All posts by Calvin Lee

About Calvin Lee

Surgeon in Modesto, California specializing in Botox, Juvederm, Veins, and Acupuncture. Worked in the past as a trauma surgeon. Grew up in New York, went to college and medical school at Brown University. Surgical Residencies in Cleveland and Springfield, Illinois. Now lives in Modesto, CA with his wife, Dr. Tammy Wu - Plastic Surgeon. They have a practice together: Surgical Artistry. Office telephone is (209) 551-1888. Website for the practice is www.SurgeryToday.com View all posts by Calvin Lee →

Botox Delivery – what it looks like in a box.

November 25, 2014Allergan, Botox, Botox InjectorsBotox DeliveryCalvin Lee

Ever wonder what it looks like when BOTOX is delivered to an office?

Here’s what the boxes look like. Inside these shipping boxes are styrofoam containers with dry ice on one side and individual BOTOX boxes on the other side. These three BOTOX containers added up to a shipment of 50 vials of 100U Botox. I have delivery of this amount of BOTOX before and it came in one large container – so I think it varies from time to time. I don’t see any obvious advantage to breaking up the BOTOX shipment. But perhaps Allergan decided that it was better that way – or they just simply ran out of larger BOTOX shipment boxes.

A tower of Botox! Delivered to our door.

Botox Delivery. No, it's not Pizza Delivery. It's better than Pizza! — Botox Delivery. No, it’s not pizza delivery. It’s much better than pizza!

This is a picture at our Modesto Botox Office of Botox delivery boxes ready to be stocked and recorded (lot numbers). It needs to stay refrigerated.

Botox WiFi?

November 24, 2014Botox, Modestoacetylcholine, how does botox work, wifiCalvin Lee

How is BOTOX and Wi-Fi related?

Basically BOTOX shuts down the signal (this signal can be thought of as “WiFi” for your phone) between nerve and muscle. There is no alteration of the muscle – just like when the WiFi signal is shut off, there is no alteration to your cell phone.

I’ve come up with this original analogy one day when talking to a patient who was cellular phone sales person. WiFi is a trademark name and is considered at this point, any wireless local area network for computers.

First, in general, how does BOTOX work?

What’s the mechanism of action for Botox? Botox prevents the tensing up of muscles. The word “tensing” could be also be considered “contracting.”

Medical professionals consider BOTOX to be one of the most effective ways to maintain youthful beauty.

In more detail: how is Acetylcholine involved with BOTOX?

Acetylcholine is the signal for muscle contraction.

Botox reduces the release of acetylcholine from the nerve endings. It is the acetylcholine, which is a neutrotransmitter messenger, which tells the muscles to contract. Without the acetylcholine released, the muscles stay in a more relaxed configuration because it doesn’t get that signal for contraction.

Thus, the real analogy is that Acetylcholine is the Wi-Fi signal

Acetylcholine carries the signal for muscle contraction. Just like WiFi carries the signal for my internet connection. Botox works on reducing the signal.

Anyway, that analogy is a fun one, and I’ve enjoyed using it in my explanations in my Botox Consultations at my Modesto Botox Center: Surgical Artistry.

So, muscles cause wrinkes?

Yes and No. Yes, muscle CONTRACTION causes wrinkles. Thus if we cut the signal for muscle CONTRACTION, the wrinkle isn’t crinkled. But the muscle by itself in a relaxed state does not cause wrinkles. So the key word here is contraction.

Disclaimer: I am by no means trying to say that Botox gives you a better WiFi signal.

That would be interesting and probably very useful – but it doesn’t work that way. I was just trying to use some real life examples to explain Botox to my patients. Please see your Botox doctor, nurse, or aesthetician in person for a personalized discussion. There is no patient-doctor relationship set up by reading this article. Nothing here is medical advice. This is just generalized information.

What is Botox FDA approved for cosmetically?

November 23, 2014Botox, Botox Injectors, FDA, Modestocrows feet, glabellaCalvin Lee

Glabella and Crows Feet

As of the writing of this Botox blog which is November, 23, 2014. Cosmetic Botox on the face is FDA approved for use in the glabellar complex and the crows feet. The glabellar complex is sometimes known as the “11’s” or the frown lines between the eyes. It is made up of more than one muscle – thus it’s a complex of muscles. And the crows feet, sometimes called fish tail, area of the eyes is the lateral wrinkles to the sides of the eyes.

How about other areas of the face for Botox Injections?

These two areas constitute the FDA approved areas for facial Botox in a cosmetic sense. There are other areas on the face – in fact many other areas – which have not received FDA approval, but these have been commonly done for the past decade. And Botox injections in these other areas of the face is considered off label FDA for Botox usage.

Getting Botox in Modesto, CA

Please consider visiting your Botox injector for one-on-one discussions. If you are near us, consider visiting our Botox practice in Modesto, CA. And if not us (Surgical Artistry), then there are these other places in Modesto to get Botox. The Botox listing of injectors is not an endorsement; it is just a courtesy listing of other practices in Modesto who offer Botox.

Belotero Balance Injection Technique – a unique method

November 22, 2014Belotero, Botox, Botox Injectors, Modestoserial punctureCalvin Lee

Belotero Serial Puncture or Serial Killer?

Belotero offers a dual cross-linking process of the hyaluronic acid which offers a natural-even integration into the dermis.

This Belotero page is for Botox/Belotero injectors. And I’ve decided to call this Belotero injection method the “aerial dive bombing technique.”

I have my own version of this technique, but it’s more of a “submarine missile attack” (more on this someother day). Actually I personally think that my idea is superior – well at least in my small hands.

Injection technique with BELOTERO BALANCE is simple and accurate

When injecting using the serial puncture technique, it is important to remember the following:

Penetrate the dermis just until the bevel of the needle is hidden.¹⁰
The needle’s bevel measures 0.75 mm in length.*
Typically, the dermis measures approximately 1.8 mm in depth.
Once the bevel is buried, filler can then be deposited accurately within the dermis.
Then repeat the process multiple times per wrinkle line.

*Bevel measurement based on the needle included with the BELOTERO BALANCE syringe kit.

Superficial injection of Belotero works!

For Killer results, consider the techniques above

and consider visiting us at our Modesto Surgical Artistry Botox Injection Center by Calvin Lee, MD

Lowest price Botox?

November 22, 2014Allergan, Belotero, Botox, Botox Injectors, Juvederm, Modestobest priceCalvin Lee

Lowest Botox Price matching?

We get this question from time to time regarding matching the lowest price of Botox or Juvederm. It isn’t a common question, but it comes up perhaps once per month or so. I figure it’s worth addressing.

This is not a blog about different Botox-like substances or Botox from other countries. We receive our Botox directly from Allergan USA, that ensures that it is genuine. So back to the topic of “Lowest Price for Botox?”

So, do we price match or compete on pricing?

The quick answer is “No.”

But we like to compete on “value”. But in the end, we don’t see this as a competition. We have a lot of respect for everyone. We have set prices that make sense to us.

So the long answer is that we hope that we are considered the “best value.” But all this depends on what patients value. It might be different than what I might value. So I can definitely understand different definitions of value when it comes to Botox injections.

Surgical Artistry doesn’t emphasize or compete with “cheapest” prices.

Our Botox Surgeons (mainly Calvin Lee, MD) value a high level of

results
safety
and comfort.

And the Office values a high level of

customer service
positive attitude
and communication

We hope to win with BEST VALUE. I think we would lose the battle if we were going for price wars on Botox.

But hopefully we might win with best value – that’s our attempt.

Here’s a link to another topic of Botox Wars – The fight for Allergan Ownership.

Botox didn’t work for my “11s”

November 21, 2014Belotero, Botox, Botox Injectors, Modestodidn't workCalvin Lee

Botox didn’t work. I still have those creases between the eyes!

I hear this problem from time to time. Botox has a hard time with certain creases in the glabellar complex – and also in the crows feet. Why? because for me, it doesn’t seem to work very well on static lines.

Static lines vs. Dynamic lines: this is the reason

Dynamic lines are wrinkles that are created with movement. Static lines are wrinkles which are present even when the muscle is at rest – relaxed. Botox main mechanism is to relax the muscle. Although, I have seen Botox’s effect on possibly tightening skin – but that’s a different topic.

Botox works best on Dynamic lines

By relaxing the muscles, the dynamic lines diminish. However, Botox has a harder time relaxing static lines.

Dynamic Lines eventually become Static Lines

It seems to me that most dynamic lines eventually becomes static lines. Thus Botox works amazingly well in my opinion in preventing static lines. This effect of Botox is one of it’s best uses.

So what can we do about these stubborn Static Lines? More Botox?

I also believe that with some patience static lines can diminish over regular usage of Botox – perhaps after the 3rd or 4th time of getting Botox over 1 year. I wouldn’t let too much time lapse between botox treatments. I don’t think necessarily MORE botox per session is the answer – but perhaps more diligent usage of Botox – or perhaps a more “disciplined” approach to Botox scheduling. Don’t forget to schedule your Botox Appointment with us in Modesto, CA.

Consider fillers or more time to help with these stubborn wrinkles.

So if time is on your side, and you can wait it out – consider waiting a bit to see if Botox will assist your body in repairing these deep static wrinkles. However, if there’s a deadline (special event coming up), some of our patients would consider dermal fillers such as Belotero or Juvederm. Much of this use would be considered off-Label-FDA usage. Dermal fillers within the wrinkles will help smooth them out!

Disclaimer: please see your physician in person for personalized recommendations. Above is just an academic discussion of wrinkles, Botox, and Fillers. I have also encountered lines which just didn’t seem to be helped much with either Botox or Fillers – the human body is certainly very challenging, and keeps our jobs as Botox injectors very interesting. Here’s a list of Modesto Botox Injectors – but of course, I hope you choose our practice (Surgical Artistry in Modesto).

Email from Allergan about Actavis 11-19-14

November 20, 2014Actavis, Allergan, Botox, Juvederm, Latisse, ModestoCalvin Lee

I got this letter below from Allergan on 11-19-14 (today) addressing the merging of Actavis and Allergan. Allergan wanted to stress that they would continue a high quality of research and development as they had before. Karla from our office sent me a copy of this email which she got, and she wrote that “It looks like Allergan will become part of Actavis soon. This email confirms it and reaffirms their commitment to continuing research and development.”

Here’s the letter from Allergan, the makers of our cherished Botox, Juvederm, and Latisse. For more information about these products, visit our Modesto Botox and Juvederm page.

November 19, 2014

To our valued customers:

As announced in a press release earlier this week, we are pleased to share that Actavis and Allergan have entered into a definitive agreement under which Actavis will acquire Allergan in a deal valued at approximately $66 billion. Bringing our two companies together represents a powerful strategic combination, creating a dynamic, top 10 global pharmaceutical company.

We anticipate that the acquisition will close in 2Q 2015. Until then, it will be business as usual, with no impact to our operations or the high quality of service that you have come to expect from Allergan. Once the transaction closes, we will notify you of any relevant changes, and it is our goal to minimize any possible impact this could have on you, your patients, and our employees.

Like us, the Actavis culture is centered around innovation and customer service, and investment in R&D will remain one of the top priorities of the integrated company. The combined company will offer a broad portfolio of products in Eye Care, CNS/Neurosciences, Medical Aesthetics/Dermatology/Plastic Surgery, Gastroenterology, Women’s Health and Urology and Anti-infective therapeutic categories, as well as the highest quality generic, branded-generic and Over-the-Counter products. The combined company will provide an exceptional level of R&D support, with approximately $1.7 billion invested annually in brands, generics and biopharmaceuticals aimed at delivering high quality products to address unmet patient needs.

We want to thank you for your support and to assure you that we remain dedicated to exceeding your expectations and delivering products and services that make a difference to you and your patients. We look forward to sharing more details of our combined products and services in the future. In the meantime, if you have any questions, please contact your sales representative or visit our websites at actavis.com and allergan.com.

Sincerely,

Brent Saunders, CEO and President, Actavis

David Pyott, Chairman and CEO, Allergan

Allergan Merger / Actavis Takeover

November 18, 2014Actavis, Allergan, Botox, Botox Injectors, Valeantbotox, brent saunders, Dublin, forest labs, merger, researchCalvin Lee

BOTOX wars

The Botox company, Allergan, has consented to be bought by generic pharmaceutical maker, Actavis for $219 a share. This gets in the way of the hostile takeover attempts led by Valeant Pharmaceuticals and hedge fund man, Bill Ackerman of Pershing Square Capital Management. But it might be possible for Valeant to out-bid Actavis?

66 Billion? That’s a lot of Botox.

According to the sources, this take-over by Actavis, is worth $66 billion.

My precious! (picture by Calvin Lee, MD Botox injector in Modesto, CA)

Who is Actavis?

In the past two years, Actavis has purchased Forest Laboratories and Warner Chilcott. Actavis’ CEO is Brent Saunders. He used to run Forest Laboratories. Actavis is headquartered in Dublin, Ireland and has administrative offices in New Jersey.

Who are the losers? Nobody?

Pershing Square Capital Management owns 9.7% of Allergan shares. Valeant indicated that it may not try to beat Actavis’s offer. Bill Ackerman and Valeant stand to benefit from the increased share price for Allergan; thus they wouldn’t lose either way.

My thoughts

This is a win-win-win for the three A’s: Actavis, Allergan, Ackerman. And it also seems to be a win for Valeant who will get 15% of Ackerman’s profits from the price increase in Allergan’s stock (which he owns nearly 10% of Allergan stock). I also think it will be a win for Botox injectors and consumers. Actavis will try to be more efficient with it’s administration of Allergan – with further cost cutting and unification of efforts. And they have pledged to continue to have research and development within the Allergan family of products. And most importantly in the end, I think the consumers (and doctors) will benefit. I feel that the Valeant/Allergan merger (Vallergant – I’ve called it), might have cut too many costs and we’d lose on research/development. Thus the new merger of Allergan and Actvis – there would be a better balance with continued research and developement. So it will be a 6 way win-win-win-win-win-win: Actavis, Allergan, Ackerman, Valeant, doctors/Botox-injectors, and patients. That’s how you do mergers! I certainly hope so. Time will tell, and I hope to be here to talk about it.

Sources:

Link to Allergan goes with Actavis instead of Valeant / Ackerman

Ackerman/Valeant walks away from Allergan

Wikipedia article on Actavis

Juvederm Voluma Injection Notes according to an Expert outside of the US

November 18, 2014Allergan, Botox Injectors, Volumainjection techniques, notes, voluma webinarCalvin Lee

Tonight I participated in a live lecture on the web regarding Juvederm Voluma injection techniques. I guess they call this format a webcast or webinar.

I joined a few minutes late. But it seemed to start with a discussion of facial muscle anatomy followed by a discussion of facial fat compartments.

Here are my notes below for other Botox injectors and Juvederm Voluma injectors if interested. My personal technique is somewhat different because I use a cannula technique and he uses a direct needle technique. Cannula technique at this time is considered off-label FDA usage. But I feel that it is, in my hands, a safer technique.

Some Juvederm Voluma / Cheek filler highlights:

Lateral support is important – at the level of the zygomatic arch.
Females have fuller frontal cheek projection it seems than males.
Anterior cheek injections can unfortunately reinforce the ptosis of the cheek.
Cheeks become lower and more medial when smiling with age – age 40 vs age 50
With volume loss in the submalar area – danger sign for “sausage” look with nasolabial filling
The nasal flare shouldn’t be hidden with injections – avoid medial cheek injections.
People who may look good in the frontal view, might not look good in the oblique view.
Aspirate when injecting deep with Voluma
With infection risk, there is granuloma risk.
He labels the zymatic arch with v1, v2, v3
v4 is the soft area of the cheek below v1, v2, v3.
v=voluma
avoid treating v4 first because of lack of bone support.
He uses a pull upwards and backwards = “pinch traction” so the skin cannot go back to it’s original tendency after placement of voluma
A discussion of J1, J2, J3, J4. These are Juvederm locations.
He talks about J4 as the vertical lip rhytids (lines) and talks about perpendicular injection to avoid elongation he says.
At Voluma injeciton site #4, there are many dangerous sites such as parotid gland, parotid duct, or the transverse artery. He uses a fanning technique for injections.
Look at patients on animation and when looking down. Animation meaning smiling.
Avoid voluma intra-orbit.
Malar crease – you can solve some of the ones which disappear when the patients smile.

Great presentation! There is always much to learn from other Voluma injectors.

Disclaimer: The above notes are not my thoughts. They come from a surgeon who works outside of the United States. They are interesting and I thought I’d share. The talk on Juvederm Voluma was brought to us by Allergan.

Best cosmetic Surgeon Award

November 15, 2014Botox, Botox Injectors, Modesto, year in reviewaward, best cosmetic surgeon, Stanislaus CountyCalvin Lee

Best cosmetic Surgeon Award for Stanislaus County

Awarded November 2014 by Contentment Health Magazine in Stanislaus County

Below is the text from the magazine. Thank you very much for the write-up. We were pleasantly surprised with this best cosmetic surgeon award for Surgical Artistry. It’s the first annual Best Of Stanislaus voting for Contentment Health and we were actually out of town when much of the voting was taking place. We never even got a chance to vote for ourselves!

Best Cosmetic Surgeon: Surgical Artistry: Dr. Tammy Wu and Dr. Calvin Lee

BEST COSMETIC SURGEON
SURGICAL ARTISTRY
2336 SYLVAN AVE., STE. C MODESTO
(209) 551-1888 | surgerytoday.com

When you choose to go under the knife, it’s essential to have a surgeon you trust completely in charge of your procedure. When it comes to cosmetic surgery, there are few surgeons in the country as trusted as the experts at Surgical Artistry. Dr. Tammy Wu and Dr. Calvin Lee founded Surgical Artistry in Modesto 11 years ago. The married pair of ivy-league educated surgeons specialize in a full range of cosmetic surgical options to every patient along with procedures including Botox treatments, vein procedures and even acupuncture. Drs. Wu and Lee are known for their exceptional commitment to their patients and uncompromising pursuit of self-improvement. When you’re looking for fantastic plastic surgery or a cosmetic procedure, look no further than Surgical Artistry.

Dr. Tammy Wu, Board Certified Plastic Surgeon in Modesto is the Plastic Surgeon for Surgical Artistry.

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Please visit our Modesto Botox Home Page for more information.