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.

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.

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)

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.

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

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.

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!

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.

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???

They fell off a truck :)

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?