Can I save money on Botox if my doctor buys it from Canada?

Our practice receives at least one unsolicited fax a week offering cheap Botox® and fillers.  The companies often describe themselves as “outlet” or “online” sources.  And they all have one thing in common: their products are imported from outside the country.

Neurotoxins such as Botox® Cosmetic and Xeomin®, botox bottle and soft tissue fillers such as Juvederm® and Restylane® are a high profit industry.  There is significant competition among practitioners for patients, and offering a lower price will usually bring in more patients.  But the cost of the product itself limits just how low a physician can drop the price and still be profitable.

Medications cost more in the U.S. than in other countries- up to twice as much.   There are a couple reasons for this.  In countries with a public healthcare system, such as Canada and the U.K., the government determines how much it will reimburse for a medication. Private insurance companies just don’t have this type of bargaining power. Another reason is advertising- companies in the U.S. market directly to the consumer, and we pay the cost for this additional marketing.

Foreign companies capitalize on this problem by offering neurotoxins and fillers at huge discounts.  This is not only illegal, however, it is also dangerous.  According to the National Association of Boards of Pharmacy:

Many websites selling prescription drugs are unlicensed, operating illegally, or operating from foreign countries where medicines shipped to the United States are unregulated. Thus, there is no way of knowing whether the medicine you receive is contaminated, sub-potent, super-potent, expired, or counterfeit, or whether it has been stored and shipped under proper conditions to maintain its effectiveness. And that Canadian online pharmacy with the cheaper prices? It may be calling itself a “Canadian pharmacy,” but it may actually obtain its medications from countries in Asia, South America, or Eastern Europe, where quality standards are more lax and counterfeit medications more widespread. 

 

The FDA has sent warnings to as many as 350 medical practices to warn them they may have purchased counterfeit Botox,  so this practice is relatively widespread.  If you are considering treatment with neurotoxins or fillers, I strongly recommend asking your practitioner where he or she purchase medications.  The answer should be: directly from the company, within the United States.

 

What has the biggest impact on your decision making when it comes to cosmetic procedures- is safety most important to you, or are you always looking for the lowest price?

Related Articles:

Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

Can I use my Health Savings Account for Botox?

It’s nearly December, the time of year when people find themselves looking for ways to use up the money in their Health Savings Account (HSA) before the year ends.  I am frequently asked if this money can be used for Botox, hair removal, or skin care products.  The short answer is: no, it can’t.  Money in an HSA does not cover cosmetic treatments.  But it can be used for things that regular insurance does not always cover.

Flu shots are covered by an HSA, as are blood pressure monitors, and blood sugar testing kits.  Your HSA may also cover hot or cold packs, bandages, and splints or ACE wraps.  So this is a great opportunity to set your household up with a first aid kit.

photo credit: www.wikipedia.com

photo credit: www.wikipedia.com

Condoms and pregnancy tests are usually covered as well, so you can always stock up if this is something you might need in the next year.

One slightly hazy area is prescription medication.  HSAs can be used to pay for pretty much any prescription medication.  And this is great for medications that are often not covered by insurance, such as EpiDuo, which is used to treat acne.  But there are some medications that are provided by prescription for cosmetic use, e.g. tretinoin.  Tretinoin does have some medical uses, but is most commonly used to treat wrinkles and fine lines.  It’s a prescription medication, but may be considered cosmetic, so I would check with your HSA first to see if it’s covered.

What’s the most interesting or creative thing you’ve used your Health Savings Account to pay for?

Related Articles:

Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

Which is better -chemical peel or laser peel?

The goal of any peel is to remove the very outer layers of skin, revealing smoother, younger appearing skin underneath.  This can be done either with chemicals or using a laser.  The results you see are directly dependent on the depth of the peel.  That is, the deeper the peel, the more significant the results.   Superficial peels are confined to the epidermis, which is the outer layer of skin (see diagram below).  Recovery from a superficial peel is characterized by a few days of redness and flaking of the skin.  Deep peels may go down into the dermis, creating what is essentially a partial thickness burn.  And healing from a deep peel can take two weeks or longer.

wikipedia.com

wikipedia.com

 

Deep or superficial peels can be done with both laser and chemicals.  But I think the trend is moving toward chemical peels being a lighter depth peel, and a laser being used for deeper peels.  Aestheticians and cosmetic therapists can perform superficial chemical peels.  These peels come in a kit (e.g. the Vitalize Peel by Skin Medica), and the results are very predictable.  There is minimal to no redness afterward.  Mild flaking starts at about two days after the peel, and lasts 3-5 days.  Deeper peels should be done by a physician.  I prefer to use a laser because the depth of the peel is very consistent and easy to adjust.  The deeper the peel, the more impressive the result is, and the longer the downtime.  Having a series of peels instead of a single peel will also give more dramatic results.  So chemical peels and laser peels are really just different tools used to achieve similar goals.  Your doctor will help guide you toward a specific treatment depending on the results you’re looking for, how much downtime you have, and your budget.

 

Do you have a question about peels?

Related Articles:

Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

Complications After Breast Reduction

The internet is a great way to find information, but sometimes it’s difficult to know how to interpret the information you find.  Case in point: looking up medical information.  Many of my patients research operations and treatments online before they see me.  I recently had a patient ask about complications after breast reduction surgery.  She had looked this up on Google, and was terrified by what she saw.  But fortunately very little of what she saw actually applied to her specific case.  Here is what I told her:

Breast reduction surgery removes a large amount of tissue: anywhere from 1-4+ pounds of tissue per side.  When the remaining tissue does not have adequate blood flow, healing problems can occur.  These might range from a small area that is slow to heal all the way up to losing a nipple.

Google Search Results

Google Search Results

The major risk factors for healing problems are

  • Smoking
  • Diabetes
  • Very large breast size
  • Obesity

If none of these apply to you, your risk of complications is significantly reduced.  But what if they do?  Can you reduce your risk of complications?  The answer is yes.  Let’s cover each individual situation.

  1. Smoking: The simple answer is to quit smoking.  Nicotine causes your blood vessels to constrict, resulting in decreased blood flow to the site of surgery.  So you need to avoid all nicotine products during the healing period, which is about 6 weeks.
  2. Diabetes: Good management of your diabetes lowers your risk of complications.  This is measured by your hemoglobin A1c level.  If your level is higher than normal, you may need to work with your primary care physician or endocrinologist prior to having surgery to achieve better management of your diabetes.
  3. Large breasts: If you have very large breasts, your surgeon may recommend a free-nipple reduction, where the nipple is taken off the breast and put back on as a skin graft.  This ensures good blood flow to the nipple in its new position.
  4. Obesity: Studies have shown that complications of breast reduction are increased in obese patients.  There is no strict weight cutoff, but I recommend my patients get to a BMI of 35 or below prior to having surgery.

Have you ever been confused or overwhelmed by medical information you found on the internet?  Where did you go for help?

Related Articles:

Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

How Often Should I Have my Skin Checked?

Skin cancer is the most common type of cancer.  Each year there are more skin cancers diagnosed than breast cancer, prostate cancer, colon cancer and lung cancer combined. Yet the average person does not know when or if to see a doctor for a skin cancer screening.

As it turns out, there isn’t a lot of data to support routine skin screenings in people with no history of skin cancer.  This has led to some confusion regarding how often to screen, and who should do it. There are three main types of skin cancer: basal cell carcinoma, squamous cell carcinoma, and melanoma.  Basal cell and squamous cell carcinomas grow very slowly, and rarely spread to other parts of the body.  Thus they are usually curable regardless of when they are diagnoses.  Melanoma, however, is the leading cause of mortality from skin cancer.  And earlier diagnosis leads to better outcomes.  So some type of screening is important.

So what should you do?

Check your skin monthly to look for any changes. You will need a full-length mirror and a hand mirror to check your entire body.  This includes your scalp, your ears, and your hands and feet.

You are looking for:

New moles or growths, or change in existing moles or growths.  Some concerning signs are:

  • Bleeding
  • Crusting
  • Itching
  • Pain
  • A spot that just won’t heal
  • A mole or spot that looks different from your other moles

You should also be familiar with the ABCDs of melanoma:

  • Asymmetry: if you draw a line through the mole, the two halves will not match.
  • Border: the borders are uneven.  They may appear scalloped or notched.
  • Color: moles should be all one color.  A variety of colors in a single mole is abnormal.
  • Diameter: moles should be smaller than the head of a pencil eraser (5mm).

This slideshow requires JavaScript.

The average person does not need to see a Dermatologist or Plastic Surgeon regularly to have his or her skin examined, but you may want to have a skin examination done once so your doctor can point out any areas to keep an eye on.  This is especially important if you have a family history of melanoma or if you have multiple abnormal moles. If you do have a history of skin cancer, I recommend having an annual skin examination by a doctor.  This could be your Primary Care doctor, a Dermatologist, or a Plastic Surgeon.

Do you have a question about skin cancer?  We would love to hear from you!

Related Articles:

Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.