Jack Berdy, MD

It is very unlikely that this is related to Dysport considering you have had it in the past without any problem.  You should follow up with a physician for a formal evaluation.  You mentioned you moved recently before getting the injections, which suggest you might want to investigate environmental factors as the cause of the problem but most important is that you see a physician in person.  Good luck.

Dr. Berdy

Thanks for the question which opens a Pandora’s box of answers.  To first directly answer your question; yes, there are some facial areas that are less likely to have negative side effects such as glabella frown lines (11’s between the brows) nor would one expect negative outcomes in the crow’s feet.  The forehead which is a common area of treatment can have unwanted changes in brow positioning since it is the same muscles that cause both forehead wrinkles as well as lifting the eyebrows, which means as one reduces the contraction that causes forehead wrinkles one also reduces the support for lifting the brows.

Next to address your cost of the product, you should know if you are paying for Botox by the unit or by area.  We charge by the unit which is the only fair standard to go by since you are paying only for what you use as opposed to being charged by the area where you are paying a fixed price regardless for how much you receive.  Also note that many people are concerned about receiving diluted (watered down) Botox which doesn’t happen when you purchase by the unit. A unit is a unit regardless of how it was diluted.

Fillers are somewhat more complex and require a more experienced hand to avoid negative or troublesome outcomes associated with asymmetry, bruising, or more serious problems.  We avoid most negative outcomes by using a microcannula for fillers which results in almost no bruising and improves the safety profile associated with fillers.  We err on the side of caution and almost exclusively use HA (hyaluronic acid) fillers which can be dissolved or reversed.  The cost of fillers is generally priced by syringe. 

Lastly, to address possible cost savings by selecting different physicians, it is rare that you should pay more to get a good result from basic Botox or fillers.  The key to selecting a physician is to select one that is very experienced in cosmetic facial injectables and that is their primary business.  Aesthetic experience is the key criteria for achieving good outcomes, not the physician’s specialty.  For complex procedures, you are best with a plastic surgeon who has gone through extensive training in anatomy but you will pay a higher price for this service.  Most dermatologists treat skin diseases and like with surgeons, injectables are not their focus, and neither have a priori knowledge of aesthetics.  Keep in mind that you will pay more for the service in Manhattan than in the suburbs which is a result of rent differentials and does not reflect on the quality of the physician. 

Also note you can save money by belonging to the frequent flyers club (Brillilant Distinctions for Allergan’s Botox and Juvederm) or (Aspire by Galderma for Dysport and Restylane).  At our office we handle all the initial signup and rewards for our patients, to offer the best experience.

Bottom line is to buy Botox by the unit, filler that is reversible, and an experienced injector that does these procedures all day long.  Good luck

Dr. Berdy

The first thing to note is that you should allow 10-14 days to see the effects of any Botox injection.  Second it is important to note that the face slimming benefit of Botox is gained from the potential long term atrophy of the masseter muscles and not directly related to the short term relaxation from Botox.  It is unlikely that the effects are taking place at different rates but in any case it is too soon to evaluate that possibility. There are several factors such as injection depth, angle, volume, and concentration that may play varying roles in evaluating the end result..While you may see some apparent reduction in the short term from the Botox the true reduction from atrophy will take 6-8 months before it is observed.

Dr. Berdy

You should allow 10-14 days before fully evaluating the effects of Botox, however 1-2 units is most likely an inadequate dose to give the visible results that you desire.  After allowing the appropriate time you should be re-evaluated by your injector and the needle marks you noted should have resolved.  Good luck.

Dr. Berdy

Ulthera specifically notes that no studies have been done on the use of Ulthera on breastfeeding females.  I suggest to error on the side of caution and wait until breastfeeding has ended before treating with Ulthera.