Ah.. fall.. the days of pumpkin lattes and cinnamon rolls are upon us. The days of throwing on a hat and T-shirt and shorts are coming to an end. Now we look at ourselves a bit closer in the mirror. Hopefully you have been piling on the sunscreen. Otherwise you are wondering where all those brown spots came from. Time for Vitamin C serums and retinol and maybe a good laser treatment.
That other thing you see are the wrinkles from squinting in the sun and frowning at ice cream melting all over you hand. People that are enjoying the days of sun, deflate a bit as fall rolls round. What to do for those wrinkles? Well, a Neurotoxin, of course. Botox, Dysport, Xeomin and Neuceiva to the rescue!
A lot is said about placement and dosage to get those serene results we love so much. Those crucial skills are better in a show, not tell format. The third crucial skill of neurotoxin treatments is the neurotoxin dilution techniques. Get it right and that ensures not only the efficacy of the treatment but also the safety forour clients. Get it wrong, well, the placement and dosage may not be enough to save you from brow drop, lip drop and other unpleasant results. The potential risks of incorrect neurotoxin dilution techniques can be significant, which is why we emphasize its importance in our training.
So buckle up and let’s delve deep into the art and science of neurotoxin dilution techniques. My goal is for you, whether you are reading this for fun or are a potential trainee, to have a clear understanding of this vital procedure. Whether you’re a seasoned professional looking to refine your technique or a newcomer eager to learn, this guide on neurotoxin dilution techniques is tailored for you. Let’s embark on this journey to mastering neurotoxin dilution techniques together.
Table of Contents
Understanding Neurotoxin Concentrations
Unless you have been living under a rock, you know that neurotoxin treatments, especially neurotoxin dilution techniques, have revolutionized the world of aesthetic medicine, offering a non-surgical solution to address various cosmetic concerns. Central to the success of these treatments is the concentration of the neurotoxin used. But what exactly does “concentration” mean in this context, and why is it so crucial?
Neurotoxin concentrations refer to the amount of active neurotoxin present in a given volume of solution. So when you inject 0.01 ml (or 1 unit in the commonly used BD syringe), how much actual product are you injecting? Different products come with varying concentrations, and understanding these differences, especially in the context of neurotoxin dilution techniques, is key to delivering safe and effective treatments.
At Cerilean Medical, we’ve treated patients with all the available in Canada neurotoxins, each with its unique specifications. Here are neurotoxin products that have Health Canada approval and their standard concentrations:
Manufactured by Allergan, Botox was the first and is one of the most well-known neurotoxin products. It comes in 50, 100 and 200 unit vials. The recommended dilution for cosmetic use is 2.5 mL of saline per 100 units, resulting in a concentration of 4 units/0.1 mL. Botox is popular for treating forehead lines, crow’s feet, and glabellar lines.
Dysport (Abobotulinum toxin A)
Produced by Galderma, Dysport is another popular choice. It’s often said to spread a bit more than Botox, making it suitable for larger treatment areas. The recommended dilution is 2.5 mL of saline per 300 units, leading to a concentration of 12 units/0.1 mL. It’s frequently used for forehead wrinkles and between the eyebrows.
Xeomin (Incobotulinum toxin A)
Manufactured by Merz Pharmaceuticals, Xeomin is unique because it doesn’t contain any protein additives, reducing the risk of allergic reactions. The recommended dilution is similar to Botox, with 2.5 mL of saline per 100 units for a concentration of 4 units/ 0.1 ml. Xeomin is often used for frown lines, forehead lines, and crow’s feet.
Nuceiva (Prabotulinium toxin A)
Manufactured by Evolus is the new kid on the block for Canada. It is quite similar to Botox but with slightly dfferent protiens. It comes in 100 iu vials and the dilution is 2.5 mL of saline per 100 units, resulting in a concentration of 4 units/0.1 mL. Nuceiva is approved for treating frown lines between the eyes.
It’s essential to note that while these products have their recommended concentrations, the actual dilution can vary based on the treatment area, patient’s needs, and desired outcomes. This flexibility is both a boon, allowing for tailored treatments, and a challenge, necessitating a deep understanding of each product’s properties.
In the upcoming sections, we’ll delve deeper into the dilution process, ensuring that you’re equipped with the knowledge to make informed decisions for every treatment. But for now, remember this: mastering the nuances of neurotoxin concentrations is the foundation of successful treatments. It’s where science meets art in the realm of aesthetic medicine.
The Basics of Neurotoxin Dilution Techniques
Dilution is more than just mixing a neurotoxin with a solvent; it’s a precise science that determines the effectiveness and safety of the treatment. At Cerilean Medical, we believe in equipping our trainees with a thorough understanding of this process, ensuring that every treatment is both safe and effective.
What is Dilution?
Dilution, in the context of neurotoxin treatments, refers to the process of reducing the concentration of the neurotoxin by adding a solvent, in this case, a sterile saline solution. The goal is to achieve a specific concentration that’s both safe and effective for the intended treatment area.
Why is Dilution Important?
1. Safety: Proper dilution ensures that the neurotoxin is administered at a safe concentration, reducing the risk of complications or adverse reactions.
2. Efficacy: The right dilution ensures that the neurotoxin works as intended, providing the desired aesthetic results without over-treating or under-treating.
3. Spread and Precision: Different dilutions can affect how the neurotoxin spreads in the tissue. This is crucial for tailoring treatments to specific areas of the face, ensuring precision and optimal results.
Choosing the Right Diluent
While saline solution is the most commonly used diluent, it’s essential to use the right type. Preservative-free saline is often recommended by the manufacturer. However, at Cerilean Medical, we use the common diluent of Sterile Bacteriostatic Saline. That means a small amount of benzyl alcohol has been added to the vial of saline. This allows more comfort for your client without compromising the stability and efficacy of the neurotoxin. This ensures the best possible outcomes and experience for our clients.
The Role of Dilution in Treatment
Dilution plays a pivotal role in determining both the potency and spread of the neurotoxin. For instance, a more diluted solution might spread more, making it suitable for broader areas, while a less diluted solution would be more potent, ideal for targeted treatments.
In the world of aesthetic medicine, understanding the basics of dilution is akin to an artist understanding their paints. It’s a fundamental skill, one that sets the foundation for all subsequent treatments. As we delve deeper into the subsequent sections, we’ll explore the practical aspects of dilution, ensuring that you’re well-equipped to deliver treatments with confidence and expertise.
Step-by-Step Guide to Proper Dilution
Mastering the art of neurotoxin dilution is paramount for any aesthetic professional. At Cerilean Medical, we’ve honed our techniques over the years, ensuring that every treatment we administer and teach is of the highest standard. Here’s a detailed guide to help you navigate this essential process:
1. Gathering Necessary Supplies
● Neurotoxin Vial: Ensure you have the correct product and that it’s within its expiry date.
● Saline Solution: Sterile preservative-free or bacteriostatic to maintain the neurotoxin’s efficacy.
● 3 ml Sterile Syringes: For drawing up the saline and mixing the solution.
● 22 g needle: for ease of drawing up saline and injecting into the vial
● Gloves: To maintain a sterile environment.
● Alcohol Wipes: For cleaning the vial tops and ensuring a sterile workspace.
● Workspace: Ensure you’re working in a clean, well-lit area. Clean the surface with a disinfectant and lay out all your supplies within easy reach.
● Neurotoxin Vial: Check the vial for any damage or signs of tampering.
3. Dilution Process
● Cleanse: Wipe the top of the neurotoxin vial and the saline bottle with an alcohol wipe.
● Draw Saline: Using a sterile syringe, draw up the required amount of saline solution.
● Add to Vial: Allow the saline to be drawn into the neurotoxin vial. The vial must be discarded if there is no negative pressure drawing the saline in.
● Mix Gently: Rotate the vial gently between your fingers to mix the solution. Avoid shaking or being too forceful, as this can denature the protein. If you are reconstituting Xeomin, be sure to invert the vial gently several times.
● Label: Always label the diluted vial with the date of dilution and the concentration.
● Refrigeration: Store the diluted neurotoxin in the refrigerator if not used immediately. Remember, diluted neurotoxin has a shorter shelf life than undiluted.
● Expiry: Always check the manufacturer’s guidelines, according to the product monograph, diluted neurotoxin should be used within 4-6 hours if kept at room temperature and within 24-48 hours if refrigerated. However common practice gives the diluted neurotoxin a shelf life of 2 weeks if kept refrigerated.
Dilution might seem straightforward, but it’s the attention to detail that ensures consistent results. At Cerilean Medical, we believe that every step, no matter how small, plays a crucial role in the overall treatment outcome. As you progress in your aesthetic journey, you’ll find that mastering the basics, like dilution, will set you apart as a top-tier professional.
Common Mistakes and How to Avoid Them
In the realm of aesthetic medicine, even the smallest oversight can lead to undesired outcomes. At Cerilean Medical, we’ve seen our fair share of common complications when it comes to neurotoxin dilution. By highlighting these, we aim to equip you with the foresight to avoid them and ensure the best results for your clients.
1. Over-Dilution or Under-Dilution
● Mistake: Not measuring the saline solution accurately, leading to a concentration that’s either too weak or too strong. Do yourself a favour and use the 3 ml syringe to reconstitute.
● Solution: Always use precise measurements. Double-check the manufacturer’s guidelines and ensure you’re using the correct amount of saline for the desired concentration.
2. Using Expired Products
● Mistake: Utilizing neurotoxin or saline solution that’s past its expiry date.
● Solution: Always check the expiry dates before starting the dilution process. Regularly audit your supplies to discard any outdated products.
3. Not Mixing Gently
● Mistake: Shaking the vial vigorously or not mixing it enough, leading to an uneven concentration.
● Solution: Gently rotate the vial between your fingers to ensure a consistent mix without denaturing the protein.
4. Improper Storage
● Mistake: Storing diluted neurotoxin at room temperature for extended periods. We have all accidently left the vial sitting in our room after a busy day. You can’t count on your units affecting the muscle predictably by using that vial the next day. Heart-breaking I know, but in the garbage it goes.
● Solution: If not using immediately, store it in the refrigerator.
5. Not Maintaining a Sterile Environment
● Mistake: Overlooking the importance of cleanliness, leading to potential contamination.
● Solution: Always use gloves, clean the workspace with disinfectant, and use alcohol wipes for vial tops. Ensure all equipment, like syringes, is sterile. Clean your clients face before injecting. I prefer Stanhexadine(Chlorhexidine/ Alcohol mix)
Mistakes are a part of the learning curve, but in a field as precise as ours, it’s vital to minimize them. At CerileanMedical, we believe that by being aware of these common errors and their solutions, you’re better equipped to offer treatments that are both safe and effective. Remember, in the world of aesthetics, excellence lies in the details.
Tailoring Dilution to Specific Treatment Areas
*For all of the following, multiply the concentration by 3 if using Dysport*
In the world of neurotoxin treatments, precision is paramount. At Cerilean Medical, we’ve honed our techniques to ensure each treatment is tailored to the individual. Here’s a more detailed guide on adjusting dilution techniques for various facial areas:
1. Forehead Lines
● Muscle Involved: Frontalis
● Skin Thickness: Thin to medium
● Dilution Recommendation: For a 100-unit vial, 2-2.5 mL of saline is standard. However, for patients with stronger frontalis muscles or deeper lines, consider a concentration of 10 units/0.1 mL and increasing the number of injection points
● Injection Depth: Superficial to mid-dermal. The muscle is the thickness of a layer of onion.
2. Glabellar Lines (Frown Lines)
● Muscles Involved: Corrugator supercilii and Procerus
● Skin Thickness: Medium
● Dilution Recommendation: Given the strength of these muscles, a more concentrated dilution of 10 units/0.1 mL is often effective. Adjust based on muscle strength.
● Injection Depth: deep into the belly of the muscle
3. Crow’s Feet
● Muscle Involved: Orbicularis oculi
● Skin Thickness: Thin
● Dilution Recommendation: Due to the delicate skin, a more diluted concentration of 2 units/0.1 mL can be effective. This allows for a softer spread and reduces the risk of bruising.
● Injection Depth: More superficial The muscle is the thickness of a layer of onion.
4. Bunny Lines (Nasalis Lines)
● Muscle Involved: Nasalis
● Skin Thickness: Medium
● Dilution Recommendation: A concentration of 10units/0.1 mL typically provides a natural result. Adjust based on the prominence of the lines.
● Injection Depth: Mid-depth to the base of the muscle
5. Perioral Lines (Smoker’s Lines)
● Muscle Involved: Orbicularis oris
● Skin Thickness: Medium
● Dilution Recommendation: Given the area’s mobility, a concentration of 4 units/0.1 mL is preferred. This ensures subtle results without compromising lip movements.
● Injection Depth: Into the shallow half of the muscle
By understanding the intricacies of each treatment area, from muscle strength to skin thickness, you can tailor your dilution techniques for optimal results. At Cerilean Medical, we believe in the power of precision, ensuring each patient receives care that’s as unique as they are.
The world of aesthetic medicine is intricate, where every detail matters. Neurotoxin treatments, while transformative, require a deep understanding and precision. The dilution process, as we’ve explored, is not just a preparatory step but the very foundation of a successful treatment. It determines the safety, efficacy, and naturalness of the results.
At Cerilean Medical, our journey has always been about excellence and continuous learning. Through this guide, we aimed to share our insights, from understanding neurotoxin concentrations to tailoring dilutions for specific treatment areas. We believe that with the right knowledge and techniques, every practitioner can achieve the pinnacle of their craft.
For those who’ve embarked on this aesthetic journey, remember that every patient is unique, and so should their treatment. It’s this personalized approach, combined with technical expertise, that transforms good results into great ones.
As we conclude, we invite you to explore further, practice diligently, and always prioritize the well-being of your patients. The world of aesthetic medicine is vast, and there’s always more to learn. Let’s continue this journey of mastery together, ensuring that beauty and science walk hand in hand.
1. What are the primary differences between the neurotoxin products like Botox, Dysport, Xeomin and Nuceiva?
The primary differences lie in their formulations and recommended dilutions. Botox, manufactured by Allergan, is one of the most recognized neurotoxin products and is commonly used for forehead lines, crow’s feet, and glabellar lines. Dysport, produced by Galderma, tends to spread more than Botox and is suitable for larger treatment areas like forehead wrinkles. Xeomin, by Merz Pharmaceuticals, is unique as it doesn’t contain protein additives, reducing potential allergic reactions. Nuceiva by Evolus is similar to Botox in that it contains the same proteins but has a differing molecular structure. It is approved for frown lines between the eyes. Each product has its recommended dilution and concentration, which professionals must understand for effective treatments.
2. Why is the dilution process so crucial in neurotoxin treatments?
Dilution determines the concentration of the neurotoxin, which in turn affects the treatment’s safety and efficacy. Proper dilution ensures that the neurotoxin is administered at a safe concentration, reducing risks and ensuring desired aesthetic results. It also influences how the neurotoxin spreads in the tissue, which is vital for tailoring treatments to specific facial areas.
3. How does one ensure a sterile environment during the dilution process?
Maintaining a sterile environment is paramount for patient safety. Professionals should always use gloves, clean the workspace with disinfectant, and use alcohol wipes for vial tops. All equipment, like syringes, should be sterile, and the workspace should be well-lit and free from potential contaminants.
4. How long can diluted neurotoxin be stored, and what are the storage recommendations?
Diluted neurotoxin has a shorter shelf life than undiluted. While it’s essential to check the manufacturer’s guidelines, as a general rule, diluted neurotoxin should be used within 4-6 hours if kept at room temperature. If refrigerated, it should be used within 24-48 hours. Always label the diluted vial with the date of dilution and the concentration, and if not using immediately, store it in the refrigerator.
About the Author: Vicki Mulyk RN
Vicki Mulyk stands at the forefront of aesthetic medicine training, leading Cerilean Medical with a commitment to ethical and effective treatments. With extensive hands-on training modules, Vicki ensures that professionals gain both confidence and competence. Her approach emphasizes the principles of beauty, aging, and best practices, making Cerilean Medical a top choice for many in the industry. Passionate and dedicated, Vicki remains a trusted voice in aesthetic medicine, always prioritizing safety and excellence.