“People come into the office and want Botox,” says
Dr. John Goldhar, cosmetic dermatologist at Toronto’s Cosmedix MD Inc. “What I tell them is to give me
the problem, not the solution.”
After all, Botox may improve forehead and
glabellar lines, but what about sun damage, marionette lines and nasolabial folds? Often, achieving the appearance the client desires involves a combination
of treatments. The answer: building a program for patients. Dr. Sheetal Sapra, cosmetic dermatologist at
the Institute of Cosmetic and Laser Surgery in Oakville, informs patients that, “over the space of a year, I will take four to five years off [their] appearance.”
Some call this “skin care packaging.” Sapra prefers to call it a treatment plan. Goldhar agrees: “I like calling things projects, especially because the procedure is step-like and we’re dealing with an individual, overall picture.”
Although both doctors customize treatments on a client-
to-client basis, certain age groups face similar concerns. The following groupings are examples of what you can expect,
but they aren’t carved in stone.
1These clients are usually in their 20s and 30s. They are looking for a glow, pore improvement or they have acne.
Sapra prescribes a combination of microdermabrasion
and chemical peels, followed by non-ablative Smoothbeam
laser to reduce pore size or solve acne problems.
2As we age, sun damage (yellowing, pigment change, broken blood vessels, brown spots) shows. For these 30- and 40-something patients a combo of Intense Pulsed Light (IPL) for
sun damage, Botox for fine lines and, depending on skin texture, Smoothbeam laser for pores and fine lines around the eyes,
does the trick.
3Clients in their mid-30s to 50s experience much of the aforementioned challenges, plus the effects of gravity and sagging. Treatment is often similar but also includes Thermage—
a method that uses radio frequency to lift and tighten skin—
along with fillers like Restylane or collagen for the nasolabial folds and marionette lines. Since results with Thermage take
two to six months, Goldhar uses IPL during the interval to improve skin’s appearance.
4Patients over 50: they’re generally receiving the same
as above plus a surgical service.
Of these programs, Sapra warns patients not to “expect a facelift” but emphasizes that over the course of a year, “you’ll be looking way better than before.” Dr. Goldhar likes to start out with the longest-lasting procedure so that patients can build upon that as the program progresses.
Next comes the question of budget. Although neither
Sapra nor Goldhar’s clinics offer discounts, Goldhar points out that, in the long run, clients often save because a “slightly less expensive procedure may allow better penetration of a more expensive one.” For example, microdermabrasion in combo with IPL may save the client an IPL treatment. (IPL averages around $2,500 for five treatments so one less is a savings of $500). As well, he explains, treatments are usually charged per unit. With overlap, fewer units are required. For example, if forehead and glabellar lines each require 40 units of Botox—for a total of
80—when done together, overlap may save units. He also adds that the actual labour involved may be less if the same clinician performs multiple procedures at the same time. These savings can be passed to the client.
Even with an annual plan in place, Sapra’s patients pay
per treatment, as opposed to one lump sum. This way, they
can monitor their results without a financial commitment. That
said, Sapra acknowledges that some offices require an up-front payment. And, paying ahead often encourages patients to complete the entire program and not lose steam part way.
In this case, Sapra advises that patients clarify what happens
if they choose to stop treatment. Can they get a refund and
is there a penalty?
So, if you’re in the market for a gentle rejuvenation, what should you do?
1) Consider everything that’s bothering you. Write it down and bring the list to your consultation. Goldhar stresses telling your doctor everything at once, before he/she does an assessment. That way, the doctor knows how much improvement you want and doesn’t have to backtrack.
2) Consider the amount of downtime you can afford. Although none of these procedures are surgical, they can involve some healing time.
3) Come with a budget in mind and tell your doctor. Inquire about refunds and payment options—many offices have financing services.
4) Go to a few offices until you find the program, the doctor and payment plan that suits you.
• Dr. John Goldhar, Cosmedix MD, 416-977-6502.
• Dr. Sheetal Sapra, Institute of Cosmetic and
Laser Surgery, 905-842-2262.