Botulinum toxin dilution: our technique.

Abstract

The optimal dilution of botulinum toxin remains a controversial matter. With the use of botulinum toxin in new and more delicate indications, dilution is the main procedure to reduce side effects. The objective of this paper is to review the literature and report our dilution method and our experience. We use either 500 U Dysport and 100 U Botox sterile vials. For facial indications we dilute them with 1 ml of sterile solution and in Dysport solution we add adrenalin with final solution 1:100.000. For platisma and dysidrosis we use more diluted solutions without adrenalin. It is very important to use a 30 U syringe to properly calibrate the low doses used. Although there is a great variation in toxin dilution used by practitioners, in our opinion this particular aspect of the technique remains very important: using low amounts of toxin in very low amounts of saline solution reduces side effects. The use of adrenalin, such as for local anesthetic solutions, needs more study but may be useful to reduce doses, to minimalize spread in nearby muscles and, in our experience, does not produce side effects.