At the medi-spa
Trouble spot: Injections
In 2006, a woman in Salinas, California, died after receiving injections of fake Botox (it was cooking oil) from a hairdresser who was not licensed to do the treatment; the stylist was later charged for causing the death.
Although serious side effects from cosmetic injectables are extremely rare, counterfeit products have caused the most serious problems. “It’s a big issue because there is only one real Botox cosmetic currently approved by the Food and Drug Administration (FDA), but there are lots of cheaper fake and foreign products,” says Julius Few, MD, spokesman for the American Society for Aesthetic Plastic Surgery and director of the Few Institute for Aesthetic Plastic Surgery in Chicago. “When considering a cosmetic filler, it’s extremely important to make sure you’re getting something that’s FDA-approved.”
There can even be trouble with real Botox: If diluted incorrectly before being administered, its effectiveness can be reduced. “Botox comes as a powder and is mixed with a saline solution, so it could be overdiluted by someone trying to stretch profits,” says Bruce Cunningham, MD, director of the division of plastic and reconstructive surgery at the University of Minnesota. “I hear patients say, ‘The Botox I got at the spa lasted only three months instead of the usual six.’ That may be because it was diluted.”
Cosmetic injections are considered extremely safe, but they can cause side effects, like bruising, redness, lumps, and bumps. Most are temporary, but some, like droopy eyelids and a frozen expression, both of which can happen with Botox, can be upsetting. “An under-
standing of dynamic facial anatomy—what the muscles do when you talk and express emotions—can make the difference between a natural-looking outcome and something that’s just plain bizarre,” says Richard D’Amico, MD, president of the American Society of Plastic Surgeons. “The farther you get from a plastic surgeon’s or dermatologist’s office, the more likely you are to have less-knowledgeable or inexperienced people doing the procedure.”
Protect yourself
Make sure your initial appointment is with a physician. A nondoctor may not know the ins and outs of where a filler versus Botox would work best, says Alan Gold, MD, president of the American Society for Aesthetic Plastic Surgery.
Check the credentials, training, and expertise of the person doing the injections. (In one state, a physician’s assistant with a day of training may be licensed.) Someone experienced in cosmetic fixes will know that the hyaluronic acid in Restylane and Juvederm, for example, can be dissolved by injecting a substance called hyaluronidase if something goes wrong—they’ll also know that some people are allergic to hyaluronidase.
Beware of prices that sound too good to be true. According to a recent analysis in the Wall Street Journal, the average price for Botox is $363; injectable fillers range from about $390 for collagen to $557 for Restylane, a hyaluronic acid. Prices can be much higher in urban areas, however.
Look at the product, Dr. Gold says: Make sure that the package is unopened and the brand name and manufacturer are the same as what you were promised. Allergan, for example, has put a hologram on its Botox packaging to foil counterfeits.
Find out the spa’s emergency procedures. “You should be told what could go wrong and how quickly a doctor can get there,” says Hannelore Leavy, executive director of the International Medical Spa Association and the Day Spa Association.
Ask about ongoing training. With new Botox-like products expected to reach the market in the next year, the situation will soon be more complicated. “All the new products disperse differently in the tissues, so you’ll need to inject each one somewhat differently,” Dr. D’Amico says. “People performing these procedures are going to need to understand the differences.”
