In this tight economy many people are shopping for Botox cosmetic aggressively by price. Here are some pearls to keep in mind when doing so:

Genuine Botox cosmetic by Allergan is supplied to practitioners in freeze dried bottles of 100 units. Unlike fillers which come in pre filled syringes of set volume, the practitioner mixes and dilutes the strength of the Botox. The stronger the concentration, the less you need. Generally most people either dilute the 100 units with either 2.5ml or 4ml of saline. This yields botox concentration of 4units/0.1ml or 2.5 units/0.1 ml. (some practitioners may dilute it more but it’s not typically recommended to do so)

Why is this important? When you are price shopping are you being quoted a price per unit or a price per area? If its a price per area and is cheaper chances are you are getting a more dilute concentration.

Is this bad? Not necessarily if you are being made aware of it, it’s just that I think you will get a better and longer lasting result with a higher concentration.  Also if you don’t get as much result as you like when you pay by the unit you just pay for as many more units that you need, not the whole area again. Pearl: Its OK to ask what concentration and how many units you are receiving.

Second big question to ask when shopping: Who’s doing the injection? Doctor? Nurse? Aesthetician? Why is this important? Botox achieves it’s effect by weakening muscles that cause wrinkles and lines when moving. To be most effective it needs to be injected into the muscle itself. Does the injector have the training, background and familiarlity with the facial muscles to be certain you are getting the most injected into the right place?Remember we are talking about very small volumes and concentrations here. You want to be sure it’s going where it needs to, not the skin or surrounding tissues where it will not have much effect-especially if you are paying per unit.

Bottom line-paying a little more to get injected by a skilled doctor using higher concentration Botox may in the long run save you a lot in satisfaction and longevity of results than a cheaper salon or mall injection.

Last pearl: Just like many other products the more you buy the better chance for additional discounts. Get a group of 3 or 4 friends together and most offices will give you a discount if everyone is getting it together. Plan on the future and negotiate a discount for your next treatment at the time of the current one by making a partial payment towards it. Consider a package combination of Botox and fillers and you can get a discount for multiple treatments done together.

Lots of patients inquire about the use of fat vs fillers (Restylane, Juvederm,Radiesse etc) for youthful enhancement. Often the answers they receive reflect the biases and experiences of the injector.

Simply summarized, here are the pros and cons of each:

Fat is your own tissue, its often available in quantity (unfortunately!) and is very versatile in many areas of the face (lip, brow, cheek fold etc).  The downside is that it requires a surgery to harvest with all its inherent risks and recovery.

Fillers are readily available without a procedure, offer uniformity of manufacture and composition and can be received in a simple office visit. The downside is that no one filler is great for all areas, and the length of time they last before needing to be repeated varies.

Here are some pearls for the “educated consumer”. Success with injectables whether fat or filler is highly dependent on the skill of the injector. Who’s doing it (doctor, nurse, aesthetician)? How often do they do it, what’s their background (surgeon, dermatology, ob/gyn, fam practice)? etc. Don’t be afraid to ask!

One argument I often hear is that fat lasts longer and is sometimes permanent compared to fillers. Whenever I hear this I always think of the child’s riddle of what weighs more, a pound of feathers or a pound of iron. Most injectable treatments use prefilled syringes containing 1-1.5 cc of material, with patients receiving anywhere from 1-4 syringes. I’ve seen many demonstrations of  fat injections where the doctor injected 40 0r 50cc’s of fat or even up to 80 or 90 cc’s! If you put that much Juvederm or other filler in someone’s  face they’d make Peanut’s Charlie Brown look anorexic! So while some of it may last a long time, most of it is gone pretty fast.

One last pearl about permanence with any filler-they are kind of like tattoos, you’d better love the result in your face because if it’s a permanent (silicone?) injection it’s going to be there for you (and others) to look at for a long time.

Many patients come to see me wanting a specific named lift. Often they’ve seen or heard about it on TV, magazines or the internet. They are often excited and hoping to hear that there is a “new” lift which they can have in an hour, immediately return to normal activity, have no recovery time, little risk and look 20 years younger!
I wish it were so.
So what are these lifts? As the trend to less invasive procedures has increased surgeons have developed a variety of procedures using shorter incisions (the “S”). In selected patients these offer the option of improved appearance with quicker recovery and less downtime. Despite all the different claims of uniqueness, most of these are all variations of similar techniques and procedures. The different names are often created for marketing purposes only.
So what should a patient know when trying to make sense of all these lifts?
I usually try to teach my patients to try not to fall into the trap of making themselves fit a branded procedure, but rather find out what different techniques the doctor is able to use to fit their personal desire for improvement. When you’re looking to have facial rejuvenation work done remember that it’s going to be right out there for everyone to see so get what’s going to meet your needs, not the popular media technique of the month! Ask lots of questions of the doctor doing the procedure, not the screening consultant. Use your judgment, can you really wipe away 20 years without some downtime? Does one technique fit everyone?

For more information write back or call 561 655-5562.

I would like to wish all my patients and guests a merry christmas and happy and healthy new year. My staff and I will be taking a break from Dec 25th to Jan 2nd. we all look forward to an exciting 2010.