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Low-cost Botox treatments raise some eyebrows

A South Tampa gym recently celebrated its grand opening with Botox shots for only $7, beating even the $10 deals also popping up this holiday season in places like medical spas and nail salons.

It's a brisk business.

Last year, Americans lined up for 11 million minimally invasive cosmetic procedures — most often injections of the wrinkle-smoothing drug and its chemical cousin Dysport. The economic climate has discouraged people from getting plastic surgery, but not the subtler — and cheaper — enhancements.

Look no further than mall-based medspas for proof that many women and men now consider such treatments as essential to personal maintenance as coloring their hair. And fans are starting young: 30-somethings account for nearly one-fifth of the market, says the American Society of Plastic Surgeons.

As the holidays approach, competition is fierce for the gift many may be giving themselves. At AnuYou Institute in St. Petersburg, for example, customers can choose between popular $10 per unit Botox days and a 12 Days of Christmas promotion — buy 20 Botox units, get five for free.

But which is the better deal? And is it okay to get a medical treatment in a gym or spa?

"It's buyer beware," said Dr. Dan Greenwald, a plastic surgeon in South Tampa. "When you shop on price, the risk of Botox is really unreliability."

Whether or not you like your results, the wrinkle-easing effects of the drug aren't permanent. No matter who does it, you'll need a refresher within months.

"It's not that you're going to have a dangerous outcome that you're going to regret for the rest of your life," he added. "It's just that you'll get an unreliable result — or a result that doesn't last as long as you'd like."

• • •

The $7 Botox offer for Vibe Fit Club's opening in South Tampa lured 42-year-old Melissa Sullivan from St. Petersburg. She had never tried Botox, but came with a friend who recommended the doctors offering the gym special.

"This is a good introductory price point for me," said Sullivan, "and if I don't like it, oh well, it wasn't that much money."

But even at $7 per unit, Sullivan said she spent $336 on her treatment. The effects — which she liked — should last at least four months, said Dr. Laszlo Teleszky.

Teleszky is a medical director at the Red Bamboo Medi Spa, based in Clearwater, which has a branch just off the main gym floor. He says Botox at a gym makes sense.

"You can come work out, tone your body, but you may have some wrinkles on your face you want to get rid of."

Wherever it is given, Botox can only be prescribed by a doctor, physician assistant or a nurse practitioner. Any doctor can do it in his or her primary care practice; no specialized background in dermatology or plastic surgery is required.

But under Florida law, in a medspa — or any aesthetic center that isn't the doctor's primary office — the nurse practitioner or physician assistant must be supervised by a board certified dermatologist or plastic surgeon, though they don't have to be present.

• • •

When you're sick, and especially if you have insurance, you may not think to ask the doctor what treatment will cost. But consumers generally pay for cosmetic procedures themselves. Plus, there's time to shop around.

Price wars in a competitive market like Tampa Bay can help you score a good deal — if you know how to shop for the product, and how to find a reputable vendor.

In 2002, the FDA approved Botox, a brand name for Botulinum Toxin Type A, to treat moderate to severe frown lines between the eyebrows. Now it's used elsewhere on the face, too.

Costs vary nationally, but on average, a Botox session goes for about $400, according to the American Society of Plastic Surgeons. If you pay by the unit — and drugmaker Allergan charges doctors $525 for a 100-unit vial — you have a good idea what you're getting. With pricing by the treatment area, however, you may not know how many units were given.

"The answer is, they just don't give you very much. That's the easiest trick in the world," said Dr. James Spencer, a dermatologist who practices in the Carillon area of St. Petersburg.

"When you're buying paper towels or something like that, of course you want to go to the cheapest place possible," said Spencer, immediate past president of the American Society of Cosmetic Dermatology and Aesthetic Surgery. "But when you're using a medication for your face, that's not the time to cut corners."

But even knowing the units used may not tell the whole story. Botox comes as a white powder that is mixed before use. The fresher the batch, the better the results. So you might get Botox that's been in the fridge for days, or has been watered down. Or you might get a similar FDA-approved medication, Dysport, that's a bit cheaper. It can yield slightly different results, depending on the area treated.

At the Venus Mini Med Spa, with locations in shopping malls in Tampa, Clearwater, Brandon and Sarasota, head physician assistant Rita Clarke finds that many people care most about looking good, not whether they get Botox or Dysport.

"If they're not asking, we prescribe what we think is best. If they specifically want something, that's what they get," said Clarke, whose clientele has grown to more than 4,000 clients in a year and a half.

"People want a good price, a good result and they want it convenient," Clarke added. "And that's the bottom line of what we do in the mall."

• • •

At Bayshore Plastic Surgery, Dr. Greenwald will share a vial of Botox among no more than three patients coming in within two hours of each other. Patients can see him open the sealed vial. His per-unit pricing is competitive, but he requires that customers purchase at least half a vial for immediate use, so his treatments may be costlier than at some outlets.

"I'm probably more expensive than going to the mall," he said, noting that Botox is a small part of his practice. "But what you get from that is a whopping good dose that's fresh — and the reliability of me."

Still, many health professionals can safely administer Botox, says Greenwald, who is also the medical director of Esteem Medspa in Tampa, where he has trained physician assistants and nurse practitioners to deliver Botox.

It's a controversial topic. Spencer, the St. Petersburg dermatologist, says his training is a quality check for consumers, who should be concerned about general practitioners doing aesthetic work without specialty training.

Then there's the perspective of Dr. Teleszky and Dr. Frank Toscano, the medical directors of the Red Bamboo Medi Spa.

Both trained as emergency room physicians, and each treated gunshot wounds and late-night emergencies for about 25 years. In 2008, they entered the beauty business, learning the art of Botox in a three-day, extensive course. They now spend most of their time on aesthetics, although both still take ER shifts.

"If a plastic surgeon spends his time doing breast enhancements, they are not going to spend nearly as much time and effort learning to do injections," Toscano said. "We don't deliver babies. We don't take off skin cancers. And we don't do jaw reconstruction. We're aesthetic physicians."

A spokeswoman for Allergan, the Botox provider, offered this guidance: "Only a licensed and trained physician who specializes in aesthetic medicine — like a dermatologist or a plastic surgeon — should administer Botox Cosmetic as this is a technique-sensitive procedure and one that should only be administered in a proper medical setting, like a doctor's office."

But in today's marketplace, consumers make the final call.

"At some point, you just have to trust," said Nancy Spencer of St. Pete Beach, who was comfortable receiving Botox from an experienced nurse practitioner at the AnuYou Institute in St. Petersburg.

Spencer bought AnuYou's $99 Groupon deal on laser spider vein removal, and was so pleased she came back for a massage. She also took advantage of a recent $10 per unit Botox day, leaving happy with the results.

"I'm always looking to try different things and new places," said Spencer, 53. "As long as they are going through the effort of giving me a good deal, then I will take them up on some of their other services."

Letitia Stein can be reached at lstein@sptimes.com or (813) 226-3322. For more health news, visit tampabay.com/health.

Shopping for cosmetic procedures

• You should be examined by a doctor, physician assistant or nurse practitioner — the only providers allowed to prescribe Botox.

• Check that your medical provider is licensed and review their disciplinary history on the state Department of Health's website: www.doh.state.fl.us/MQA.

• Ask about the credentials of the provider.

• Get recommendations from friends and people you trust.

• Consider what could happen if you're not satisfied. Is the provider well enough established that he or she will be there in a month to make things right? How long will the effects last? How serious could a poor outcome be?

Low-cost Botox treatments raise some eyebrows 12/03/10 [Last modified: Saturday, December 4, 2010 8:53pm]

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