Botox and hyaluronic acid fillers in Tokyo: prices in Japanese yen and English-speaking clinics

Botox is a brand name for botulinum toxin type A, a medicine injected into specific muscles to relax them. Clinics in Tokyo list it for expression lines on the forehead, between the eyebrows (the glabella), and at the corners of the eyes (crow's feet), as well as for the masseter muscle at the jaw, the shoulders, the calves, and underarm sweating. The product made by Allergan is sold in Japan as Botox Vista. Korean-made toxins such as Botulax, Coretox, and Innotox are also widely offered, usually at lower prices. Shirono Clinic and AOHAL Clinic state that they use only Botox Vista.

Hyaluronic acid fillers are gels injected under the skin to add volume or soften folds, for example in the cheeks, lips, chin, under the eyes, or along the nasolabial folds. Brands named on Tokyo clinic websites include Juvederm (Allergan, with products such as Voluma, Volift, Volbella, and Volite), Restylane, Teosyal RHA, Neauvia, and the Korean brand Neuramis. Hyaluronic acid filler can be dissolved with an enzyme called hyaluronidase, which most clinics in this guide list as a separate item.

Not every product or use is approved in Japan. BIANCA Clinic states that Botox Vista is approved by Japan's Ministry of Health, Labour and Welfare for glabellar lines and crow's feet in adults under 65. AOHAL Clinic's price list states that Botox Vista is approved for glabellar lines, crow's feet, and the masseter, and that injecting other areas, including the forehead, is an unapproved use. Ledian Clinic and BIANCA Clinic state that Botulax, Coretox, and Innotox are not approved in Japan and are imported under the physician's responsibility, and Ledian Clinic says the same of Neuramis filler. BIANCA Clinic and AOHAL Clinic note that if a serious adverse event follows an unapproved product or use, you may not be eligible for compensation under Japan's government relief system for adverse drug reactions. This is routine in Japanese aesthetic medicine, but you can ask the clinic which product it will use and what approval status applies.

Botox is priced in three different ways, which makes direct comparison difficult. Most clinics charge per area (for example, ¥28,000 between the eyebrows or at the eye corners at Matsurika Clinic, or ¥44,000 for each of these areas at Shirono Clinic). Ledian Clinic lists a set number of units per area (10 units for the forehead). BIANCA Clinic charges per unit (¥900 per unit for Botox Vista) and estimates 6 to 10 units for the forehead, crow's feet, or glabella, plus a treatment fee of ¥25,500 per session. The masseter needs many more units than a forehead line, so jaw prices are higher: from ¥16,500 for 50 units of Botulax at Ledian Clinic to ¥110,000 at Shirono Clinic.

Brand makes a large difference. At Elm Clinic, the forehead costs ¥15,800 with Botox Vista and ¥9,800 with Botulax; at GRACY TOKYO CLINIC, one area costs ¥22,000 with Botox Vista and ¥11,000 with a Korean toxin. Fillers are usually priced per syringe or per cc, and one syringe of most Juvederm products contains 1 cc. Some clinics add a separate charge: Elm Clinic adds a ¥20,000 treatment fee per session, BIANCA Clinic adds ¥25,500 per session and ¥2,600 per area for needles, and Ledian Clinic charges ¥22,000 when one syringe is split across more than one area. Several clinics discount multiple syringes, so ask for the total for the amount you need.

Check whether tax is included. Most Tokyo clinics list prices including Japan's 10% consumption tax, but Azabu Skin Clinic states that all its prices exclude tax, Tokyo Skin Clinic lists both, and Ledian Clinic shows both figures. Tokyo Midtown Skin Aesthetic Clinic Noage's English price list does not say. Consultation fees also vary: ¥3,300 at Omotesando Rejuva Medical Clinic, Art Lounge Clinic, and Shirono Clinic; ¥5,500 at AOHAL Clinic; ¥11,000 at Matsurika Clinic, waived if you proceed with treatment the same day; and free counseling at Ledian Clinic. Elm Clinic states that its Botox prices already include consultation, treatment, and needle fees.

Injectables depend heavily on the person injecting, so it helps to know who will see you. At Omotesando Rejuva Medical Clinic, three doctors offer consultations in English: clinic director Dr. Rena Hirata, a Galderma-certified injection trainer, Dr. Reiko Sakio, and Dr. Kikuno Onchi, an Allergan Clinical Trainer. At Art Lounge Clinic, clinic director Dr. Yoko Nakano offers consultations in English, but she also performs treatments throughout the day, so book ahead and ask for an English consultation. Tokyo Skin Clinic in Roppongi is run by two multilingual doctors. Ledian Clinic and BIANCA Clinic state that English-speaking staff are available, Matsurika Clinic provides English-language support whenever possible, and KAI Clinic Tokyo arranges an English-speaking staff member on request.

Prices can depend on language support. Art Lounge Clinic and Omotesando Rejuva Medical Clinic state that English-speaking patients pay the standard prices; Art Lounge Clinic keeps a separate price list only for patients who need an interpreter. Matsurika Clinic says some fees differ for patients who need language support. KAI Clinic Tokyo charges a ¥22,000 initial consultation and a 20% language support fee from the second visit for care in languages other than Japanese, and ¥22,000 per visit if it arranges a professional interpreter. Elm Clinic's English pages are machine-translated, and the clinic says its staff speak only Japanese.

• Which product will be used (Botox Vista or a Korean toxin; Juvederm, Restylane, or another filler), and its approval status in Japan.
• Whether the price is per area, per unit, or per syringe, and how many units or syringes the doctor expects you to need.
• Whether a treatment fee, needle fee, anesthetic, or consultation fee is added, and whether the quoted price includes tax.
• Whether a doctor who offers consultations in English is available on the day you book, and whether language support changes the price.
• What a follow-up or touch-up visit costs, and what hyaluronidase costs if a filler needs to be dissolved.
• Whether foreign-issued credit cards are accepted. Omotesando Rejuva Medical Clinic accepts credit cards, WeChat Pay, and Alipay; Art Lounge Clinic accepts Visa, Mastercard, JCB, American Express, Diners Club, Discover, and UnionPay; Tokyo Skin Clinic accepts Visa, Mastercard, Diners Club, American Express, and JCB.

Clinics describe little downtime for either treatment. Matsurika Clinic states that you can wash your face, bathe, and wear makeup immediately after Botox or filler, and asks patients not to massage filler areas strongly for two weeks because the filler may move. Side effects that clinics list for Botox include swelling, bruising, pain, and a temporary feeling of stiffness or unnatural expression. Azabu Skin Clinic notes that Botox on the forehead or between the eyebrows can cause swelling around the eyes, a lowered eyebrow, or a drooping upper eyelid, which normally resolves within a week to a month.

Fillers carry a rare but serious risk. AOHAL Clinic and Shirono Clinic list blood-vessel blockage among the possible complications; AOHAL Clinic states that, very rarely, blockage of an artery in the face has been reported to cause skin necrosis, and blockage of an artery to the eye has been reported to cause blindness, visual impairment, or stroke. Ask the doctor how they reduce this risk and whether hyaluronidase is kept on hand.

On timing, BIANCA Clinic states that Botox usually begins to work about three days after treatment, reaches its full effect at around two weeks, and lasts about three months, with muscle activity usually returning to its original state within about six months. Shirono Clinic gives four to six months. Shirono Clinic states that hyaluronic acid filler is absorbed by the body in about six months to a year. If you are traveling, allow time for a follow-up visit about two weeks after Botox, when touch-ups are usually assessed.