Price of Beauty: Botox and Fillers

People still sometimes get confused about the difference between Botox and fillers. Botox works through muscle paralysis  to decrease facial motion and help eliminate fine lines. Fillers represent a wide range of products used to enhance facial volume.

What is Botox?
Botox, like Dysport and Xeomin, are neurotoxins, which means they are injected in order to weaken the muscle contracting. The most common place they are used is the glabellar area which is the area between the eyebrows – the famous “11’s”. The next most common area is the crow’s feet, which is the area lateral (to the side of) of the eyes. The third most common site is the forehead. This has the risk/benefit of altering the eyebrow position – either raising or lowering them or not changing them, depending on how much is injected and where. Less common areas to inject these are the chin and upper lip. They are also injected into the axillary region (armpits) to stop sweating (often lasts 6 months in this area). These agents take 4-10 days to work and last about 4 months, when used in the face.

How much does Botox cost?
There is some variation in the prices for Botox to be injected. Everyone is using the same Botox (or Dysport or Xeomin), with just  3 companies controlling the entire market. It is much more expensive for physicians to buy these from the company that makes them than people realize. Some places will charge by the area (eg injecting the glabellar area) but most places charge by the unit.

Factors that may affect the price:

  1. Who is doing the injecting and what is their experience doing this?  Is it a plastic surgeon? A doctor – family doctor or other doctor? A nurse? An Esthetician? A Medispa?

    I personally do all of my own injections and I always have. I presently charge $12 per unit. You certainly can find it for slightly less but if you pay less, you almost certainly will not be getting a board certified plastic surgeon doing your injection himself. The highest I have come across in the Northern Va area is $19/unit. The average cost seems to be about $15/unit.

  2. Geographic area: You will almost certainly pay more in certain areas such as Bethesda, McLean or Tysons Corner than you will pay in Sterling, Virginia (where my office is location). This is just a function of the rents being higher in those areas.
  3. Groupon and other deal websites: If you get your Botox through Groupon, you may be able to pay less. However, be wary since you have no control over who is injecting you. Frequently, the places offering Groupon for Botox are not making any money on their Botox, after they pay off Groupon.

How much do fillers cost? 
The same discussion above also pertains to fillers. We are all getting our fillers from the same major companies. They are ready to inject straight out of the box. No one can make the fillers, last a longer or shorter time. Depending on the filler, they will last in general from 1-2 years with the more dense fillers lasting longer (eg Voluma – closer to 2 years) and the thinner fillers (as used in the lips or under the eyes – eg Volbella) lasting more like 1 year.

There is skill in how they are placed by the injector -both the location and the comfort. The same concerns I expressed above – who is injecting your Botox, also applies to your fillers.

The cost of the fillers are going to depend on 4 things:

  1. Which filler is being used?
    Some fillers cost more for us to buy and this is being passed on to the patient
  2. The size of the syringe:
    Is it 0.5cc or 1.0cc or 2.0cc. Of course, the more filler being injected into you, the more it will cost.
  3. Who is injecting? Is is a plastic surgeon or dermatologist or personnel at a medispa or traditional spa? As with Botox, I do own injections! Once again, this is very uncommon for a plastic surgeon to do his own injections.
  4. Geographic area:
    Once again, you are going to pay more in Bethesda, McLean or Tyson’s Corner.

Pricing will vary as per above but for most 1 cc fillers, you should expect to pay between $600-900 per cc. Volbella, which comes as 0.55 cc will be about $375-550.

 

Have questions about Botox or facial fillers? Please call my office at 703-406-2444 to schedule a complimentary, private consultation.

How Much Does SculpSure Cost?

In this video, I discuss our Sculpsure pricing – and why our pricing is so much lower than our competitors. 

As you may know, Sculpsure is the latest innovation in non-invasive fat reduction. This means that there are no incisions. The laser energy travels through the skin (it is safe for all skin types) and heats and kills the underlying subcutaneous fat. Cynosure’s studies have shown up to a 24% reduction of fat – though it is important to remember that some people will get more and some will get less.

If you’d like to talk more about Sculpsure, please do not hesitate to schedule a complimentary, private consultation with me calling our office at 703-406-2444.

Advantages of Sculpsure over Liposuction or a Tummy Tuck - Berman Cosmetic Surgery Blog

Advantages of Sculpsure over Liposuction or a Tummy Tuck

There are several of advantages to getting a SculpSure treatment over Smartlipo (which I love), liposuction or more invasive surgery such as a tummy tuck or arm lift. This popular procedure melts up to 24% of stubborn fat with highly advanced laser technology.No Downtime:
The biggest advantage with Sculpsure is that it is totally non-invasive. There are absolutely no incisions or downtime. I had my love-handles treated twice, and both times, I went immediately to the gym from my office. SculpSure is so convenient you can do it on your lunch break or on your way home for dinner. Treating an area only takes 25 minutes and you can treat several areas, one right after another.Low on Risk & Side Effects:
There are very few risks and side-effects from the treatment. The laser light can travel through any skin color and only penetrates into the subcutaneous fat. It is safe to use even if you have had a hip replacement (as I have) or abdominal surgery (we don’t, however, want to place the paddles directly over scar tissue). I do tell all of my patients to make sure they eat something and drink lots of water before they do their treatment.

Sculpsure is a great addition to your diet and workouts to maximize your chance of improvement. I always stress to my patients, that there are no magic treatments. If you want maximum improvement, you will want to increase your exercise and improve your eating.

Sculpsure has been shown to decrease your truncal fat up to 24% (this result will vary from person to person) but this still means you will have 76% of your fat left behind. Sculpsure is a great start and a great addition to a workout routine. Combining this with your new diet makes it more likely that you will see results sooner.

It is important to know that doing Sculpsure now does not prevent you from doing more invasive procedures, such as a Smartlipo (laser lipo) or a tummy tuck later on if you feel you need a more invasive procedure to get your desired look.

Questions about SculpSure? Please call my office at 703-406-2444 to schedule a private, complimentary consultation.

w Soon After a Breast Augmentation Can You Work Out - Berman Cosmetic Surgery Blog

How Soon After a Breast Augmentation Can You Work Out?

This is a great question and one that comes up very, very frequently. It comes up a lot because many of the women that I perform a breast augmentation (BA) on exercise regularly and want as little interruption as possible.

In general, I am more progressive than most other surgeons in that I allow my post BA patients to get back to exercising sooner . I do ask that they don’t significantly elevate their heart rate for prolonged periods of time for the first week. A suggestion here is going for long walks, at a comfortable pace, but nothing more strenuous than that.

After the first week, they can do things like take a spin class or use the elliptical machine  essentially, anything that will elevate their heart rate but without a lot of bouncing movement. The elliptical or spin bike provide a much more comfortable experience than trying to jog, as an example. They can also begin strength training for their lower body, as well as for biceps and triceps. At this stage, they should avoid chest exercises or difficult back exercises. I believe gentle stretching is very helpful from the beginning, and should become easier after the first week.

Most of my hard core runner patients will start running after 2.5-3 weeks. I always advise starting easier (shorter distance and shorter time) for the first few times out running.

Chest exercises such as push ups should be held off until  4 to 6 weeks post-surgery. Start lighter and go easier during the first few sessions. When you are contracting your pectoral muscles, it is very normal for your breast implants to be displaced upwards, while the muscle is contracting. They will return to normal immediately, and it does not do any harm.

Two of my most notable patient stories on the topic – and these women certainly represent the exception, not the rule!

  •  I performed a breast augmentation on a very close friend of mine. She and her husband were the couple that got me into doing triathlons and Ironmans. I did a BA on her before she moved to Florida. She did a half Ironman (1.3 mile swim, 56 mile bike ride and 13 mile run) after only 5-6 weeks from her BA. She is the exception, not the rule!
  • A number of years ago, I performed a breast augmentation on a woman who clearly did a lot of weight lifting. I saw her a week after her BA and she mentioned that she never stopped doing her pull ups after surgery. I have never had a patient do this before. She did no harm, so this does show you that it is hard to really hurt things. She did run the risk of increased bleeding or bruising, but she experienced no problems, despite her pull-up regime.

Have questions about this procedure? Please call my office at 703-406-2444 to schedule a private, complimentary consultation with me

Berman Cosmetic Surgery & Skin Care Center - Body Surgical Procedures

How much does Sculpsure cost?

As you may know, Sculpsure is the latest innovation in non-invasive fat reduction. This means that there are no incisions. The laser energy travels through the skin (it is safe for all skin types) and heats and kills the underlying subcutaneous fat. Cynosure’s studies have shown up to a 24% reduction of fat – though it is important to remember that some people will get more and some will get less.

Generally, Sculpsure will cost $1,500 for a session. However, we are only charging $1,000 because we want to make this is more easily affordable to more people (and yes, we do offer financing).

How Does it Work?
A treatment consists of 4 paddles, which are about the size of a small cell phone. The entire session only takes 25 minutes. You can treat multiple areas, one after another, in the same visit.  To explain, you can put 4 paddles along your lower abdomen and after this immediately, place the 4 paddles on the outside of your hips, or the inside of your hips or knees or bra line or love-handles, etc.

No Downtime:
One of the best things about this treatment is that there is no downtime associated with it. I have actually treated my own love handles with SculpSure and after each of my two sessions, I immediately went to the gym.

How Many Treatments Will You Need?
I tell my patients that they should plan on treating each area twice, with 4-6 weeks between each session, to get the best results. You can certainly do more than two sessions per area, but the minimum you should plan on is two sessions. There are no hidden costs with this treatment, as it does not require any medication or an operating room.

Why You Should Consult with a Plastic Surgeon if Considering SculpSure:
The most important reason to see a plastic surgeon when inquiring about SculpSure is because a plastic surgeon is in the best position to explain whether you will be best served with SculpSure or Smartlipo (laser liposuction) or some type of excisional surgery. It is important to know whether your expectations are realistic for the given procedure, especially given the financial investment you are making. A plastic surgeon can also give you a good sense of the pros and cons of each option to help you make the right choice for you. In my office, your treatment will be carried out by an esthetician specially trained in the art of SculpSure. We will do our very best to make sure that your treatment is as comfortable and specific to your needs and body goals.

Have questions about this procedure?
Please call my office at 703-406-2444 to schedule a private, complimentary consultation with me.

Berman Cosmetic Surgery & Skin Care Center - SculpSure

Sculpsure and Your New Year’s Goals for Your Body

When Christmas and New Years (and all the parties!) come to an end, many of us are mortified to find our clothes too tight and the scale much higher than we like! Now is the time when so many of us create New Year’s resolutions. What can we do to maximize our success?

As a trained Life Coach, the first thing that comes to mind for me is to be very realistic in our goals. We should be bold in our resolutions, yet realistic. Secondly – and this is key – we need to break our goals down into manageable steps we can do every day, or at least most days. Third, we need some accountability. And lastly, many of us benefit from having a reward or penalty for sticking or not sticking to our plan.

Realistically, if you have never been one to exercise, it may make more sense to aim to do a class at the gym 3-4 days per week, rather than plan on doing 3 hours a day at the gym. Sure, there are people who do go to the gym for 3 hours per day, but is that going to be you 3 weeks into the New Year, once that initial excitement has faded? Probably not. With focused effort, you can likely accomplish your goals in one hour of gym time.

It is great to have a set amount of weight you want to lose – whether that be 10 lbs or 100 lbs. However, remember that the closer you get to your ideal weight, the harder it is to lose those last few pounds. One of the things that I have repeatedly observed in women is that they go on strict diets and work out faithfully for 3-4 weeks. At the end of this time period, they weigh themselves and low and behold, not one pound has been lost. They get frustrated and quickly return to their previous eating patterns.

What can you do to minimize this effect? My strong suggestion is to NOT weigh yourself for at least 6 weeks. Or better yet, until you feel that your clothes are looser. I have many patients who will take advantage of something such as Sculpsure (a non-invasive way to reduce fat but not weight) at the beginning of their diet to increase their likelihood of seeing a noticeable difference in their body sooner even without a decrease in the umber on the scale. It can reduce the fat in a given area by up to 24%. However, as I always stress, this still means that 76% of your fat is left behind. There is no substitute for better dieting and exercising if you want to look your best. But Sculpsure is a great way to jumpstart your success and is also an incredible catalyst for success.

A slow, steady weight loss of 1-2 pounds per week is realistic and sustainable. I am also a great fan of our Paleo Meal Replacement to help you achieve this. However, I will be the first to admit that there are many good diet plans besides the one that I am suggesting, but my staff and I have had great success with it.

It is extremely helpful to have someone you are accountable to. It is best if you can find an exercise and diet partner. If not, you should keep a log and make sure that you share your progress daily. Knowing that someone (besides yourself) is going to be checking is a huge motivator.

Most people will do better if they plan on having certain rewards for sticking to their plan. It can be helpful if they will also include some “penalties.” These are not meant to be hard on your ego and make you feel bad about yourself but rather to motivate you.  They can be things like giving a certain amount of charity each time you break your plan or could be extra sit-ups or giving your partner a massage (assuming that feels at least a tad bit like punishment to you, that is!)

For those select patients who want to work more closely with me on the above, I do offer life coaching by phone. If this is an area you could use some help with, please do not hesitate to contact my office at 703-406-2444 to further discuss!

Featured Product: Ultra Hydrating Serum - Berman Cosmetic Surgery & Skincare Center

Featured Product: Ultra Hydrating Serum

Our Ultra Hydrating Serum is a must have for everyone! This Hyaluronic Acid serum is wonderful for all skin types and all ages. It doesn’t clog pores and is extremely hydrating. With the cold weather, everyone can benefit from a little extra hydration. You can also apply it to other dry skin areas and use it as often as you need. Use alone or add it to your favorite cream/serum for enhanced hydration. With each drop, skin appears brighter, firmer and rejuvenated – who doesn’t want that?!

How our Estheticians recommend adding this product into your daily regimen:

Morning Routine:

  • Cleanse skin
  • Apply your favorite daytime serum (let sit for 1-2 mins.)
  • Apply hylauroinc acid serum (this will help your other serums penetrate deeper into the skin and also hold in moisture)
  • Apply moisturizer with SPF 30+

Evening Routine:

  • Cleanse skin
  • Apply eye cream
  • Apply serum and/or retinol
  • Apply hyaluronic acid serum
  • Wake up with plump, hydrated, glowing skin!

Have questions for our team? Contact us at 703-406-2444 to schedule a complimentary skincare consultation with our Estheticians! 

 

 

 

 

 

Dr. David Berman -Board Certified Plastic Surgeon

What to Look for in a Plastic Surgeon

The absolute most important thing to look for in a plastic surgeon is whether he or she is actually a Board certified plastic surgeon. There is nothing that upsets a board certified plastic surgeon more than other doctors who seek to confuse the public into thinking they are board certified plastic surgeons.

To illustrate: there is no such thing as a Board-certified “cosmetic surgeon.” It is NOT a real certification given by the American Board of Surgeons! Any doctor can call themselves a “Cosmetic Surgeon” – they don’t even have to be a surgeons! This is a scary scenario that is becoming far too common.

Another confusing title is “Facial Plastic Surgeon.” This is someone who has done ENT training (Ear, Nose and Throat), who likely things it sounds more like a plastic surgeon to call himself a facial plastic surgeon. These doctors can be well trained in surgery at the neck and above, but often go far beyond their specialty training by performing liposuction and breast surgery, etc. This goes for obstetricians and gynecologists as well, who perform liposuction and Botox. This is not part of their training. Even more inappropriate are oral surgeons – and even dentists – who are performing Botox and fillers – and sometimes cosmetic surgery. I don’t understand why someone would choose a non-plastic surgeon to do fulfill their plastic surgery needs.

Next, I would recommend that you select someone with at least a few years of experience.

It is also incredibly important to choose a plastic surgeon that you have a good rapport with. This is not something concrete that you can objectify, but rather a feeling. I strive for a natural look and this will appeal to many. However, there will be some patients who like that overdone, way overfilled look that Hollywood is famous for. These select patients will have a better rapport with someone other than me. I am also quite down to earth and enjoy hearing about my patient’s lives. Some doctors are more paternalistic, which will appeal to a different set of patients.

I always give my cell phone to all of my post-operative patients. This will be ideal for most patients, but there will be some patients that may prefer to only go through an answering service.

Lastly, I do all of my own injections for Botox and fillers. If you prefer that the plastic surgeon do your injections, you should find out ahead of time who is actually doing your injections.

If you have any questions, or want to chat about potential procedures, please do not hesitate to call my office at 703-406-2444 to schedule a private, complimentary consultation with me.

Advantages of Sculpsure over Liposuction or a Tummy Tuck - Berman Cosmetic Surgery Blog

Common Non-Invasive Cosmetic Procedures: How They Work and How Long They Last

There are now some great non-invasive procedures available these days, providing long-lasting results with minimally discomfort or downtime. Below are a few of my favorites:

 

  1. FOR THE FACE: My favorite by far, is the Picosure laser. This laser is a true game changer. It is not super well known, because it is a very expensive laser for the doctor to purchase and therefore is not in a lot of physician offices. You are not likely to find this in a medispa either.What makes this Picosure Laser so special is that because it fires 1,000 faster than other lasers, it can do a facial resurfacing with NO DOWNTIME. This means that you can significantly improve the irregular coloration in your face, neck, chest and hands, with just 3 treatments, spaced a month apart. And again, with absolutely no downtime. .Also, because the Picosure fires so quickly, there is little inflammation – meaning it can be used in skin types 1-4 with little risk of hyper-pigmentation. It will also stimulate your own collagen and elastic production, which will help diminish fine lines and wrinkles.

    How long do results last? This will vary from person to person. The most important thing is to use a good sun block (which we offer in the office) and good skin care after your treatment (also offered in our office). Good skin care that is pharmaceutical grade and can only be found in a doctor’s office, will continue with minor exfoliation and collagen stimulation. It can last a year or several years, depending on your genetics and how well you care for your skin.

  2. FOR THE BODY: Sculpsure is the most popular (and its competitor Coolsculpt) for spot reductions of fat in a completely non-invasive way.  Both of these techniques will destroy fat cells (Sculpsure through heat and Coolsculpt from freezing, which I feel has more complications) and these fat cells are permanently destroyed. They will not come back. However, it is important to work on better dieting and exercising to decrease your overall body fat. If, on the other hand, you eat poorly and put on fat, those remaining fat cells will expand in size and you will look larger. Thus, the total number of fat cells is reduced forever, however, there is no “free lunch” and you still have to look after yourself.
  3. LASER TATTOO REMOVAL: The Picosure laser is the very best tattoo removal laser that exists. It fires 1,000 faster than other lasers to vibrate away the tattoo pigment. You will need half the number of treatments with the Picosure laser than you will need with other lasers. I have seen pure black tattoos disappear after only 3 treatments. This laser rarely causes ghosting. It is also the only laser that removes blue pigments.
  4. LASER HAIR REMOVAL: With our Cynosure Elite laser, hair removal is permanent, unlike the less expensive lasers frequently found in medispas. However, when your hormone environment changes such as with pregnancy or menopause, you can get stimulation of dormant hair follicles. Most people will need 5-9 treatments to eliminate most or all of their hair. It should be noted that no laser treatments will work on white or blond hair or very fair hair.

Why More Men are Getting Cosmetic Procedures – and What They’re Having Done

There are a lot of reasons more men are getting cosmetic procedures. Probably the largest reason is cultural. It is simply more culturally acceptable for men to do things to improve their appearance these days, other than just going to the gym to exercise. In addition, as techniques become less invasive, it makes it much more possible for them to do procedures that no one will know about. As a society, we are also blurring the boundaries more and more around what is strictly female and strictly male behavior. Cosmetic procedures are a natural extension from this blurring of the lines.

What are the top male cosmetic procedures?

  • Generally speaking, the most common procedure done on men parallels what is most common for women, namely Botox and fillers. The difference is that men frequently need to get more units of Botox into the glabellar area (between the eyebrows) and crow’s feet. I prefer to put a total of 25 units often in men’s glabellar areas. In women, I usually put in 20 units. Also in the crow’s feet, men usually need a total of 25 units total on both crow’s feet, rather than the usual 20  units that women usually receive. Men frequently don’t want brow elevation in the lateral third as women do since men natural have a more horizontal eyebrow appearance.
  • Men of course also see me for tattoo removal (we have the very best tattoo removal laser – the Picosure laser) and laser hair removal – especially on their backs and chest (I use the Cynosure Elite laser).
  • More men are getting laser facials and regular facials to keep their facial skin looking shiny and healthy.
  • Also laser treatment for the spider veins on their faces is also quite common.
  • Sculpsure (non-invasive way to reduce fat, which is better than Coolsculpt) is very popular for both men and women since both sexes want to reduce fat in a select area. The areas will be different typically for men versus women. Men tend to want fat reduced in their abdomen, love-handles (flanks) and sometimes chest area, whereas women will also do thighs, bra fat, knees and upper arms. The other option is using Smartlipo to treat these areas. Not surprisingly, I have a number of both men and women who are using my Paleo Meal Replacement to help them lose weight.
  • A nice option for men who do not want to have a facelift is a neck z-plasty. These scars tend to fade well and are less invasive and less expensive than a facelift, when the main problem is loose neck skin.

The most common surgical procedures in my practice are Smartlipo (laser liposuction) and male breast reduction (gynecomastia). Less common for men in my practice are tummy tucks for those with undesirable loose skin. For those concerned with excess skin or fat in the neck area, I feel that I can deliver the best results using Smartlipo over Kybella or Sculpsure.

Have questions about cosmetic procedures for men? Please call my office at 703-406-2444 to schedule a private, complimentary consultation with me.