by Susan Isom

Botox injections remain the most popular nonsurgical cosmetic procedure in the United States. 

What a decade ago seemed scary and taboo — needles filled with botulinum toxin being prodded into wrinkle-prone facial areas — is now widely accepted, and sometimes considered part of one’s beauty ritual.

With that growing comfort and popularity comes the expected jump onto the bandwagon, with an overwhelming number of practitioners now offering Botox.

Compare prices, but don’t shop by price alone

This isn’t the time for a Groupon. We receive many calls asking to compare our prices to those offering a deal on Botox, but most have circled back as soon as they realize there is a difference — in placement, longevity and skill. Millimeters make a difference.

As a master injector, I look at the shape of a patient’s eye and eyebrow, for example, and match dosage and dilution for the desired effect. I may inject a 55-year-old woman’s forehead differently than a woman in her early 30s.

It’s fine to price-shop to some extent, but know that sometimes you’ll pay more for injections administered by more experienced practitioners. Botox treatments may be advertised for $250. But be wary of a price that sounds too low. You should expect to pay at least $400 an area for a seasoned injector.

Compare units and understand your number

Most practitioners price Botox by the unit, meaning the number of units of botulinum toxin needed per area. Typically, the area between the eyebrows requires around 20-25 units, while horizontal forehead lines average between 14 and 18 and crow’s-feet 9 to 12 per eye. These are just guidelines, and one should ask questions about the amounts he or she tends to use. In general, the greater the amount, the more chance you could end up with a frozen forehead.

Botox and similar neurotoxins, including Dysport and Xeomin, can be administered in a lighter or more aggressive dosing so talk with your injector about the look you want. Most of my clientele want a less aggressive approach. Smaller amounts of strategically placed Botox deliver the best results, in my experience.

A “new approach” of administrating Botox is called Baby Botox. It’s a technique using micro-injections of product, so we can eliminate fine lines yet retain some muscle movement.

Remember that a good injector will keep your unit numbers on file for a future visit, so you can discuss whether you felt the amount was too much or not enough for your desired look. There’s no such thing as one size fits all when it comes to Botox, which is why understanding injection quantities can make you a more educated consumer.

The longevity of Botox can also vary depending on who does the injections. Some practitioners, typically those offering too-good-to-be-true deals, tend to water down Botox more than a reputable injector will. There are guidelines to how many cc’s of saline should be used to dilute the toxin, which is standard procedure, but some injectors add a bit more to increase the number of injections they can get per vial. Unfortunately, patients won’t know if they’ve received over-diluted shots until the Botox begins to dissipate.

Get your dollars’ worth

Administered properly, Botox typically wears off within three to four months. The protein found in Botox is no longer present in the body three weeks after injections but the results from the product will continue for months. Some patients may experience extended results lasting longer than four months.

There are possible side effects to Botox, such as drooping eyelids or eyebrows. The complication, though rare, tends to occur when the practitioner is less experienced and isn’t as well versed in facial anatomy. In cases of severe eyelid drooping on one side, the injector has usually botched the placement of the Botox above the eyebrows. Sometimes this can be made better by placing more Botox to balance the mistake and lift the droop, but most times the patient must wait out the injection period, typically resulting in a droop lasting three to four months

There are tricky spots that can stump even the most established practitioner. Injecting the lower face, around the jawline or lips and mouth, is less forgiving than injecting the frown lines or the eyes.

Fewer units are needed in these spots, but muscle attachments, and how muscles work together, are more intricate. Be sure that whomever you select has done a lot of injections in the part of the face you’re interested in treating.

I give the patient a mirror and let them talk. Some parts of the face can bother a patient more than others, and it’s those conversations that help us understand each separate case. That is just as important as the skill of the injector.

Ask about pain, recovery and follow-up visits. Botox can hurt. Although the needles are tiny and the pressure light, there’s still the pinching feeling of a sharp object injecting something into your skin. Even with the best injectors, there can be light bruising afterward.

I advise getting Botox a couple of weeks or more before an important event. Not only does that allow potential bruising to subside, but it also lets the neurotoxin take effect. I also encourage a patient to return for a follow-up appointment at the two-week point. At that time, I can check in to see if the patient is happy with the results or if there is a complication or concern.

Experience counts

While it’s becoming just as easy to book an appointment for Botox as it is for a manicure, that doesn’t mean everyone is qualified. Becoming a good injector is not watching a bunch of “YouTube videos.”

You should feel free to ask a lot of questions. It is also important to ensure that the person injecting you has had official training in cosmetic injections, and is a certified injector. Never be afraid to ask to see credentials.

All injectors have a beginning, including myself. There are many women from years past I wish I could call and ask for another chance. Some I may have lost through lack of experience or nervousness. Your injector should get better with years of experience, training and advance placement techniques.

We were recently recognized by Allergan, the makers of Botox, as a Platinum Level Account, putting us in the top 4 percent out of 35,081 Allergan accounts nationwide. This is attributed to the amount of injections we administer at EL Clinical and the predictability of the performance of Botox Cosmetic and Juvederm facial fillers.

I have been fortunate to administer training to other injectors and receive continuing education from Allergan, which has strengthened my abilities, my assurance and loyalty to Botox Cosmetics.

So until the next big thing comes along which still could be years away, millions of us will continue to rely on Botox to fight those forehead wrinkles, frown lines and crow’s feet, so we can be well on our way to looking and feeling our best.