I must admit, I don't understand the differing results among reputable board certified dermatologists.
Based upon observations of the instagram board:
A) older instagram accounts are wildly more negative. The instagram accounts that started prior to 2017 or so are much more negative. It’s not a small effect (I’d speculate that older accounts are, in general, less willing to experiment - and have patients less willing to try something new. And an entirely new toxin requires experimentation, especially for off-label use)
B) the negative accounts never mention experimental tuning. They generally mention just one run - altho sometimes in large number of patients (which just seems stupid given need to experiment). Context: even among positive reviews, only a fraction mention tuning, altho I’d be surprised if more didn’t tune but didn’t mention it on the board. But the key point is approximately none of the negative accounts mention tuning.
C) clearly many practitioners have no idea how to calc price margins - eg talk about it being more expensive per treatment even at watered down dosages. And many completely unaware of pricing changes. Genuinely weird. As is the common confusion about ‘units’.
D) even among positive reviews there is frequent (but not universal) mention of a substantial fraction of patients switching back to older BONT. 50% is given multiple times. (My comments: my guess is a significant fraction of those will switch back again after being reminded of real efficacy in older BONT - as opposed to glowing memory. Also, 50% switching back before protocol finely tuned seems entirely reasonable.)
E) many mentions in negative reviews that the negative reviews are based upon fact that movement starts at same time it did for older BONTs. Positive reviews note same thing, but then note that return to baseline takes substantially longer than with earlier BONTs. (Comment: this effect is surprising but it shows up multiple times so probably real and it would explain a lot of people’s disappointment if they are judging by movement. What fraction of practices use this measure instead of return to baseline?)
F) pretty strong agreement on quicker start of efficacy, even among negative reviews.
Other observations:
1) units used in upper face seem to be about 120+.
2) there are relatively few completely non-credible reviews (eg one that says took 3 weeks to see start of efficacy)
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