In one of our private waiting rooms at Surgical Artistry, I have displayed a bowl of empty Botox bottles used up in 2014. I’m happy to report that 503 patients helped me use up these bottles of genuine Botox over the course of the year. However, I have two more days of the year to go! My wife, Dr. Tammy Wu – Modesto Plastic Surgeon, says I am a hoarder (hopefully not compulsive).
I am very thankful for all those who have trusted me with their cosmetic injections.
Botox is supplied differently in each country. I am only familiar with how it is supplied in the USA. Specifically, I’m familiar with how I receive it in my Botox Practice in Modesto, California, USA.
Botox Vials
I receive Botox as either a 50U or 100U vial. It is sold by Allergan (who also supplies Juvederm), but can also be purchased by several other medical distributors such as McKesson or Moore Medical.
Botox purchased from a Moore Medical Catalog in 2014. It says $690 for a 100U vial and $497 for a 50U vial.
From my experience, the 50U Botox vial costs more than half of the Botox 100U vial. That makes some sense because of excess packaging costs and requirements.
It is shipped in Styrofoam containers on dry ice, and usually I receive it the next day after I’ve ordered the product. And I order directly from Allergan, USA.
Botox Delivery. No, it’s not Pizza Delivery. It’s better than Pizza!
Botox Powder
The Botox arrives as dry powder vacuum sealed within the vial. The Botox powder is very fine and it almost looks like a completely empty vial except for some fine Botox dust lining the bottom of the vial.
Picture of 50U Botox vial, picture by Calvin Lee, MD Modesto Botox Surgeon
Once obtained in the office, we immediately place it in our specially designated Botox refridgerator which is temperature monitored.
Side Notes:
Please consult your own physician about any of the topics above. Here’s a listing of about 40 places to get Botox in Modesto. The general public cannot purchase Botox for any of the suppliers mentioned above.
Like using fire to fight fire. Well, probably more effective than that. Botox injected in other parts of the muscle or an opposing muscle might lessen the undesirable original Botox effect.
Injecting Botox into the antagonistic muscle
But sometimes, Botox effects can be offset by additional injections of Botox into the opposing muscle (antagonistic muscle). Most of the structures in our body are affected by muscles on a push and pull balance. Botox affects that balance, but we can again re-establish a new balance point by working on the opposing muscle. However Botox only works to relax a muscle. For example if an eyebrow looks like it has dropped, then we can further inject Botox in the muscles which normally depress the eyebrow such as the corrugator muscle or the obicularis oculi muscle – this could help spring the eyebrows back up.
Injecting Botox into the compensatory part of the same muscle
Another way to help with Botox problems is the consider relaxing other parts of the same muscle. Sometimes we get a particular “surprised” look in the eyebrows with Botox. This is the look where the eyebrows on the side go way up when we try to raise the eyebrow. Sometimes this is called the “M” look or the “Spock” look and there are other names to this such as the “Mephisto” look. I think the Spock look explains it quite well – with the pointed eyebrows. This is usually caused by an unequal weakening for the frontalis muscle (forehead muscle) at the central component of this muscle. When the central part of the frontalis muslce is weaker the lateral part tries to compensate by becoming eve more active. We can compensate for this by injecting the lateral parts of the frontalis muscle with more Botox.
What about eye drops for lid ptosis (droop)?
If there is a eyelid droop, there are certain medications that can help the lid raise. But there are other side effects associated with this technique. I hope to come back to this topic in another blog.
Time heals Botox
With time, Botox effects wear off. Fortunately some of the ill-effects of Botox are due to drifting of small quantities of the injected Botox. Thus a few weeks might be all it takes for some of the effects to wear off.
The info here is just for informational discussion
This info isn’t meant as some sort of personalized medical advice. Please see your Botox doctor or injector in person to have a discussion regarding Botox and any need for Botox correction.
My Botox practice is in Modesto, CA. I respect Botox injections as challenging procedures. I’ve had my share of Botox problems and need for corrective Botox solutions. I look at each of these Botox problems as an opportunity to improve for my Modesto, California patients.
I have always valued accurate, precise, deliberate dexterity. Typing is one of those things that demands a certain amount of dexterity.
An incredible Christmas gift
I got a Christmas gift from a relative when I was probably around 9 years old; it was a how-to-type book. I remember devouring that book up with our family’s type-writer in the basement. Yes, an old fashioned type-writer. The keys got stuck, and I used much ink practicing every page in that book. I think it was one of the best gifts and best memories. Today, I want to thank my relatives for that awesome gift about 35 Christmases ago. I think it helped lead me to a life where dexterity was of utmost importance – especially as a surgeon and Botox injector.
Online typing test
Excuses, excuses, excuses
If I could make excuses, for the result above (121 words per minute) I’m typing on an uneven surface, at an unreasonable height. One of these days, I’ll try to find a stable surface to type upon – or a different keyboard for that matter – one that doesn’t squeak and doesn’t bounce around, and I hope to have an even better result. I believe that the height of my typing speed was back in high school, and it’s been somewhat slowed down on purpose because of respect for carpal tunnel syndrome -which I somewhat suffered from during my Surgery training years. My carpal tunnel is just about gone, but I know part of that was from watching the way I type. So I typed this whole paragraph probably at 100 words per minute which is a relaxed pace for me.
Quick answer? 8-12 units of Botox per side. Because we usually want to treat both sides of the eyes, we would double that number and that would be 16-24 units.
8-12 units of Botox per side? (16-24 units of Botox)
Yes, about 8-12 units of Botox could be injected per crows feet (left or right). However, everyone is different. I have done more and I have done less. This depends on Male vs Female, young vs old, and of course on personal preferences and experiences with Botox.
Another consideration is eyebrows. Eyebrows can also be lifted with a certain style of crows feet injection, or even an extension of the crows feet injection. Women and men have different eyebrows. Women have more of an arch, which complements a certain style of crows feet Botox injections – these injections hug the eye a bit closer – especially toward the eyebrow region.
And yet another consideration is swelling under the eyes. Sometimes too much injection in the crows feet can lead to temporary swelling under the eyes. These are things to discuss with your personal Botox injector – preferably in person and at an appointment (face-to-face).
What to do for really deep Crows Feet lines? Static lines.
Fillers may be an option. I like to use Belotero as a filler for crows feet if needed. Juvederm could also be used, but in my hands it tends to be a little bit bumpier. But it is usually my preference to try Botox alone first.
That’s the beauty of Botox. It is customizable.
Everyone will have different preferences and have a different response to Botox. It becomes a science and art – this injection of Botox.
I hope I helped to answer the question of how many units of Botox are needed to help with crows feet around the sides of the eyes.
Summary
Let’s say we just wanted one number to be the answer. Perhaps hang on to the number 20. It’s a nice round number, and it’s between 16-24 units of Botox (for both sides). I would say that 20 units of Botox is a nice treatment for many people’s crows feet!
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
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.
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. 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
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.
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.
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.
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.
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.
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!
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.
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.
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.
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.
Lowest price Botox? We compete on results, safety, comfort, customer service, positive attitude, and communication. Thus we hope to have the BEST VALUE.
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.
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.”
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!
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.
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.
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.
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.
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.
