How do most doctors usually handle patients who need to return for symmetry issues or additional units after Botox? (photos)

#1. How do you handle the financial portion of patients who come back to your office 2 weeks after their botox treatment and either need more units, or have symmetry issues requiring additional units? #2. For patients returning to your office after having a recent botox treatment and claim their result is not satisfactory, how do you handle payment issues? In what cases do you provide 're-do's' of botox at no charge, if ever? Thank you kindly.

Doctor Answers 17

Botox Touch Ups?

  Dear nancygraelee,  There is no "formula" for Botox administration and each patient may need more or less Botox for a specific area. I treat these matters on a case by case basis as well. If I am seeing the patient for the first time I tell them up front that I will start conservatively and see them in 2-3 weeks to assess their early results. This may require more Botox and they know up front that this may be the case. Since Botox takes 3-4 months to stop working, I find it easier to ease a patient into the end result rather than potentially over treat an area and have them unhappy for several months. If I have a long treatment history with a patient and they need a "touch up" then I generally do this at no cost. Bottom line....It depends on the situation. Good luck. #Dr. Gervais

Minneapolis Plastic Surgeon
4.8 out of 5 stars 176 reviews

How do most doctors usually handle patients who need to return for symmetry issues or additional units after Botox?

Each doctor injector has their own personal office policies. And this should be addressed prior to injection. I call this the "What if issue!" In my practice I offer 10 units touch up to areas treated within 2 weeks of injection. In my initial fee I have some leeway to offer this opportunity. There are reasons I do this. First, is the allow a better doctor patient relationship to preform the intended treatment to the best result. By additional units of BOTOX might just alleviate any issues as to results (hopefully). There are always some patients that desire more units than are willing to pay for them. But in general 85% return for I call this the "touch up" visit. The second reason is at this secondary visit over 60% ask additional cosmetic skin care/surgery questions. Thus this allows as we say an upsale. Recently I have seen younger BOTOX patients stating they are receiving $5/unit charges. I find this unbelievable, but they are intelligent young patients. I try to explain that the pure cost of 50 units is just below $300 from Allergan so from there the per unit cost is $6. Than add office overhead costs, and professional component to the fee. Thus I believe these $5/unit fee are either illegal BOTOX, diluted BOTOX, or just out right lies to the prospective younger patients..Other expert postings would be appreciated... from MIAMI   

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 174 reviews

Charging for Botox "touch up"

I handle this on an individual basis. If there is a small asymmetry and I think that it can be fixed with a little extra product I do not charge. Making a patient happy is worth a few dollars to me. However, if I told a patient that they needed 50 units and they did not want to spend what that cost I will not give them more for free when they say that it didn't work. Also, if a patient just desires more product, they need to pay for it. I also charge by the unit. 

Jo Herzog, MD
Birmingham Dermatologist
5.0 out of 5 stars 19 reviews

Botox pricing

There is a lot of variation in the pricing structures. There are two main methods in place.
1. By the area.
2. By the units.

I used to charge by the area (site) and if patients needed a little touch up within the first two weeks after the injection, there was no charge.
Lately I have switched to charging by the unit. If patients need a few more units to achieve symmetry then they pay for those extra units.

Either method is ok to use. The most important thing is communication and clarity in explaining to the patient the method of calculating the price. As a patient you should not hesitate to ask the doctor or staff to explain it. It will only make things easier for everyone. I have a written protocol that I give to patients to explain things in detail.

Dr. J

Disclaimer: This answer is not intended to give a medical opinion and does not substitute for medical advice. The information presented in this posting is for patients’ education only. As always, I encourage you to see your personal physician for further evaluation of your individual case

Tanveer Janjua, MD
Bedminster Facial Plastic Surgeon
5.0 out of 5 stars 104 reviews

Botox/Dysport "Touchups"

Hi Nancy.  Great question....but one without a simple answer.  There are two situations we encounter periodically when it comes to our 2 week checkup.  The first is the patient that did not go with our recommendation.  If a patient chooses a smaller number of units than we advise and then is subsequently disappointed with the results, that patient will always pay for the additional units.  It usually takes a little reminder, but once discussed, most patients just understand that they needed more product to achieve all of their desired goals.

The other situation (usually with first time patients) is that something about the injection did not turn out exactly as we thought it would.  While this does not happen often, it does happen.  When it happens, we correct it on our own dime.  Usually once the "formula" is developed with new patients, it becomes easier to inject and these situations are avoided.  This is also why there is value in trying to find one injector you are comfortable with and sticking with that person.  

To view Dysport before and after photos, take a look at the link below.  

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.4 out of 5 stars 7 reviews

Botox touch-ups

Botox is a great treatment, especially for the glabella, forehead, and crow's feet area.  If there is a small asymmetry as the result of injections then there is no charge at the two week follow-up visit.  If a patient needs an additional area such as the forehead and only paid for the glabella area, then the patient needs to be responsible for the additional area of Botox.  For the best results please consult a board certified dermatologist with a great deal of experience with Botox.

Michele S. Green, MD
New York Dermatologist
5.0 out of 5 stars 78 reviews

Hybrid of Area and Unit pricing

Hi Nancygracelee,

I used to charge by the area $450 for the first area (no specific dose) and $300 for additional areas.  Since I started injecting Botox for patients with enlarged masseter muscle from grinding their teeth, I created a hybrid pricing of both area and unit.

I treat 4 areas with botox: The frown lines, forehead, crow's feet, and masseter muscles.  For the first area treated there is an injection fee of $150,  additional area injection fee is $100.  Then there is a separate unit dosing fee of $10/unit.

For the typical dose of 20 for the frown lines, the hybrid calculation is now $150+(20x$10)= $350. A second area which also uses 20 units is then $100+(20units x$10/unit)= $300.  

If a male patient needs 30 units for the frown lines, then they would pay $450, but a petite older lady who doesn't want to be overly frozen may only use 15 units which would then cost them $300.  

The injection fee is for the time and supplies used to perform the procedure.  1 syringe, 2 needles, 6 injection sites (3 on each side for frown lines).  It doesn't matter to me if they use 15 or 30, the number of injections performed is the same.  However, the man using 30 units should pay more than the older woman who only used 15.  If the woman comes back in a week or two and decides it was too weak and wanted another 5 or 10 units, then I will not charge another injection fee, only $10 per unit for as much as they want to finish treating that area.

By charging for an area only, some repeat injection and more botox is essentially bundled into the cost whether the patient uses the extra or not.  I think this hybrid pricing helps to separate out the labor from the cost of the supply.  If more botox is needed, it is usually a small fee.

Occasionally there can be a Botox "dud" in which all of the patients treated with the same vial did not get any result.  If this can be proven, then the company will provide a replacement vial and I will perform the re-do at no charge.  However, this is rarely the case.  The patient may report that the botox worked for one or two of the areas, but the crow's feet was not enough or it is wearing off faster than the frown line or forehead (which is usually the case.)  Since the botox clearly worked, I can only offer more units of botox without charging a second injection fee for the same area.  This seems fair to my patients and we have not had any complaints.


Dr. Yang

George Yang, MD
New York Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

Botox Touch-ups

Thank you for the question. This is a gray area in cosmetic medicine and is best handled with a practice-wide policy. In my practice, as is typical for the West Coast, Botox is administered by the unit (i.e., patients pay for a certain number of units --  and many request that number). This doesn't leave much room for free touch-ups, but if a patient has some asymmetry or really needs a couple more units for the desired affect, I do it for free.  It is more common to see this in practices that charge by the area (e.g., forehead treatment costs $X regardless of the units used).  In these situations, if the patient is undertreated, a free touch up is more than justified.

Evan Ransom, MD
Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 113 reviews

Botox touch ups

Each office has a different practice on touch ups, but our response is we "comp" the extra units.  First, we see all our first injection patients (or first time in our office) three weeks after botox to provide an objective response.  That way I can see either best case scenario of how it affects patients, if they need a touch up, or if they need additional filler to deal with the residual fold or etching that botox can't fully efface.  That gives me an accurate expectation of how our selected dose performs.
I comp any additional botox required in that meeting for a couple of reasons.  One, I consider myself an expert in neurotoxins, capable of providing the best outcome that is available with the medication.  So I hold myself to a standard that is different than "discount" and non-core specialty providers.  Two, I feel we are well versed in how the medication is supposed to behave, and where it provides the best outcomes.  So I think a re-do isn't a failure, because we all will have areas we can touch up.  But personally I want to see the full result as much as the patient does, so I don't mind comping a few units to get there.  And three, I want the customers to receive boutique care.  So they need a little something for the effort.
And they the patients are happy, they return in the future, and I apply what I learned from the touch up to make future injections more effective.

Kevin Robertson, MD
Madison Facial Plastic Surgeon
4.7 out of 5 stars 14 reviews

Botox touch-ups

For patients who have the amount of botox I recommend at the time of their initial consultation, I will do minor touch ups at no charge providing they return with 3 weeks of the initial injections. For patients wishing for further improvement in treated areas I will frequently do at no charge but I indicate to these patients that they will require more product with their next treatment. I make it clear to patients who might desire a dose less than what I recommend that there will be additional charges if they need additional product and these patients are charged. We have never had a request for a refund after doing thousands of Botox injections since 2007.

John Porcaro, MD
Port Saint Lucie General Surgeon
4.2 out of 5 stars 10 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.