How Botox and Fillers are Different for Men vs. Women

While women have historically dominated in use of Botox and Fillers, this has been changing rapidly over the past 5 years, with more and more men now taking advantage of these procedures.

Botox and facial fillers are the most common non-invasive procedures for both men and women. However, how many units I typically use for men is different than how many I use for women. The most common place to place the Botox for both men and women is still the glabellar area (the area between the medial eyebrows — the 11’s). Because men have larger muscles here, I will place 25 units, in this area rather than the 20 units I place for women.

Both men and women will treat the crow’s feet with Botox. While I usually place 10 units per side for women (this is only a general number, sometimes, I will place 5-12.5 units per side), I will often place 12-15 units per side for men.

The forehead is treated very differently for men versus women. Women often want a small amount placed over the lateral third of the eyebrow to try and elevate the lateral third and give them a nice arch. Men will not want this since this tends to produce a more traditionally “feminine” look. Men will typically ask for a more horizontal eyebrow, so I will avoid Botox over the eyebrow or I will put it  in equally medially and laterally above the eyebrow.

The most common place for a man to place fillers is the nasolabial fold. They will generally not request that fillers be placed along their zygomatic arch since this is a feature more commonly desired by women rather than men. In women, this will both soften their nasolabial folds and emphasize their zygomatic arch. Men will place fillers in the pre-jowl area, which help make the jowl area be much less noticeable.

Want to know more about Botox and Fillers? Please call my office at 703-406-2444 to schedule a complimentary, private consultation with me.

Recovery from Botox and Expected Results - Berman Cosmetic Surgery Blog

Recovery from Botox and Expected Results

In this video, I discuss what results you can expect following Botox injections, as well as what recovery looks like. I always like to share that I perform Botox injections in our office myself – it is quite rare to receive injections from a Board Certified plastic surgeon!

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

Price of Beauty: Botox and Fillers - Berman Cosmetic Surgery Blog

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.

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.

How Long Should Botox Last

Botox Lasts 4 Months

Generally, you can expect your Botox (or Dysport or Xeomin) to start working within 4-10 days and to last 4 months. However, I have found over the years that there is a moderate amount of variation to this number. I have had patients tell me that it started to work the very next day. I do believe that if it has not started to work in 10 days, then you will need another dose. Rarely, but it has definitely happened, that some patients are resistant to Botox and it just does not work on them. I would always try a second dose of Botox before concluding that it does not work.

It is important to remember that depending on what area is injected, there will almost certainly be some movement and that this is OK. However, the movement will be very much reduced.

It is important to remember that Botox decreases the lines due to movement. It will not change the fine lines in your lower eyelid. However, the deep furrows between your eyes, will gradually get less and less deep, if you do Botox religiously for a year or more. They will not go away with just one session, if they are present even when you are not frowning.

I personally like my patients to come back every 3.5 months. Why? The analogy that I share with my patients is that if you put your leg in a cast for 4 months and then go to the gym for a few weeks and then go back in the cast for 4 months and you keep doing this for a year, your leg muscle will be a little bit smaller than the normal leg. However, if you put your leg in a cast for a year straight, the leg muscles will atrophy and will be much smaller.

What does this have to do with Botox?

If I keep injecting your muscles (eg the glabellar area which is the area between your eyes) before it has a chance to recover, these muscles will atrophy. I have found that after a year of doing this, frequently (not always though) many patients will require fewer units to get the same result. This means instead of needing 20 units in the glabellar area, you may need only 10-15 units. Sometimes it can also last longer too.

Schedule a free consultation.

Cost of Botox

There is no exact number that I can give you so that you will know exactly how much you will pay for Botox. However, I can give you guidelines.

All doctors and places where you can get Botox (should you elect to get Botox from a Spa which I don’t recommend but that is a personal choice) will either charge you per unit or per area. This is somewhat similar but I prefer the unit approach and I will explain why.

Areas of Botox Treatment

There are 3 main areas where Botox is usually given: the glabella area (which is the area between the eyebrows) the crows feet (which is the area lateral to the eyes). Note that this will improve those lines that get worse when you smile; it will not help the fine lines that are present at rest.

Other less frequent areas which Botox is sometimes given include the chin bunny lines (side of the nose) upper lip axillary region (armpits for hyperhidrosis which is excessive sweating)

The reason that I prefer to charge by 5 units is because you are paying for what you get. I usually place 20 units in the glabellar area, although sometimes men and occasionally resistant women will need 25 units.

For the crow’s feet, I usually place between 10-12 units per side. The forehead is highly variable depending on what the patient wants. I frequently place 2.5 units above the lateral third of the eyebrow, in order to give some eyebrow elevation. I will often put about 10 units more in the central forehead. For the forehead above the eyebrows, it is quite variable, if I put any and how much. For people over 50 years old I am very cautious since it is easy to cause some droopiness to the eyebrows.

My usual fee is $12/unit. I am one of the few plastic surgeons I know, who does his own Botox (and filler injections). This is quite a reasonable price for Botox. You can always find it cheaper on Groupon but then you really should be asking yourself, “Do I really want someone other than a skilled plastic surgeon, injecting a potentially dangerous substance, into my body, just to save a few dollars??”.

I do enjoy doing my own injections because I feel that doing both Botox and fillers, is artistic and the tools are Botox and frequently fillers and your face is the canvas.

My consults are free, so if you are curious, I invite you to book an appointment with me.

Botox vs. Fillers

Botox vs Facial Fillers

This is a very common question I get from people. They hear a lot about both products and don’t understand the difference. I recorded this video about the differences between Botox and Facial Fillers to educate people on the results they can expect from each product.


The commonest areas are the glabellar area (area between the eyebrows) where the 11’s occur. Also the crows feet and parts of the forehead. Oftentimes, if the Botox is injected carefully and in a small amount, you can experience and elevation of the lateral third of the eyebrow, which many women like.
Less common areas to treat, but still can be very effective include: the bunny lines at the side of the nose, the excessively wrinkled chin and in very small doses the upper lip in select cases.

Facial Fillers

Facial fillers are what they sound like. They fill in!!! They replace soft tissue that has been lost as we age. If you look at a child’s lovely face, they don’t have lines or wrinkles because they have an abundance of fat in their face. As we age, we usually gain fat in the lower half of our body and lose fat in our face. In addition, they can be loss of skin elasticity as we age. Think of our skin as the wrapping paper and the fat and muscles of our face as the package. If the package shrinks with ageing, then the skin will hang and sag. Fillers can take up much of that laxity and, in fact, people refer to the addition of several cc’s of fillers as a “liquid facelift”.
Botox is a drug which is injected which causes the muscles to stop contracting. Botox is largely used in the upper face: the crow’s feet, between the eyes and the forehead.
I encourage anyone interested in either of the products to schedule a free consultation to find the right solution for them.

Botox or Fillers

shutterstock_93865783What is the difference between fillers and Botox? How old do you have to be to get them?

Great question! I find a lot of patients get confused between the difference between Botox or Xeomin versus fillers such as Radiesse, Juvederm or Restylane.

Botox and Xeomin are injected into or near a muscle in order to prevent the muscle from contracting. Thus they are most commonly used in 3 areas: The glabellar area which is the area between the eyes, where many people get the famous 11s. The next most common area is the crows feet which is located lateral to the orbit. The third area is the forehead. These drugs will either decrease or prevent entirely the muscle from contracting. They both take 4-10 days to work and last about 4 months. Occasionally they will be injected into the sides of the nose to help with the “bunny lines” or the chin to prevent a chin that wrinkles too much.
Secondarily, they may be helpful in preventing migraines that start in the forehead or between the eyes. I recommend that my patients come back to me, every three and a half months, before the effect of the Botox wears off.

Fillers do what their name suggests. It fills in for a loss of tissue, usually fat. There are several places that these are injected. Probably the most common is the nasolabial folds, however, the area in front of the jowls is very common in my practice. As well as the cheeks, in the cervical mental area (between lips and chin), temporal area, tear troughs, and even the backs of the hands.

There are a number of fillers but the main three categories are: hyaluronic acids such as Juvederm & Restalyane, Radiesse which is made from calcium-based microspheres, and lastly, using the patients own fat. Juvederm lasts between 10-16 months, Radiesse often last 18 months or longer and fat can last forever. Each filler has certain advantages but this is best discussed with you in a consultation.

You should get fillers or Botox when you need them. There is no magic age. If you don’t need them then there is no point in getting them in advance. However if you would benefit from them, there is no reason to wait!


Dr. David Berman