If a practitioner wanted to treat fanned crows feet, they could use a 3:1 reconstitution of Saline to Botox by pulling up 10 units of 1:1 Saline: Botox and then a further 20 units of Saline to create 30 units of solution.

Anti-wrinkle injections vary in concentration, therefore it is essential to refer to the brand’s reconstitution chart. For example Xeomin and Dysport are often reconstituted in the same way as Botox, despite Dysport having 300 units per vial, as opposed to 100 units.

What needle should I use to reconstitute?

It is recommended to use a 21 or 22 gauge needle to reconstitute Botox and anti-wrinkle injections to allow for a slower reconstitution and preserve the toxin molecules.

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