Discarding Botox & Diluting Fillers? Dr. Herzog Weighs In


diluting fillers?



Should doctors discard unused botox daily? Is it wrong for doctors to dilute cosmetic fillers? These are great questions, and dermatologist and Family Savvy contributor Dr. Jo Herzog shares answers to both in today’s post.


QUESTION: Dr. Herzog, someone is advertising that they give superior service at their spa stating that the doctor there throws away his Botox daily and does not dilute fillers. Why would anyone throw Botox away? I think that my doctor dilutes my fillers.What is wrong with that?

Dr. Jo Herzog dermatologist Family Savvy

Dear Patient,

I’ll start with the Botox question, as it is a quick & simple answer. If you use enough Botox, you will never throw any away, and you will always have fresh product on hand. In the old days when we were starting out with Botox, we would schedule our patients in blocks to use our Botox up that day. That is now a rare occurrence, because we use it up before it expires.

We now also know that Botox is “fresh” for longer then we once thought. Office employees would be waiting in line if there was any “extra.” So, in a nutshell, nobody should have to throw botox away.

Now, on to your question about fillers, which requires a bit lengthier explanation.  Less experienced injectors use everything straight from the package all of the time. Experienced injectors, on the other hand, use their expertise to modify their injections, when indicated, to best fit the patient. For example, they might add lidocaine to Juvederm, Radiesse, or Belotero to make the injections more comfortable, or they might add epinephrine to decrease chances of bruising.

Some Juvederm comes with lidocaine already in it, as does all of our Restylane and Perlane. Sculptra comes without fluid added and must always be reconstituted. The mixing when using Belotero or plain Juvederm and Radiesse is the adding of anesthetic. The amount is minuscule, and I would hardly call this diluting. The patient is still getting the full amount that she purchased plus the anesthetic to make injections comfortable. So, my patients will hear me say, “I am going to mix up your Radiesse,” because I add lidocaine to it.

Fillers can be intentionally diluted to better address the needs of the patient. In order to do a good job of getting a filler into tiny creases, we can thin it out and use a much tinier needle to inject it. A thicker filler could not go through a tiny needle. This is most often done for tiny creases around the lips. I do not need to do this often. This process takes more time and effort, but if you want good results, you use the technique as needed.

Again, the patient pays for the amount of actual filler that we used BEFORE it was thinned out. Thinning out fillers might cause them to last less time, so we try to do this only if absolutely indicated.

The diluting that you need to watch out for is one that you did not mention. All Botox, Dysport and Xeomin is reconstituted from powder form. There are cheaters out there that are probably diluting this by adding more then the correct amount of liquid. The only way that you would would know that is if your Botox/Dyspot/Xeomin did not work or did not last. There are other reasons that these may not last, but diluting is the biggest one.

Be aware of people that are selling product for less then they can buy it for. Big bargains can be “come ons,” foreign bootleg material,  or diluted product. Reasonable deals do happen, but they are most often sponsored by the drug companies that are competing against one another. Case in point: my office is currently having a 20% off deal on Dysport because we are passing the savings we are receiving from the drug company along to our patients.

Hope all of this helped answer your question,

Be well,

Dr. Jo

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  1. Hi Brian! I am not qualified to answer that; a medical professional would need to address that. I have heard that some doctors save for future use, but I think my Dr. Jo Herzog just uses what is needed at one time. Hope this helps!!!!

  2. i just have a question regarding fillers. I am a Nurse in a dermatology clinic. When doctors order for filler injection, we dilute the filler with lidocaine. Usually, after the procedure, there are still remaining fillers on the syringe. My question now is, how long does that left over can be use in case the patient wants to use the remaining?

    Thank you very much

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