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Everything One Needs to Know About Botox

Botox Treatment by MedCos

In this article, Dr. William A. Carter answers all of the most commonly received questions about our Botox treatment at Medical Cosmetics. For more information, please don’t hesitate to contact us today. We’d be more than happy to schedule a consultation.

What Happens During a Visit for Botox?

I will ask the potential patient what they already know about Botox and what they would like it to do for them.  Answers to these questions let me know how much additional information I will need to provide and whether or not Botox (or one of the other FDA approved botulinum toxin-A products) is the best option for their goal(s).  After the ensuing discussion and if it is mutually agreed upon that Botox is the best way to accomplish the patient’s desired goal, then pre-treatment pictures are taken.  For the first Botox treatment with me, I like to obtain a beginning set of facial pictures that are taken both at rest and with specific facial movements.  This will enable me to have the patient return in 2 weeks (when the full benefit of the Botox treatment has become evident) and compare pre and post-treatment pictures.  The patient and I look at these pictures together.  For any area of the face that I had treated with Botox, if either the patient or I are not completely satisfied with the result, then we discuss whether additional Botox would achieve a more desirable result.  If it would, then I would provide the supplemental Botox at no further cost to the patient.  (The cost of this additional Botox is variably dealt with on an office-by-office basis.  Some offices charge full price for this supplemental Botox.)

Botox LogoThe majority of offices do not provide the benefit of topically numbing the skin prior to injecting the underlying muscles with Botox.  At my office, all patients are given the option, of topical skin numbing and most of my patients avail themselves of this partial discomfort lessoning technique.  To be fair, for most of us even without topical numbing, the injection discomfort is minimal and brief.

Botox is inserted into the relevant muscles for treatment with a tiny 31 gauge needle.  After the treatment, patients will have visible small areas of swelling where the Botox was injected.  These last for about 5 minutes.  Rarely, a bruise may occur at one of the injection sites.

I do not insist nor even any longer suggest that my patients observe any “do’s or do not’s” after a Botox treatment.  I tell them all to go about their day and their life just as they were planning to do.  After having done 55,000+ Botox treatments over 20+ years, I have found that the industry concerns regarding spread or late occurring Botox effect at a non-injection site have never materialized.  Do not worry about this.

Medical Cosmetics Botox

What Does Botox Cost?

At my office Botox costs $14.50/unit.  Dysport is $5.70/unit.  Jeuveau is $13.00/unit.  Note that for equivalent effect, 1 unit of Botox = 2 ½ units of Dysport = 1 unit of Jeuveau.  Some offices will charge considerably less per unit of any of these products, and then also charge a flat “injection” fee.  At Medical Cosmetics we do not have an injection fee.  If a patient is receiving 100 or more units (this is rare) of Botox at one session, then their cost would be $13/unit.  Also, if the patient is receiving 2 or more syringes of facial filler at the same time as their Botox, there will be a factored-in discount of 10% for their Botox, or possibly a discounted $50 off of the combined cost of the Botox + filler.  Offices vary widely in their approach to these things.

Typically, one could expect to pay approximately these costs for relaxation of expression wrinkles for these regions of the face:  Glabella (the part of the forehead between the eyebrows) $130-290.  Crows feet region (both sides) $104-290.  Forehead $26-145.  “Lip flip” or treatment of either upper or lower vertical lip lines $52-116 (per lip).

What Are the Possible Side Effects of Botox?

Common side effects of Botox include:  A chance of 1 or more small bruises, incomplete achievement of the desired effect, or possibly an undesirable change in eyebrow position.  Much rarer side effects would include a transient headache, or temporary mild respiratory congestion.  I have never encountered “spread” of Botox effect or unanticipated Botox action away from the injection site.

How Long Does Botox Last?

For facial use, Botox will last between 3-4 months in 85% of all people.  The unfortunate 7½ % among us will only enjoy 2 months of diminished wrinkling from a Botox treatment.  The genetically blessed 7½ % of us will have 5-6 months of wrinkle relief!

Interestingly, when Botox is used for localized sweat reduction it will last an average of 8-9 months.  I do not know why this is the case.

Where Can It Be Used?

MedCos Botox Injections

I will most often use it in the office, but sometimes we do “Botox Parties” at individual’s homes or at hair salons. Botox is used most often in the upper face as listed in the answer to the Cost question above.  It can also be used around the nose, the mouth, above or below the jawline, the anterior or posterior neck, and anywhere there is excessive sweating.  When we use Botox for the prevention of migraine headaches, in addition to many of the aesthetic areas that are injected, it is often also injected into the temporalis muscles, the posterior cervical muscles, the superior aspects of the trapezius muscles, and sometimes even into the scalp.

How Does Botox Work?

This is the most fascinating story, and it is a bit complicated.  Suffice it to say that Botox weakens muscles by interfering with acetylcholine release at the neuromuscular junction.

If I Have Botox Once, and Then Never Again, Will My Wrinkles Be Worse Than Before I First Had It?

Absolutely not!  In fact, it could logically be argued that even one Botox treatment every 5-10 years would help to lessen the depth of memory etch creases on a person’s face over time.  Of course, the more often one has Botox treatments the less the evidence of expression wrinkles over time.  This desirable outcome tends to lead to recurrent reinforcing Botox utilization behavior.  This is why I sometimes refer to Botox as “cosmetic crack.”

It Sounds Like Most of the Botox Treatments That You Do Are for Appearance Enhancement.  Do You Inject Botox for Other Conditions?

Most definitely.  We do a great many Botox treatments for migraine headache prevention.  In fact, I have been injecting myself for this reason for 20 years.  This keeps me completely migraine free unless I wait too long between treatments.  We also do a lot of treatments for TMJ pain, teeth clenching/grinding, and even sometimes for cases of depression.

William A. Carter, M.D.

Medical Cosmetics, LLC

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