How NOT to sell me a cosmetic procedure.....

I am generally dissatisfied with my skin.  I've been pondering microdermabrasion vs peels etc for a long time but never went further than buying Roc's home microdermabrasion kit with the vibrating/spinning applicator

I pretty randomly chose Skin Vitality as somewhere to try, they happened to be featured in a Groupon offering cheap Botox.  I pushed aside my other knowledge of them-their appearance in the Global News 16:9 Botox exposé (episode is Worry Lines).  In that episode they were one of the clinics where medical supervision was via Skype.  The doctor who injected my Botox (Dr Torgerson) was featured as someone who does it himself!

Anyway, I emailed and asked about prices of peels.  The reply said they started at $85 and offered a free consultation.  Why not?  I booked a midday appointment today and trotted in.

I was met by a "medical consultant".  Very friendly.  Briefly heard that I wanted to know about peels but then told me my concerns of uneven skin and fine lines around my eyes etc would be much better treated with skin tightening.  Their machine is an Elos machine which uses IPL (intense pulsed light) and radiofrequency waves apparently.   I suppose IPL is usually a big selling point but I'm a bit biased.  Wasted a pile of money on almost completely unsuccessful hair removal with IPL a few years ago.  I was bombarded with information about the technology, the features on Oprah, how it would fix my sagging skin/lines/under eye circles.  I would look 10 years younger after it.  She stated that since I'm 33, I'd look 23.  She showed me a quick PowerPoint presentation.  Interestingly, the before and after images weren't actually that dramatic.  You'd think they'd use their best cases for a presentation so it doesn't really give the impression of being fantastic.
The presentation was followed by her taking out the calculator and telling me about the promo they had. I zoned out for most of her calculations after I realised she was basing them on 6 treatments and the reduced price cost was around $2400!!

I said I wanted to think about it so she offered me a free trial of it to see what the treatment was like and meet the nurse.  She got me a slot an hour later.  I went for lunch and came back.  I was on time, they were around 25 minutes late.  The nurse, to be fair, was fantastic.  The first thing she said was "you don't need this!".  She thought peels or Fotofacial would be more appropriate.  She reckoned Fotofacial would be better for evening out colouration and tone.  She said the tightening was usually for people in their 40s and 50s but that I looked OK for 33!

She kindly did the treatment anyway just to see what it was like.  The mini test is around the eyes.  I was given protective goggles and the area was covered in gel.  She ran the handpiece over the lateral (outside) borders of my eyes.  I could see a tiny flash of light with every pulse and felt some heat each time but it wasn't painful.  Apparently full face takes approximately 40 minutes.

I had to meet another consultant then who gave me more quotes-special offer, today only etc etc.  Again, I said I wanted to think about it all.  She was very nice about it all though.  Gave me her card and said she'd be there until 8pm.

So, here are the eyes that apparently look like someone in their 40s or 50s:

I'll agree that the areas under my eyes are puffy but I think lack of sleep contributes.  I also think a bit of Restylane in my tear troughs might help more.  There are tiny lines, but I hadn't been overly concerned by the ones at the edge of my eye and I'm wary of what I'd do with the ones on my lower lid.  Danger zone!

I did a quick search on RealSelf and it comes up as ReFirme.  Opinions are mixed and certainly not worth coughing up $2500 when money is tight!

What really stopped me though?

The sales pitch.  I barely got to talk about my concerns before I was told I was basically in terrible shape and in need of major anti-aging work.   I was bombarded with information about something I hadn't even considered and felt pressurised into agreeing.  I was given the "this offer is only for today" pitch which I despise.  I've had it in gyms before and have always scurried to the door.   She promised something that she actually could never back up and that wasn't going to happen-that I would look 10 years younger.  Doubtless the estimation of my age would be based on her impressions!  I liked the nurse immensely and if I had spent most of my time with her and not felt like I had to sign up for a series of treatments, I might have considered it.  The way it was though?  No way.

In contrast, Dr Torgerson did suggest something I hadn't thought about the day I went in for my Botox injection (initial treatment).  He suggested filler in my tear troughs.  It was done completely differently though.  It was a "something you might like to think about" and he said (lied) that he was just being picky and mean.  There was no way I felt under pressure to decide that day.  At all.  I got to go home and Google etc.  (This description by Dr Ravi Jain is my favourite) I still don't have the money for it right now, but if I had I'd probably do it.  Because it's my decision and I'd feel like I had made it with all the best information and without being rushed...

Latisse is a maybe today!

I popped back into Dr Torgerson's office today.  Still not sure if I had enough of a response to my Botox treatment so I emailed the office and they brought me in today.  Very glad of the day off to do things like this!
Everyone was really nice.  Coffee (yum) and a brief wait before seeing Dr T.   He was lovely.  I felt like a bit of an idiot for wasting his time but he was good about it.  He said the result was good but we may as well kill it totally and gave me another few units.  Painless and quick.

While I was there I was watching a little monitor in the treatment room which was scrolling  through adverts for Botox, Juvederm and Latisse.  He told me they had Latisse.  I had to let him know I was one of his first buyers!  He reckons best results will be after 6-8 weeks.

Later I was in the Bay at the Lancome counter looking at mascaras and debating the different types.  The assistant reckoned I didn't really need a lengthening one since my eyelashes are long.  Nobody has ever said that before!

Here's the picture of me in mascara now.  Brows are crazy-am letting them grow in a bit before going for professional shaping.  Also using Latisse on the edges to try to even the brow.   We'll see!

Mascara is Clinique high impact  curling-gives good curl!  "Tube" type (quick description of tubing mascaras.  Warning!  Page plays stupid adverts and difficult to find the stop button

One month on!

Thought I'd be updating this more often...but it's hardly like anyone is reading it anyway!
Have been bothered by the effect of the Botox since I got it.  Zero side effects; just not sure I've gotten the desired effect.   It's really difficult to know what to expect as a first timer.  I can still frown, but it's not at all as strong as it was.  My worry is that it's still enough to keep the lines showing.  Unfortunately I can't actually ask the person who injected me, but I did manage to get some answers on RealSelf about the expected outcome and whether or not I needed a topup.  Some answers were more useful than others.  Some didn't even read the question.   But it mainly seems like practices differ-some like to completely remove movement, others don't.  One mentioned that it should reduce motion enough to soften the lines.  I really do think it should be better

This is me at a month (and still struggling to capture it properly on phone camera!)

I'm going to email the office and see if they can find an appointment for me.  I could only get in Tuesdays, evenings or weekends for the last few weeks and they said nothing was available.

Now...the Latisse!

I'm still terrified using it every day.  They completely dismissed any worries regarding iris colour change in the office and pointed to one of the assistants with blue eyes who had no issues.  A bit of Googling showed that light blue eyes weren't the highest risk anyway.  My type of eyes are-light brown/green that already contain some brown.  There are also unsubstantiated claims of Latisse-induced iris darkening on some blog comments/reviews etc online.  I know Allergan claim none in the clinical trial but 100 participants in it is nothing.
I've  had some itching and dry eyes with it-mainly the first two weeks.  Part of it could be the dry winter air and all the heating indoors too though.  I tried morning application for a while-didn't make much difference.  I gave up on the enclosed brushes after reading reviews on makeupalley and invested in some disposable eyeliner brushes instead.  They are much easier to handle and apply more accurately.  As for effects?  I'm not sure.  Maybe seem slightly longer when I put on my mascara.  Pics are below...I'm getting better at taking these ones at least:

 Hard to tell!

Next post: teeth that stole Christmas and made me cry, plus planning Christmas away from friends and family!

Day 5 and some eyelash fluttering!

Today was day 5 post Botox.   I spent the weekend frowning away to myself to see if I still could.  The day after I was convinced my nose felt funny but then I realised that it was just slightly itchy and it went away (hello, hypochondria/paranoia).  I really felt very little difference over the weekend.  By yesterday (day 4) I felt that my frown had lessened.  Today is day 5 and I can still frown a little but it takes more of an effort.  It feels like it's a weaker expression too.  I frown less enthusiastically!  I've read that it can take a week or so for the full effects so will see how it goes and whether the effects become more pronounced before I ask about a top-up.
This is day 5:

Hard to tell the effects based on the photo which isn't helped by the harsh daylight and hasty make-up application.

I called into Dr Torgerson's office today to pick up some Latisse.  It's the new big thing in eyelash enhancement!  I remember reading about the drug used in it years ago when it was a glaucoma medication.  They had found that people using Lumigan grew longer lashes.  I was very tempted to get my hands on some having stubby, sparse lashes.  The (rare) side effect of darkening of the iris stopped me though.  Allergan (again) decided to make a formulation for eyelashes though and it's just arrived in Canada so I picked some up from Dr Torgerson's.   It's expensive ($160 for a month's supply-shudder) but I wanted to give it a try.  I've also spent money on plenty of lash enhancers that did nothing at all and saw one priced at $170 in Sephora.  I'd also just been to see an oral surgeon about a dental implant and that looked to be so awfully drawn out, expensive and miserable that I was in the mood for a splurge.
It comes in a box with 60 little applicators packed in 2s.  The idea is to apply a drop from the little bottle and use one applicator for each eye, once a day.
Box and applicators:

I also got a cute bag for it which definitely justified the price :-)

Eyelashes before:

 These frequent photos are making me think I need to pay more attention to my eyebrows...and also that I quite possibly need a nose job.  Nose job won't be happening though!  Sigh.

Also saw Dr Torgerson on Global News 16:9 where they did an exposé on nurses/aestheticians injecting without full supervision and dodgy companies selling Botox online.  Glad I went to a real clinic! This link should work for a while.  It's the "Worry Lines" episode.  Scary stuff!

The Big Botox day

My appointment with Dr Torgerson eventually arrived.  I was terrified.  I'm not usually a bad patient but this really did worry me.  I was volunteering for a medical procedure based purely on vanity.  No medical need whatsoever.  It wasn't going to make me healthier, just a bit less grumpy looking.  And for that I was risking a frozen face and droopy eyes.  Was I crazy?  What would my mother say if she knew?  And why was I spending so much on myself when I should be saving to go home and visit my family?!?

Despite the major butterflies (seriously-they were more like huge flapping bats) in my stomach, I arrived at Dr Torgerson's office.  My nerves pretty much vanished when I met his office staff-Helen and Breanne.   They are so nice and so warm.  It was impossible to stay worried!  Helen is also Irish which was a bonus.  I was given a lengthy medical questionnaire and a cup of coffee and settled down to my form filling.

Dr Torgerson was maybe half an hour late seeing me but the time passed quickly and he was obviously with someone else-not just messing around on Facebook or something!  Helen took my "before" headshots and I waited in a big dentist-like chair in the treatment room.

When Dr Torgerson came in, any lingering fears vanished.  He is immensely likeable and spent the first few minutes just chatting about my work, the move to Toronto and so on.  We then discussed the Botox and he commented that glabellar lines are perfect for it (I think they were the initial cosmetic indication too).  He explained the physiology of action, the duration, what I'd expect during and after the procedure and potential complications.   He likes to completely freeze the muscles involved in creating those lines (which he likes to call "concentration lines") unlike other parts of the face where he tries to retain more movement.  The usual dose he uses is 25 units.  He then said there was one more thing that I might benefit from at some point.  My heart sank.  I'd been dreading the critical eye of a plastic surgeon and the pronouncement that I needed a nose job, a jaw revision, new ears, Botox all over, new lips.  "In fact", I was sure he'd say, "we should just get a refund on this face and get you a new one altogether".  He didn't.  With apologies for being mean and picky, he said that I had "tear troughs"-a fold/hollow at the edge of the eye.  He reckoned it probably looked flatter and I looked more drawn when tired.  I had to agree.  He told me that filler (like Restylane) could be injected to plump it-giving a fresher appearance.  He by no means pushed the procedure-just said it was something to think about.  These photos made me think that he's probably right!  Still can't afford it though.

Anyway, I signed my consent form for the procedure and we got on with it.  His fancy chair can be tipped back and he told me that he uses a teeny tiny needle (32G!) for the injections.  I was given a squeezy Botox toy just in case.  The injections were really fine.  5 of them in total.  Some felt a bit funny-like a crunchy sensation by the inner brow-but perfectly tolerable.  It really is just a little pinch.  I held a little gauze to my head for a few minutes and then was ready to go.  He said it would take at least 3 days to show an effect and that top-ups were free if I didn't see enough of a change.   He also mentioned that they were getting Latisse the following week...which definitely sounded interesting too!

I chatted with Helen and headed out the door.

How did I feel?  Fine.  Can't say there was much of a sensation.  That part of my forehead felt a little fuller than usual and a bit heavy but didn't really bother me.  The tiny marks weren't even visible.  I went home, my Botox virginity lost forever...

Choosing someone to allow near me with a needle...

Having made the decision to go ahead with Botox, I was left with the task of choosing who and where!
The options in general seem to be:

• Doctor who specialises in cosmetic procedures: plastic surgeon/dermatologist/cosmetic doctor
• Doctor who did a course in Botox and does some injections to earn some extra cash (usually a GP)
• Nurse working for a doctor-variable degrees of supervision
• An aesthetician of some sort-spa or salon

I have nothing against nurses.  In fact, I think they're often better at procedures than doctors sometimes-they take more care.  However, when it comes to a neurotoxin being injected into my face, I basically want somebody with all the bells and whistles!

Botox is generally regarded to be safe but there are complications and risks with any medical procedure.  And it is just that.  A medical procedure.  Not a pedicure.

Risks include:

• Spreading to muscles not injected
• Eyelid or eyebrow ptosis (drooping)
• Facial asymmetry
• Difficulty breathing or swallowing
• Flu-like illness
• Local effects: bruising, pain
• Just getting the wrong effect!  Looking "frozen" or "done"

So who to go to?  I Googled around a bit and found it hard to decide.  Some providers charge per unit of Botox-from $10-$15/unit.   The amount they use in different areas varies though.  Allergan (who make Botox) suggest 20 units for glabellar lines but some will use 30 or 35.  And men need more.  Groupon or someone had a $99/20 units special from DLK dermatology on Avenue Road in Toronto but it was a nurse injection and they wouldn't even give information about what times they were available by email.  If you won't email me, I can't be bothered.

I decided to potter along to the National Women's Show in the Metro Convention Centre in Toronto the weekend before last.  Free samples were promised so I paid $14 to go (this grasp of economics may explain my financial issues).  There was a mix of stands-food, travel, beauty, massage...and some cosmetic surgery ones.  I spent a while watching Restylane injections which was interesting and then pottered around a bit more.  One laser centre stand had a hand-written sign offering Botox and saying it was $8/unit.  A woman in a white coat was manning it with a  baby in her arms.  She chatted to me while quieting the baby and then the doctor joined in.  Apparently it's $8/unit if the nurse does it and they were offering something like $10/unit for the show.  They were injecting patients perched on a bench in the middle of the hall.  He took out a crumpled diagram to show me that glabellar lines needed 30-40 units.  I decided to think about it.

They were announcing the end of the show when I passed another stand.  It was larger and looked professional with a surgical chair shielded by a screen.  The doctor could be seen around the side and he waved cheerily when he turned around and saw me watching.  He then went back to work on injecting though and seemed to concentrate completely on what he was doing.  He looked young and friendly so I picked up a brochure.  His name was Dr Cory Torgerson and he was a surgeon who initially trained in ENT surgery and then did further post graduate training in facial plastic surgery.  His practice was all facial cosmetic surgery-rhinoplasties, blepharoplasties, injectables etc etc and located in Yorkville, Toronto.  I browsed the website and liked what I saw.  I also had a look at http://www.ratemds.com/ and the ratings were mainly positive (some a bit tooooo positive, a couple unhappy; overall very good).

I decided to email the office and see what they said.  One of my first questions was "who does the injections?" and then if there were any openings on the Thursday and the cost.  The response from Breanne was rapid.  Dr Torgerson himself does all the injections.  She said I could pop in for a consultation that Thursday at 12.15pm.  Consultations are always free.  Their Botox is also per area-$300 each.

I liked the rapid reply, the friendly tone, the fact that he does all his own injections and the free consultation so I decided to go ahead.  Breanne even patiently dealt with me changing my mind about the time the next day when I asked for a later appointment instead.  Had completely forgotten a midday work meeting. 

I read Botox horror stories while waiting for the day to arrive and asked cosmetic doctor Twitter friends (@EternalYouth and @DrRaviJain) if I'd be frozen after it.  Eek!