BOTOX® COSMETIC

Botox® Cosmetic is a naturally derived protein that can temporarily block the nerves that activate the muscles that cause you to frown or to have wrinkles. If you can't contract that muscle, then the wrinkle may be diminished or disappear. Patients often ask how Botox® Cosmetic works on wrinkles that are already there, but please remember that just moments ago you were probably frowning or squinting anyway, and the wrinkle that you currently see was exaggerated just very recently.

These muscles are not used for anything else but the creation of the wrinkle (and facial expression), and therefore it is safe to put them at rest. They will very slowly begin to wake up, and as you see your wrinkle begin to reappear you may schedule another appointment. Botox Cosmetic doesn't work for the first 2-10 days, but then it does last 4-6 months. With repeated injections over time, the muscle that is put to sleep may slowly atrophy and become weaker. As it does, it will wake up a little less each time and the wrinkle may begin to disappear on a more permanent basis. The result is that you won't have to come in as often for these treatments and what few wrinkles that are left will be diminished.

CONSULTATION

There is a fee for your first visit with Dr. Coverman or Jennifer Jordan, PA-C. If you decide to have your Botox® Cosmetic treatment on the day of that visit, the consultation fee will be waived. The fee is waived if Botox® Cosmetic is the only thing that is discussed at that visit, and if it is the sole purpose of that visit. If any other items are discussed at that visit, including the use of Retin A, other treatments for wrinkles, other procedures offered or performed at Dr. Coverman's office, any other anti-aging therapies, or any other medical problem or condition, the fee will not be waived and the regular office visit fee will apply. You may be treated on the day of your appointment if medically indicated. No test dose is necessary.

FEES

$10 per unit (30 units per area) = $300*:

1. Glabella - between the eyebrows.
2. Forehead - the full forehead.
3. Crows feet - lateral to the eyes; BOTH eyes included.

* 2nd or 3rd area done at same time only $250 per area. (2 areas = $9.16 per unit, 3 areas = $8.88 per unit)

All fees are subject to change. The fee is always what is current at the time of your actual treatment. Old fee schedules, handouts, or web site fees do not apply. Any quoted fees must be in writing and are only good for six months. No "verbal" quotes are accepted.

SALES

You may see exciting "sales" advertised in the newspapers. Typically they may say something like "30% off" or "$40 off first area," "$60 off second area" and so forth. Exactly what does this mean? $60 off what? 30% off what price? Remember, if Botox® Cosmetic is going to work properly, you need 30 units per area. If anyone advertises a sale you really need to do the math. The bottom line should be this: Did you get all 30 units, and what exactly did you pay? With Dr. Coverman you always get 30 units. If you don't understand someone else's "purported" sale - ASK! Just do the math and you will see four things consistent in Dr. Coverman's practice:

1. You always get 30 units
2. You always get the same price
3. No fake "sales!"
4. You always get REAL Botox® Cosmetic

SCHEDULING

After you have met with Dr. Coverman or Jennifer you may call our office at any time to schedule your Botox® Cosmetic treatment session. Tell our receptionist you have already had your visit with Dr. Coverman or Jennifer and you are ready to go. If you are a candidate you may have your Botox® Cosmetic treatment at any time.

There is a $150 non-refundable fee for missed appointments without a 24 hour notice. If you need to cancel, please record the date, time, and name of the person you spoke with.

PRETREATMENT

Dr. Coverman strongly recommends that a numbing cream be applied prior to the treatment. Although this won't block all discomfort, often it can improve this by about 50%. You may purchase some of these over the counter but we recommend other more potent creams. PLEASE ASK US!

Please apply this one hour prior to your intended procedure. It will work even better if you place saran wrap over the cream and then tape all of the edges airtight. Some patients don't want to come to the office with cream or plastic on their face, so if you bring the cream with you, we can apply it for you just prior to your treatment. Although it won't be on as long, a little bit is always better than nothing.

SAVE the numbing cream! It can be used again for this treatment, other treatments like it, or for waxing, hair removal, even insect stings and sunburns. You will always find a use for this cream. Never put it on a fresh burn, infected skin, inflamed skin, or ANY weeping, open, or oozing skin. Never apply to any undiagnosed rash. For any questions, always ask our staff.

If you have ever had herpes or think you may have (cold sores or fever blisters), inform Dr. Coverman or our staff prior to scheduling your appointment. We will give you a series of anti-herpes pills to take the day before the treatment, the day of, and the day after. This should help or suppress or prevent herpes from flaring, but there are no guarantees. A herpes flare could cause pain, pigment, infection, and scarring.

TREATMENT DAY

We will remove the make-up in the treated sites and then the Botox® Cosmetic will be injected. You may go right back to work. There could be bruising.

POST TREATMENT

We want the Botox® Cosmetic to stay in the appropriate muscle but we don't want it leaking into other muscles such as over the upper lids.

1. Do not bend over at all for the next four hours - squat to pick up your purse rather than bending over, do not bend over to tie your shoes - either pick your foot up on a stool or bench or have someone else do it for you.
2. Do not lay down or plan on reclining for four hours.
3. Do not work out, exercise, or lift weights that day.
4. Squint and wrinkle your brow and the areas treated as much as possible for the first 15 minutes after treatment - this should distribute the Botox® Cosmetic throughout the involved muscles.
5. Do not touch, manipulate or massage the treated areas - we want you to squint in order to distribute the Botox® Cosmetic into the muscle, but we don't want you to push into any other unwanted muscles or anywhere else.
6. You may apply make-up and go back to work. Do this gently and carefully!

COMPLICATIONS

There is a needlestick which may give some temporary discomfort. It is also possible that we might nick a small blood vessel: if so, it would be more commonly one of those lateral to the eyes at the crow's feet. This might cause a temporary bruise but this usually clears within 4-5 days. There could be a larger bruise or hematoma. Don't plan your Botox® Cosmetic treatment just prior to any major social events. Plan your work, travel, social and school calendars accordingly. If the Botox® Cosmetic leaks towards the muscle of the upper eyelid, there could be a lid droop which could last 4-5 weeks. This is extremely rare, but it can happen. In every one of the cases Dr. Coverman has ever seen, it has always been reversible without any further treatment necessary. Dr. Coverman has never had a patient where the eyelid totally closed and the patient couldn't see. Likewise, as some of these muscles are put to sleep, there can be a loss of facial expression, and one is trading the loss of wrinkles for some loss of expression. In extremely rare cases, one could develop antibodies to the Botox® Cosmetic, and if so, the Botox® Cosmetic injections will not work in the future. A very rare complication is persistent headaches. Dr. Coverman has only had one such case among thousands of injections. It cleared spontaneously without any further treatment.

Rarely some patients feel there is an eyebrow droop, or that their lids look or feel "heavy." In Dr. Coverman's experience this has always been reversible.

When a patient has had a long-standing furrow or wrinkle, sometimes the texture and/or color at the very bottom of that wrinkle changes. Often it is a bit redder than the surrounding skin. Even if the wrinkle is fully corrected 100% - the texture that was under there sometimes cannot be improved or changed or residual abnormal color whether red or otherwise may persist. We are simply correcting the wrinkle but we cannot correct texture; nothing other than laser resurfacing or peels can. It must be understood that this is not necessarily a bad thing but Botox® Cosmetic does have its limit. In some patients - we can inject fillers at the very bottom of the wrinkle at additional normal charges to get that last little bit elevated but even that may not correct the problem.

IMPORTANT INFORMATION REGARDING FEES AND PRICING

Just like the laws of physics, you can't alter the facts. You need a certain amount of Botox® Cosmetic in order for it to work properly. Any less, doesn't work! You can't dilute the bottle with more water and squeeze another few patients out of a bottle of Botox® Cosmetic. You need 30 UNITS of Botox® Cosmetic PER AREA to work. If you have seen ads for "$100 Botox® Cosmetic" check carefully. That is usually $100 for 10 units, but you need 30! In other words, the 30 units that you really need would cost $300—the same that Dr. Coverman charges. The difference is that we tell you that up front, and don't try to confuse anyone with falsely low fees.

One of our patients went somewhere else because it was "cheaper"—only $160. She was told it was $10 per unit. Therefore she only got 16 units—not 30. It didn't work! That's why she came back to Dr. Coverman.

All doctors pay the same amount for a bottle of Botox® Cosmetic, and no matter how they may try to squeeze extra patients out of a bottle, or manipulate their advertising, you must realize that the proper amount must be used. Some doctors don't even tell you how many cc's or units they use: they may try to tell you that they are "treating you as an individual". That is nice, but it is not enough information. DO NOT ACCEPT VAGUE REPLIES! As stated above, you need 30 units per area if it is going to work, so don't accept less.

Dr. Coverman was among the first recognized by Allergan, the manufacturer of Botox® Cosmetic, as a preferred provider in the Austin area. (Please see botoxcosmetic.net.) You are always treated in a clean, attractive, and professional medical office. The Botox® Cosmetic is always fresh and absolute sterility is maintained. You will NOT be given a glass of wine, or any other alcoholic beverages. There will be no "party" atmosphere, and Dr. Coverman doesn't do "Botox parties" poolside or in rented hotel rooms. If you do refer a friend, and after they have had the treatment, we do offer 20% off your next cosmetic procedure at our office. This would apply to Botox® Cosmetic, any injectable filler, or one of our aesthetician services with Tammy or Christi.

WHICH BOTOX® COSMETIC SHOULD YOUR DOCTOR USE?

Some doctors who advertise very "cheap" Botox® Cosmetic are able to do so because they buy Botox® Cosmetic out of the country. This is not the same product that is offered in the United States. The FDA frowns upon this and it may be illegal. The FDA has serious concerns that medicines obtained outside of this country may be "fake," "diluted," or not of the same potency or purity that which is offered and sold legitimately within this country. If you are not sure - ASK! If you have any doubts, please ask your doctor to show you the bottle. If there is any writing in French or another language, it was not made for sale or use in this country. You might ask your doctor where he got it. No Botox® Cosmetic for sale or use in the United States comes "from" Canada. Many fakes come from Russia or China. Dr. Coverman pays full price for only USA distributed Botox® Cosmetic that is sold by and approved by Allergan, the only legitimate manufacturer.

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