Botox - Patients ask Dr. Ringpfeil answers
Please feel free to use the blog below to share information about Botox or to ask Dr. Franziska Ringpfeil a question that might be of interest to others.
Philadelphia and Mainline Center of Dermatology and Cosmetic Surgery
Philadelphia's Botox® Specialists
Botox became a common household term in recent years and is one of the most popular cosmetic services. It works. It is safe. It is predictable and provides noticeable results with virtually no downtime.
Basic Botox treatment hides facial wrinkles created by repeated movement. Advanced use of Botox affords shaping of facial features. If performed conservatively, your family and friends will appreciate that you look more relaxed and younger but they will not be able to figure out how you did it.
Please note - the estimates above may vary by patient.
Calculator is based on $15/unit of Botox. Enjoy a 20% discount if booked on Botox day.
Price List
| price / syringe | lasts (months) | # treatments | |
|---|---|---|---|
| Botox | $15 / unit | 4-6 | 1 |
| Botox Special | $12 / unit | 4-6 | 1 |
Purchase of a full syringe is required. When only a partial syringe is needed, the remainder can be injected to another area.
All Botox injections are performed by our dermatologists.
We do not employ injectors!
Haverford – Mainline Office
Franziska Ringpfeil, MD.
Board Certified Dermatologist
Dr. Ringpfeil: "Botox is so much more than a wrinkle chaser. It allows me to enhance the attractive features of a face and restore youthfulness."
Philadelphia Office
Jayne E. Bird MD.
Board Certified Dermatologist
Dr. Bird: "Looking carefully at the facial features, I mix art, knowledge, and experience to magically erase these lines and facial depressions that hide your younger look."
Next Botox Appointment: Tue, Sep 26 1:30PM
Botox vs Fillers
Unlike filler placement to areas of the face where aging causes loss of volume of the skin, the underlying fat and bony structures, Botox targets facial wrinkles that are created by dynamic movement. As we age, loss of skin elasticity allows repetitive muscle movement to create a visible crease in the skin. Botox weakens this muscle movement and prevents the line from forming. Many times, it even reverses wrinkles that have already settled.
BeforeAfter
BeforeAfter
Let’s take the eyes, for example. With every smile, our body releases endorphins which keep us happy. It would be unhealthy not to smile anymore, But with the help of Botox we can now have a guilt-free smile without fearing that we deepen the dreaded crows feet. On the other hand, we can untrain the forehead muscle and those between the brows to no longer look constantly strained or angry.
Botox works best to prevent wrinkles. Once wrinkles are visible at rest it will take some time until the skin returns to its original shape. Deep static lines may need help from a filler if they have not resolved after 3 Botox injections 4-6 months apart.
Areas
The most common areas for wrinkle relaxation are the frown lines between the brows, crow's feet on the outside of the eyes, forehead lines and vertical lines above and below the lips where lip stick may bleed.
In addition to wrinkle relaxation, advanced use of Botox allows shaping of brows and lifting of brows and eyelids. We can up-turn corners of the mouth and soften a puckered chin. We can also reduce prominent vertical bands in the upper neck, minimize a gummy smile and turn a square face into a more triangular one.
Botox is currently FDA approved for cosmetic use for frown lines between the brows and for the treatment of lines on the outside of our eyes that occur with smiling and squinting. The use in all other areas is off label, just like the use of aspirin is for prevention of heart attack or stroke.
Other Brands - Botox vs. Dysport and Xeomin
Botox brand was the first neuromodulator approved for cosmetic use in the United States and it is the only one currently approved for medical diagnoses in this country. Dysport and Xeomin are equivalent neuromodulators that have since been approved by the FDA for wrinkle reduction on the upper face.
Dysport differs from Botox brand by a slightly smaller molecule size and therefore slightly wider spread. Xeomin is almost identical to Botox brand but it is bit more pure which reduces the risk of tolerance formation.
Risks and Safety
Cosmetic Botox has an excellent safety profile. You should not receive Botox during pregnancy or while nursing a baby. It is contraindicated in anyone with a neuromuscular disorders or a first degree relative with neuromuscular disorder. You should not receive Botox when you are sick. In addition to this, Dysport should be avoided with a cow milk allergy.
Do you inject botox in the masseter muscle for bruxism at your office?
Yes, we do. Pending the strength of your muscles, between 10 and 60 units of botulinum toxin every 3-4 months might be needed for results.
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Hello,
I was wondering if you provide intradermal Botox injections as a service (for refining pores and reducing oil production)?
Thanks.
We do not currently provide this service because results are not always reproducible.
Is there an additional consultation fee on top of the per unit charge for a first timer?
We waive a consultation fee, if you are interested in Botox and have your treatment at the time of initial consultation. If during this visit you wish to discuss other matters, either medical or cosmetic, and if time allows to address these, additional charges are due. We usually schedule full cosmetic consultations differently than first time Botox consultations, so please be sure to tell our schedulers what you would like to achieve during the visit.
I am a 41 year old white female, fair skin. I am getting married June 2017. I have a semi-deep wrinkle that goes across my forehead. Would you typically recommend botox or something else? I have blue cross insurance, I have a good job. Do I need a referral or can I just book a consultation to get a plan and go from there? Thank you
Static lines take some time to unwrinkle, especially if we have formed them over decades. In a young person who just notices static lines, they will disappear after the first Botox injection. Lines that have been present for many years may be invisible after the third round of Botox injections. The effects of Botox on the forehead are overcome by about 3-4 months at which time it can be injected again. It sounds as if Botox might be the right solution for you. You may book a proper cosmetic consultation with me in Haverford or Dr Bird in Center City and we will guide you through your options. Insurance does not currently cover cosmetic consultation. The fee for this cosmetic consultation is $115.
Dear Dr. Ringpfeil,
I have facial asymmetry resulted from my habit of chewing on one side(I had a tooth problem several year ago and I have dominantly used my left side to chew). Now I found that maybe my masseter muscle on the right side is much stronger than the left side, resulting my right face looks bigger. I am wondering whether botox injection can solve this issue. Thank you!
Botulinum toxin (Botox) treatments can certainly help. It might even be possible that a single treatment will do the job if you know chew evenly. It is also important that we look at photographs of your face prior to the tooth problem so that we can see if any preexisting symmetry was present that might not resolve.
I am interested in having the hollows at my temples filled in. I have had this done in the past with Radiesse filler. Is this something you do on a regular basis and do you feel comfortable doing this procedure? I would like to schedule an apt if you feel you can achieve a good result.
thank you.
Filler injection to the temples are frequently performed in our office since this technique became accepted standard for facial rejuventaion/reflation about 5-6 years ago. I normally use Radiesse for this procedure unless someone has had radiation treatment to the face or has reservations about Radiesse.
I had sculpts for my checks 3 injections so far. I don’t think I will go for another one. I want to address the frown lines and forehead w/ Botox. I feel as iif this issue is not being addressed. I also ask the dr to after the fine lines on my upper lip. I have fuller lip naturally but w/ age they have lost shape and column I was given juvide xl which was injected in a horizontally. The mouth is ok but I still see the small lines on upper lip. I’ m not sure if I should stay here or go elsewhere. The sculpts did help but it also has created a small problem with lines that r now visible from the edges of my bottom lip down the chin area. I also have a small booked blood vessel onMy face which I have asked to discuss, but I get no response. I’m starting feel a bit Leary. I don’t want to look 20 or 30 just refreshed. My family has good genes so we are lucky in that way. I’m confused and not sure what to do. I’m suppose to have a another conslt on what I want to do next. Stay w/ the sculptors or not.
I feel confused at this point
Nothing will be done at this review. I feel as if
I’m being pushed out like statements like you’ll just need a touch up next year. Nothing about what was discussed in the beginning
I am trying to provide advise based on the facts you provided:
It appears that you have lost the trust in your injector. Personally, I think it is great that you have a review scheduled where expectations can be voiced and before and after pictures can be compared. If your trust is fully lost, I advise that you consult with another injector so that you know that your expectations are realistic or not. In general, fine linens on the lips can be improved with filler but depending on severity, they might not fully go away. If too fine, filler injection might leave an overfilled look. Also, forehead lines are best treated with neuromodulator such as Botox unless the brows are used to correct heavy lids. While we do not work with Sculptra in our office, this substance is excellent to achieve long lasting volume where volume shifted naturally due to gravity.
Dr. Ringpfeil,
I have been a Nurse Practitioner for almost 7 years. I would like to transition into medical esthetics. Do you have any advice for making that transition? Do I need to find a training center (to get certified in botox injections, etc.) or do some physicians do training themselves? Your feedback would be very much appreciated!
Thank you,
Lynn
I am afraid that I have no qualified input in this matter.
I have read quite a bit on chin pebbling and have seen some Drs. on RealSelf say that results can be permanent as the collapsing muscles that cause the chin pebbling are arrested so that can’t do more damage and what the patient does have is reversed with one treatment. Do you find this to be true?
None of our patients had permanent damage to the muscle after injection for pebbled chin. The force in the chin muscle returns after 4-6 months.