Under treated and over paying for Botox? Movement in forehead and eye area after 6 weeks. (photos)

32 year old Female.I have been getting Botox since I was 28. I've gone twice now to a reputable MD derm in my city for Botox. Price is flat few $600 for a "full area." I was treated with what she called "baby Botox." It's been almost 7 weeks and I can fold my forehead quite a bit. I don't have static wrinkles, but do have a highly expressive forehead in addition to a strong glabellular muscle. I feel I am over paying for treatment. Even my eye area has movement. Am I getting ripped off?

Doctor Answers 10

$600 for Botox in forehead

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Hello! Thank you for your question and for sharing your pictures. Different offices use different pricing strategies-some doctors price Botox by unit, others price Botox by area. If you've paid a "per area" price, you should be given a dose which meets your personal expectations regardless of how many units that takes. However, sometimes it takes a couple of visits to establish the right dose for each individual - and if you do not tell your doctor that you are unsatisfied, there is no way that they will know that you need a higher dose. I would recommend that you go back to your doctor, and request additional units in the areas were you feel like to have too much motion. I hope this helps!

Denver Physician

Botox injections for the forehead

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Hi, thank you for your question.  Botox in cosmetic surgery is used to immobilize nerve impulses from reaching selected facial muscles in the forehead.  Several rounds of treatment are suggested as the drug needs to build a residual base on which to build on.  The results of Botox are expected soon after the injection, but reaction times vary. It’s been 7 weeks since your procedure and you shared your concern about there isn’t enough immobilization (i.e., your eye area still has movement).  I would suggest that you give it some time for the full effect of the drug’s binding to its muscle receptor, to manifest more fully.  By the 12th week after your procedure, the drug is no longer bound to its muscle receptor, making it an ideal time to have a second injection. Waiting longer means that the effects wear off and the next treatment will not have a residual base to build upon, it will be like starting over from scratch. Others prefer to wait longer, having follow up injections when the drug has mostly worn off but may still have some residual effect – this would be at 4-6 months after the 1st injection.  And still others wait till they see unacceptable amounts of movement of wrinkles before returning for more injections. 

Jan Zemplenyi, MD
Bellevue Facial Plastic Surgeon
5.0 out of 5 stars 17 reviews

How long should Botox last?

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In the a past few years there has been a movement toward less paralyzation of the musculature with Botox. In my office we aim to have no lines at rest but still have some movement because we feel this is the best of both worlds. You don't look "frozen" but the wrinkles aren't getting a chance to be etched into your skin. We expect some motion after treatment and just because you can make wrinkles or folds at full contraction doesn't mean the Botox isn't doing what it's meant to do, which is to keep your skin looking fresh and youthful. More Botox initially may seem to last longer (less movement) but it doesn't really make a difference in the end, everyone still needs re-treatment after 90+ days.  I can never understand the need to not be able to move when you express yourself. So, possibly your doc is in the same mindset of many of us and that is to make you look good without looking frozen or fake.  

Lee P. Laris, DO
Phoenix Dermatologist
4.8 out of 5 stars 16 reviews

Botox results

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Thank you for your question pele713. I am sorry to hear about your situation. Botox is a purified protein used to address wrinkles associated with facial expressions such as those seen when one raises the eyebrows or smiles. In our office we have patients return two weeks after their treatment at which point the peak effect of Botox is seen. At this time we take after photographs to assess the results and determine if additional units are required. If the recommended dose is used at the initial treatment and the results are not perfect, we provide complimentary additional units. In this way we are able to guarantee our results. Some offices charge for Botox by the unit, while others charge by the area. Please follow up with your doctor for specific recommendations. Good luck!

Botox results

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In most cases Botox results last 3-4 months with good injection technique and proper dosing. There is a small group of patients for whom Botox will last less than the 3-4 months. My concern when injectors price by area is that they are tempted to use a lower dose to improve their margins. That is one reason why I just use per unit pricing. If under injection is the problem in your case, then a higher dose will give you a longer duration of action. I would discuss with your injector your concerns and ask to know how many units were injected into your frontalis muscle. In my practice, I usually inject 8-10 units into the frontalis in the average patient. Males and those patients with a stronger frontalis muscle of course require more Botox.

Get your Botox how you like it

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You need to get your Botox how you like it but beware that there are some trade offs. Over injecting the forehead can lower the brow. I prefer my patients have some movement of forehead but maximum brow lift. If you paid by area you should get area how you want it. If you want no motion, go back and ask for that to be corrected.

Jo Herzog, MD
Birmingham Dermatologist
4.8 out of 5 stars 20 reviews

Under treated and overpaying for Botox

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Go back to see your doctor to discuss your concerns in person.  If you are not happy with your results, then you should see another doctor for your injections.  I do think that paying by the unit is a better situation for the patient than paying per area.  When you pay a flat fee per area, the injector may have an incentive to use a lower number of units, which could possibly lead to sub-optimal results.  Regards,Dr. Ort

Richard Ort, MD
Lone Tree Dermatologic Surgeon
5.0 out of 5 stars 28 reviews

Botox longevity

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It is best to follow up with your treating physician and discuss your expectations for treatment.  Typically if your botox isn't lasting 3 months you may need more botox.

Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 521 reviews

Botox for forehead

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Obviously, you have lost faith in your doctor and you should sit down and talk with her about your expectations and how you can achieve them. $600 is not overcharging for this area

Melvin Elson, MD
Nashville Dermatologist
5.0 out of 5 stars 7 reviews

Movement in forehead and eye area after 6 weeks.

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Thank you for your question.  Rather than venting in this online forum one may be more effective with confronting the treating physician.  Most reputable physicians would want to know if a patient is satisfied and happy with the results of treatment.  In my practice if a patient came back at two weeks with persistent movement then we would discuss additional treatment to correct the appearance.  Reach out to your physician and let them know of the movement persists.  Good luck.

David J. Wages, MD
Peabody Plastic Surgeon
4.8 out of 5 stars 33 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.