On-Label Reconstitution Across the US Neurotoxins — A Reference Table for Injectors

A neurotoxin reconstitution chart is the asset injectors reach for when they open a product they do not use every week, and getting one wrong is a dosing error rather than a documentation error. This page assembles the on-label reconstitution data for all five botulinum toxin type A products currently approved in the United States, alongside the reconstitution practice Dr. Chris Croley teaches in Empire Medical Training's hands-on curriculum — with a hard line drawn between the two.

Two categories of information appear below and they are labelled every time they appear:

• Label data is taken verbatim from current FDA prescribing information accessed through DailyMed. It is the manufacturer's approved instruction.
• Taught practice is Dr. Croley's clinical practice as taught in Empire's curriculum. It is one experienced clinician's approach, not a standard of care, and it sometimes differs from label.

Croley names all five products in Empire's reconstitution session and works through BOTOX, DYSPORT and DAXXIFY in detail. He names XEOMIN and JEUVEAU without stating their reconstitution volumes; those rows come from the package inserts and are marked as label data only.

The five US botulinum toxin type A products

Every one of these labels names preservative-free saline. None of them approves bacteriostatic saline. Croley teaches that many US practices use bacteriostatic saline for patient comfort — an off-label diluent choice covered in Empire's companion resource on benzyl alcohol — but the label column above is the label column.

BOTOX Cosmetic and BOTOX — label data

BOTOX Cosmetic's dilution table is short because the label targets a single working concentration.

Both rows produce 4 Units per 0.1 mL. The aesthetic dosing follows directly: 0.1 mL (4 Units) into each of five sites for glabellar lines, total 20 Units; 0.1 mL (4 Units) into each of three sites per side for lateral canthal lines, total 24 Units; 0.1 mL (4 Units) into five forehead sites alongside five glabellar sites, recommended total 40 Units. The platysma band indication departs from the 0.1 mL aliquot: 0.05 mL (2 Units) into each of four upper-platysma sites and 0.025 mL (1 Unit) into five sites on each vertical band, for totals of 26, 31 or 36 Units depending on band count.

The therapeutic BOTOX label, which carries the 100 Unit and 200 Unit vials, publishes a wider range because its indications span from intradermal hyperhidrosis to large-muscle spasticity.

The 4 mL row is the one aesthetic injectors meet most often outside the face: the label's primary axillary hyperhidrosis instruction is a dilution of 100 Units in 4 mL, giving 2.5 Units per 0.1 mL, with 50 Units per axilla delivered as 2 mL intradermally across 10 to 15 sites.

Taught practice. Croley uses the 2.5 mL reconstitution of a 100 Unit vial as Empire's default working concentration, giving 4 Units per 0.1 mL, and varies from it deliberately — tighter for the perioral field, looser for wide-field indications. His reasoning is covered in Empire's resource on concentration as a clinical instrument.

DYSPORT — label data, including the two glabellar options

DYSPORT is the product Croley flags as structurally different, and the label bears him out. It is supplied in 300 Unit and 500 Unit vials, and its dilution table runs across both.

The 5 mL row for the 500 Unit vial is a two-step preparation: the label instructs reconstituting the vial with 2.5 mL, then drawing that solution into a 5 mL syringe already containing a further 2.5 mL of saline, because no more than 2.5 mL should be introduced into the vial itself.

For glabellar lines, the label specifies a recommended concentration of either 12 Units per 0.1 mL or 20 Units per 0.1 mL. On a 300 Unit vial those are the 2.5 mL and 1.5 mL reconstitutions respectively — exactly the two on-label options Croley names in Empire's session. The glabellar dose is 50 Units in five equal 10 Unit aliquots: 0.08 mL each at 12 Units/0.1 mL, or 0.05 mL each at 20 Units/0.1 mL.

This is the most common source of cross-product error in a busy room. An injector accustomed to one full tick mark per point on a 4 Units/0.1 mL preparation who transfers that motion to DYSPORT delivers 20 Units where 10 were intended. The DYSPORT label makes the volume relationship explicit, noting that the dose can be decreased or increased by administering a smaller or larger injection volume — 0.05 mL for a 50% decrease, 0.08 mL for a 20% decrease, 0.15 mL for a 50% increase.

DYSPORT also carries a formulation detail worth knowing before you dose: the vial contains human serum albumin and lactose, and the label states it may contain trace amounts of cow's milk proteins, which is reflected in its contraindications.

DAXXIFY — label data

DAXXIFY is the most recent US approval and the one whose reconstitution departs most visibly from the 2.5 mL habit. It is a 150 kDa toxin supplied without accessory proteins and formulated with a 35 amino acid stabilising peptide excipient (RTP004).

The glabellar dose is 40 Units per treatment session, divided into five equal intramuscular injections of 8 Units each — two into each corrugator and one into the procerus. At 8 Units per 0.1 mL that is five 0.1 mL aliquots.

Croley explains the design reasoning behind that 1.2 mL figure rather than treating it as an arbitrary number: "It is approved as a longer-acting neurotoxin. The on-label approved dosing is higher. In the glabellar complex we would give 40 units instead of 20. If we put the same amount of fluid in there, we have to give a larger volume in one place... So with DAXXIFY we do things a little bit differently. It's reconstituted with 1.2 mL. This allows us to give a higher number of units with a lower volume, so it doesn't spread everywhere."

That is an accurate reading of the label's intent. A 40 Unit glabellar treatment prepared at 4 Units per 0.1 mL would require 1 mL of fluid distributed across five points, twice the deposited volume of a 20 Unit treatment at the same concentration. Reconstituting at 8 Units per 0.1 mL keeps the aliquot at the familiar 0.1 mL while doubling the delivered dose.

One further label property is unique to DAXXIFY and matters operationally: it may be administered within 72 hours after reconstitution, refrigerated at 2°C to 8°C and protected from light, where every other US botulinum toxin label specifies 24 hours.

XEOMIN — label data only

Croley names XEOMIN in Empire's reconstitution session but does not state a reconstitution volume for it. The rows below are taken from the XEOMIN prescribing information and are label data, not taught practice.

XEOMIN publishes the widest dilution range of any US botulinum toxin, because its indications run from glabellar lines to sialorrhea to limb spasticity.

The 8 mL and 16 mL rows require the same two-step preparation DYSPORT uses at 5 mL: reconstitute with 4 mL first, then combine with further saline in the syringe.

For glabellar frown lines the label instructs 4 Units into each of five sites — two in each corrugator, one in the procerus — for a maximum recommended dose of 20 Units. Reading that against the table, the 100 Unit vial at 2.5 mL is the row that produces 4 Units per 0.1 mL and reproduces the familiar 0.1 mL aliquot.

XEOMIN's other formulation distinction is that it contains no complexing proteins: the vial holds incobotulinumtoxinA, human albumin and sucrose only.

JEUVEAU — label data only

Croley names JEUVEAU without stating a reconstitution volume. The row below is label data.

JEUVEAU is supplied only as a single-dose 100 Unit vial, and its label specifies one reconstitution.

The label frames it as a whole treatment rather than a table: reconstitute to a concentration of 4 Units per 0.1 mL and a total treatment dose of 20 Units in 0.5 mL. Glabellar dosing is 0.1 mL (4 Units) into each of five sites.

Post-reconstitution storage — label data

None of these products may be frozen after reconstitution, and all five labels describe the vial as single-dose. Published survey data from dermatologic practice has long documented that clinicians store and reuse reconstituted vials well beyond label windows — Liu and colleagues reported in the Journal of the American Academy of Dermatology in 2012 that 68.6% of surveyed American Society for Dermatologic Surgery members routinely stored reconstituted toxin for more than a week with no observed infections. That is real-world practice data, not a label permission, and the gap between the two is a risk-management decision each practice owns and should document.

Reading the chart across products

Three habits make the table above usable at speed.

Find the concentration row first, not the volume. You are choosing a units-per-0.1 mL figure. The diluent volume is the means, not the goal.

Check the aliquot the label actually uses. Four of the six label rows above pair a 0.1 mL aliquot with the recommended dose. DYSPORT's glabellar aliquots are 0.05 mL and 0.08 mL, and BOTOX Cosmetic's platysma aliquots are 0.05 mL and 0.025 mL. Volume is not a constant across labels.

Do not read across brand columns as if they were equivalent. Nothing in this chart supports converting a dose from one product into another. Every US botulinum toxin label states that its units cannot be compared to or converted into units of any other botulinum toxin product. Empire covers why that is a pharmacology fact rather than a legal formality in the companion resource on the unit construct.

The taught-practice figures here reflect Dr. Croley's clinical practice as taught in Empire Medical Training's hands-on curriculum. Technique is learned under supervision; this article is educational and is not a substitute for training.

Injectors preparing to handle more than one neurotoxin in practice work through vial preparation with live product in Empire's Complete Botox Training and Cosmetic Neurotoxins Training. Those extending across the full face may find Empire's botox face chart and frontalis dosing material useful alongside this table, and Complete Facial Aesthetic Training covers the broader treatment planning context.

Related guides in this cluster

Part of Neurotoxin Reconstitution and Dosing.

Clinical GuideWhy a Unit of Botox Is Not a Unit of DysportBotox units vs Dysport units are not the same measure. Units are defined by each manufacturer's own potency assay — here is why no conv Clinical GuideBacteriostatic vs Preservative-Free Saline — What the Benzyl Alcohol Actually DoesBacteriostatic saline for neurotoxin reconstitution is off-label but well studied. What benzyl alcohol does to injection pain, potency Clinical GuideConcentration as a Clinical Instrument — How Dilution Governs DiffusionNeurotoxin dilution and diffusion, worked as a decision. When to choose a tighter concentration, when to choose a looser field, and wha