Please note: This guide should only be used to supplement pre-existing understanding of the pharmacological sciences of Botulinum Toxin (sometimes known as Botox®) and pre-existing experience in the application of this science in a clinical setting. Always refer to the manufacturer instructions for accurate and up to date information on the correct storage, reconstitution and delivery of these products.

Practitioners should follow guidance provided by their regulatory body (GMC / GDC / NMC) and always practice aseptic technique.

Botulinum Toxin Reconstitution

You will need:

• – Botulinum Toxin 50 units (or your chosen formulation of Botulinum Toxin*)
• – 1ml syringes
• – Drawing up needles: green needles (21g x 1.5″)
• – Injecting needles: yellow needles (30g x 0.5”)
• – 0.9% bacteriostatic normal saline
• – Sharps bin
• – Disposable medical gloves

Method for Botulinum Toxin reconstitution:

1. Check product for authenticity, tampering or damage

Prior to opening, check the product to exclude inauthenticity, tampering or damage and expiration. Botulinum Toxin vials should be delivered on ice and are contained in small card boxes which should be intact.

A holographic sticker can be found on the vial to confirm it as an authentic product of Allergan. The expiration date and batch number should also be printed on the vial.

2. Check the vacuum seal

Check the vacuum seal in the vial by piercing the rubber cap with a needle. You should hear an audible ‘hiss’ as the vacuum is released.

3. Draw up saline

Using a green needle and a 1ml syringe, draw up 1.1ml saline. Drawing up the extra 0.1ml accounts for losses in the needle. The resulting strength of this reconstitution is 5 units/0.1ml. Table 1 displays the resulting strengths from different volumes of diluent with different vials of Botulinum Toxin.

TIP:  Always use bacteriostatic normal saline as the diluent as per manufacturer guidance. Reconstituting with sterile water can cause the client great discomfort during treatment.

4. Add the saline to the Botulinum Toxin

Insert the needle into the vial and inject the saline in a controlled and steady manner with the bevel of the needle at the base of the vial, which should be held tilted at 45°. Releasing the vacuum with a needle prior to the introduction of saline (as detailed in step 2) will help you achieve a steady inward flow of saline and avoid the creation of bubbles.

5. Mix the product

Disconnect the syringe and mix the product by gently rotating the vial. Do not invert or shake the vial as this could create bubbles and cause difficulty when drawing up.

TIP: Reconstitued Botulinum Toxin should be a clear and colourless solution without particulate. If you have any concerns about the appearance of the reconstituted product do not use it and contact the manufacturer directly.

6. It’s time to draw up!

Insert the drawing up needle and syringe back into the vial with the bevel of the needle at the base of the vial, again held to 45°. Steadily withdraw the plunger to draw up 1ml reconstituted Botulinum Toxin trying to avoid bubbles. Again, do not invert the vial whilst drawing up.

TIP: It may be helpful to introduce a small volume of air into the vial prior to drawing up to facilitate the aspiration of the solution. If you do choose to do this make sure you only inject air into the vial and not into the solution.

THE BUBBLE FACTOR:  If you do draw up a bubble of air into the syringe don’t panic! If you notice a bubble, stop aspirating and remove the needle and syringe from the vial. With the needle facing upwards, aspirate a little air to remove any solution from the needle. Then encourage the bubble to migrate to the top by lightly tapping the syringe or with a push-pull motion on the plunger. Once the air bubble has been eliminated from the body of the solution, advance the plunger until you see the product at the tip of the needle. Then reinsert the needle and syringe into the vial and continue drawing up.

7. Replace the drawing up needle with the injecting needle

Note: there is no need to prime your 30g needle.

8. Your Botulinum Toxin is now reconstituted and ready for injecting (after cleansing the client’s skin appropriately)!

*Remember, different preparations of toxin may come in different quantities or may need to be considered in terms of different units. This article describes a standard reconstitution method for Allergan’s Botulinum Toxin Cosmetic only.