How do I do top-ups when it comes to Toxin in aesthetics?
You treated someone 2-4 weeks ago with toxin and now they’re back with you, saying that they aren’t sure how well the toxin has worked and that they think they might need a ’top-up’
Firstly, this is fairly common in aesthetics, as patients often won’t remember how pronounced their wrinkles were when you last saw them, especially since the Botulinum toxin will have taken effect so gradually. They may be focused on one area or one wrinkle.
The first step is to hand them a mirror and open up their before photos on your laptop or iPad. Have the toxin doses in front of you too, that you used initially on them. Here I won’t discuss doses in terms of numbers of units or graduations of the syringe, but in more general terms which will hopefully be more helpful universally, across brands of Botulinum toxin. Go through each area, one at a time, and decide together how good of a response there has been. After looking through the photos of the three areas treated, you might decide together, something like this:
a) Forehead – with eyebrows raised, I can see that there is a little movement still at the lateral parts of the forehead.
b) Frown – there is a good result with the toxin but there is maybe room for improvement.
c) Crows feet – it looks as though the crows feet result is pretty good and the toxin has relaxed the muscles.
If there have been no side effects relating to that area and you both feel there is room for further improvement, consider giving the Botulinum toxin treatment again with a fraction of the original dose. Often I use around 1/3-1/2 of the original toxin dose unless we both agree that there has been no improvement at all, in which case I occasionally give the full dose again. This part isn’t an exact science, but a good general principle is that it’s better to ‘underdo’ it rather than ‘overdo’ it with Botulinum Toxin, as that way you’ll have less chance of causing side effects.
Lastly, I recommend that you explain to your client that this is your way of finding the correct dose for them. Next time, after this has all worn off, if they are returning for this treatment, you can combine the dose of the initial treatment with this ’top-up’ dose and give them a combined dose, so that next time, hopefully, they won’t need to return for a Botulinum toxin top-up. This can be a worry for aesthetics practitioners starting out, but communication and consultation with your patient are the key.
Here are some of our before and after photos with toxin examples: https://visage-aesthetics.com/antiwrinkle-toxin-to-forehead-lines/