Monthly Archives: December 2014

Bumps after Botox?

“I have horns!”

Horns right after Botox injections?   I heard this exclamation after a Botox injection today.  And I thought to myself – what a great topic for my Modesto Botox Blog.

They aren’t horns, they are bumps.

Well, that sounds almost as bad.  But these bumps are from the injection of Botox under the skin and sometimes into the muscle (depending on the location of Botox injections).  Botox is reconstituted as a liquid (from a powder), and then injected as a liquid in these locations.  Liquids will naturally take up some space, and they look like little bumps.  Probably a little bit bigger than those TB testing shots that we get from time to time in our forearms.

The bumps usually go away in about 15-30 minutes.

Fortunately the Botox bumps usually go away in a few minutes.  Sometimes by the time a patient drives home.

The Botox bumps I’m discussing in this blog are the ones that can be seen immediately after a Botox injection.  I’m not discussing bumps that occur hours after or days after the Botox injection.

What else could it be?

If these Botox horn or Botox bumps don’t go away, it could be something else like a hematoma.  A hematoma is a collection of blood – from bleeding, which could happen after injections with a needle.   And the collection of blood could cause the bump.  Hematomas will also resolve with time, but ideally, I try to avoid large hematomas by observing the injection site during and after my Botox injections.  Sometimes hematomas can’t be avoided.  But I would try to minimize them.  A smaller Botox needle might help, too.   Hematomas usually will result in bruises which will also resolve.  At least this is what I do in my Modesto Botox Practice.

Below is a picture of me, not a picture of Botox bumps.
Calvin Lee, MD
Calvin Lee, MD
Disclaimer:

If you haven’t looked directly at my crows feet or glabellar lines – in person and at my office – then we have not established a formal doctor-patient relationship.  Please see your own doctor.  There is no medical advice here, just medical information for general use – nothing here is directed at any specific person.


Botox Vials

Botox Vials


 

Juvederm

juvederm

Do you have Juvederm?

That’s a somewhat non-specific question.  And sometimes patients use the word Juvederm to mean all sorts of fillers.  And the answer is yes, we have Juvederm in our Modesto office.   As of the writing of this Modesto Botox blog, we have all the different Juvederm which is available in USA.

First of all, how do you spell Juviderm?

Juvederm is the spelling.  No wait, it’s JUVÉDERM®

You need to have it all in caps and that fancy É and you need to trademark symbol.  That’s how it’s spelled correctly.  So I guess everyone for the most part spells it incorrectly.  So “Juviderm” is fine too.

Thus the confusion.

Juvederm is like Calvin Klein.  What?  So do you have Calvin Klein?  Well, it’s not exactly like that either.

Perhaps I should try to explain.

Juvederm is a family of fillers with varying properties.   They have different thickenesses, different size needles which come in the packaging, different duration, different indications, and of course injectors will have different preferences.

The empty boxes of the dermal fillers used today
The empty boxes of the dermal fillers.  Juvederm boxes up on top.  There are two syringes of Juvederm in each of the Juvederm boxes.

Juvederm in different countries…

Juvederm has different names, and outside of the USA there are many other variations of Juvederm.  Many of which I’ve not tried nor do I even know about (yet).

Juvederm in Modesto, CA, USA

I pretty much the entire collection of Juvederm products available in the United States in my Modesto Botox/Juvederm practice:  Surgical Artistry.  My wife (board certified plastic surgeon, Dr. Tammy Wu), and I feel that the entire range of products are necessary for obtaining the desired results.

The different Juvederms are like different sized paint brushes

With the different Juvederm products, we feel that we can achieve different outcomes and for different skin thicknesses.

Juvederm Products – biggest difference is thickness

They are made by Allergan.

  • Juvederm Voluma
  • Juvederm Ultra Plus XC
  • Juvederm Ultra Plus
  • Juvederm Ultra XC
  • Juvederm Ultra

The XC products have lidocaine added inside.  Some patients might be allergic to lidocaine or may approach a toxic dose of lidocaine with too many syringes selected; thus a non-lidocaine version of the product may become more desirable.

The products above are listed in general from thickest to thinnest.

Read my blog about the relative thicknesses of dermal fillers.

There’s a whole world of folks arguing about the terms thickness, viscosity, G-prime, compressibility, lifting capacity, etc.  I understand some of the subtle differences.  But “thickness” is a simple way to look at it.

And XC probably stands for Xylocaine, or perhaps it stands for extra comfort?  I’m not sure, but perhaps it’ll be for the patients to decide – especially if they say, “that didn’t hurt at all, doctor!”  Music to my ears.

Although Lidocaine may rhyme with Candy Cane.  It’s not Candy.

Feel free to read my blog about toxic doses of lidocaine and how to calculate an estimation of safe limits of lidocaine; and there is a discussion of central nervous system adverse effects: nervousness, tingling around mouth, tinnitus, tremor, dizziness, blurred vision, seizures, depression, loss of consciousness.

Allergan makes Juvederm and Botox

and a host of other products – mostly related to eye care.  And Allergan is going to be merging with Actavis.

Visit us for your Juvederm consultation: Surgical Artistry in Modesto, CA

www.InjectionArtistry.com 

Calvin Lee, MD

Calvin Lee, MD


 

 

A Thank You Letter from Allergan

This letter was sent out to myself, Dr. Tammy Wu, and my Modesto Plastic Surgery staff.  We had sent out one of the original letters of support for Allergan which was mentioned in this letter.

Allergan manufactures and distributes the Botox, Latisse, and Juvederm which we use very often in our Botox practice in Modesto, CA.

Highlights of this letter from the makers of BOTOX:

  • November 17th, Allergan announced that Actavis will acquire Allergan.
  • Actavis shares the long standing Allergan commitment to innovation.
  • The acquisition will probably close in quarter 2 in 2015.
  • Until then, it is business as usual for Allergan Medical.

Read the rest of the letter:


December 17, 2014


Dear Aesthetic Customers:

I would like to take a moment to thank you for supporting Allergan over many years, and in particular, during the last eight months. Many of you sent letters and emails voicing your support for our company and our priorities. It was your voice that provided the fuel and reinforced the importance of maintaining a culture that continues to bring value to patients and customers.

As you know, on November 17th, we announced that Allergan has entered into a definitive agreement whereby Actavis will acquire Allergan. I am very pleased with this outcome and excited for the next chapter as Actavis is highly committed to the success of the Aesthetic specialty, and to providing new programs to further support the growth of Aesthetics market and your continued success. Importantly, Actavis also shares the long standing Allergan commitment to innovation, and bringing meaningful new products to market.

We expect that the acquisition will close in Q2 2015. Until then, it will remain business as usual for Allergan Medical, with no change to your representative support and continuation of the programs and services that you value, including our Allergan Partner Privileges (APP) program, Brilliant Distinctions, Direct to Consumer Advertising, and Allergan Practice Consulting services.

We know you have choices in the market, and always appreciate your choosing Allergan. We look forward to serving you and your patients during the months ahead and as we combine Allergan with Actavis later in 2015.

Sincerely,

David Pyott


 

Yearly Botox growth 2014

Yearly Botox growth measured by the number of people who have had Botox or Juvederm at least once per year at our Modesto Botox Office: Surgical Artistry. 2014 data.

Basically, this is the growth of different patients seen per year at my Botox Practice in Modesto. It doesn’t matter if the patient comes to the office one time for that year for Botox or 100 times.  Well, I’ve never really had a patient come to our Modesto office 100 times for Botox.

The numbers come out of a computer program provided by the Allergan company (makers of Botox and Juvederm). The computer program is the analytics part of the Brilliant Distinctions program (BD Analytics).  I’m proud of the growth, and very thankful. Half of my time is reserved for Acupuncture and the other half is for cosmetic injectables.

2014 yearly botox growth data without numbers

I intentionally left the numbers off the Botox and Juvederm growth chart because I thought they were somewhat distraction.  Above is a screen capture of a chart created in Excel.

Notes about the Botox and Juvederm Data:

  • The data does not go back to 2006, when Surgical Artistry was formed.
  • The cutoff date between the years is December 15.
  • A different cutoff date was used in a prior analysis where mid August was the cutoff between the years.  That (August to August) shows a greater increase in numbers when looking at the percentage increases for the years 2012 and 2013.  The older charts and Botox/Juvederm data is here:  Botox and Juvederm Growth 2013.
  • Botox growth percentages.  2012: 53.0%, 2013: 35.0%, 2014: 31.6%
  • Juvederm growth percentages.  2012: 36.5%, 2013: 44.2%, 2014: 46.8%

www.InjectionArtistry.com (please feel free to visit us in Modesto, CA).

The Best Botox Blogs

Listing of my Botox Blogs in reverse chronological order

I figured, I should start by listing my blog posts, then select the best out of it and post them in BOLD.   I’m writing this to you from Modesto, California.

I discovered that there are a lot more Blog posts than I had ever remembered.  This is a work in progress – not done yet.  I am just linking these pages by hand.  There’s probably a quicker way.  But this works for me too.  It allows me to practice typing!

  1. Modesto Piano Playing – dexterity challenges – Car Wash Video.  Believe it or not, I tried to combine a new christmas present of a camera, with a car wash, piano playing, and Botox dexterity
  2. Typing abiliity related to Botox injections?  Showing off a bit of typing speed.  Typing this blog helps my typing speed too.  Although I’m really not trying that hard to type with tension or even that fast for that matter.
  3. How many units for crows feet Botox?  A very common Botox question.
  4. Bumps after Botox?  Ever get those bumps on your forehead after getting Botox injections?  Well, it’s common to ask, and I figured I try to explain.
  5. Juvederm – just some basics on what is Juvederm.  I didn’t go into the molecular details here.  Perhaps another blog for that topic.
  6. A thank you letter form Allergan – more info about the Actavis takeover/merger.
  7. Yearly Botox growth 2014 – in terms of number of patients; not number of visits.
  8. The best Botox blogs.  um, this page.
  9. How does Botox work?  The biology of Botox!
  10. Can Botox cause botulism?  Honey can cause botulism.
  11. Spending too much money on internet webpages?  Try making your own!  Because it really doesn’t cost all that much – but it does take a good amount of time.
  12. My life with Botox and cosmetic dermal fillers.  I think it’s a reasonably good life.  I don’t do trauma surgery any more.  But perhaps someday I’ll get back into it.
  13. Who is Allergan?  Allergan makes Botox and other products.
  14. Latisse as an adjunct to Botox eye treatments.  How to apply Latisse video is located at this blog page.
  15. Skin aging infographic from Colorescience.  How we age and what to do about it.
  16. Botox terminology: Glabella.  Sometimes referred to as Glabellar – especially when there’s a word next to it, such as Glabellar Complex.
  17. Botox award from Allergan.  They give awards for this?  Sure I’ll put it somewhere in the office.
  18. Dexterity for Botox injections – Chopin?  Chopin Etudes for exercising those delicate fingers required for Botox injections.  You can take many things to a higher level.  This is my attempt as a Botox injector.  This isn’t a blog about getting Botox in the fingers of pianists.  That might be another topic another day.
  19. Botox mailing list growth – I use mail chimp.  This mailing list is more than just Botox, it has plastic surgery patients too.  Conclusion – it’s about 47 patients added per month to the mailing list for all of Surgical Artistry.  The post title is a bit misleading.
  20. Cosmetic procedures besides Botox.  I wrote this because I had patients who were surprised that I do other things besides Botox.  So here’s a few other things which I do which include Asclera, Belotero, Derma Pen, Obagi Blue Peel Radiance, Voluma.
  21. I didn’t know you inject Voluma?  Of course I do, and I love it.  It is a Juvederm product.
  22. Medical Botox vs. Cosmetic Botox, differences?  This is just the on-label FDA uses.  The off-label uses are a much bigger list.
  23. Monthly Botox chart – November 2014 update.  I like to see things graphically so here a graphic.
  24. Botox Report: Number of Patients for the Month.  Using the analytics section of Brilliant Distinctions.  The month would be November, 2014.
  25. Does Botox Hurt? – this is a great question!  I think most folks would say that it doesn’t hurt much at all.
  26. Botox Delivery – what it looks like in a box.  Nope, not pizza delivery to our Modesto office.
  27. Botox WiFi?  An original analogy that I made up to help explain more about how Botox works.
  28. What is Botox FDA approved for cosmetically?
  29. Belotero Balance Injection Technique – a unique method called serial puncture.  I have yet another secret method – but that’s perhaps for another blog.  I’ll probably call it “submarine attack.”
  30. Lowest price Botox?  We compete on results, safety, comfort, customer service, positive attitude, and communication.   Thus we hope to have the BEST VALUE.
  31. Botox didn’t work for my “11’s” – a discussion of when fillers are needed to compliment Botox in the Glabellar complex.  And there’s a discussion of the difference between static and dynamic wrinkles.
  32. Email from Allergan about Actavis 11-19-14.  Actavis to take over?
  33. Juvederm Voluma Injection Notes according to an Expert outside of the US.  The lecturer was Dr. deMaio.  I don’t agree with everything he says, but I really appreciated having the opportunity to see him lecture on a webinar.   I particularly liked how he talked about using Voluma for “lateral support.”
  34. Best cosmetic Surgeon Award.  Stanislaus’ Contentment Health Magazine had a first ever voting in the community of “bests” and we were given this award for Best cosmetic surgeon.  Congratulations to everyone!
  35. Latisse Pricing changes at Surgical Artistry Modesto, California.  Still a great price.
  36. Neotensil is now Available at Surgical Artistry.  Under eye shape-wear.
  37. Juvederm Voluma for the Lips?  This was a question we got over the phone.
  38. Botox in Modesto – where to get Botox? This is a list of 36 possible places to get Botox in Modesto.  It seems that Modesto is Botox Central!  I’m sure the list will continue to grow.  I used lists from Find-a-provider from Botox, Dysport, and Xeomin.  Just compiled this as a response to a question which I received in my office in Modesto, CA.  The questions I receive are often inspirations for Botox blog postings.
  39. Cosmetic Fillers compared in terms of thickness.  Fillers are different in many ways, and one of the ways that they are different is how thick they are.  I rank them in the order of thickness – according to how I see it.
  40. Botox related products at Surgical Artistry.  Basically a listing of injectables.
  41. What does an Allergan Botox bill look like? Botox and Juvederm can be expensive.
  42. Will I ever have more than 100 Botox Patients per month?  I’ve already done this! Yay!
  43. Botox, Veins, and Acupuncture: How my time is broken up in the office.  I’ve provided a pie graph.
  44. Why a patient would choose Surgical Artistry – Staff View.  – So that’s what they think of me…  I won’t say if any of this is actually for real, but this is what they said on email when recently asked to provide their thoughts.
  45. Muscles, nerves and Vasculature of the face for the Botox and Juvederm Injector.
  46. Facial Fat Compartment Anatomy for Botox and Juvederm Injections.
  47. After Botox, I have a headache.  Headaches can be a side effect right after getting Botox injections.
  48. Allergan and Valeant – Letters against the possible “Vallergant” merger.  Dr. Tammy Wu wrote one of the very first letters.  I think this started the trend.
  49. Radiesse is back at Surgical Artisry.  Radiesse is a wonderfu filler.
  50. Calvin Lee, MD Modesto Botox Surgeon Stats as a Botox injector.  2013 statistics.
  51. Modesto Botox 2013 in review.  More about our Botox practice in 2013, including a discussion of overhead costs.
  52. Juvederm before and after picture for cheeks.  This was before Juvederm Voluma.
  53. Axillary Hyperhidrosis Botox (excessive sweating) treatments in Modesto by Calvin Lee, MD.
  54. What to do in case of Dermal Filler Emergency.  Really important page.
  55. Botox is now approved by the FDA to treat Crows Feet.  But doctors have been injecting crows feet already for the past 10 years before FDA approval.  That’s called off-label use of Botox.
  56. Botox Development built into Brilliant Distinctions.  Our Allergan representative asked if I’d write a bit about Brilliant Distinctions and they got this blog.
  57. Botox in Modesto – Consider having it done by Calvin Lee, MD.  This was the blog which inspired the home page of www.InjectionArtistry.com
  58. Belotero and Botox for around the eyes.
  59. Botox and Juvederm growth of about 60% per year for the past 2 years.  This is a good blog if you’re into tracking the growth of a Botox/Juvederm practice and if you like bar charts.
  60. Growth Rate for our Modesto Botox, Juvederm, and Latisse practice.
  61. Botox and Juvederm informational event at Surgical Artistry.  The Botox rep keeps wanting me to do another even like this wihch was in August 2013.  This blog keeps some of my notes regarding the event and also has some FaceBook screen captures of what people thought of it.
  62. Attributes of Highly Effective Botox Injectors.  I decided to stalk famous injectors as if they were celebrities.  For the past 2 months.  I went around the country to participate in lectures, courses and conferences regarding Botox, Juvederm, and other cosmetic injections.  I also made it a point to personally get to know some of these injectors.

Superior BOTOX webpages which I’ve made:

Fruits of labor.  Miewa variety of Kumquats from our garden in Modesto, CA.
Fruits of labor. Miewa variety of Kumquats from our garden in Modesto, CA.

Ideas for future blogs (notes to myself):

  • What is Juvederm?  A large family of filler products.  Different products are available in different countries.  I’ll be writing from the USA – specifically Modesto, CA.
  • The surprised overly arched eyebrow look with Botox.  How to fix that.  Sometimes called the “M” look for the eyebrows.  Or the “Spock look.”
  • Brow ptosis (drooping), how to avoid and get the best of all worlds where the wrinkles go away on the forehead and the eyebrows stay up.

How does Botox Work?

The Biology of Botox

I was a neuroscience concentrator at Brown University.  So I might just call this blog the Neuroscience of Botox instead.  My wife, while at Brown, studied Biochemistry, so I might also call it the Biochemistry of Botox.  Regardless…

botox mechanism 2 botox mechanism

The main gist of what Botox does is a relaxation of muscles.  At least that’s how we view it on a grand scale.  On a more minute scale, we might see it as the prevention of release of neurotransmitters and peptides from the axon of neurons.

Mechanism of action for Botox, sequentially:

  1. Biochemical activity occurs at the neuron side (rather than the muscle) of the neuromuscular junction (NMJ)
  2. Two chain polypeptide with a heavy chain and light chain.
  3. Heavy chain of Botox targets axon terminals of neurons.
  4. After the heavy chain of Botox attaches to the surface of axon terminals, the toxin is taken into the neurons by endocytosis.
  5. The light chain is released inside the neuron cytoplasm.
  6. The light chain has protease activity and degrades the SNAP-25 protein (Synaptosomal-associated protein 25).  SNAP-25 is normally required for vesicle fusion which releases neurotransmitters from the axonal endings – usually acetylcholine (ACH).  Without the intact SNAP-25 protein, ACH is not released as a signal for muscle contraction.

 More Botox Biochemistry Notes

  • SNAP-25 is a type of SNARE protein.  SNARE stands for Soluble N-ethylmaleimide-sensitive factor attachment Protein Receptor.  SNAP 25 stands for Synaptosomal-associated protein 25.
  • Without SNAREs there is no fusion and thus no synaptic signal transfer.
  • Without acetylcholine being released the muscles no longer have their signal for contraction.  Acetylcholine is an excitatory neurotransmitter at the neuromuscular junction in skeletal muscle.

YouTube Video demonstrating the Biology of Botox

Botox on a molecular level is shown in the video above.  I did not make this video.

Visit us for Botox in Modesto

Other Botox info links

Disclaimer:  There is no medical advice here.  Medical facts change from time to time, please double check these facts.

Calvin Lee, MD
Calvin Lee, MD

Can Botox Cause Botulism?

Botox cause Botulism?

Yes, when injected incorrectly and with certain patient factors.  But please read on.

Botox from Allergan is a highly purified protein derived in the laboratory from a bacteria which can cause botulism.

What Bacteria does Botox come from?

Botox is purified in the lab from a bacteria known as Clostridium botulinum.  It is a gram-positive, rod-shaped, anaerobic, spore-forming bacterium.

Botulism and the Bacterial cause

Botulism is a rare illness that causes paralysis of the body including breathing muscles.  It can be caused by several different strains of Clostridium: Clostridium botulinum, Clostridium butyricum, and Clostridium baratii.

Various forms of Botulism

There are about 5 various forms of botulism, but the three main forms are  foodborne botulism, wound botulism, and infant botulism (which can be caused by honey ingestion in infants).  The bacterial spores from clostridium botulinum are common in soil and water.

Various forms of Botulinum Toxin

The Botulinum toxin are a varied group and consist of 8 types.  Botulinum toxin types A, B, E, F, and H affect humans.  The other types affect other mammals.  Botox is Botulinum toxin type A.  There are three forms of Botulinum toxin type A used medically:  Botox, Dysport, and Xeomin, and there is a botulinum toxin type B called MyoBloc which is also used medically.

Iatrogenic = accidental overdose.  Another form of Botulism.

An iatrogenic form of botulism (in addition to the three main types described above) can occur from accidental overdose of these botulinum toxins.  How can an overdose occur?  Too high of a dosage, injected into blood vessels or accidental spread from intended medical targets.

“Botox is to Botulism as Penicillin is to Mold”

But one elegant way to think about Botox is this analogy:  “Botox is to Botulism as Penicillin is to Mold.”  That statement is trying to say that Botox is harnessing the good powers of something considered harmful; just like how penicillin was derived from mold.

With cosmetic dosing and usage, the chance of overdose related (iatrogenic) Botulism is small.

“Good Medicine given in dangerously high doses is a Bad Poison”

Medicine can become a poison when given in supra-physiologic amounts.  That goes for just about every medicine.  This is my own quote, but in many ways, this can be considered common sense and applicable to many facets of life.  The common quote is “too much of a good thing is bad.”

In my opinion, when genuine cosmetic Botox is injected properly, it is one of the safest drugs I’ve used.

The risk of Botulism from Botox is extremely small

Hopefully this discussion isn’t too scary.  What I mean to say is that if Botox is injected in huge amounts and incorrectly, there is a risk of Botulism.  There may also be risks when patients inadvertently push the Botox away from their intended targets.  But when injected in small amounts (ie. for cosmetic use) and carefully (and with experience), the risk of Botulism is extremely small.   Medical Botox usually is a higher dose of Botox than Cosmetic Botox.  Medical Botox is frequently 10 times higher dosage than Cosmetic Botox.  But even so, the risk of iatrogenic Botulism is miniscule.   As with any potential risk, we should be aware and treat Botox with respect.

Treat Botox with respect – a message to myself as a Botox injector.  Here are some tips to avoid Botox complications

As injectors we should continue to watch out for high doses of Botox.  Perhaps we should break up those doses into a staged approach, meaning that the patient could come back a few days later for more Botox instead of cramming it all in at once.

We need to watch out for blood vessels.  We should aggressively seek out vessels that we can see or feel with our hands and avoid them, and consider taking notes of offending vessels when repeated Botox is anticipated.

We should take care to think of Botox as a three-dimentional injection.   The depth of injection matters to me.

And it goes without saying, that we should use the proper Botulinum toxin for the indication.  No shortcuts here.

As for patient factors, I continue to warn my patients to avoid large amounts of pressure on the injected spots and avoid rattling the area with devices such as clarisonic for a few days after the injections.  This is just my own thoughts on the topic of Botox migration.

Please visit us in person for more of your concerns and questions about Botox.

Calvin Lee, MD

More info on Botox and Botulism

Our website: Modesto Botox – www.InjectionArtistry.com  or visit the home page of our Modesto Botox Blog or visit our Plastic Surgery page.

Please see your own doctor or Botox injector for a personalized discussion.  There is no medical advice here, just medical information.  This is just my own opinion for this blog.  Allergan has nothing to do with this blog.  In fact Allergan sales people have said things to me before which make me believe that they wouldn’t agree with this blog.  Please double check facts in this blog which may change with time.

www.InjectionArtistry.com

botox-bottles-botox-blog-2.jpg

Spending too much money on internet webpages?

Spending too much money on BOTOX advertising – a bad thing?

“If they spend THAT MUCH money on webpages, they obviously aren’t good enough”

Maybe I need to cool it with websites (but it’s fun!). Overheard on the streets of Modesto, “Don’t go to Surgical Artistry because they spend way too much money on advertising with webpages. If someone needs to spend THAT MUCH money on webpages, they obviously aren’t good enough.”

Whoa! Wow! I know I’m frequently misunderstood. I think it comes out to a penny a webpage.

Give me a chance to clarify before judging my BOTOX skill to be inversely proportional to the amount of money I spend on WEBPAGE ADVERTISING (which I think is close to nothing, and I don’t consider all of this advertising – just a strange hobby). I spend a prepaid amount which is $95 per year for hosting, and about $1-$15 per year per website – for example www.InjectionArtistry.com and www.ModestoAcupuncture.com (These are $11 each per year). Each website could have a ton of webpages without additional cost. I don’t consider this spending a lot on webpages – plus, it’s a hobby!

Proof:  this is what my internet webhosting account looks like today 12/13/14.
Proof: this is what my internet webhosting account looks like today 12/13/14.

$95 a year for my BOTOX website hosting

Every year, I think I spend much more on paper (to write on and print/copy) than I do on websites. Sorry for the misunderstanding.  I will rethink my plethora of webpages.  Thank you for the indirect feedback!  I appreciate it all.

My life with Botox and Cosmetic Dermal Fillers

Proof that I work.

A surgeon colleague, whom I hadn’t seen in awhile, said to me yesterday – so what do you do with your time now that you’re not operating as much? This pictures shows 10 syringes of Dermal Fillers used today!  I didn’t use any Radiesse today though – it is one of my favorite fillers too! You can see that there are 4 different types of Juvederm boxes shown here.  Today was heavily weighted with the Juvederm family of cosmetic dermal fillers with a few Belotero syringes too.   The friendly surgeon seemed surprised that my day is filled with fillers and Botox.

My BOTOX and filler injection website is www.injectionartistry.com

In the picture from top to bottom

  • Juvederm Ultra XC
  • Juvederm Ultra
  • Juvederm Ultra Plus XC
  • Juvederm Voluma XC
  • Belotero
  • Belotero

 

The empty boxes of the dermal fillers used today
The empty boxes of the dermal fillers used today

This picture also shows that there are several different kinds of fillers, including different kinds of Juvederm.  These fillers have different thicknesses.

How big is your BOTOX needle?

Different Sizes for BOTOX Cosmetic needles

When I first trained to perform BOTOX injections.  I used 30 gauge needles.  I think these are still the most popular needles used for BOTOX Cosmetic made by Allergan.  But as I got into vein sclerotherapy with Asclera, I started using smaller needles and one day I thought, why not use the smaller needle for BOTOX.  My wife at the time was skeptical, and I gave it a try and it worked very very well.  This was back in 2006.  Now I think the use of smaller than 30 gauge needles for BOTOX has caught on.  The smaller needles tend to be much more expensive, but I think it’s worthwhile.

That is not a small BOTOX needle.  No real needles were injected in the making of this photo.
That is not a small BOTOX needle. No real needles were injected in the making of this photo.

Disclaimer:  Photo above is of a model, not a real patient.  The doctor in the picture above is Calvin Lee, but not Calvin Lee, MD.  (Both people in the picture have the same name).

Smaller is usually better

A smaller needle used for Botox is usually better.   Smaller needles hurt less, bruise less, and cause less damage to surrounding tissues such as nerves and blood vessels.  But there’s a point where a smaller needle might blunt more quickly or bend.  So in my mind there’s a sweet spot for picking the right sized BOTOX needle.

32 gauge needle

For me, the right sized BOTOX needle is a 32 gauge needle (smaller than a 30 gauge).  I am also currently trying out the possibility of 33 gauge needles.  The larger the gauge, the smaller the needle.  a 32 gauge needle roughly .23 mm in outer diameter.  a 33 gauge needle is .21 mm in outer diameter.  Compare that to a standard 30 gauge needle which is .31 mm in outer diameter.

I’m slightly concerned that the 33 gauge needle will dull quicker, but I still need more experience with the 33 gauge needle.

Wikipedia has a needle gauge comparison chart for diameters.

The manufacturer of the needle matters

The different brands of needles have vastly different needles in my mind.  Some are sharper, the bevel is different, and the ability to stay sharp is different among the brands.  I have also found that needles will be slightly different from one to another – even in the same box.  If you are reading this and wondering which brand, I would recommend trying a few different ones yourself.   If you need to know which one I use, feel free to call our Modesto Botox Practice – Surgical Artistry.

I tend to be very picky with needles – I value fine craftsmanship

I am an acupuncturist so I am probably a bit strange with my attitude toward needles.  I frequently use needles that are smaller than a 34 gauge needle for acupuncture.  So I value fine craftsmanship when it comes to needles.  For acupuncture, I routinely use Seirin needles.  They have extremely fine needles for facial rejuvenation acupuncture.

facial rejuvenation acupuncture needles
facial rejuvenation acupuncture needles

I have learned, that like sutures, the smaller the needle or the smaller the suture, the more expensive the product.  But it’s understandable due to the challenges of manufacturing.

Visit us in Modesto, California for BOTOX injections

I also like to use small needles for Juvederm injections – smaller than the ones that come in the box.  But that’s another discussion and needles need to be FDA approved, and thus, this would be considered an off-Label-FDA usage.

Our website is www.InjectionArtistry.com