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Injectable Treatments: Botox & Filler Injections > Wasted Botox?

I use a 1ml syringe with a 30g luer lock needle for Botox injections. We were taught to draw up the botox through a 25 or 27 ga needle, then switch it for the 30ga needle (so the 30ga needle is not dulled by passage through the rubber septum).

When I do this, though, I always lose 0.1 ml (using 2.5ml/100units) to evacuate the air from the needle and fill it up with solution. at this dilution, I'm wasting 2 units per person; after 10 patients this works out to $110 (at a cost of $5.50/unit) of lost product (or $200 gross revenue).

I really can't see any way around this...just wondering how people handle it.

01.30 | Registered Commenterdr steve

Very easy - BD Ultrafine syringes with needle attached. Take the cover off the bottle so you don't dull your needle by putting it through the rubber stopper. It works wonderfully!

01.30 | Registered CommenterJH, MD

but can you replace the cover if you have Botox left over? seems you're committed to using the whole bottle when you remove the cover and septum.

01.31 | Unregistered Commenterdrsteve

Steve,
I dilute my Botox or Dysport with a 27 gauge needle attached to a 3 cc syringe. After diluting, leave the 27 gauge needle thru the stopper; connect a 1 cc syringe to draw up your Botox, recap the needle with the 3cc syringe and then when you are nearing the bottom of the bottle, remove the metal ring and stopper with a can opener, draw up with the 27 gauge on a 1 cc syringe. I always use a new 27 gauge and 3 cc syringe for each bottle but lose very little. Hope this helps.

01.31 | Unregistered Commentersrr

We were trained (6 years ago) to remove the metal ring and stopper and then dilute the product. The stopper can be reinserted and the remaining product saved for the next patient. Just make sure not to touch the inside of the stopper so it stays sterile.

Also, if you carefully withdrawl the product with a 31 gauge syringe and DO NOT TOUCH the inside of the vial with the needle, there will be no "crunching" when injected and less pain. When we get down to the bottom of the vial and cannot draw out enough to do it without damaging the needle, we transfer the remaining few drops to a newly reconstituted vial. We also do the same thing for Dysport although our 31 gauge needle just fit the mouth of the tiny vials!

(a "decapper" from a company called Kebby works great to safely pry the metal ring off the vial the blue one works for Botox and I think the green for Dysport - they have a website)

01.31 | Unregistered Commenterdjsmd

You can use the 30g needle directly inserted through the rubber and it won't dull it to a significant degree. Use 1/2 ml insuline syringe. You may have to use 2 or 3 syringes per client but it's quicker than fuddlin' around with changing the needles.

02.6 | Unregistered CommenterGene

Where can I buy just the micro-needle? They do in fact get dull after one or two injections. nan1026@rocketmail.com

02.6 | Unregistered Commenternancy

When you dilute 2.5ml to 100 unit vial you get 4 unites per 0.1mL. With the idea that you are losing some units each time you transfer botox from the vial to your syringe after repeated draw. I would dilute 3mL to each 100 unit vial and still assume that each 0.1mL contains 4 units of botox. Losing some units during transfer of liquid is inevitable. I wouldn't get overly critical over the exact units or 0.5mL units lost during the transfer.

02.12 | Unregistered Commenterkw

If you have some spare time, take your 30g needle and inject a cherry tomato . Then put the needle through the rubber stopper and try to inject the tomato again. With a new needle touch it to glass and now inject the tomato. I think you'll be surprised..

Take the rubber top off and fill your insulin syringes. The rubber top can pop back on, but make sure you have the bottle placed in the refrigerator where it won't tip over.

06.5 | Registered CommenterM S

In dilution ratios that are lower ( more concentrated) it is correct to take the ring and stopper off - being careful to not contaminate the product or lose it. These dilutions ratios favor the ultra fine insulin syringes and are great for 1:1 ratio calculations. You need to tilt the vial as to obtain all the Botox but avoid jamming the needle tip on the glass bottom
(difficult) as it will dull the fine non changeable needle tip. You may need more of these type of syringes / client. I also noted that the longer the open vial is exposed to air, (Repeated times or left out long periods) the less potent the botox is so-Cover Product and refrigerate ASAP after obtaining your amount.
I currently - prefer to use the 2.5:1 dilution ratio it seems to remain more stable.( Ring & Stopper Intact)...Until the end.
When using the 2.5:1 dilution -I agree that there is some Botox waste / injection about 1-2 units as you have stated.
( BTX in the Hub and needle are wasted sometimes twice with drawing and and switching needle and after delivery depending on techniques used))
These are some suggestions-
1) You could charge for the extra amount of loss to the client. ( Easy Fix)
2) Use a 27 1/2" gauge needle on a 1 cc TB syringe.( they are packaged together at the medical supply like PSS) to draw up the calculated amount, aspirate the needle amount back into the syringe - change out your needle to 30 gu 1/2" and push needle amount back into new needle so you don't lose everything in the hub and the needle.
ALSO..***.I use a very expensive dead space syringe by Baxter- Inkjet 1cc /100 syringes / $35.00/ box - They are green and the dead spce pushes the botox product in the hub of the syringe in to the needle so you are wasting less Product.
Overall though it is still costs more....but you are wasting less product. Which I believe is important.
So inevitably, charging the client a little more to cover this expense is justified Say $10 -$20 dollars - and you can thereby minimize your losses
Hope this is helpful-
Good Luck!

07.25 | Unregistered CommenterC.Vz

Where do you get the no waste syringes for $35 a box? I get them from PSS but at twice what you are paying.

Thanks Pat

Just use the 0.3ml insulin syringe with the 31G needle attached. I think I pay less than 30 cents a syringe.

07.26 | Unregistered CommenterLH

I was at first, but these Midwestern ladies with their very tough skin ended up with pinpoint bruises towards the end of the series of injections. The needle just didn't slip in well and I started changing needles after about 5-6 pokes. Reduced the pinpoint bruises quite effectively. Then I heard about the no waste syringes and I really liked them because I could market the "no waste" thing and I could change needles. I am always on the lookout for improved supply prices.

so where DO you get the injekt syringes for $35/box???

09.8 | Unregistered CommenterSS

They fell off a truck :)

11.3 | Unregistered CommenterDon

I found both the decappers and no-waste syringes at an online place called Acuderm, Inc. The decapper costs $38.25 and no-waste syringes are around $18.95/box of 100. I haven't ordered from them yet. Has anyone heard of them?

08.6 | Unregistered Commenterjfar1

I have ordered from Acuderm and was satisfied with the product and delivery time but am looking at their no waste syringes and also the decapper and wondering the same thing. The decapper says 100 mL vial so I am wondering if it will also do a 50 mL because that is what we buy more of. We use 2.5 mL per 100 mL bottle dilution and are having trouble getting the last little bit out of the bottle and we are also using regular 1 mL syringes. Anyone used the no-waste? What is the difference - how do they not waste since they still have a hub? just wondering before I buy another box of syringes we won't end up using.

09.4 | Unregistered CommenterCKRN

I just started injecting and the PA who trained me told me that when diluting 100u bottle with 2.5 ml of saline, using the BD .3 ml insulin syringes, the final "dosing" would equal 1 Botox unit per "4" of the units listed on the 30 unit insulin syringe. However, when I do the math, I calculate that each .3 ml insulin syringe contains 12 u of Botox making the "4" actually have 1.6 units. Am I missing something here or is the PA's math wrong?

10.4 | Unregistered CommenterLES

you are correct
2.5cc into 100u makes 40u per 1cc
it should be 4u per 1/10th cc its easier to see in a 1cc syringe but the .3cc is easy in the hand
despite the size of the syringe they still have the 1/10th markings so
each tiny line would be 0.4u thus 4 lines would be 1.6u total. In time you will be able to calculate this quickly even when dusing different dillutions

10.4 | Unregistered CommenterDrGM

Try to use 27G attached to 3cc syringe, dilute in 1,1 ml (the waste is 0,1).
Take the rubber off and use insulin syringes 8mm 31G. Easy 1:1 dilution and no waste...

You don't need to buy a decapper! You can use a regular bottle opener like what you use for beer bottles! Takes the top right off! Way cheaper than 35$ or even 99$ "decappers" I have seen. A hemostat works great too! Simple!

05.27 | Unregistered CommenterLisa G.

The decappers work great. We have several blue (100 unit vials) and 1 green (for the 50 u "samples"). In 8 years I've only had to open one vial with a hemostat because the decapper wouldn't work and it was pain. It took me several minutes. I guess if you are taking the top off outisde of the room it doesn't matter what you use but we prefer to do it in the room when needed and looks more professional that using a can opener.

Comes right off with a curved hemostat, you just flick your wrist, pops right off. Oh well! No use splitting hairs over such things...whatever works!

06.10 | Unregistered CommenterLisa G.

Has anyone tried UniTox specialty syringes? We too are wasting 1-1.5 units with every syringe. We sometimes use 3 different syringes per patient. It turns out we are losing 25units a bottle!
I just read about the UniTox and it sounds like something we'd like to try.

07.10 | Unregistered CommenterTina

I have been doing injectables for over 9 years. My Instructor thought us never to put a needle through the rubber. It not only dulls your needle, but it douse not alllow you to get all your product. I use the 0.3 ml insuline syringe and draw directly from the vial. The needle is alway sterile and you shouldn't touch the wall of the vial with the syringe to prevent contamination. I pay $42 per 100 syringes. These syringes with the 30 G and 1/4 inch needle are very good and patients don't complaint of pain.

07.12 | Unregistered CommenterLuz

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