In just the past week or so, I have been asked by both a relative of mine from Indiana as well as a patient about the cost comparison of some cosmetic procedures, particularly Botox and Kybella. I am particularly troubled when they tell me they can get a Kybella treatment for $500 or a Botox session for $195. I like to think that we are competitively priced for our cosmetic procedures and we do have to place a value on the time, skill, and expertise of a dermatologist in performing this procedure. We do a good number of cosmetic procedures and try to take advantage of buying in bulk for our sister locations in order to keep costs down. But when I am told of prices such as above, I have to stop and think how is that even possible. Even with our volume discounted purchases, these procedures require more in the cost of the medication than is being charged for the procedure, at least in order to perform it appropriately. I have to ask myself if these spas or salons are truly willing to subsidize the cost of the medications in order to just say they performed the procedure.
In the above instances, in my experience and in the opinion of most reputable cosmetic surgeons, we know that it will take on average about 2 vials per treatment session of Kybella in order to treat the fat under the chin adequately. No matter what volume you purchase Kybella in, there is substantially more overhead costs involved with just the purchase of 2 vials of Kybella than is being advertised for the cost of the procedure. The same can be said of Botox. While there may be more variability in the size of the areas to be treated or the amount of units needed for each patient, there are few patients who can have their forehead, glabella, and crow’s feet adequately treated with less than $200 worth of Botox. This does not even take into consideration the substantial costs involved in the overhead of the facility and staff required to run a medical office.
Unfortunately, this leaves me with a few thoughts. First, and most likely, I think these places are drastically under treating the patients for what they are expecting to accomplish. If I were to use a fraction of the amount of Botox or Kybella than necessary as established through clinical trials and experience, I cannot hope to see the amount of improvement or desired effect that I expect to occur with these procedures. I would also expect the patient would be much more likely to be disappointed in the results and less likely to repeat the procedure or to recommend it to others. The second possibility is that the medications are being obtained from an alternative source at a much lower price than from the genuine companies that produce or distribute the product. In some instances, products may be obtained from overseas at a lower cost. This may or may not be a truly legitimate product being shipped. Lastly, these salons or spas could be incredibly altruistic and generous to the point they are willing to lose money on the cost of the medications and to donate the time of the provider and staff in order to satisfy their patients’ desires for cosmetic enhancement. I think this to be the least likely of the scenarios.
When you see an advertised cosmetic procedure at a drastically discounted rate, I would recommend you stop and inquire how much of the product is being utilized as compared to treatment norms, what is the source of the product being delivered, and what are the credentials or experience of the provider treating you. Make sure you are not comparing apples to oranges and being blinded just by an artificially low advertised price.
Joel Bain Herron, MD
Northeast Dermatology & Cosmetic Surgery Center
SKIN Dermatology & Aesthetics