Hi,   As one of a selected group of Principal Investigators (national researchers) on studies that are conducted for FDA approval of new technologies including Reloxin, the new Botox alternative, I 'd like to note one point in response to your query: Approval of cosmetic surgery procedures in the U.S. (and of prescription medications too) generally requires more stringent and extensive studies than are required for these same treatments to be used elsewhere in the world. Our FDA requires additional studies to verify the safety and effectiveness of treatments even after they have been approved for use elsewhere in the world.I feel that this provides American patients with the utmost protection where new treatments are concerned and this has helped us to avoid medication disasters such as the thalidomide tragedy. The resultant additional expense accounts for at least part of the difference in cost of these treatments in the U.S. compared to other parts of the world.    As to more Botox injections being given in Canada than in the U.S., I  do not find this to be the case, based on my discussions with Canadian cosmetic surgery experts with whom I teach for Medscape/WebMD and other international educational institutes. The number of Botox injections you receive is determined by the number of units of Botox that you require to achieve the best results, by the best placement for these injections, and by the individual philosophy of the cosmetic surgeon who treats you.   Hope this helps!   Dr. Hema Sundaram