Posted: November 18, 2013
The costs of Botox are so variable; it is confusing for the consumer to understand why there are such differences in pricing.
In general, Botox fees go by “area” or by “unit”.
Here is a typical ad. I see these everywhere—online, storefronts, groupon, Valpak coupon books, you name it:
“BOTOX LAS VEGAS, $7 PER UNIT”
That sounds great, considering my fees are $800 for a 50 unit BOTOX® Cosmetic vial from Allergan = $16 per unit. So how can a practitioner be making a profit on $7/unit? Are they doing it for free? I don’t think so…
Botox can be bought from any person with a DEA license. The company Allergan is the ONLY supplier of the Botox brand in the United States. The company sells Botox in 100 and 50 unit single patient use vials. See below for pictures of what the Allergan vials look like. Your doctor should be happy to show you the vial during your treatment, so for your own safety, ask to see the vial. It’s yours, after all. Single patient use means one vial for one patient. This is essential to avoid patient cross contamination.
Other brands of Botox are also safe, effective and FDA approved for facial wrinkles. These include Xeomin by the company Merz (http://www.xeomin.com) and Dysport by Medicis (http://www.dysportusa.com). These brands of Botox are also labeled as single patient use vials.
Botox is FDA approved to treat frown lines and crows feet lines. Any other area treated is considered “off label”. “Off-label use” means that a prescription drug is being prescribed for a purpose not listed on the product’s label. When done under a licensed physician, off-label use of prescription drugs is legal and may be useful for optimal results.
In my practice, Botox is most commonly used for 3 main areas, the frown lines, the crow’s feet lines, and also the transverse forehead lines (which overlaps the frown line zone). A single patient use 50 unit vial allows for a significant reduction in wrinkles in all of these areas, but allows you to maintain some facial animation, and I think naturalness is important. I use the 100 unit vial to treat the armpits and it works amazingly well to decrease or eliminate severe armpit sweating issues, also called “axillary hyperhydrosis”. The 100 unit vial can also be used if the patient desires additional areas of the face. I reconstitute the vial immediately in front of the patient before injecting. Any remaining Botox in the vial after your treatment is completed is discarded immediately in front of you. No, we can’t save it for next time.
As a Board Certified Plastic Surgeon, I do not delegate injectable treatments. I do them myself. I follow the rules and the FDA packaging for usage of Botox as a single patient use vial. It is not worth my hard earned license to do otherwise. Plus, when I said the Hippocratic oath upon getting my medical degree, I meant it!
Here’s what the Allergan prescriber informational pamphlet says:
“BOTOX Cosmetic is supplied in single-use 50 Units and 100 Units per vial. Prior to intramuscular injection, reconstitute each vacuum-dried vial of BOTOX Cosmetic with sterile, preservative-free 0.9% Sodium Chloride Injection USP. Draw up the proper amount of diluent in the appropriate size needle and syringe to obtain a reconstituted solution at a concentration of 4 Units/0.1 mL and a total treatment dose of 20 Units in 0.5 mL for glabellar lines and 24 Units in 0.6 ml for lateral canthal lines. Then slowly inject the diluent into the vial. Discard the vial if a vacuum does not pull the diluent into the vial. Gently mix BOTOX Cosmetic with the saline by rotating the vial. BOTOX Cosmetic should be administered within 24 hours after reconstitution. During this time period, reconstituted BOTOX Cosmetic should be stored in a refrigerator (2° to 8°C). BOTOX Cosmetic vials are for single-use only. Discard any remaining solution.”
Here’s why you see cheap Botox:
- It is very common practice for an office to reconstitute a vial of Botox and split it amongst 2-4 patients. When done with separate syringes and separate needles before patients arrive, theoretically there should be no patient contamination risk. So many doctors continue to follow this practice. If it is done any other way, there is a possibility of cross-contamination between patients since the office is using the vial over and over again for several patients.
- By Nevada state law, only physicians, RNs, and PAs are allowed legally to inject Botox. So it is important to know who your injector is, and what are their certifications, training, experience, and motives?
- A person can also dilute the Botox by whatever ratio they want, so the patient never actually knows how much Botox they have received. It could be a pretty dilute concentration. You get what you pay for.
- You could be getting old Botox that has been sitting in the refrigerator for weeks or months.
- Sadly, some offices purchase Botox from unknown origins both domestically and overseas, and you have no idea what is being injected into your body. Severe life threatening complications have been reported from the illegal and unscrupulous use of injectables.
For more information about Botox, visit:
Actual pictures of the BOTOX® Cosmetic vials from Allergan: (The 100 unit vial is purple, the 50 unit vial is red)
Dr. Hayley Brown MD, FACS
Board Certified Plastic Surgeon
Desert Hills Plastic Surgery Center serving Henderson and Las Vegas, Nevada