Thank you for your question KimPP. I understand your concern. Botox is a purified protein used to address wrinkles associated with facial expression. When injected into the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The most common areas of treatment are in the upper face. These include the horizontal lines seen on the upper forehead when one raises the brows, the vertical lines seen between the brows when one frowns (frown lines), and the crow's feet seen around the eyes when one smiles.Botox comes in a powder in small vials on dry ice or a cold container. Upon receipt from the manufacturer the product is refrigerated or frozen until it is used. However, there have been reports that if the product is left at room temperature upon arrival for as long as 72 hours before refrigeration, there is no change in efficacy. Per the manufacturer’s guidelines, Botox is prepared by reconstituting the powder with preservative-free normal saline. I prepare the product using preserved saline which allows for greater comfort during injection and for the product to last longer. The guidelines call for use of 2.5 mL of saline for 100 units on Botox or 1.25 mL of saline for 50 units of Botox, which yields 4 units per 0.1 mL. I use these volumes, but some doctors prefer to use more or less to make the product more dilute or more concentrated. When the product is more dilute, it is easier to use smaller doses which are generally required in the lower face. On the other hand, when the product is more concentrated, it is less likely to spread. Because of variability in preparation, the terms used for dosing are units, not volume. This is because the same number of units can be administered with different volumes of product depending on the preparation. Recommended dosing is given in units, which is a measurement of activity seen in laboratory testing. Depending on the size of the syringe and the reconstitution method, a variable number of units can fit in one syringe. I use 1 cc syringes with the reconstitution method described above. Therefore, a full 1 cc syringe will hold 40 units. Usually I do not fill the syringe completely. For example, when using 20 units, the syringe will be filler half way to 0.5 cc.Botox is a prescription strength medication that is injected into the skin or other areas. Therefore, it is important that the treatment is performed by a trained medical professional. This can be a physician, physician’s assistant, nurse practitioner, or nurse. Laws vary from jurisdiction to jurisdiction on who is allowed to provide the treatment. In California, for example, any of these aforementioned medical professional is permitted to provide a treatment. With the recent explosion of cosmetic medicine, there are more and more people offering such services. This includes core physicians such as plastic surgeons and dermatologists as well as other physicians who are trained in cosmetic treatments such as general physicians, gynecologists, or other specialists. It is important to understand that just because a doctor is a plastic surgeon or dermatologist does not necessarily make them an expert on Botox. General doctors who routinely perform Botox treatments multiple times per day likely have more experience and expertise than a plastic surgeon who spends most of his time performing surgeries and performs perhaps only a single Botox treatment per month. Similarly, there are many outstanding nurse injectors who spend their entire days performing cosmetic treatments, as they are often delegated to nurses. Their experience can at times be great than that of many doctors. This understandably makes it difficult to find a good provider. I recommend looking for experience (specifically in Botox and other minimally invasive cosmetic treatments such as fillers and lasers), before and after photographs, and testimonials. Looking for an office who offers the most competitive price is often a recipe for disaster. We have had many patients come to our office to correct various issues they have had when they selected an injector based on price alone.The investment for a Botox treatment varies from office to office. It depends on the region, office, and injector. The total investment also depends on how much product is required, the areas treated, and the individual. For example, if someone has a larger forehead, a higher dose will be required. If multiple areas such as frown lines and crow’s feet will be treated the investment will be more than that if only a single area is treated. In general, men have stronger muscles than women both on the body and on the face. For this reason, men usually require higher doses than women. Please click the link above for more information. I recommend that patients look for a qualified injector instead of the best price. Look for experience, before and after photographs, and testimonials. The investment range for a Botox treatment is $200 - $500 per area. Areas include frown lines, crow’s feet, etc.With any injection, there are risks such as pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take special precautions to minimize these risks such as using a painless technique. We also treat bruises with a laser as early as the next day. Bruises usually resolve within two weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take two weeks for full resolution. In addition to these risks, with Botox there is also a risk that the product spreads or diffuses to nearby structures. Spread to nearby muscles can lead to side effects such as the temporary appearance of droopy eyelids or a temporary asymmetric smile.
