You will have people ask “How is the counterfeit product legal?” Well, as with most laws created by politicians and lawyers there are loopholes. It is not illegal to import the product from Canada but it is illegal to dispense and use on a patient. The next question will be “How will a patient know?” I show patients the bottle (which does not have Chinese or Arabic writing on it), the expiration date, and lot number. When using filler I take a sticker off the syringe and place it in the chart with all that information. Thus, if a patient ever wanted to know if the product was real they could have a copy of the lot number and check it with the company. Additionally they can check with a company via phone or website to see if the physician is registered. If he or she is not registered and they are injecting, something may be amiss. There is also a hologram on the box is similar in nature to the holograms on dollar bills which allow us to distinguish counterfeit money from real money. Finally, if there is a Medicis rebate offer (which often happens once per quarter) the patient must mail in the box top to get the rebate. If the product is not real, then they do not get the rebate (as the box top will not have the hologram).
4) How long does it take to kick in?
I always tell patients to wait up to 14 days to see the full effect of either Botox or Dysport. However, because of the way I inject, some people will start to notice an effect within the first 2 days. Some areas of the face kick in faster than others, so if a patient is concerned they look “crooked”, I tell them to wait no less than 14 days before coming back in. The reason being is that if I inject a second time to correct an area that has not fully kicked in, the patient will most certainly end up crooked when everything does finally kick in. The technique I have developed ensures smooth coverage of all muscles to create a natural, “unfrozen” look so I typically do not receive such phone calls. It is also important to note that all of us have some asymmetry in our faces which makes us look natural and unique. I maintain the balance of the asymmetrical face to avoid making people look like mannequins.
5)What are the side effects?
The good news is that patient cannot get botulism and there are no long term side effects. The most common issue is if someone injects into one of the danger areas of the face (i.e. right in or under the eyebrow or under the eye itself), they can get a facial droop. This is why it is important to have a quality injector who has years of experience in injections and who knows anatomy well. I always stay far away from the danger areas and have not had any incidents where patients have a facial droop. Some people also notice they get a headache from the injections. It is a side effect that hits a minority of the patients and is rare considering I use the same injections to treat headaches. The headache usually does not last more than a day or so and I simply tell patients to take Tylenol, Aleve or Ibuprofen. Finally, with any injection there is the chance of infection, bleeding or bruising. To avoid infection I use a sterile technique and clean the area vigorously multiple times throughout the procedure. To avoid or minimize bleeding and bruising I use a very small needle and inject at such an angle as to minimize pain and tissue trauma.
6) How many times a year should I do this?
As mentioned above, the treatment lasts about 3 months. It wears off gradually and at the end of the second month and patients can expect to feel some motion of the muscles return. I ask patients to do treatments 2-3 times per year as we are now finding that keeping up with injections basically keeps those muscles relaxed permanently. As such, it trains the patient not to make those expressions which contract the muscles which :etch” the lines and this in turn can stop progression of and even begin to reverse some of the lines! So is it worth the effort and cost? Definitely! They have done studies on twins where one received regular doses of Botox/Dysport and the other did not. The twin who had the treatments looked 10 years younger than the one who did not when they reached their 50’s.