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.

Surgical Facelift Alternatives - Berman Cosmetic Surgery

Surgical Facelift Alternatives

People mistakenly believe that a facelift fixes your face and makes it perfect and instantly takes many years of aging off of your face. A facelift does certain things very well, but does not address many other aspects of aging.

What does a facelift do, exactly? A facelift is primarily designed to tighten the skin and underlying muscle of the neck and face. The most dramatic change occurs in those with a lot of loose neck skin. There is some improvement in the pre-jowl area and even less improvement in the naso-labial folds. Of course, one can add things like laser resurfacing, fillers or fat transfer and Botox, and a blepharoplasty. However, you can do these other things in the office, without paying for anesthesia or in an operating room facility.

So what are some surgical facelift alternatives?
Aging is multifactorial. This means that there is not one aspect of our face that shows our age. Just a few of the many things one can do to improve your face and delay for many, many years a facelift include:

  • Picosure laser:
    almost every women over the age of 35 will develop areas of irregular pigmentation – areas that are darker and lighter than the rest of the skin. The Picosure laser, with break-through technology, fires 1,000 times faster than any other laser. This means that you can get your face (and neck and chest and hands) resurfaced, with NO DOWN TIME! You need to plan for 3 treatments, each spaced a month apart. The Picosure laser can also help with fine lines and soften your skin. It can even help with acne scarring (although this will typically require 6 treatments). It will also dramatically improve age spots on the face.
  • Chemical Peels:
    We also offer an array of chemical peels such as the ViPeel, megapeels, and pharmaceutical skin grade products to further assist in this area.
  • Smartlipo to the submental area:
    Most people develop fullness and slight sagginess to the upper central neck area (submental area). This area usually responds very nicely to Smartlipo. This area is quite small and does not require any oral sedation, meaning you can be in and out of my office in just 30 minutes and can return to work the very next day.
  • Facial Fillers:
    As we age, we lose fat in our face and experience a deepening of the nasolabial folds. These respond very nicely to fillers such as Juvaderm, Voluma and Volbella.
  • Botox:
    Crowsfeet, glabellar and forehead lines in particular respond nicely to Botox. These lines are a result of movement.
  • Upper and Lower Blepharoplasty:
    The upper blepharoplasty is designed to decrease the redundant upper eyelid skin, while the lower lid blepharoplasty can help decrease the bulging and/or the redundant skin.

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

Berman Cosmetic Surgery & Skincare Center - Reversing Facial Fillers - Blog

Reversing Facial Fillers: Where, How and How Often?

There are a large number of facial fillers on the market and they are becoming immensely popular. Although, not quite as popular as Botox, they are quickly becoming the “next biggest thing.” Although there are millions of women and men doing this, for those that are newer to this, you are probably wondering the following:

Should I do do this? Who should I let do the injection? What are the risks? And if I hate it, can I reverse it?

Let me preface my comments by saying that I have always done all of my own injections for fillers and Botox for my patients. I know many places use estheticians and other doctors that are not plastic surgeons (even dentists). Most of the time, this is probably fine but there is a lot to be said for having an experienced plastic surgeon do your injections. But ultimately, that is your decision, based on your comfort level.

Not all facial fillers are reversible. Only those that are made from hyaluronic acid can be reversed. The good news is that all the facial fillers that I use are made from hyaluronic acid: namely Juvaderm and Voluma, and their associated families of products. This also applies to Restylane and Perlane and that entire family of fillers. This does not apply to Radiesse or Sculptra, which are made from a completely different material.

When a filler is injected, I always tell my patients to massage any firm areas that they may notice during the first week. You can certainly ice an area after an injection, but it is not required. Also, if you are happy with the look after the injection, it will almost certainly stay that way. Everyone gets some water absorption and slight swelling after the filler is injected. I strongly advise everyone to wait 2 weeks after the filler before considering making any changes. Since people sometimes examine the area injected very critically, it is important to realize that there may be subtle differences between the areas injected and along the areas injected (eg the two sides of the lip) that may be noticeable to you at day 2 or 3, but will be fine by day 14. The important thing to note here is to not be in a rush to make changes in the first two weeks!

I believe the main advantage of knowing that your filler is reversible is having peace of mind that you are not “stuck” for many months or years with the filler if you end up not really liking it. The practical side is that you are very unlikely to even need it reversed. You should also know that if you inject the reversing agent, it may dissolve ALL of the filler injected into that area, which you may not want. It is not an exact science and we cannot control exactly how much of the filler will melt away with the reversing agent.