Doing a special for youon botox.

Monday December 12.

All day.  $50 off one area, $100 off two. 

Treats and fun things as well.  The season of giving is upon us.  And I am thankful, so I want to share.  I will also be posting lovely little things on my facebook site, so check it out and become a fan! (if you are not doing so already).  http://www.facebook.com/laurengreenbergmd

1. I have tons of goodies coming up. 

• Did you print out your brilliant distinctions coupon? If you are signed up, you will get rebates which you print out and bring in to me for additional money saved.  This is good for Allergan products: Latisse, Juvederm, Botox.
• Botox special day: September 8.  This may be the last one of this for a while (I am able to offer it with help from the rep).  24 units for $275, 48 for $450. 
• $100 off each syringe of Juvederm.  Til September 15.  This is not a mail in rebate. Read my blog on what to do before doing filler to avoid bruising! (it works!)
• Restylane and Dysport (another brand of botox) day.  September 15.  Use two syringes of Restylane, and get a free area of Dysport (a $325 value!!)  Dysport also has a special going on right now, where you get $50 off each treatment, and another $50 off if you can show you used Botox or Dysport from 3-12 months ago. (These are mail in rebates for the money off, the free area of Dysport is from here.)

2.  Groupon and other “deals of the day” and plastic surgery.

I have not done any of these.  Today I got the Plastic Surgery Practice magazine, and their lead article was about doctor offices and the “deal of the day” sites.  They state “Partnerships between medical practices and third party “deal of the day” organizations such as Groupon, when based on compensation per lead is fee splitting, which is violation of the law in many jurisdictions.”  I do not mean to single out Groupon.  There are many sites: livingsocial, dailydibs, etc.  In the article the people interviewed do feel these laws are antiquated and have not caught up with the internet and e-commerce age. But as of now, deals of the day are in a legal gray area.

Until everything is clearer, I will stick with the good old fashioned specials.  They might not be broadcast widely, but I am more about grass root support anyway.

Please feel free to forward on to a friend.

Ahh. I get it.

So then I had to have the talk, which I hate to give, about how aging continues.  What works for you when you are 30 may not work for you when you are 40.  She can’t get that super smooth forehead anymore without dropping her eyebrow, which will make her look tired.

Why does the botox “stop working”? Because we continue to age.  Particularly for the forehead, as you age, your brow drops.  The reason you form the forehead lines is because you are lifting your eyebrows up with your forehead muscle so you can see.  It’s a bit of a paradox- as your forehead lines get deeper you want to do botox more, but that is just when you can’t–  If you block that forehead muscle, you will get a smooth pretty forehead.  No wrinkles.  But your brow will drop.  And for many, it will cause hooding over the eye and have the opposite effect of what you want- it will make you look older and more tired, not rested.

So what is the fix?

In many ways botox is a bandaid.  At some point you need to fix the problem.  The problem is some combination of your eyebrow falling down too low and your upper eyelid having too much extra skin.  The fix is an eyelift, browlift, or a combination.  To figure out which is best for you, consult a plastic surgeon to help you evaluate.  The surgeries have different downtimes, scars, etc.  and you need to figure out which one will best address what bothers you.

So the botox is working.  The issue is aging marches on.

Nonsurgical procedures are common.  The whole beauty (pun intended) of nonsurgical procedures is there is “no downtime”  and they are secret.  No one knows why “you look refreshed” “relaxed” “young for your age.” But if you get a bruise… uh oh.  There goes the whole anonymity of it all.  There is no downtime, but you need to go to work, drop kids off at school, go to the grocery store.  If you get a bruise…. How many times are people going to believe you bonked your head on the car door (silly me!) or your kid threw a toy which accidentally gave you a bruise (oh no!) on your cheek?

I had a patient whom I did filler on last week who said, “OH MY GOSH!”  as she had the epiphany a woman whom she knows very well who says she was doing “nothing” has for a while been doing fillers.  The culprit? How did my patient figure it out?  Aha!

A bruise.

So.  There is no sure fire way to avoid bruising.  When I take a sharp object (ie a needle) and poke it through your skin (sorry, I know it is graphic), you can bruise.  The face is very vascular (ie has a lot of blood vessels), and certain areas have higher tendencies to bruise than others.  Should we give up? Throw in the towel? No. 

There are things you can do to help.

I wrote on this a while ago.  See original blog:

Two weeks ahead of time:

• Avoid medications which cause bleeding.  See my blogs: aspirin NSAID products, herbal products, and any vitamins or pills in general which are “heart healthy.”
• Some people tend to bruise more.  In general, if you know you are a bruiser, expect you will bruise.
• If you are doing Sculptra, which involves injections over a more broad area, expect some area may bruise.
• The cheek/eye junction and the mouth like the bruise the most.
• Don’t schedule it right before a big event like a wedding, reunion, etc.  Murphy’s law will reign supreme, and we will hit something.



Two days ahead

• Start herbals which decrease bruise and swelling: arnica and bromelain



The day of

• Exercise if you are going to waaay ahead of injection time. (Yes, you Palo Alto girls.  Walk the dish early in the morning or wait until a day out.) You don’t want to be hot, sweaty and have your blood vessels be dilated when you come in.
• Ice on the way driving into the office



After

• Elevate
• Ice
• No bending over, straining, lifting heavy objects (like kids)
• Crank the AC in the car.  Being hot= blood vessels dilated= easier to bruise.
• Do the anti bruising and swelling herbals
• No exercise (this includes anything which raises your blood pressure or makes you hot and sweaty. Yes, this includes things which I cannot discuss here.)
• Sleep with your head elevated

If you have any sign of bruise, do not work out until the bruise is gone.  Once you bruise, it will take a week til it is fully gone.  For most women it is not bad, particularly if you have darker skin.

And pray to the anti-bruising angels. There is always a little luck involved.

$50 off one area (24 units. Final cost $275)

$100 off two areas (48 units. Final cost $450)

Doctor injected. Fresh botox. 

Brilliant distinctions coupons and discounts CAN be used with this offer.  I can’t extend this discount to any other day- I am only able to do this through a special deal I get which I pass on to you.

Brilliant distinctions is not that way. It is a frequent flier program for botox and you actually get money back and discounts. I hate getting tons of emails, and understand reluctance to these things, but if you are going to do botox, might as well save some money. And they promise not to send more than a handful of emails a year.

There currently is a promo:
Raffle giveaway if you refer friends to sign up. They are giving away $1000, $100, and $50 gift cards.

And when your friend signs up she gets a $50 credit.

Allergan is trying to build brand loyalty. Take advantage of this by getting their promotions.  As I said before, if you are going to do this stuff, might as well save some money.

Dr. Greenberg & the Latest Cosmetic Plastic Surgery Trends

Dr. Lauren Greenberg, a board-certified plastic surgeon in the Bay Area in Northern California is an avid blogger who tirelessly pursues cutting-edge plastic surgery trends. She typically covers a wide spectrum of topics, from surgical enhancement with breast augmentation or liposuction, to reasons to consider when choosing a cosmetic surgeon. In her most recent posts, she addresses the growing popularity of nonsurgical enhancement with treatments such as BOTOX Cosmetic ® and skin rejuvenating products.

The most recent survey from the American Society for Aesthetic Plastic Surgery (ASAPS) shows 85% of the almost 10 million cosmetic procedures performed in 2009 were nonsurgical treatments such as facial rejuvenating products and skin volumizing dermal fillers. At her Bay Area plastic surgery practice, Lauren Greenberg, MD responds to this latest development in the field of aesthetic enhancement, and the growing popularity of http://www.laurengreenbergmd.com/skin/botox/ [BOTOX Cosmetic]® injections, as well as skin care treatments and products.

In a recent article, Dr. Greenberg addresses the common misconceptions associated with cosmetic enhancement in general, and BOTOX injections® specifically. As the popularity of nonsurgical enhancement continues to grow, Dr. Greenberg reminds her readers this widespread acceptance of nonsurgical procedures has only come about recently. BOTOX® Cosmetic and dermal filler treatments were often lumped together with more dramatic surgical procedures such as liposuction or breast augmentation. However, she says the most recent development demonstrated by the statistics from ASAPS is important because it shows the general population is beginning to understand the beneficial impact of nonsurgical procedures.

The use of BOTOX® injections to treat headaches has garnered substantial attention of late, which Dr. Greenberg says has created a gray area for patients considering such treatment. In a recent article entitled, “Will Insurance Cover my BOTOX for Headaches,” she discusses several recent cases within her practice in which insurance covered the non-cosmetic use of BOTOX® injections. She stresses that the process is fairly arduous and dependent upon the patient’s ability to document the need for such treatment. In the end, Dr. Greenberg says insurance is slow to keep up with the trends, but adds that helping patients wade through the complicated realm of insurance coverage, as well as choosing the appropriate procedures, is an important part of providing exceptional patient care.

About Dr. Greenberg

Dr. Lauren Greenberg earned her medical degree from the Northwestern University Medical School. She then completed her general and plastic surgery residencies at Stanford University, and a fellowship in breast and cosmetic surgery in Nashville, TN with well-known and highly-experienced plastic surgeons. Dr. Greenberg is a member of the American Society of Plastic and Reconstructive Surgeons, and the California Medical Association, and pursues a varied schedule of national presentation, lectures, and volunteer programs.

Dr. Greenberg’s plastic surgery practice is located at 750 Welch Road, Suite 117, in Palo, Alto, CA 94304, and can be reached at (650) 617-9907, or found online at www.laurengreenbergmd.com or the Lauren Greenberg, M.D. – Cosmetic Plastic Surgeon Facebook page. Additionally, Dr. Greenberg maintains a special interest in post-pregnancy plastic surgery procedures and has created her www.bodypostbaby.com blog to educate women about physical changes brought on by pregnancy.

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This is well known, and you can read my other blog for more information.  The question then comes up, “Well shouldn’t insurance cover it?”

Ah. Health insurance.  I can tell you in general, health insurance doesn’t want to cover things, particularly if they can be construed as being cosmetic.  We see this in all areas where there can be grey zones: breast reductions, eyelifts, abdominal muscle laxity, Retin A. 

There is good science to support migraines are helped by botox.  Your plastic surgeon knows your headaches may be helped by botox. (Though some headaches do not respond to botox- so don’t think it is a sure thing.)  We are not the ones who make the decision if it is covered or not.  Your insurance company does. 

So, the how to:

1. You need to show why traditional therapy has failed you or why you can’t do it.  This should be done with your current treating doctor. Example:  I had a patient who despite being on 2 different meds would end up in the ER for toradol shots and end up missing work.  She had frequent headaches.  Her treatment was failing her.  She got approved. 

2. You need to get preauthorization.  Some insurance plans will say preauthorization is not needed, but in general if insurance doesn’t approve it ahead of time, I am wary they will cover it after.  Particularly because botox is seen as a “cosmetic” wrinkle treatment, you need to have insurance okay it.

3. Get receipts from your treatment and notes from other doctors.  You can help build your own case by showing your decrease in headache medication, ER visits, etc as a result of your botox treatment.

4.  I have found the glabella area (between the brows) helpful, and the only area needing treatment in many of my patients.  For some patients whose migraines are refractory and complex, you may need injections in the temporal area, neck, and other areas, and for these patient I would recommend a neurologist who specializes in botox treatments for migraines.

About a decade ago when botox first came out it was so taboo.  “Who would do that?”  “Inject that stuff  into your face?”  “It makes you look freaky / frozen / etc.”  It conjures up images of Nicole Kidman and her Oscar acceptance speech where she was “so surprised” to get the award (said with a face which could not show anything, much less surprise.) 

I remember being at a dinner party about 10 years ago with a bunch of people, and the men said, “I can’t believe people do botox.”  I was there with at least two friends I know did botox, as I injected their botox.  “Really?”  “Oh I can tell when someone does.”  “Has anyone at this table done it?”  My friends were sweating bullets.  They had us raise our eyebrows, smile, frown.  “No.”  Well, I wasn’t going to out my friends, but I have no issue outing myself.  “You are wrong.”  Then they tried unsuccessfully to guess who had done it.  “I have done it.  Can you tell me where?”  Again, I had to raise my brows, frown, smile.  Even knowing I had done it, they couldn’t figure out where it was injected.

When botox is done well it doesn’t look like it was done.  You can still raise your brows (just not as high. So you are surprised, not SURPRISED.)  Same goes for those wrinkles between your brows. (Your kids will thank you for not being able to muster that look of YOU DID WHAT?!, it will be more of a you did what?)  Around the eyes, it is a no brainer.  I see no benefit when I smile to see those crows feet running all the way down my cheek.  I still get enough crinkle to have smiling eyes…. just not enough to look my age.

There is an art to injecting botox.  More is not always better.  Pick your botox injector wisely.  Sometimes a few light wrinkles are better than a sea of frozen face.  At least I think so.

$50 off 24 units (one area)

$100 off 48 units.                                                                                                                                                             

The doctor injected botox… fresh botox… the new issue of People magazine…the music… the food…(No rebates or mail in things to get the money back- you get it that day. Simple!) 

Call for an appointment now! Times almost gone. 650 617 9907.