How to Reconstitute Botox & Dysport - Reconstitution FAQ

Updated August 28, 2024

In this blog post, Drs. Roberts reviews how to reconstitute Botox and Dysport, as well as some frequently asked questions on reconstituting Botox.

What product is used to reconstitute Botox and Dysport?

To achieve predictable results, avoid negative side effects and provide a high-level of patient care, 0.9% Preserved Saline is used which contains Sodium Chloride 9.0 mg/ml and Benzyl Alcohol 9.0 mg/ml.

In a study conducted in 2002, 100% of patients reported less pain, less discomfort when preserved saline was used, rather than with non-preserved saline (Alam, Dover & Arndt Ach. Dermatol. 138:510:2002). Benzyl alcohol acts as a mild anesthetic and kills bacteria making the reconstituted product last longer.

What is the reconstitution ratio for Botox/Dysport?

Many practitioners ask if Dysport is reconstituted differently than Botox. One vial of Botox has 100 units and one vial of Dysport has 300 units. Both products are reconstituted the same way: 1 ml of preserved saline to 1 vial.

The ratio for Botox or Dysport Reconstitution:

• 1 ml of preserved saline : to one vial of Dysport (300 units)
• OR
• 1 ml of preserved saline : to one vial of Botox (100 units)

The higher concentration (compared to the instructions on the monograph) makes botulinum toxin treatment last longer and reduces negative side effects by minimizing the spreading/diffusion of the product to adjacent muscle groups. It also has a more profound action on the specific marked target muscles, will have less swelling and is easy to calculate.

To learn more about Botox vs Dysport, register for the online Level 1 course which has a specific video discussing the differences between the two products.

How to reconstitute Botox and Dysport

To reconstitute a vial of botulinum toxin, the following supplies are required:

• Reconstituting syringe (3 mL)
• Preserved saline
• Vial of botulinum toxin – either one vial of Dysport (300 units) or one vial of Botox (100 units)

The first step is to insert the reconstituting syringe (3 ml) into the vial of preserved saline and draw out 1 ml. Remove the needle and then insert it into one of the vials of botulinum toxin listed above. Let the vacuum draw the saline down into the vial. Do not remove the metal cap on the botulinum toxin vial until after you have reconstituted. You can then load your insulin syringes with the reconstituted product. Make sure you date both the vial and box with the date of reconstitution.

Once Botox/Dysport is reconstituted, how is it stored and how long is the vial good for?

If there is any remaining product in the Dysport/Botox vial after completing the patient’s treatment, place the stoppered vial back inside the box. Store the box inside the fridge (2-8 degrees C). All products, including Botox and Dysport, must be stored in the fridge once reconstituted. Prior to being reconstituted, each brand has different storage requirements.

Ideally you will want to use the reconstituted vial of botulinum toxin within 3 weeks, however it can last up to eight weeks when stored properly in the fridge (Hexcel et al 2003).

Who can reconstitute Botox/Dysport? Are there any parameters?

Any trained team member can reconstitute. The key is to ensure your Team has received proper training (we recommend the Level 2 – Team Training course which covers all the clinical integration including reconstitution, loading syringes, billing, photography, marketing etc and also includes hands-on clinical instruction).

Dysport/Botox Reconstitution FAQ

Are there any specific storage conditions for reconstituted Dysport, especially regarding temperature and light exposure?

Reconstituted Dysport should be stored in the refrigerator at a temperature of 2-8°C (36-46°F) and protected from light. It is crucial to use the reconstituted product within a specific timeframe, as outlined by the product's instructions, to maintain its potency.

What are the best practices for labeling and tracking reconstituted vials to ensure patient safety?

Label vials with the date, time of reconstitution, and the concentration. Use a tracking system to monitor usage and ensure vials are not used past their potency period.

Is there a difference in the potency of Botox/Dysport when reconstituted with a different ratio of saline?

Yes, altering the saline ratio can affect the potency and diffusion of the product, potentially leading to inconsistent results.

How can you avoid contamination during the reconstitution process?

Use aseptic techniques, sterile equipment, and reconstitute in a clean environment. Avoid touching the vial stoppers and needles.

What are the signs that reconstituted Botox/Dysport has degraded and should not be used?

Degraded product may show cloudiness, discoloration, or particles. If any of these are observed, the product should be discarded.

How does the reconstitution process differ for Botox/Dysport when using it for different medical or cosmetic indications?

The reconstitution process may vary in terms of dilution ratios depending on the treatment area and desired outcome. Follow specific guidelines for each indication to ensure optimal results.

Additional Resources

The following videos and resources are available in the online Level 1 course.

• How to Remove the Decapper (Video)
• Botox vs Dysport - the differences between the two neuromodulators, comparing the unit calibration, reconstitution, drawing up, billing, efficacy (Video)
• Patient In-Take Forms & Clinical Documents (PDF)
• The Roberts Facial Rejuvenation Photography Series syllabus (PDF)