Ahhh.
So you are wondering why the spa down the street is offering “one area” of botox for $150 and another place costs $400. How can this be?
Botox comes in a vial with 100 units. We doctors must reconstitute the botox, which is a fancy way of saying we add saline to it to suspend the botox in fluid so we can inject it. Whoever is mixing the botox can add a different amount of fluid. This means 1cc of fluid could have totally different amounts of active botox depending where you are. So how do you know what you are getting?
girlfriends guide to plastic surgery questions to ask (ie what I tell my girlfriends to ask):
1. How many units am I getting? They can dilute away, but asking how many units will tell you what you are really getting. A standard dose for “one area” is 24 units.
2. What is one area? This is a somewhat old terminolgy, though we still use it as well. One area is the forehead, or the glabella (the area between your eyebrows), or the eyes / crows feet. The usual dose per area is 24 units, so one area is 24 units, and two areas is 48 units. These areas aren’t concrete, and my most common dosing is “two areas,” but I spread those 48 units between the forehead, glabella, and eyes, which is technically 3 areas.
3. Do you use fresh botox? When we started injecting botox a decade ago, everyone had botox days to use fresh botox. Then people became lax, and the word on the street was an opened vial of botox lasts up to a week. I am a plastic surgeon, and I am a 40 something year old female. I use botox. I can tell you a botox vial that is even a day old doesn’t kick in as quickly or last as long for me as fresh botox does. So I stick with the fresh stuff. I think it works better. Most places don’t care if your botox doesn’t work as well. It just means you will be back sooner.
4. Why do I care if a doctor injects it? Granted I clearly have a bias in this area, but I think doctors do it better. There is an art to botox. I don’t like the frozen face. I like patients to be able to animate, smile, frown… just not as deeply as before. Subtle, natural results are hard to achieve. I think we plastic surgeons have an advantage as we are injecting the same muscles we operate on. I know where the orbicularis and corrugator muscles are. I operate on them. I know how they move, how deep they are, etc etc.
SO, my biases:
Ask for units. Is it fresh? Who is injecting it? Whoever is injecting should write down what they did. Where did they inject? how much? Again, botox is an art. Every patient is different, and only if you document what you do can you fine tune it in the future.