Botox price and where to get it

I am in my late 20s and looking to get my first Botox treatment for frown lines, forehead lines, and crow's feet. I don't want to get ripped off, so can someone please tell me - What is the normal cost of Botox? How many units of Botox do most people need to smooth wrinkles and prevent wrinkles? Does the cost of Botox fluctate depending on where in your face you get it injected?

The price of Botox and how many units are injected in each area really varies among physicians and geographic areas.

There is also conflict about who people should or should not go to for Botox treatment. Both to avoid getting "ripped off" and to get a good, natural looking result.

In my clinic, Botox is $12 per unit. I charge by the unit and encourage patients to know how many units they get in each area they have treated. I agree that charging by the "area" encourages under-treatment by the injector - they still charge the same whether they are using 10 or 20 units. In general, though, you should do your homework and find a Botox provider who is experienced, knowledgeable and has been around for a while with a loyal clientelle. Providers who are in it for the volume business and don't care about repeat clients or forming a relationship with their clients should be avoided.

Units I use:

Forehead: 8 to 12

Glabella: 12 to 20 (usually 16)

Crow's feet: 12 to 20 (usually 16 - and that includes a bit under the tail of the eyebrow to give a lift)

Chin: 8

Upper lip: 4

Jaw for Teeth Grinding / TMJ: 16 to 60 (usually 20 per side)

I wouldn't go shopping for champagne and caviar at JONS or K-Mart. I also wouldn't get Botox at the local mall. I would go to a doctor's practice - that way, if there's a problem, you have someone to speak to.

A quick note about an ongoing turf battle.

The doctor does not have to be Board Certified in Plastic Surgery. It doesn't take a rocket scientist to inject Botox (which is not to suggest that Board Certified Plastic Surgeons are all rocket scientists). It does take a bit of knowledge, a good hand and some common sense. Nurses, PAs and physicians who have decided to specialize in cosmetic procedures should have plenty of that. Board Certification just means the doc has completed a specialization in something. It does not mean that he/she is good at everything. There are plenty of Board Certified Plastic Surgeons who are always operating and therefore rarely inject. Theses people are not good injectors. There is no Board Certification for injection and laser procedures, by the way.


http://www.westsidemedicalspa.com/botox.html

Kenalog Dent

About 3 months ago I had kenalog injected into my TT scar and also lasered (whisper). 1 month ago I had my second laser treatment. Last night I noticed a dent near my scar and the skin looks thinner there. I say thinner because I can really see alot of veins I didn't see before.
Googling this brings me to the kenalog? Is there anything that can be done to stop the dent from getting worse or fixing it?
I plan on calling my PS Monday but this is just really bothering me!
Thanks!
Melissa


Hi Melissa,
The dent is not going to be a major problem. It does sometimes happen from kenalog injection, but its easy to fill it in. It generally will not get worse and worse. It just happens and then either improves on its own, or we fill it in. Once it is filled in, collagen stimulation happens and we usually do not have to fill it in a second time.

Red after Chemical Peel and Blepharoplasty Question

I have had 4 deep chemical peels done to remove severe acne scarring over the past 7 years. After the last one my skin has stayed bright red. It has been almost a year now and it is not fading. I now have to always use a moisturizer with a green tint and thick waterproof makeup in order to cover it up and it still looks red in pictures. I won't even let my husband see me without makeup. I am scared to go swimming with my kids because the makeup might wash off. I had the chemical peels so I wouldn't have to wear so much makeup. What would be the best treatment to get rid of the red?

Also I am 37 and have droopy upper eyelids, they almost rest on my upper lashes. The are not crepey but just a fold. Is there something I could do other than eye surgery?


That's a long time to be red! You should not have to suffer through this without help.

I would go to your dermatologist and ask their advice about the redness. IPL photofacial or YAG laser treatment would be a good idea for you. You will probably need several treatments, but it is worth it.

By the way, you may want to speak to the office that did your last peel. This is a problem that they had a hand in causing, so they may want to take some responsibility in fixing it.

In terms of your eyes, I do not think that you are going to get away from having a blepharoplasty (eyelid surgery) - there's no way to tighten that skin non-surgically. The good news is that it sounds like you have an issue that insurance may cover: when the skin folds over so much that it interferes with vision, medical insurance will cover the procedure. I would speak with an oculoplastic specialist.
Hope that helps.

Radiesse in the Tear Troughs

Dr. Rivkin

The middle of this past May '08, I had injections in/under my eye hollows with Radiesse. I had a lot of bruising and swelling, but was told that this would go away, some of the bruises were very deep and purple and lasted nearly two weeks. But, they DID go away.

the end of the second week, I began to swell in a different way all under my eyes, on top of the cheek bone, and got weird discoloration at the sight of the injection. A brownish/reddish color. I went to the Dr. who did the injection and was given a prescription for oral steroids, as well as an antibiotic.

The swelling went away, but even now, mid July the discoloation is there and I need makeup to cover it...it is very noticeable..

do you have any solutions, adivce, or thoughts? what could this be?

thanks so much for you time

-pepper


Hi Pepper,
This is one of the reasons that i do not use radiesse under the eyes. I think this is pigment deposited as a result of prolonged bruising. I'm not sure how to make it resolve. Perhaps hydroquinone cream? I use 8%, but it doesn't always work. steroid injections are also a possibility - I would start with kenalog 10.
Hope that helps


http://www.westsidemedicalspa.com/radiesse.html
http://www.westsidemedicalspa.com/non_surgical_bleph.html

Restylane Cold Feet

Hi Dr Rivkin, I am booked to have Restylane on Tuesday and, after reading some of the horror stories on this site, am now feeling anxious and reluctant. I will not be having Restylane in my lips, but would like to use it to decrease smokers-type lines above my upper lip and improve the slight down-turning at the corners of my mouth. The Dr I will be seeing only uses a topical cream for numbing. I am mainly concerned about the amount of pain I will experience and swelling and bruising afterwards. I have read that using Arnica tablets after the procedure can help with bruising and swelling. I would greatly appreciate your advice as most of the posts on this site regarding Restylane are extremely concerning.


hi,
first off - don't woory.
if you are going with an experienced and qualified injector - you should be fine. the nightmares you hear about are not caused by restylane, they're cause by inexperienced injectors screwing up. topical cream should be fine.
just let it numb for 20 minutes or so.
bruising is always a risk - just talk to your doc and ask him to please be gentle. arnica is a great idea - i give it to every filler patient.
hope that helps

Blue under the Eye due to Juvederm? Use Enzyme!

Hello Dr. Rivkin,

I have been getting filler under my eyes to fill hollows for about two years, first restylane and most recently juvederm. About nine months ago when I went for a touch-up, I bruised quite a bit under my right eye only. Since then, I have a purplish discoloration under that eye that can be camoflauged with concealer but is still very distressing to me. Because it is dark under that eye, it still looks under certain light as if I have a hollow.

The nurse injector said that sometimes blood will get trapped inside the filler itself and that if this is the case, I would need to let the filler completely dissipate so that the the blood can be untrapped. This is not a good option to me because I don't want to have one eye with a hollow under it. Or, she said I could try a laser treatment, but she said that might cause the filler to dissolve as well.

My question is two-fold. Have you heard of blood getting trapped inside the filler? If so, would a laser treatment cause the filler to dissipate? If it does, is it immediate?

Thank you very much for your time.



hi,
you know, that's quite a long time to be walking around with a purple eye, especially since there is an enzyme that is easily obtainable that can dissolve the juvederm under your eye in less than 24 hours! if she really thinks that there is blood trapped in the filler (and there really isn't - its the filler itself that has been placed in too superficial a plane that is probably causing the discoloration - you're seeing it through the skin - its called a tyndall effect), then she should have used hyaluronidase (the enzyme) to dissolve the filler when you first noticed it.
people who are injecting filler under the eye should really not be doing so unless they are comfortable with using the enzyme - my personal pet peeve.
in any case - you should get the juvederm dissolved with enzyme from your right eye and then start over under that eye, taking care that the injector injects into a deep plane.
hope that helps

Freckles and Hydroquinone

Dr. Rivkin
I’m a 22 year old male with red hair and fair skin. When I go out in the sun during the summer time I get freckles all over my face. I was considering using a prescription cream to remove them. I know there are laser treatments but would rather use a cream. Would I be able to use the prescription cream all over my face rather than on individual freckles? If so, would I still be able to get a tan on my face without freckles? If the cream works, would the freckles permanently be removed or would I need to re-apply the cream each year. As far as I know, the freckles aren’t a health hazard and this would be for cosmetic reasons. Would my doctor be able to prescribe the cream for cosmetic reasons alone?


hi
hydroquinone cream is a good way to reduce the appearance of freckles, but they will come right back if you tan.
sometimes the freckles go away and do not come back, but usually, you will have to use the creamperiodically as the freckles do come back.
this is assuming that the cream works, which is not always the case.
if it does not work, there is a chemical peel treatment called cosmelan that can be tried.
if the results of that are not enough, you will have to lose the tan and get photofacial treatments.
yes, your doctor should be able to prescribe hydroquinone, but the standard percentage is 4%. i have the pharmacy make me an 8% cream that i think works better.
in any case, the one thing that will definitely make the freckles come back is sun or tanning. so you need to wear block and a hat.

Botox - When to Come Back?

Hello, Dr. Rivkin,

I'm wondering if you have an opinion about how long someone should wait between Botox injections.

I have an appointment for one coming up next week. I realized looking at the calendar that it will have been exactly 12 weeks since my last appt. It's beginning to wear off.

I've had botox twice -- in my crows feet and between my brows. The first time it worked really well for about a month--and then very quickly wore off. I waited 3.5 months after the first injection and got my 2nd--this one has lasted longer than the first, but as I said it's beginning to dissipate.

My Doc might say it's okay, but I'm just wondering what your experience has taught you--about why sometimes botox wears off more quickly, and if one should wait a while for the stuff to wear off, or treat it as soon as it begins to do so. And then there is the problem of developing antibodies to it if you do it too quickly.


hi,
botox usually lasts about 3 months.
the variability is usually due to dosage. the more botox you put into an area, the longer it will last, up to a point. the price you pay is that the more units you put in, the more paralyzed you are. i would much rather have my patients get less botox and look natural and have good movement. too much botox and they start to look like nicole kidman, and not in a good way.
my patients usually come back anywhere from 2 to 4 months after each dose. if the botox has not completely worn off, that's fine, i just give them a smaller dose and they pay less (i charge by the unit for botox).
don't worry about antibodies - it is exceptionally rare that people develop these to botox.
i would go in when the lines start to bother you. don't worry about timing it.
cheers,

http://www.westsidemedicalspa.com/botox.html