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March 2006
by Dr. Amy M. Ortega
Medical / Plastic Surgery
Know Your Botox®
Botox® injections have become one of the most-popular, nonsurgical treatments for facial wrinkles. Many doctors, spas, and other types of clinics are offering Botox®, and at a wide price range. With so many options and little knowledge, many people opt for the least expensive, thinking that all Botox® treatments are alike. However, what they don't know can hurt them. Here's how to prep those patients who might seek other methods of freezing time.
What's in the mixture?
Botox® is being sold by only one manufacturer, Allergan (visit the websites www.Botox.com and www.Botox®Cosmetic.net). And it comes in a powdered form with 100 "units" to a vial. It is then "reconstituted" with normal saline solution, which is the same type of saline from a hospital IV. There are many ways to dilute the substance—some doctors prefer a concentrated solution, while others prefer to dilute it with more saline before injection. Patients should know that what matters is not so much the volume they receive, but the number of units. In other words, more volume injected does not necessarily mean more Botox®!
Facial dynamics
If your patients end up a bit confused, reassure them that there's much more to Botox® than meets the eye. Different areas of the face require different Botox® amounts to achieve the desired effect. And, it's very hard to compare one treatment to the next.
Men generally require a little more Botox® if their faces are muscular.
Also, people whose faces are more muscular, such as some men, will require more Botox® to get the same result as some thinner women, who have less muscle mass in the face. People with more dynamic wrinkles may also require more injections, which results in more Botox®, to get the effect. The right amount for the average person is usually within a certain range, but because this is not an exact science, patients should not assume the "average" dose will fit perfectly for them.
A dash of...
Patients may wonder, "how does 'fewer units' per treatment affect me?" Patients may not get as significant of an effect as if the proper amount was used, or it may not last as long. Which leads to another question: Is diluting Botox® dangerous? Remind patients that Botox® paralyzes certain facial expression muscles to reduce the "dynamic wrinkling" that results from muscle movements. Some Botox® injection risks include temporary paralysis of parts of the face that patients may not want paralyzed, such as eyebrows. This happens every now and then, even in experienced hands, and is not dangerous—it just takes a while to get eyebrow motion back.
A more disturbing, but very rare, problem to look out for is if the muscles that move the eyeball itself are paralyzed, which causes double vision. Injecting the Botox® close to the eye can increase this risk, which is why patients should be advised against this, unless injections are administered in very small doses and volumes, very superficially. In theory, a larger volume injected diffuses through a larger area, such that larger volumes of solution could have this effect even if not injected exactly near the eye. Again, most experienced practitioners would know how to avoid this situation.
| Average Botox® amount | |
| Area | Unit Range |
| Glabella (between the eyebrows; those vertical wrinkles created from furrowing the brow) | 15-20 |
| Crow's-feet (both sides, so half on each side) | 20-25 |
| Forehead (horizontal wrinkles created from raising the eyebrows) | 20-25 |
The 'right' stuff
There is no steadfast rule to the "right amount," but figure No.1 contains some ranges for the "average patient," who is a female of average height and weight.
The right amount for the average person is usually within a certain range, but because this is not an exact science, patients should not assume the "average" dose will fit perfectly for them.
Men generally require a little more Botox® if the face is muscular. Patients may require less Botox® if they just had their last treatment three months ago and it hasn't completely worn off yet. Patients may require more if they've been receiving treatments for a while and their system becomes less responsive. In the future, there may be different types of Botox® available, such that if you don't respond to one type you can try another.
To ensure safety, patients should know what they're getting. "Bargain" centers tend to dilute Botox®, therefore treating more patients with fewer units and charging less. The low price draws more patients, and this strategy can result in a higher profit margin per vial (100 units). However, watered-down Botox® just doesn't work as well—no surprise.
The money shot
Explaining the cost of the treatment is important for your patients. It helps distinguish your center from that of a "bargain" Botox® center, and it breeds trust and loyalty among clients. It makes the most sense to charge per unit of Botox® used. That way, regardless of volume, patients pay fairly for what they get. However, this becomes very confusing because many people need different amounts to get the same effect.
But use caution. Charging more for those who "need" more tends to irritate people. Again, because of ignorance, they don't know what they're getting and why. Patients may assume the practitioner is using too much Botox® or is just unfairly charging too much. Not knowing what the cost will be from one injection to the next also doesn't sit well with most patients. Many people like to have a set price, which is why many doctors end up quoting "per area" of injection, rather than by the unit. If a patient requires a great deal above the average amount, it would not be unreasonable to charge by the unit for the extra.
What's a fair price? It depends on how many units! Botox® per area ranges from $195 to $400 in Atlanta, GA. Patients should expect to pay a little more in a doctor's office, particularly in the hands of a specialist, versus some sort of spa or bargain business. Many reputable doctors' offices have recently lowered their prices, knowing that they're not really making money on Botox®, but rather offering a service their existing and new patients expect and want.
What to tell a patient
Remind your patients that they're not just buying the Botox® itself. When they receive an injection, they're paying for the knowledge, experience, time, common sense, and in some cases the practitioner's integrity. In addition, patients also then have someone available if they have a question or problem. And, of course, if patients seek the alternative route and get half the proper amount from bargain Botox® centers, they're actually losing. They'll end up getting injections more frequently because they would wear off quicker, which will cost more in the long run.
Amy M. Ortega, M.D., is a board certified, double-fellowship trained cosmetic plastic surgeon with special interest in cosmetic surgery of the face, breast and body. She can be reached for surgical consultation at her office in Atlanta, GA, at (404) 751-2500. For more information ABOUT DR. ORTEGA, visit www.ASAbeautiful.com.
