Pricing Dermal Fillers: Radiesse, Sculptra, Belotero, Juvederm, Kybella...

Should I switch to a new filler? Can I increase my profits or decrease my cost? Fillers are a must-have in any cosmetic practice, so how do you make sense of the options?

You've got to have them since they're one of the primary reasons you're generating new patients AND they keep those patients coming back every month or two. Many generalized (includes surgical treatments) generate 40% of their income from injectables and others (nonsurgical) can turn these needles into wildly profitable practices. But you can also spin your wheels just bumping along the barely-breaking-even line by either under-pricing or over-paying. So what's the current state of cost/price in the market?

In a market report released in 2015, according to Research and Markets, dermal fillers average price (in the US at least) are estimated around $400-$1500 per treatment (patient cost). That's quite a range. So what's going on here? It's a busy and (increasingly) confusing market but here are some stats/thoughts on some of the market leaders.

RADIESSE

Radiesse is primarily around the patient's mouth (specifically correcting nasolabial folds but also lips) but is also commonly used to increase volume in hands (where you can end up using a lot of it, increasing the cost/price). Typical usage is between a half to 2 or more syringes. Like with other facial fillers, the effects on Radiesse on the body will take for as long as 10-12 months. An average cost for a Radiesse treatment is around $900, with a range of $400-$1200. Most procedures are on the chin and cheeks.

Patient satisfaction seems to be around 83%. Adverse reactions include ashes, loss of volume swelling, and lumping. These, as with others, are generally attributable to poor technique or over-treatment.

BELOTERO

Similar to Radiesse, Belotero targets the nasolabial folds and the lines around the mouth. Although, there are some physicians that have used it to target dark circles and lines under the eyes.

It is possible to get multiple treatments for Belotero as well. The filler lasts around to 6 months, maybe up to a year. Although some patients may have shorter filler effects. The treatment costs around $625.00, with a range of $200-$1350.

Patient reviews (from a well known patient site) tended to be slightly higher than Radiesse which is interesting but not terribly informative. It worked well for patients who had their under eye lines treated, on their lip lines, crows' feet, tear troughs, and glabellar area. Complaints include bruising, swelling, and bumpiness.

SCULPTRA

Sculptra is a liquid based injectable that also targets the above mentioned treatments for lines. The use for the filler has been used for those who have lost weight and want to treat lines.

Primary treatment areas for Sculptra are temples and jowls and there's some increase in the after-care instructions including daily 'face massage' of the treatment areas. Repeat treatments may need to be administered after four to six or four to eight weeks, depending on the patient's results from the first treatment. (Always better to under-treat and have them come back than over-treat and have them unhappy.)

Price of treatment is around $1900, with a range of $150-$3800. Selling price of Sculptra to physicians is estimated around $750-$800. According to some physicians Sculptra retains on the face for around 6 to 24 months.

Sculptra seems to hover around a 90% patient satisfaction rate. Among the reviews on one website, 21% reported lumping and adverse reactions (which seems high).

JUVEDERM

Juvederm is one of the most popular volume enhancing fillers in the market. The target areas are lips, cheeks, and lines and wrinkles. A technique to administering the filler on the cheek is creating circles around the target area (similar to a Venn Diagram). Aside from the cheeks, lips are also a popular treatment region.

Juvederm products have a selling price of around $350-$1000. Cost of treatment is around $550, ranging from $250-$990. Treatment lasts from 6 to 12 months.

In looking into patient feedback, only Juvederm received more than 90% positive rate from patients across different review websites. Many are also doing returning treatments after their results. Common complaints for the filler are sagging and swelling under eyes and lips.

KYBELLA

We thought we'd take a look at something outside of fillers with Kybella since it's main usage is to remove the fat under the chin. Multiple treatments are done to achieve the expected result. Like with all the treatments here, Kybella can be done quickly. In administering Kybella, the box comes with a temporary tattoo guide which should be stuck under the chin. (We don't have personal experience with this so would appreciate ayone's thoughts from the community.)

Physicians buy a vial of Kybella at around $600. As for prices, Kybella has a range of $600-$2500 for a treatment, with an average of $1375.

The treatment is well received with an 87% positive rating on one website. Swelling is normal with the treatment after a few days. The treatment had boosted patient self-esteem. Negative reviews are few so far, some had mentioned they saw no change prior to treatment and should have opted Liposuction over injections.

Read the sister post on pricing of Botox, Xeomin & Dysport.

Pricing & Costs

There are a lot of physicians who enter the market at the low end of pricing in order to attract new patients (very successfully since this is essentially a commodity now) but if your prices don't include enough just to break-even, you’re heading for trouble. Medical businesses are expensive to run and it's more true than ever that a dollar saved is a dollar earned. All vendors are not all pricing fillers the same and it can cost you literally thousands of dollars a month right off the top-line profit if you're not getting the best deal from your local pharmacy or the manufacturer. Depending upon where you are in the world you might want to do a little research and find out if you can get a better deal.

Warning: Everyone is getting bombarded with solicitations from companies in China promising the lowest cost. Do NOT buy any drugs or pharmacy products from China (or South East Asia, or Africa). These countries do not have the same regulations as the US, Canada, and the EU where regulatory safeguards are in place.

5 Years Of Good Experiences With Artefill (PolyMethylMethacrylate)

I've been using Artefill for volume with good results for the last 5 years.

On a recent chart and procedure review, I looked critically at the use of fillers in my practice over the past 5 years. I use HA's (Hyaluronic Acids) mainly for lips; some Sculptra (activator) for volume in thicker facial tissues; lots of Radiesse-everywhere except the lips; some PRP and an increasing amount of Artefill (except for lips) to take care of patients suffering from both "filler injection fatigue" and significant volume loss.

As part of a regieme of (re)creating Beauty using the CT3+V=Beauty, Color Correction, Texture, Tightness, Tone + Volume, VOLUME is a key player for rejuvenating the facial shape and contours, putting the skin on stretch-which restores texture, tone and luster, and is often more economical (social down time and real money) for patients with less risk. When coupled with smaller lifts, blephs and various resurfacing, the overall result is synergystic, less traumatic, equally dramatic and probably more rejuvenating than any other single element taken to it's maximal benefit alone.

It is illegal to inject silicon for aesthetic use in Nevada, so Artefill is my only choice for "permanent" revolumization. Interestingly, when I discovered how well my early Artefill patients were doing, I started using even more of the product and pricing it aggressively so that patients could afford to get significant corrections with 6 to 12 syringes. Overall, it ends up being less expensive for the patient than what they spend on restoring volume with temporary gels.

We have patients out nearly 5 years, who have maintained good correction from their initial injections with this FDA approved version of poly-methyl methacrylate. While the FDA approval of this filler is for correction of nasolabial folds, I have used it off label all over the face, the dorsal hands, for horizontal necklace lines and depressed scars.  I have learned from other talented physicians, the techniques of deeper, comfortable injections that lead to significant permanent correction of temple, peri-orbital, glabellar, zygomatic, malar and "tear trough" volume. More deflated patients have avoided rhytidectomy by using up to 20 syringes. My own 56 year old, jolly cheeks enjoy 6 syringes of this material done over a year ago. My wife, though a Grandma, appears more than a decade younger than her stated age. She is a walking example of combining modalities without major surgery and a great educator for my patients.

Perhaps physicians are rightfully afraid of long lasting/permanent fillers considering the horror stories of previous products. However, any laser or scalpel carries the risk of permanent poor aesthetic outcome. And this ain't your traditional, poorly tested filler. It's got data approaching 10 years outside the US which is devoid of serious complication. The risks that do show up with this filler are generally avoided with good technique. Last year, I shot nearly 600 syringes of Artefill without any unexpected issues-just some bruising and discomfort. No granulomas, lasting nodules, sloughs, Tyndell Effect or infections... ever, so far.

So maybe the well trained hand, wielded by an artful and educated physician in the service of the well educated patient is a mitzvah (a good and honorable deed). After all, what patient enjoys quarterly mammograms or DRE's, anymore than the patient who comes to the office every 3 to 6 months to maintain their lip and tear trough filler?

Lasting corrections, done conservatively, with safe, evidence based products, should be more widely offered and utilized. They benefit select patients by allowing them the chance to (re)build their volume once and maintain it, rather than recreate it over and over. They still top off the small volume we all continue to lose, but they now find other services in the practice to utilize because they are so happy with their Artefill results.

I know I am.

Comparison of what's in a Dermal Filler: Radiesse, Restylane, Perlane, Juvederm Ultra, & Sculptra

What's in Restylane or Perlane? Here's a synopsis.

Radiesse

1.3 cc syringe, active ingredient is 30% "powdered synthetic bone"
Very good for nasolabial folds, cheekbones, jaw lines. Not good for lips. Lasts about 3-6 months after the 1st treatment, about 12-18 months after the second treatment. Considered "semi permanent" because the collagen that it stimulates will last for years after the product has dissolved. Cannot be dissolved with any chemicals such as Hyaluronidase. Can also be used on the backs of the hands.

Restylane

1.0 cc syringe, made out of cross linked Hyaluronic acid.
Lasts about 6 months. Tends to absorb a little water, which causes some temporary swelling. Good for nasolabial folds, lips, mild to moderate wrinkles. It can be dissolved with Hyaluronidase. Lasts from 3-12 months; 6 months is about average.

Perlane

1.0 cc syringe, similar to Restylane
The "particle size" in the Perlane is larger, which makes the Perlane thicker. It tends to be used for deeper wrinkles and contouring. It is very good for deep nasolabial folds, straightening the jaw line. It can be dissolved with Hyaluronidase. Lasts 3-12 months; 6-9 months is about average.

Juvederm Ultra ( Juvederm 24 HV outside the US)

0.8 cc syringe, similar to Restylane
Injects very smoothly and tends to flow nicely under the skin. Very good for lip enhancement. Absorbs a little less water than Restylane so there is a little less swelling, which may be important in the lips. Even though the syringe is smaller, there is a higher concentration of Hyaluronic acid in the material which gives it about the same amount of Hyaluronic Acid as Restylane. It can be dissolved with Hyaluronidase. Lasts 3-12 months; average is about 9 months, less in the lips.

Juvederm Ultra Plus (aka Juvederm 30 HV in other countries)

0.8 cc syringe, similar to Juvederm Ultra, but 20% thicker
Very good for deep nasolabial folds. Softer than Radiesse, less likely to leave a palpable lump in the skin.

Sculptra

One vial can produce 6-10 cc of material.
Comes as a powder, must be mixed with water and local anesthetic at least 2 hours prior to use, preferably mixed 24 hours prior to use. The initial effect only lasts for a few days. The fluid is absorbed, but the powder is left behind. The powder causes the skin to get thicker. 3-6 treatments, space 1-2 months apart, are needed. Vigorous massaging is needed 5 times per day for a few weeks after the material is injected (this is done by the patient at home). Very good for replacing lost volume in the cheeks.

Black Market Botox....A Better Buy?

Botox: $50 for 100mu?

Thought that would grab your attention.  I've heard you can find Botox on the internet for that price.  I wouldn't recommend it.

Occasionally a patient will ask me to explain why those people in Florida "died from Botox."  They are referring to a story that was widely publicized in early 2005 about some people in Florida who were sent to the hospital after receiving phony Botox injections and becoming paralyzed.  There was another story around the same time of a woman in California who died from Botox injections done by a hair stylist.  Hair stylist?  Yes, you read that right.  The very important distinction is that they didn't actually ever have Botox injected into them.  They were duped and actually had raw-grade Botulinum toxin type A used on them. 

Right about now you might be thinking, well that would certainly never happen to me.  My vials all say Botox and have the purple, red, orange colors on the box.  Matter of fact, I'm guessing that the guy in Florida thought his product was safe since he used it on himself.  I actually know a physician who had ordered, but never used, this killer Botox that he ordered from the same source. He thought he'd found a better source to get the real thing at a cheaper price.

Botox is a trademarked name for a substance that is made by Allergan. Anything else is phony and potentially very dangerous and most certainly not worth the savings that might be had.  This bootleg industry has become so prolific that I wanted to be sure everyone knew what to look for and what to avoid.  Fake Botox is frequently made in China or Korea. Authentic Botox is made and distributed world wide by Allergan and has a hologram indicating it's credibility.

To view the hologram on a vial of Botox:

1) Examine the vial under a desk lamp or fluorescent light source

2) Rotate the vial back and forth between your fingers; look for horizontal lines of rainbow color on the label

3) Confirm that the name "ALLERGAN" appears within the rainbow lines.

I'm guessing that this black market industry will soon learn how to counterfeit the hologram as well.