May 5, 2022

foundation aesthetics courses

Could you be wasting your botulinum toxin without realising? If we said there were seven, yes, seven things you could implement now that will help you to stop wasting this precious product, saving you money, and increasing the longevity of your Botox® vial, I am sure you would want to know more…

In this blog, Dr Tim Pearce will explore some of the key areas for wastage including leaving product in the vial or in the syringe, alongside accidental wastage squirted into the air or on the patient’s face, and wastage due to injection technique including where it does not work, where it is not needed, and simply injecting too much and over treating.

Dr Tim will be discussing more medical aesthetic training tips as part of his upcoming webinar series, so if you’re looking to increase your CPD-certified learning and want to learn more skills to make you a better clinician, then step one is to register for the free webinars by Dr Tim.

How are you wasting your botulinum toxin?

botox fillers needleBotulinum toxin type A, including the Botox® brand is not a cheap medication, for the practitioner or the patient, so every aesthetic clinician is eager to eke out as much value for money from every vial as possible, yet many might be inadvertently wasting product and denting their bottom line. Let’s look at the seven ways you could be guilty of wasting Botox.

1. Wasting Botox by leaving it in the bottle or vial

The first challenge is trying to get every drop of product from the Botox vial into your syringes so that you can make sure that you do not throw away precious botulinum toxin when you dispose of the bottle. This is tricky and most people will leave something behind.

If you like to withdraw straight through the vial stopper with a fresh needle, you will almost always leave a considerable amount inside the vial. This is proven in a 2014 study with random sampling of ‘used and empty’ vials that showed an average of 5 units of potential wasted Botox via this method of drawing up the product.

You can rescue some or all by removing the rubber bung and directly syringing the remaining product. Dr Tim reminds you not to use that needle to inject the patient because toughing the needle on the glass of the vial will make it very blunt and unpleasant for your patients.

To do this, remove the cap and bung from the vial using pliers or a special decapper. Then, look down the side of the label so you can see through the glass and tilt the vial towards that angle until you can see the small collection or meniscus of remaining liquid at the edge of the glass. Insert your needle with the bevel towards the glass and aspirate the liquid. Because the needle is expendable, you may choose to bend it a little to get closer to the remaining liquid to extract every drop.

You can then transfer the product to your delivery syringe (with a fresh, sharp needle), remembering to flick the syringe body to bring any air bubbles to the surface at the needle end so the air can be expelled (and not product). If you push slowly on the plunger as you expel the air, you will eventually cause a bead of product to come from the needle tip, this can be quickly sucked back in if you are working slowly, so you will not waste product.

2. Wasting Botox by throwing away product that is still in the syringe

A more common cause of botulinum toxin wastage is from the dead space in the top of the syringe, which means that valuable product (around half a unit of Botox) can wind up in the sharps bin. This can be avoided with the use of low or zero dead space syringes.

3. Wasting Botox by accidentally squirting it onto the patient’s face

This type of product wastage happens if you leave a tiny air bubble in the syringe following your treatment prep.

As you are injecting, especially with the inertia on the rubber bung as you compress the plunger to inject, you are compressing the gas in that bubble. Hence, you do your injection, release the needle, and as you come out of the skin, it decompresses again and squirts Botox from the end of the needle and onto your patient’s face (and not in their face where you wanted it). In fact, up to 50% of it, if it is a big bubble goes onto the surface of the skin, even though it looks like you compressed it into the skin. This is a considerable, yet subtle cause of product wastage amongst practitioners, notes Dr Tim. In a busy clinic, this kind of wastage can soon add up and lose you money.

4. Wasting Botox by squirting it into the air

If you are not the one ordering the botulinum toxin or paying the bills, you, or members of your team may be guilty of this kind of wastage during your Botox syringe prep. To expel the air, you may be pushing out product and air and wasting it all over the floor.

This can be avoided by leaving more dead space in the syringe (by pulling back your plunger) before attempting to free and release any air bubbles by flicking and pushing the plunger upwards again. Slowly is the key so that you can catch that final bead of product before it leaves the needle tip, allowing you to suck it back into the syringe.

5. Wasting Botox by injecting it where it does not work

Facial Muscles Anatomy

Botulinum toxin can also be wasted by injecting it into places where it will not cause a clinical effect. Typically, this may be into the aponeurosis in the forehead. There is no point in injecting where there is no muscle present.

6. Wasting Botox by injecting it where it is not needed

Another means of wastage is by treating lines that are caused by muscles elsewhere. The most common is the orbicularis oculi (OO) muscle that is treated initially, and then at a follow-up review, because the zygomatic muscles are still putting pressure through the area, the clinician is minded to inject yet more botulinum toxin into the OO, when the zygomaticus major muscle is causing the crease, and they have wasted extra Botox in the OO.

Similarly, another common occurrence seen by Dr Tim is double treating the procerus muscle to target a crease (often a deep vertical line) that is caused by the corrugator muscles pushing inwards, when the procerus is more likely to push downwards to create a crease across the nose and has already been deactivated on initial treatment.

Dr Tim’s top tip for the procerus is that in his experience you do not need more than 4 units of Botox into this muscle to get a good result in most patients, yet he routinely sees dosing of 8 or even 10 units, could you be delivering more than you need here and wasting product?

Beware of falling into the ‘special Botox testing face’ trap that leads to over treatment (and product wastage). When your patient is home in those first couple of weeks – and to ensure that they have received value for money for their Botox treatment and achieved the result they were expecting – they will create ‘special faces’ in the mirror that they have never pulled before!

If you contract every muscle possible in your face, you can sometimes cause a line to form that has already been treated effectively with botulinum toxin. This is typical where OO gets recruited as they test their frown by scrunching their whole upper face, leading them to ask for a top-up at their follow-up review appointment. Aesthetic clinicians need to ensure that they are not retreating already relaxed muscles (and wasting product) simply because the patient is recruiting additional muscles to create lines.

7. Wasting Botox by injecting too much in the target areas

Botulinum toxin is designed for the treatment of dynamic lines, caused by movement, but will not work to improve long-standing static lines. Many patients expect ALL lines and wrinkles to disappear after their first anti-wrinkle treatment with Botox and will complain at their follow-up appointment that it is not 100% line free, demanding a retreatment.

Such deep, static lines may take months to improve as the skin rejuvenates with repeated relaxation of the underlying muscles in the region and may never fade entirely. If you treat again, when the muscles are clinically relaxed, you will be wasting product, and the key to this problem comes down to your consultation and the way you educate your patients that this is not an instant magic wand.

How do you avoid wasting Botox?

What are your thoughts on ways to avoid wasting botulinum toxin? Dr Tim also notes that he often uses less than the licensed doses, depending on the specific anatomy and muscle movement of his patients. Are you using a one-size-fits-all dosing regimen that could mean you waste product in some patients who do not need as much product to achieve a good result? Food for thought, isn’t it?

Why not drop him a comment or question on social media if you want to discuss tips for maximising every drop of Botox in aesthetic practice; you can find Dr Tim Pearce on Instagram.

Aesthetics Mastery Show

Are you wasting your botulinum toxin without realising?

To find out more, watch the Aesthetics Mastery Show, where Dr Tim shares 7 things you can do to STOP wasting your product so that you can save money and increase the longevity of your Botox vial.

Essential eLearning aesthetic treatments

One way in which practitioners can improve their skills is to invest in training. If you’re a medically qualified aesthetic clinician, then eLearning foundation courses could be a great way to support your learning. Dr Tim Pearce has created a pair of courses which provide essential knowledge for aesthetics practice. Find out more about the courses together with a list of modules at:

In addition, browse our FREE downloadable resources and access FREE eLearning by following Dr Tim on social media.

Are you anxious about delivering cosmetic injectables safely?

If you want to learn more about mastering medical aesthetic treatments and complications or conquering the anxiety of where to place your needle, then register for the next Dr Tim webinar.

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Dr Tim Pearce eLearning

Dr Tim Pearce MBChB BSc (Hons) MRCGP founded his eLearning concept in 2016 in order to provide readily accessible BOTOX® and dermal filler online courses for fellow Medical Aesthetics practitioners. His objective was to raise standards within the industry – a principle which remains just as relevant today.

Our exclusive video-led courses are designed to build confidence, knowledge and technique at every stage, working from foundation level to advanced treatments and management of complications.

Thousands of delegates have benefited from the courses and we’re highly rated on Trustpilot. For more information or to discuss which course is right for you, please get in touch with our friendly team.

 

Botox® is a registered trademark of Allergan Aesthetics plc.

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