Virgin to Any Facial Fillers, Treatments, Botox?

I am 39 and I believe very attractive. I went in for a consult at a PS office with his nurse that does all of the skin procedures for him. I explained I just wanted to look a little refreshed. She told me I needed the following 1. Ultherapy $1750 2. Botox 57 units $570 3. IPL 5 sessions $2500 4. 5 syringes of Juvederm and one other filler for $2500 Does that seem extreme to you? I thought it seemed right but now after reading other posts, it seems so. Thanks!

Doctor Answers 5

Facial aging

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You have seen the marketing side of cosmetic surgery. They will advise you to get the treatment for every machine the own.

You have not seen the doctor!!!!

Just to feel refreshed , clear skin, glowing skin. You may only need medical grade skin care that will cost less than $500 and lasts 3-4 months.

May be a chemical peel.

Baltimore Plastic Surgeon

Proper and Natural-Looking Facial Rejuvenation Requires Restoring Lost Volume & Skin Resurfacing

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Without photos it is difficult to say what you particularly need. However, in general terms, rejuvenation of the skin requires attention to restoring age-related volume loss (loss of fat, muscle, bone and cartilage) and resurfacing the skin (smoothing, softening, brightening).

It has only been in the past ten to fifteen years that we have had what might be described as a revolution in our thinking about what happens to our faces (and necks and hands, for that matter) as we age. Whereas once we thought that everything related to combined effects of gravity and skin laxity (looseness), which led to aggressive, invasive plastic surgery procedures (i.e. facelifts, necklifts, and blepharoplasties) to pull skin tight and cut off excess skin, today we more correctly understand that much of the aging we see arises from the loss of volume underneath the skin, i.e. loss of bone, loss of cartilage, and loss of fat.

So, when we see with the passage ot time a nose drooping, where once it was upright and straight, we know it's because of a loss of supporting cartilage underneath the tip. If we see jowls along the jawline, or pronounced smile lines and marionette lines, we appreciate that there has been loss of cheek fat and a displacement downward of the remnants of the cheek fat pads that are at the root cause of these problems. When we sigh at the development of bags, dark circles, tear troughs and hollows under the eyes, we can appreciate that they have come about by the vacuum left as the heart-shaped, robust fat pad that once inflated that area has shrunken and shriveled and gone Southward and inward leaving the skin resting on the bone of the lower portion of the orbit of the eye and reflecting the dark underlying blood vessels and musculature in the region. And when we compare the face of a young Gregory Peck with that of the actor at a more advanced age, we realize that these changes in face shape, width, etc.,are due to underlying bony changes and reorganization.

If we have a favorite armchair that loses its tufting with time, do we send it off to the upholsterer and expect that the upholsterer will simply pull the remaining fabric taut and trim off the edges so that we end up sitting with our derrieres right on the wooden frame. Insead, we expect him to replace the lost stuffing. But that's not what surgeons routinely did to their patients in the past. They pulled the skin tight over the underlying bone and trimmed off the excess leaving their patients smooth, but looking like skeletons or cadavers or to use the words of one prominent NY plastic surgeon, "deformed." The famous comedienne Phyllis Diller used to poke fun about her freakish post facelift look.

It's taken us a long time, but we now know that restoring volume to the face (and to other deflated areas like the hands, etc.) is the essence of rejuvenation. It's not enough to tinker with the house. We need to fix the aging and shrinking foundation.

Fortunately, we have a whole variety of regulatory agency-approved volumizing fillers, like Radiesse in the U.S. and many others in other places, like Europe, Canada and Israel (Stylage XXL, Restylane SQ, Juvederm Voluma) that allow experienced aesthetic physicians to inject the precise amounts in the exact locations to quickly and easily (in minutes) restore more youthful facial contours without the need for scalpels or stitches and surgical scars. What's more, as a person ages, the exact placement of the materials and the quantities can be modified and tailored to precisely fit the aesthetic needs of the moment. Something that also cannot be as easily achieved with the surgical use of fixed- sized permanent implants.

Neuromodulators (Botox, Dysport, and Xeomin), too, can take a prominent role in rejuvenating when hyperkinetic muscles of facial expression contribute to crow's feet, worry lines, scowl lines, and bunny lines, for example. When these are present, treatment with neuromodulators can yield extremely gratifying results.

Unfortuantely, for the most part, I have not been impressed with the benefits of IPL and fraxel lasers, nor of the current radiowave or ultrasound therapies for either skin tightening or texturing. There is a whole lot more of marketing hype than hard science for a lot of these so-called "energy-based" devices. Chemical peels, on the other hand, are tried and true modalities that have a proven track record for smoothing and brightening skin, flattening rough spots and evening out blotchy discolorations.

So, while I could not comment on the specifics of this case, the recommendations cited in the question seem a bit much, to say the least, for a 39 year-old who describes herself as very attractive. Of course, it should go without saying, that consultation with a board certified aesthetic physician with extensive experience with all forms of injectable volumizing fillers, neuromodulators, and peeling agents is a must for achieving truly natural and gratifying results.

Nelson Lee Novick, MD
New York Dermatologic Surgeon
4.9 out of 5 stars 33 reviews

Rejuvenation Options for First-Time Patient

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I am sorry for your experience with this nurse in the plastic surgeon's office because not only is it disgusting how much was recommended to you, but that you were seen only by a nurse and not with the doctor himself.  If you are looking for a mild, conservative rejuvenation/refresher, it is very likely that you don't need any of the things she tried to sell you. Perhaps all you need is a good skincare regimen and/or something very easy and light like a micro-dermabrasion treatment or light chemical peel.  Obviously, it is difficult to recommend anything without seeing you in person. I would suggest consulting with a board-certified dermatologist who will be seeing you him/herself and not dishing you off to a PA or nurse.  Good luck!


Channing R. Barnett, MD
Boca Raton Dermatologist
4.1 out of 5 stars 8 reviews

No need to undergo treatments you don't see a need for

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It seems this nurse was not listening when you said you wanted a little freshen-up.

There are a lot of simple procedures that you can do a little at a time along the way to stall the aging process and to brighten and lift.

Pick what bothers you most and attend to that first. If it's a frown line you might be perfectly happy with Botox alone. If it's some discoloration, only the IPL or some good skin care products. You are always in the driver's seat, so don't be pushed into treatments you see no need for.

How YOU feel about your looks is most important.


Rebecca Fitzgerald, MD
Los Angeles Dermatologic Surgeon
4.1 out of 5 stars 22 reviews

Too much too soon

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Yes, this does sound much too extreme to me as well and it sounds likely that you will never even see the doctor so you are paying a tremendous amount of money for a nurse's opinion and expertise. For all of my new patients I usually recommend starting slowly and first addressing their particular concerns. Plus I do all of the injections for my patients.

Mitchell Schwartz, MD
South Burlington Dermatologic Surgeon
4.7 out of 5 stars 12 reviews

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