Thank you for your question.
You submitted a photo and you state in your question that you visited a doctor using a
Groupon and your question was to the physician that you want to improve what you describe
as a number “1” as opposed to a number “11”.
Basically, you want to improve the area between the brows and the doctor recommended 50 units
of Botox® and you’re questioning is that too high, is the doctor trying to make more
money and you did mention that you got this through a Groupon.
Well, I can certainly give you some ideas of how this area is handled Groupon or not.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
I’ve been in practice in Manhattan and Long Island for over 20 years.
I and my colleagues and my specialty were amongst the first doctors to use Botox® and
so I’ve been using Botox® for patients since 1993.
So first understand what it is the concept of Botox® and Botox® is called a neurotoxin
but there are other neurotoxins in the same category like Dysport® and Xeomin® . So
when it comes to the number of units, you may want to be specific on whether or not
it was Botox® which unfortunately Botox® is kind of used generically like Kleenex®.
It might be that your doctor was suggesting Dysport® . As far as the glabella is concerned,
generally this area, 50 units is not typically a starting dose.
I think that one thing that is very important to establish for yourself is choosing a doctor
who you can have a long-term relationship with when it comes to considering Botox®.
People will often try Botox® and do it in these different discounted ways but I think
that a lot of people will be very disappointed by the experience.
If you are going to have a long-term relationship with a physician, I really doubt that you
are going to get the best doctor for you by virtue of a discounted method.
I think that given that Botox® is the number one non-surgical cosmetic procedure or the
application of Botox® is a procedure and Botox® as a product, this strategy may not
be ideal for you.
So just the science again, we are talking about the glabella in which there are 2 sets
of muscles there and they are called as the corrugator muscle and procerus muscle.
These are the muscles that contract that cause that line to form.
Now if that line is always there even when you are relaxed, well that line is also a
static line.
So it is very important that you understand that this line may not significantly improve
with the first treatment of Botox®.
I always tell my patients that the skin is like folding paper or creasing a shirt and
so if you iron a shirt and then you crease it over and over, well those creases will
stay.
The same thing with Botox®.
What’s different is that when you relax, the body will form collagen at the deeper
levels of the skin so that the lines will improve but they will improve with time.
So clearly, there is a need for better communication and I was referring to the other injectable
neuromodulator such as Dysport® where the units are different than Botox®.
So you have to be sure that you are speaking specifically of Botox® versus Dysport® . Typically
I would not exceed at 25 units for the glabella especially for someone who is getting it done
for the first time.
It’s my approach in my practice to be conservative with the first treatment and routinely I will
see patients after 2 weeks to re-evaluate if they need more.
Well with Botox®, you can add more but if you do too much, you can’t undo it so I
feel like a stepwise or a ladder approach to dosing so that a patient gets the outcome
at the right dose that gives them the best value for the longest period of time.
That requires some work and it requires having someone come in more than just for that one
transaction.
So, I think that you need to get another opinion or at least at a minimum contact the doctor.
Get the specifics.
Ask why the doctor wants to do the 50 units.
This is a field that I find remarkable where how much miscommunication occurs or lack of
communication.
I make it a point to spend a lot of time with my patients and I’ll take their photos and
show them on the screen what I see and have them see it.
See their pictures and evaluate it and that we are both on the same page and we have a
good understanding.
So again, if you are speaking about Botox®, 50 units do seem like a lot.
Contact the doctor to get some clarity as to whether it is Botox® or Dysport® or any
other product and ask about what will the follow-up be like after you get this treatment.
You have to find a doctor to be comfortable with and I think that prize is probably the
least effective way of finding the right doctor for you.
So I hope that was helpful, I wish you the best of luck and thank you for your question.