“How Much do you Charge?”

(Sorry for the length, but important information!)

Last week, I received a call at the office, and this is how it went…

  • Me: Thank you for calling Cielo Aesthetics & Wellness.  How may I help you?
  • Caller: How much do you charge for Botox®?
  • Me: Hello! Have you had Botox or any of the other neuromodulators before?
  • Caller: (rudely) Just tell me what you charge for Botox!
  • Me: We charge $11… (cut off by caller)
  • Caller: (even more rudely) That’s more than I pay in Scottsdale!
  • Me: Well, then you should stay in Scottsdale.

I don’t usually “show my ass” like that to a client, but she was so rude and frankly, this sort of thing is happening too often lately.  I’m a human being, a business professional (though admittedly I didn’t show that at the end of the call) and a highly trained aesthetic specialist who’s not only been doing these injections for nearly 20 years, but have also trained thousands of injectors across the country for the past 12 of those years.  I’m going to address a trend in the industry that allows some of these other practitioners to provide such great deals on aesthetic treatments.

The FDA’s office of Drug Security, Integrity and Recalls was established to protect patients from harm caused by impure, counterfeit or otherwise illegally acquired drugs.  Due to the global sourcing of drugs and the easy availability of products distributed through questionable supply chains, this office has been particularly busy!

As a medial aesthetic provider, our office is inundated with emails and telephone calls from companies claiming we can save thousands of dollars by purchasing our injectable products from them vs. the United States based companies from whom we currently, and legally, obtain our products.

Drugs purchased through legitimate, FDA regulated supply chains in the US are considered safe and effective as the US has one of the most secure regulated supply chains in the world.  Unfortunately, whenever there is an opportunity to increase profit, there will be those who exploit it.  Competition continues to rise in the aesthetic marketplace and patients/clients seek out less expensive options, without considering or understanding the risks that may arise from obtaining medication from unregulated sources.  With technological advances, it has become easier for those seeking to profit from the sales of potentially counterfeit products by making them appear to be US approved product.

Thousands of physician offices have received letters from the FDA about working with suppliers outside the legitimate pharmaceutical supply chain.  Sadly, despite these warnings that they’ve purchased product from unlicensed, foreign and unsavory suppliers which the FDA confirmed sold substandard or counterfeit product, some physician offices and medical spas have elected to continue purchasing these less expensive products through questionable sources.

If a drug hasn’t been approved by the FDA it is because it hasn’t been determined to be safe or effective and the company selling the product has not had their manufacturing practices/handling procedures inspected by the FDA for safety.  Drugs imported from foreign or unlicensed suppliers may be perfectly fine…but they may have come from unknown sources, may have unknown ingredients, may be counterfeit, or may not have been manufactured, transported or stored under proper conditions as required by the US law, regulations and standards.  This can lead to poor results, adverse reactions or worse.

We’ve all heard the stories about the patients who were knowingly treated with unapproved Botox® in 2004 and became paralyzed.  Over the years, many practitioners have been convicted…yet remain in practice.

The new danger is primarily driven by patients who demand ever less expensive injections.  They come to the office armed with internet ads, Groupons, and other enticements to get treated with “Botox” at far lower prices than are available for approved product.  This pricing pressure may cause a provider to  look to less expensive outside sources from which to purchase their product, believing the claim that it is the exact same product as is available in the US.  In their defense, the product may have been manufactured by Allegan, or Galderma, or Merz…but not within the US. Even if approved in other countries, simply importing or causing importation of an unapproved drug when there is an FDA approved drug available is illegal in addition to being dangerous.

Listen, neuromodulators (Botox®, Xeomin, Dysport) and dermal fillers (Juvederm family, Resytlane family, Radiesse, etc.) are expensive!  They cost we providers a lot of money.  We want to keep our prices competitive, but we also want to provide safe and effective treatment to our clients.  If a price sounds to good to be true, it likely is.  Botox sold for less than $9 or fillers under $350 (for a full syringe) should raise a red flag as that is below cost. When a business contracts with Groupon, about 50% of the sales price goes to Groupon.  If the provider is discounting the product (after paying for the product and paying Groupon), there is no way for the provider to make any money…in fact, he/she is more likely losing money if they are using approved products. No one is in business to lose money.

There are many, many options for those seeking cosmetic injections these days.  As a trainer, I can tell you that some of you are being injected by those who’ve been in the industry for only days.  Groupons are often used in locations where turnover is high and new injectors are getting their start.  Many new injectors fail to seek out and purchase qualified training from reputable facilities, choosing instead to take the shortcut available to them by simply having the drug company sales rep do “over the shoulder” training with their product.  That is certainly a legitimate method for learning about a specific product if you already know how to inject fillers and toxins but it should NOT be the only method for training!  Sales reps are knowledgeable about their products, but they lack the anatomy and physiology knowledge required to provide safe outcomes – and I don’t know many who would tell you otherwise. There are very serious complications that can occur from aesthetic injections and putting yourself at risk over a few dollars is simply not worth it!

Cosmetic injections are an art.  Providing safe and aesthetically pleasing results isn’t just “chasing a line”. Just because someone is relatively new to injecting doesn’t mean that they won’t be good at it, nor does it imply that someone who’s injected for many years will be, though experience does provide very valuable lessons.  Seek information about your injector - have they attended accredited training and continuing education courses?  The number of social media posts and followers doesn't necessarily relate to experience or skills.

So, in closing, remember it is your FACE – presented to the world every day.  Those of us who’ve spent years honing our craft, from initial certification to weeks of annual conferences to ongoing training sessions to daily injecting of thousands of clients, deserve to be greeted with other than “how much do you charge…”.  If price is more important to you than having an experienced and skilled injector, then we truly wish you all the best.  However, please keep in mind that it is much more difficult for us to “fix” a poor injection than to have done it right the first time.

(The information above contains excerpts from a Journal of Drugs in Dermatology article published in September of 2014)