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50 mail-in rebate on any purchase of two boxes of latisse From July 1, 2011to December 31,2011
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Draws are done at the end of each month.

Scars after surgery or trauma can cause a significant degree of psychosocial distress for people. For centuries, surgeons have been searching for methods of reducing scars and optimizing healing, to reduce these effects. To date, we know that several technique related factors as well as post surgical factors can effect the quality of the final scar. A new drug called Avotermin (trade name Juvista®) is based on the transforming growth factor (TGF)-β family of cytokines. These growth factors play a critical role in the final appearance of scars, and this represents one of the first drugs based on growth factors that may make a real difference in scars.

Renovo is a biopharmaceutical product company involved in in the discovery and development of drugs to reduce scarring. I have no relationship with the company whatsoever (I have nothing to disclose).

The July edition of the Plastic Surgery Journal (the main journal for plastic surgery in the North America) published the results of a study (1) performed to assess the efficacy of intradermal avotermin (TGF-β3) for the improvement scars following revisional surgery. They tested the drug in 60 patients, using intradermal injections of the drug immediately after the surgery and again at 24 hours. They used a double blind design study where neither the investigator or the interpreter of the results knew which patients were getting the real drug vs a placebo. There was significant improvement in the appearance of the scars in the avotermin treated group. Further, scar profilometry (think of this as a cast taken of the scar) showed significant reduction of the total scar surface area, compared to the placebo group. Microscopic assessment of the scars on biopsy showed that the collagen in the avotermin treated scars more closely resembled normal skin! That is pretty amazing! The final conclusion is that it seems to really work! This is a good example of Level I evidence in Plastic Surgery (that is the best evidence that there is).

What does that mean for consumers? This means that we can expect the drug to finally make its way to market within the next 2 or 3 years. There is no word yet on the price or availability of this drug.

But, before getting too excited about this, I want to inform you that the phase III clinical trials that ended in Europe in Feb. 2011 had disappointing results, since the drug failed to significantly improve the scars in a group of 350 patients tested. Photographs of the scars one year later were assessed and the independent panel of experts, using the Global Scar Comparison Scale, as well as the patients themselves assessed the scars and concluded that the results were not significant for either dose of the medication. So there are still things to be worked out before this drug comes to market, but overall, this seems to be a promising drug to all those people out there suffering with bad scars.

References:
1. So,Karen MB et al Avotermin for Scar Improvement following Scar Revision Surgery: A Randomized, Double-Blind, Within-Patient, Placebo-Controlled, Phase II Clinical Trial . Plastic & Reconstructive Surgery: July 2011 – Volume 128 – Issue 1 – pp 163-172

The standard textbook advice for capsular contracture is capsulectomy followed by site change and device exchange(1, 2). That means taking out the old implant, as well as the surrounding scar, closing the pocket, followed by making an entirely new pocket opposite to the original (under the muscle if the original was over the muscle) and using a new implant. There are as many option
I have tried using medications (such as ACCOLATE®- aka Zafirlukast) on a few patients to alter the tightness of early capsules (3, 4), but the results have been disappointing. Surgery appears to be the best option at present, and that is what I usually recommend. Simply ‘cracking’ the old capsules with the implants in place is not recommended(5, 6), and voids the manufacturer’s warranty, but used to be recommended in the literature(7). That said, there are many variations and options available for this kind of surgery. Some authors have suggested that we can leave the old capsule in place and just create a new pocket in front of it(8, 9), but the problem is that the old capsule will remain present for many years and can be a source of problems (it can collect fluid, for example). Instead of removing the original pocket, they obliterate the old pocket with ‘quilting sutures’ and then create a new pocket. Instead of putting the new pocket in front of the old capsule, some surgeons have placed the implant behind the old capsule, thereby using the old capsule as extra cover over the new implant. The question remains: What causes breast capsules? Many years ago, some plastic surgeons thought that some kind of mild infection was the cause of the problem(10). After many years of clinical and applied research, this idea has returned, with the concept of biofilms(11-13). We perform all of the recommended processes and procedures to reduce the risk of capsular contracture(14). Our capsular contracture rate is quite low, but not zero. We know that topical antibacterial agents will help to reduce the risk(15-17) of capsular contracture, as will minimizing the manipulation of the implants during insertion(18). We also use intravenous antibiotics during the operation(19) because this has been proven to be effective. Despite using all of the recommended processes and procedures, some patients will still get capsules. Some day, this may be eliminated with the use of special drug eluting coating on breast implants that will prevent the development of capsules, until then, we will still get the occasional patient with this problem.
With respect to what to do in your case, I have to say that this is a complex area where several key decisions need to be made, and they need to be made together. I can advise you what the outcomes are from each of the possible choices we have, but what is best for you is not possible to say without a proper surgical consultation, including a careful physical examination.
References:
1. Spear, S. L., Carter, M. E., Ganz, J. C. The correction of capsular contracture by conversion to “dual-plane” positioning: technique and outcomes. Plastic and reconstructive surgery 112: 456-466, 2003.
2. Lee, H. K., Jin, U. S., Lee, Y. H. Subpectoral and Precapsular Implant Repositioning Technique: Correction of Capsular Contracture and Implant Malposition. Aesthetic plastic surgery, 2011.
3. Scuderi, N., Mazzocchi, M., Rubino, C. Effects of zafirlukast on capsular contracture: controlled study measuring the mammary compliance. International journal of immunopathology and pharmacology 20: 577-584, 2007.
4. Huang, C. K., Handel, N. Effects of Singulair (montelukast) treatment for capsular contracture. Aesthetic surgery journal / the American Society for Aesthetic Plastic surgery 30: 404-408, 2010.
5. Laughlin, R. A., Raynor, A. C., Habal, M. B. Complications of closed capsulotomies after augmentation mammaplasty. Plastic and reconstructive surgery 60: 362-363, 1977.
6. Nelson, G. D. Complications of closed compression after augmentation mammaplasty. Plastic and reconstructive surgery 66: 71-73, 1980.
7. Little, G., Baker, J. L., Jr. Results of closed compression capsulotomy for treatment of contracted breast implant capsules. Plastic and reconstructive surgery 65: 30-33, 1980.
8. Xue, H., Lee, S. Y. Correction of Capsular Contracture by Insertion of a Breast Prosthesis Anterior to the Original Capsule and Preservation of the Contracted Capsule: Technique and Outcomes. Aesthetic plastic surgery, 2011.
9. Mladick, R. A. Treatment of the firm augmented breast by capsular stripping and inflatable implant exchange. Plastic and reconstructive surgery 60: 720-724, 1977.
10. Burkhardt, B. R., Fried, M., Schnur, P. L., et al. Capsules, infection, and intraluminal antibiotics. Plastic and reconstructive surgery 68: 43-49, 1981.
11. Marques, M., Brown, S. A., Cordeiro, N. D., et al. Effects of coagulase-negative staphylococci and fibrin on breast capsule formation in a rabbit model. Aesthetic surgery journal / the American Society for Aesthetic Plastic surgery 31: 420-428, 2011.
12. Tamboto, H., Vickery, K., Deva, A. K. Subclinical (biofilm) infection causes capsular contracture in a porcine model following augmentation mammaplasty. Plastic and reconstructive surgery 126: 835-842, 2010.
13. Adams, W. P., Jr. Discussion: Subclinical (biofilm) infection causes capsular contracture in a porcine model following augmentation mammaplasty. Plastic and reconstructive surgery 126: 843-844, 2010.
14. Berry, M. G., Cucchiara, V., Davies, D. M. Breast augmentation: Part II–Adverse capsular contracture. Journal of plastic, reconstructive & aesthetic surgery : JPRAS 63: 2098-2107, 2010.
15. Pfeiffer, P., Jorgensen, S., Kristiansen, T. B., et al. Protective effect of topical antibiotics in breast augmentation. Plastic and reconstructive surgery 124: 629-634, 2009.
16. Adams, W. P., Jr., Conner, W. C., Barton, F. E., Jr., et al. Optimizing breast pocket irrigation: an in vitro study and clinical implications. Plastic and reconstructive surgery 105: 334-338; discussion 339-343, 2000.
17. Adams, W. P., Jr., Conner, W. C., Barton, F. E., Jr., et al. Optimizing breast-pocket irrigation: the post-betadine era. Plastic and reconstructive surgery 107: 1596-1601, 2001.
18. Mladick, R. A. “No-touch” submuscular saline breast augmentation technique. Aesthetic plastic surgery 17: 183-192, 1993.
19. Khan, U. D. Breast augmentation, antibiotic prophylaxis, and infection: comparative analysis of 1,628 primary augmentation mammoplasties assessing the role and efficacy of antibiotics prophylaxis duration. Aesthetic plastic surgery 34: 42-47, 2010.

BBL -IPL Treatments (Intense Pulsed Light)
This is a great technology to jump-start your skin care program. Get rid of fine lines, brown spots, and red spots and small veins. (This is not a laser treatment).
Fees: $200- $400 per session. Most people need at least two sessions to start, then a maintenance program to keep their skin looking great.

Laser Hair Removal
I have been providing hair removal services since 1994, before almost anyone even knew it was even possible. My team performed some of the original research on this subject. Our staff is extremely experienced, and we have retreated patients who were treatment failures at other clinics, and we have assumed care for patients who were abandoned when the original clinic went out of business.
Over the years, I have invested in new equipment and devices on an ongoing basis. We provide the most effective equipment based on clinical trials and ongoing research at Wellman Labs associated with Harvard Medical School. Since 2009, we have used the LightSheer Duet Laser, the de facto gold standard of laser hair removal systems. Prior to that, we used the Original LightSheer device, which was very effective, but much slower. For your convenience, the LightSheer Duet is so fast and painless that, for example, a man’s back can be treated in less than 30 minutes (this used to take several hours).

Facial Areas (per treatment session- NOTE: Facial areas will require approximately 6 treatment sessions to remove most of the hair permanently)
Upper/Lower Lip: $75
Chin: $100
Jawline: $100- $125
Neck: $100-$200

For areas off the face, about 4 treatment sessions will be needed.
Bikini: $200 to $350 per treatment
Underarms: $125 per treatment
Full Back: $650 to $900 per treatment
Thighs: $600 – $800 per treatment
Leggs Program- (Get Rid O the Razor): $900 per treatment, lower legs only $400-$500 per treatment session

Maintenance Program: Some patients with hormonal imbalance may continue to grow some unwanted hair (particularly the face, sometimes the back areas) may require an ongoing maintenance treatment plan. These are provided at approximately 10% of the original total treatment cost.

Laser Resurfacing
Full Face Laser Treatment ( UNLIKE THE PREVIOUS PRICES MENTIONED, THESE FEES ARE FOR SERVICE ONLY- they DO NOT include anaesthesia, medications, taxes or any other fees)
NOTE: Many patients will benefit from treatment with botulinum toxin (Botox) at the same session. The muscle relaxant will prevent the wrinkles from folding the newly developing skin, so that it heals flatter and smoother. Typically, I recommend two treatment sessions- one on the day of the laser treatment, and second one at 12 weeks after the laser treatment.
Light ProFractional Treatment (3 day healing time) $600- $800
Moderate ProFractional Treatment (4 day healing time) $750-$1,250
Moderate Flat Beam Resurfacing PLUS Moderate ProFractional $1,800 – $2,500
Quick n Easy Full Face Treatment (1 week downtime) $2,500-$3,500
Deep Full Face Treatment (for extensive sun damage treatment) $7,500-$11,000 (including ancilliary treatments may be provided at the same time to improve results, priced separately)

Lumps, Bumps, and Thingy’s (MBT) Growing on You?
One Mole, Bump, or Thingy (MBT):- incl processing, aftercare, & followup care: $350-$450
Two MBT’s (lesions): $450-$550
Three MBT’s: $500-$550
Four MBT’s: $550-$600
Whole Bunch of Moles, Bumps, or Thingy’s: Rates vary with complexity and number of lesions to be treated.

Price includes getting the specimens sent to the lab and interpreting the results for you, and suggesting further treatment if necessary. We use advanced techniques for removing these unwanted skin blemishes, and we aim for permanent removal, leaving you with almost no scar or mark indicating previous removal.

ANSWER: REALLY DISTORTED BREASTS WITH OVERSIZED BREAST IMPLANTS- ARE THE RESULTS OBTAINED PREDICTABLE?

First of all, sorry to those women who got what they asked for, instead of what would work best for their body shape and size.

Remember, breast augmentation is NOT an easy operation. You have to be FITTED for a breast implant that will work properly for your actual breast/chest size and shape. You CAN’T have any size you want, you can ONLY HAVE A SIZE THAT FITS YOU (sorry for shouting there). There is a range of devices that will properly fit a given breast/chest. That range is typically narrow. Breast implants come in different shapes and sizes for a reason. What manufacturers have done is increased the amount of projection (how far out the breast implant sticks out from your chest), but kept the base width of the device the same.
By the way, do not let your surgeon talk you into the use HIGH PROFILE devices in your breasts (if you have normal breasts to begin with). The literature shows the patients with these devices end up with problems that are difficult to manage(1). In other words, although the early results look OK, we will have a problem that is very difficult or maybe impossible to fix about 10 years from now. High Profile breast implants should be used very rarely if ever in normal breasts, in my opinion. I have seen irreparable problems with these- young women with really stretched out skin that is so thin that I can almost see right through it(2). If you have a really bad result, your best option may be to start over. That means that the implants have to be removed, along with at least a ‘hemi-capsulectomy’ (removing half the shell around the breast implant). This will allow the remaining part of the capsule to be absorbed into the breast tissue. Leaving the entire capsule intact results in a potential space that does not close, and sometimes collects fluid for many years to come. The muscles will have to be repaired and reattached to the chest wall during this first procedure, just as they were before the operation. Then you may need to have a fat grafting session, where fat is transferred from one part of your body to the area just under the skin of your breasts. This may help the skin to regain some of its elasticity and thickness (collagen). Following that, if everything heals well, and there are no problems with the tissues, an appropriately sized breast implant may be used to restore more volume.
References
1. Tebbetts, J. B., Teitelbaum, S. High- and extra-high-projection breast implants: potential consequences for patients. Plastic and reconstructive surgery 126: 2150-2159, 2010.
2. Handel, N. Secondary mastopexy in the augmented patient: a recipe for disaster. Plastic and reconstructive surgery 118: 152S-163S; discussion 164S-165S, 166S-167S, 2006.

References:

1. Spear, S. L., Dayan, J. H., Clemens, M. W. Augmentation mastopexy. Clinics in plastic surgery 36: 105-115, vii; discussion 117, 2009.
2. Spear, S. L., Low, M., Ducic, I. Revision augmentation mastopexy: indications, operations, and outcomes. Annals of plastic surgery 51: 540-546, 2003.
3. Spear, S. L., Pelletiere, C. V., Menon, N. One-stage augmentation combined with mastopexy: aesthetic results and patient satisfaction. Aesthetic plastic surgery 28: 259-267, 2004.
4. Stevens, W. G., Stoker, D. A., Freeman, M. E., et al. Is one-stage breast augmentation with mastopexy safe and effective? A review of 186 primary cases. Aesthetic surgery journal / the American Society for Aesthetic Plastic surgery 26: 674-681, 2006.
5. Handel, N. Secondary mastopexy in the augmented patient: a recipe for disaster. Plastic and reconstructive surgery 118: 152S-163S; discussion 164S-165S, 166S-167S, 2006.
6. Heden, P. Mastopexy augmentation with form stable breast implants. Clinics in plastic surgery 36: 91-104, vii, 2009.
7. Dickinson, B. P., Handel, N. Approaching Revisional Surgery in Augmentation and Mastopexy/Augmentation Patients. Annals of plastic surgery, 2011.
8. Cannon, C. L., 3rd, Lindsey, J. T. Conservative augmentation with periareolar mastopexy reduces complications and treats a variety of breast types: a 5-year retrospective review of 100 consecutive patients. Annals of plastic surgery 64: 516-521, 2010.

Surgery
Whenever one considers surgery, one has to add the cost of the facility in which it is provided, as well as the cost of anaesthesia. These can be significant, and are added to the cost of the procedure. The typical cost of anaesthesia is about $700 for a one-hour procedure. This covers the cost of the doctor (anaesthesiologist- a medical specialist who has spent about 5 years of extra training AFTER medical school) as well as all the equipment, drugs, and disposable items used to provide you a safe and effective, pain free experience. The facility fee includes the cost of the experienced operating room personnel, the monitors, equipment, fluids, iv’s, and all the other items used, as well as a use fee for all the items you will hopefully never need to use, but you want to be available ‘just in case’ (cardiac resuscitation defibrillators, backup power, and emergency drugs, etc.) as well as the basic operating room equipment, such as air filtration devices, air sterilization, sterilization equipment, and so on. The facility fee costs about $500 to start on average, costing more for longer procedures.

Breast Augmentation
See above for explanation regarding anaesthesia fees and facility fees in the Surgery section.

The price of breast implants varies a bit, but they generally cost about $800 to $1300 each, and if you are looking for breast augmentation, you will generally need two of these. The price for the surgery, including the follow-up care, is about $3,000 to $4,000, depending on what exactly needs to be done. Dr. DeLorenzi does NOT charge you again for a follow-up visit when you come back for your annual checkup for up to 5 years after surgery.
BOTTOM LINE: Breast Augmentation Surgery costs a total of $7,120 to $9,960, depending on various factors (including the facility fees, anaesthesia fees, and implant fees, and the HST). Most women will usually fall into the lower range of this price structure (ie about $8,000 including taxes) unless there are significant size differences, nipple differences, or other significant problems that have to be addressed at surgery.

Breast Lift (Mastopexy)
Fee $4,500 to $13,000, including anaesthesia, facility fees, and taxes. Why such a wide range? Some women only need a slight repositioning of one nipple-areola complex, while others need major tissue readjustment, fat grafting, breast implants, liposuction of the sides, and so on. The prices for your surgery will depend on whether or not implants are used, whether it involves one or both breasts, how much tissue has to be removed or altered, and whether or not liposuction and fat grafting are needed. Most women with significant breast droop who need implants for the best results should consider having two separate operations. Read my other articles about this.

Gynecomastia (Male breast reduction)
Liposuction alone: $4,000 to $6,450 (total for both sides)
Liposuction plus excision of breast tissue: $5,500 to $8,270 (total for both sides)

Liposuction:
See above for explanation regarding anaesthesia fees and facility fees in the Surgery section. The cost of liposuction will depend on the devices used. For example, using the BodyJet device, the cost of treating a single area is about $4,000. A single area is about the size of your body that can be covered by your spread out hands. Some areas are less expensive, such as the area under your chin. Remember to add the costs of anaesthesia and facility fees and the HST to your total costs. Typical liposuction fees range from $3,000 to $14,000 including anaesthesia, facility fees, and taxes, depending on what you want. Some patients have deep tummy scars, for example, which can be almost completely filled in so that they don’t show at all. This can be done using advanced lipografting techniques that also help stretch marks and cellulite look better, permanently.

Cellulite: Many women will have bumpy, ‘cottage cheese’ changes in the skin of their thighs, lower abdomen, and buttocks, amongst other places. This primarily happens after puberty, but rarely some children present with this problem. It is NOT a disease or pathology. It appears to be a normal condition, but nevertheless it is almost universally hated. It rarely is seen in men (except those with extremely low male hormone levels), and unfortunately has no known permanent cure (yet). There are some treatments that may temporarily improve the condition. We are currently investigating yet another device which may improve cellulite. Our previous investments in technology to correct this problem have been somewhat disappointing, but we still keep looking. If you have this problem, and would like to try investigational treatments, please contact our office and let us know. We will send you a special access code so that you can enter your confidential medical information securely on line. The clinical study has not started yet at the time of this writing.

Facelift
The type of facelift will make a difference in how long the results last. Typical fees range from $10,400 to $25,690, depending on whether or not you want your forehead and eyelids done and whether or not you need volume in your face (fat grafting), laser resurfacing, liposuction of the neck, botox, fillers, and so on. The wide range in fees is due to bundling of several different components together (whether you want a touch up or a complete overhaul!).

Abdominoplasty (Tummy Tuck ) including anaesthesia, facility fees, and taxes.
NO liposuction/muscle repair, skin only from lower tummy: $6,100-$7,200
Including Liposuction, Muscle Repair, Flanks, Lower Back, $9,800 – $15,900

Rhinoplasty (Cosmetic nose surgery)
Tip Only – $3,500 to $4,000
Tip and Bump : $4,500 to $6,500
Tip, Bump, Bone Displacement, Tip Grafts: $6,500 to $9,000

Otoplasty (Pinning back the ears)
Both sides: $4,500 to $5,000
Chin Augmentation
$3,000 to $3,800

We are always being asked to give prices, even before discussing the requirements of surgery. How much is that? The answer is never as easy as it should be, and it always looks as though we are trying to beat around the bush. Prices are usually a price range, rather than a prix fixe affair. Many of the surgical options I offer include products, as well as services- breast implants are a good example. Prices have to include these implants, which vary in price from model to model, as well as from manufacturer to manufacturer.

I have to rely on the services of my team members to do a good job for you. I need my experienced nurses to help take care of you just as much as I need the services of my experienced anaesthesiologists to provide you with a safe and effective surgery. Unlike the purchase of an object, plastic surgery involves skills, knowledge, and judgment. Just like any other set of problems, patient concerns come in a wide variety of complexities, with varying levels of difficulty, and often many choices. I have over 20 years of experience dealing with all aspects of cosmetic surgery, and by now there is not much I have not seen and dealt with. I try to be a straight shooter, and give people my honest opinion about what is best for them. I have sometimes angered people because I will not tell them what they want to hear. I want to make sure that people understand the risks a well as benefits of the procedure that they are requesting. I want to make certain that people understand how I think that they will “turn out” before we do any surgery. Unfortunately, some people are just not good listeners, or they may have a distorted view of reality. Some patients just don’t want to hear that their problem will not be fixed perfectly with the procedure that they are asking for. They would prefer to believe that they know better because… they read someone’s website? Yes, that happens. Some one once said that the most dangerous person is one with partial knowledge. I am not sure if that is true, but I deal with people who think that they know more than they actually do. I would much rather not operate on that person, because they will NEVER be satisfied with the results that might reasonably be obtained. If you are looking at the ‘before’ photos of a relatively perfect 20-something year old model in a magazine, and you are not a similar perfect looking 20-something year old model, then there should not be any surprises when I don’t think that you will turn out like the “after” picture either. Similarly, when looking at patients who have breast implants, and you are a petite 5’2” 100 lb woman, you should not be comparing yourself to a lithe 5’ 10” 130 lb woman. Try to find examples of patients that have a similar height and weight to your own, and who have a similar build. Those are realistic comparisons that may be meaningful and helpful to you. The 375 cc implants in the 5’ 10” woman may look completely natural on her, but may not on you. (By the way, the reason that there are no ‘before and afters’ on my website is because the College of Physicians and Surgeons has deemed this practice to be against regulations. Many surgeons post before and after photos anyways, despite the rules against doing so. I will continue to follow the regulations, even though it most likely does give an unfair advantage to my colleagues. )
Unfortunately, with shortening of attention spans, trivial 140 character tweets, and ‘in-depth’ news items that last mere seconds on network TV, in depth knowledge is just out of style these days. If you are going to proceed with any type of procedure, you really need to do some homework- it is for your benefit. You can look at all the books, magazines, and websites you want, but you will not be a surgeon when you are done. You need to have some guidance to help interpret the myriad decisions that go into any type of surgery. I encourage you to see more than one plastic surgeon, since we are all different, and you may communicate better with one than with another. Most of us (plastic surgeons) really do have your best interests at heart, and we really do want you to be satisfied with your results.
You have to be honest with yourself first- be sure in your own heart what you really, really want. How many friends do you know who go out and buy something because it was “a real bargain”? How many friends do you know who go out to buy, say a red dress, but come home with a green one instead, because it was a ‘steal’? In the end, they still want a red dress, but because the green one was cheaper and available, they come home with something that they did not really want? If you really want something, don’t settle for something you don’t want as a substitute that will just not satisfy you in the end, because it will just be money… wasted.

In order to have a good working relationship, I have to trust the patient just as much as the patient has to trust me. I have always held that the most important three factors in a medical relationship are that 1- the patient has to like me, 2- I have to like the patient, and 3- they have to have a problem that I can fix. If one of these is missing, there is going to be trouble!

This price list is necessarily incomplete. Because of repeated requests for information, here are some guidelines for prices for different kinds of surgery and treatments that are popular in my clinic. These prices will usually include everything, including all taxes, supplies, implants, and so on- since when people are shopping, they want to know the bottom line, not just what one part costs. Unlike shops that only advertise the “teaser” amount, I am giving you the totals, including taxes, so you know exactly what to expect. Please note that there will always be a range of prices, since not everything is exactly the same, and some patients have problems that are more complex than others. There are a few exceptions in subsequent articles where the prices are not complete, but these examples are clearly noted.

Botox®: Botox® is a muscle relaxant (a neuromodulator) that causes muscles to soften and relax for a period of about 3 to 4 months. Instead of filling a line with a filler, Botox® relaxes the muscles that are causing the wrinkles.

Glabellar Elevens: (Forehead lines between the eyes that look like the number 11): Typically a treatment of this area will cost between $250 and $400 dollars including everything (including taxes). This depends on the size of the muscles being treated- larger muscles need more. Some men with deep lines will need even more than $400 worth of Botox(R) to get improvement. Adding filler to the area will improve the duration of the results, and improve the satisfaction ratings, reducing the treatment interval to twice annually. Larger quantities will cost less than smaller quantities if they are administered at the same time. It is important to realize that this is an expensive medication, and because it is a drug according to the Federal Government, it is strictly regulated, and as such there is no discounting allowed by the manufacturer to high volume users. We do however heavily discount the medication when it is provided in large quantity to individuals who need it.

Botox® for Hyperhidrosis (severe, unpredictable sweating)
Hyperhidrosis patients often have an extra change of clothing in their office. Dry cleaning, not to mention the cost of damaged clothing can be a real concern for these patients.
If nothing else has worked for you, and you have tried all the different antiperspirants without success, then you may want to consider Botox® treatments. Treatments are usually given every 6 months for several years. Many patients seem to require fewer treatments over time. For many patients, this has been a life changing benefit. Did you know that many private insurance companies subsidize the cost of treatment? Check with your insurance provider to see if this is a benefit of your policy.

New Treatment: There is also a new treatment we are currently evaluating for patients with severe sweating problems that may provide a permanent solution. If you are bothered by excessive underarm sweating and are willing to participate in a clinical trial, please call our office to discuss this. We can send you a special access code so that you can enter your confidential medical information securely on line.

Fillers: Fillers are used to fill in the lines of the face, sometimes to fill in scars (such as acne scars) and also to do a Filler Lift ® The fillers can restore the youthful contours of your face as well as improve the amount of moisture in the skin. As we age, the amount of natural material in our tissues decreases, so restoring this material helps get things back into shape. There are many different kinds and brand names out there. The biggest ones are probably Restylane®, Juvederm®, Teosyal®, and Esthelis®. Each one is slightly different, and has slightly different indications (one for cheeks, one for lips, one for hands, and so on). The price charged for these includes the price for the material itself, plus the cost of the service. To round it off, the price of a single 1 ml syringe of the material is about $500. Buying in larger quantities is less expensive, for example the second syringe is about 10% less (for example, two syringes of quality product cost about $950). The discounts will increase significantly from there, so that 5 syringes (5cc) will cost about $2,000 (a savings of 20%). Some specialty products are slightly more expensive, and some thinner products (less of the active ingredient) are cheaper. Think of it like buying good quality vs. cheap paint. The cheaper one will need two coats to get the same results, so it is not really cheaper when you are using it. We only deal with the high quality filler products.