Botox and neuromodulators in Newport News.

Current offer

A limited-time price of $450 covers the three upper-face areas treated together with Letybo — the frown lines between the brows (glabella), the forehead, and the crow’s feet. It applies to Letybo only, not to Botox or to the other neuromodulators, and it is a promotion rather than our standing price. The price covers up to 70 units of Letybo across the three areas. Units beyond 70 are $9 each for as long as this offer runs, against our regular $11 per unit. Priced by the unit instead, those three areas come to more than $450 at every dose in the ranges above: the lowest typical dose across all three is 42 units, which is $462 of Letybo.

The $450 price is conditional on signing a photo consent for before-and-after photographs. The same three areas are treated without photo consent at the regular per-unit prices above. Declining photographs is a normal choice and changes nothing else about your care.

The offer runs through December 31, 2026, or until the first 50 patients have taken it, whichever comes first, and the full terms are set out on the offer page. It is one price per session; as with any first neuromodulator appointment here, we book a review at about 14 days, when the result has settled, and adjust rather than overcorrect. Whether all three areas are appropriate for you is still a clinical decision made at the consultation.

Book online

More than one appointment on this page can be booked on its own, so it is worth starting from the one you want rather than the general list of services. Which product we use is still settled with you at the consultation, and the consultation is free either way.

• Book a Letybo appointment — priced at $11 per unit above.
• Book a Botox appointment — priced at $14 per unit above.
• Book a masseter or trapezius assessment — the ultrasound assessment appointment for jaw clenching and jaw slimming and for the trapezius, booked separately from the areas priced above.

What the evidence shows

Two different literatures get quoted as though they were one. They are not, and they point in different directions.

For the shoulder line, the studies are small. A randomized, double-blind trial published in 2026 gave twenty women either forty units or eighty units of letibotulinumtoxinA — the same molecule as the Letybo priced above, sold there under a different brand name — spread over ten points along the trapezius. Both doses produced a statistically significant reduction in trapezius area at twelve weeks, with no measurable advantage for the higher dose, and a median satisfaction score of four. A randomized trial in thirty women measured the muscle on ultrasound rather than by eye and found it roughly two to three millimeters thinner at three and at six months. A split-shoulder trial in twenty volunteers used thirty units per side under ultrasound guidance; at one year the side treated with incobotulinumtoxinA was still measurably thinner than at baseline, while the onabotulinumtoxinA side had regained size. Past those, the cosmetic literature is cadaver mapping and case series — a 2026 technical note describing the method in three patients says in its own words that it should not be read as evidence of efficacy. Taken together, that supports a real but modest change, measured in millimeters, in small groups of mostly young women. It does not support a promised silhouette. Nor is it judged at two weeks the way we judge a forehead: in the published work the measurements start at about four weeks and run out to twelve and beyond.

For pain, the better evidence is less encouraging. A 2025 systematic review and meta-analysis pooled seven randomized trials and 261 patients with myofascial pain of the neck and shoulder, at doses ranging from 20 to 400 units, and found botulinum toxin beat saline by about ten points on a hundred-point pain scale — statistically real, and below what anyone would call a clinically meaningful difference. Its authors concluded that it cannot be recommended for that use. An earlier randomized trial of a single twenty-unit injection into an upper trapezius trigger point found no advantage over saline on pain score at three or six weeks, although pressure-pain threshold did improve at six. If your reason for asking about this is pain rather than shape, that is the evidence you are entitled to have before you spend anything.

Dose, and what that costs

The frown lines take twenty to thirty units. The published trapezius protocols above used twenty-five to eighty units in total — thirty units per side in the ultrasound-guided trial, forty or eighty units over ten points in the dose comparison, twenty-five units over five points in the three-patient report. Those figures come from other brands, and units do not convert between products, so read them as the scale of the thing rather than as a prescription. The scale is the point: this is a body-sized dose, not a face-sized one, and the invoice follows the dose here exactly as it does everywhere else on this page. At our prices, forty units is $440 of Letybo or $560 of Botox, and eighty units is $880 or $1,120. We publish no flat price for the trapezius because there is no flat dose. Your number comes out of the assessment, and you will have it, and the total, before anything is injected. Consultations are free.

Weakness, and who should not have this

The trapezius is not decorative. It holds the shoulder blade against the ribs and rotates it upward every time you lift your arm overhead. Weakening its upper part enough to change the shoulder line is, by definition, weakening it. The published harm is not hypothetical: a case report describes a woman who developed subacromial impingement — shoulder pain on overhead movement — after a third round of injections into both upper trapezius muscles, in association with weakness of the muscle. The injections were stopped and it resolved within three months. That is one patient, and it settled; it is also exactly the mechanism you would predict, which is why we ask what your shoulders do all day.

If you lift, swim, row, climb, throw, carry a pack, or compete in anything that loads the shoulder girdle, this is not a treatment to take on during a training block or a season. The same goes for work. If your ceiling is your workplace — the trades, painting, styling hair, moving patients, carrying a child on one hip all day — a few months of a weaker shoulder is a real cost rather than a footnote. Tell us about your training and your job at the assessment: it changes the dose, and sometimes it changes the answer. We would rather talk you out of this one than take the money and have you find out in week three.

One more consequence of a large dose. Whether repeated botulinum toxin injection produces neutralizing antibodies and a fading response is genuinely contested. One line of expert opinion recommends the purest available formulation and specific caution for repeated large-dose injections and for younger patients who will accumulate a large lifetime dose; others argue that measurable antibody formation is rare with current type A products and correlates poorly with loss of clinical response. We are not going to pretend that is settled. What we take from it is practical: the trapezius is the treatment that moves your lifetime total the most, so it is worth deciding what else you want treated in the same year, and worth not topping up early because a result faded sooner than you hoped. Individual results vary.

Why the assessment is an ultrasound appointment

We own a Clarius L20 HD3, a 20 MHz handheld ultrasound, and the trapezius appointment is booked as an assessment because looking first changes what we do. Three things the scan settles that a photograph cannot. First, whether the shoulder line you dislike is muscle at all: the contour there is made of the trapezius, the fat lying over it, and the projection of the collarbone and the point of the shoulder underneath — and botulinum toxin does nothing for two of those three. Second, how deep the muscle actually is at each injection point. Mapped ultrasound measurements in forty women show the fat layer, the muscle thickness and the depth from skin to mid-muscle all changing as you move back across the shoulder, and differing from person to person; a needle set to a standard depth puts units into fat on one person and past the muscle on another. Third, it gives us a number to measure against — the same points, scanned again at follow-up — rather than two photographs taken in different light. Anatomical work also maps where the accessory nerve enters the muscle, a zone to place injections around rather than into.

The masseter or trapezius assessment is the appointment to book for this, and it is booked separately from the areas priced above. The units are what you pay for, and only once we have both agreed on the number.