Kathryn R. Shrift, MD (retired)

Some people will dilute Botox to a greater degree to treat areas where they want the toxin to diffuse more widely, such as the forehead, in hopes of getting a more even result.  As long as they are charging per unit Botox and not for the amount of fluid that each unit is diluted in, then they are not ripping off their patients.  A temporary side effect of using a greater dilution (such as 2cc per 100units of Botox as opposed to 1cc per 100 units) is that the larger amount of fluid will create more of a welt under the skin.  However, this should go away rather quickly.

Thanks for your question and for uploading those photos.  The name for what you're seeing is purpura, and happens as a result of breakage of a blood vessel under the skin.  Although not always seen following IPL, it can happen, especially around the nose.  Although inconvenient in the short term (it may take a week or so to resolve, similar to a bruise), the good news is that it means those vessels were severely damaged by the laser and are likely to resolve!

While Juvederm and other hyaluronic acid fillers are great choices for certain problems such as fine lines and the hollows under the eyes, it unfortunately is not more effective and in fact Radiesse tends to last a bit longer.  The most common reason for experiencing "minimal non-lasting results" is use of too little product in the initial treatment session.  Perhaps 2 or 3 syringes of Radiesse would have gotten you the results you were looking for.  If you're wanting the longest lasting option, then ask your physician about Sculptra, but be prepared to wait to see results, as improvements are not immediate.