Category Archives: Modesto

How big is your BOTOX needle?

Allergan, Botox, Juvederm, Modesto,

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

 

 

Who is Allergan?

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Allergan is the Company who makes BOTOX

Allergan is the company who makes BOTOX, Latisse, and Juvederm.  These are three popular products offered at Surgical Artistry.  Latisse is a take-home product, unlike BOTOX and Juvederm which are injected (by Dr. Calvin Lee).

logo_allergan

Allergan cosmetic products

Allergan is also regarded as an ophthalmic (eye) pharmaceutical specialty company

Allergan makes many other pharmaceutical products – many of them are for the eye – conditions such as dry eye.

Eye Products include:

  • Restasis
  • Lumigan
  • Acuvail

How many Billions in sales for Allergan?

  • It is estimated that Allergan has $7 billion in sales in 2014

Advertising spending for Allergan?

  • In 2012, it is estimated that Allergan spent 162 million in advertising.

Allergan Location?

Headquarter is in Irvine, California

Allergan Merger?

Allergan plans to merge with Actavis.  The battle for Allergan started in April 2014 when Valeant made a bid for Allergan.  Actavis plans to pay $66 billion for Allergan.  Brent Saunders is the CEO and president of Actavis.

For more information about Allergan including the CEO’s BLOG.

  • Allergan home page – this is a great place to start learning about Allergan.
  • AllerganViews: The CEO of Allergan has a blog.  “Our Pursuit, Life’s Potential.” That is Allergan’s vision, and every day, around the globe, our more than 11,000 employees work to deliver on this vision.  David Pyott is the current CEO, as of the writing of this blog which is Dec 10, 2014.
  • Allergan on Twitter
  • Allergan also runs the Brilliant Distinctions program.  Click here to log in direction to Brilliant Distinctions.

Links For Physicians and Nurses who inject Botox and perform Breast Augmentation

Visit Surgical Artistry in Modesto, CA

That’s our BOTOX and Plastic Surgical Practice in Modesto, CA

Latisse as an adjunct to BOTOX eye treatments

Actavis, Allergan, Botox, Brilliant Distinctions, Latisse, Modesto, Valeant

How to use Latisse – scroll to video

BOTOX around the eyes

BOTOX can be used to accentuate the eyes by lessening the wrinkles around the eyes.  Two areas of FDA approved usage of Botox around the eyes would be for the Glabellar complex and for the crows feet.

What if the eyelashes were accentuated?

Enter Latisse!

Latisse would make the eyes really stand out beautifully by allowing the lashes to grow longer, thicker and darker.  There’s much discussion to Latisse.  Consider visting the official Latisse website.   Or one of our Modesto Latisse webpages.   And there’s more information about us at our Modesto Botox webpage.

Picture from Allergan. She is not an actual patient of Surgical Artistry's.
Picture from Allergan. She is not an actual patient of Surgical Artistry’s.

If the eyes are windows to the soul.  Eyelashes are some pretty impressive window treatments.

Latisse comes in a 3ML or 5ML kit.  But Latisse kits are usually not sold at your local Hunter Douglas window covering dealers.  You can find them in doctor’s offices, such as ours in Modesto, CA.

Please visit our Botox practice in Modesto, California and we’ll show you some of our own personal tips regarding Latisse.

Here’s a Video regarding applying Latisse – the video is made by Allergan.  Allergan is currently in the process of merging with Actavis.  Valeant apparently is no longer in pursuit.

Credits and Disclaimers:  Latisse picture is not from an actual patient of ours.  Please visit your doctor in person for medical advice and for personalized details regarding Latisse and BOTOX.

Skin Aging Infographic from Colorescience

Botox, Botox Injectors, Crows Feet, Modesto, Obagi, , ,

Skin Aging Explained – and how to fight it

I got this infographic about Skin Aging from Colorescience.  It was sent over in an email.  I posted it to our facebook accounts and it started getting some shares.  I think that’s an indication that skin aging is a pretty populr topic.

infographic on Skin Aging - need Botox
Skin Aging Explained and what to do about it. Click to enlarge.

 

Highlights from the infographic on Skin Aging from Colorescience:

  • Sun Damage – more than 90% of age-related skin changes are caused by the sun.  Use sunscreen – in particular it says, use their product called Sunforgettable.  And we carry that product at Surgical Artistry, Modesto.
  • Dehydration – use hyaluronic acid.  We have many products with hyaluronic acid made by Obagi and SkinCeuticals.
  • Acne Treament – spot treatments dry out the skin.  Use products for the whole face.
  • Food – sugars, sweets and saturated fats increase the likelihood of a wrinkled appearance.  Solution:  avoid processed food, eat plenty of fresh fruits and veggies.
  • Exercise: only 18% of women meet the recommended amounts of exercise
  • Sleep: Getting insufficient sleep ages the skin prematurely and fosters eye area puffiness.  Solution:  ban bright electronics at least 90 minutes before bed to improve quality of sleep.
  • Makeup Removal.

What is Sunforgettable?

It is a powdered mineral sunscreen with Zinc and Titanium dispensed with a brush, and it comes in 3 different skin tints.

sunforgettable sunprotection

What? No mention of BOTOX wrinkle prevention?

BOTOX, to me is one of the most effective treatments to receive to help prevent wrinkles.  It has received FDA approval for the Glabella area and Crows Feet areas.   Botox has also received approval for cosmetic use in wrinkle prevention in other areas of the face.   I guess BOTOX wasn’t mentioned in this article because Colorescience isn’t the manufacturer of Botox.  Otherwise, of course they would have included Botox in this discussion of skin aging.

And Smoking? even more important than BOTOX or Sunscreen.

It’s tops on my list to quit smoking – as a top thing to do to slow down skin aging.

My top three for Anti-Aging skin?

  1. Stop smoking
  2. Use Sunscreen with ZINC
  3. Consider BOTOX use

Slowing down the aging skin is a passion of ours at our Modesto Botox Practice:  Surgical Artistry.

Visit my blog from a few years ago about Zinc and Sunscreen

Hawaii picture by Calvin Lee, MD
Hawaii picture by Calvin Lee, MD

Disclaimer:

I didn’t write this infographic.  Please visit us: Modesto Botox, Plastic Surgery, Veins, and Acupuncture.  Please verify all ideas presented here with your doctor.  I am not your doctor unless you have seen me in person.  We carry Colorescience skin care products in addition to NIA 24, Obagi, and SkinCeuticals.

BOTOX Terminology: Glabella

Allergan, Botox, Botox Injectors, BOTOX Questions, Modesto

What is the glabella?

Glabella has very little to do “gorilla” or “umbrella”.  Although they rhyme.  And if you got a gorilla angry, he/she would have a furrowed glabella.  And if you were caught in the a rain storm without an umbrella.  I think you would also be furrowing your glabella.  And for some patients they look like gorillas if they have very strong muscles in the glabella.

It is the area between the eyebrows above the nose.  Interestingly, it is derived from the latin word “glabellus” which means smooth.  And a smooth glabella is the goal of a BOTOX treatment for the glabella.  We sometimes consider the wrinkles that form in this are the “frown lines” between the eyes or eyebrows.

I'm activating my glabellar complex of muscles here (between the eye brows).
I’m activating my glabellar complex of muscles here (between the eye brows).

Is Glabellar Botox FDA approved?

Yes, BOTOX is FDA approved for cosmetic use in the glabellar complex

How many BOTOX Units are used in the Glabella?

Usually around 20.  But ranges from 12-40 units have been used in my Modesto Botox practice.  Men and younger patients, with their stronger muscles, usually need a higher dose of BOTOX units.  However some younger patients are looking for prevention, and thus may not need as high of a dose.  Customization is key.

What muscles comprise the Glabella?

The procerus muscle in the middle, surrounded by a pair of corrugator/depressor supercilii.  Everyone has different presentations of this muscle.  The anatomy is slightly different for each individual, and the strength of these muscles differ as well.  This leads to individualization of each BOTOX injection.

So basically three muscles:
  • Procerus in the middle
  • Depressor supercilii
  • Corrugator supercilii

Botox 111

If BOTOX doesn’t work for glabellar creases, what’s next?

Consider fillers for the static lines of the glabella.  BOTOX may work somewhat for the glabellar static lines; however, BOTOX is mainly a treatment for dynamic lines.  Dynamic lines (wrinkles) are formed when the muscle contracts.  Static lines (wrinkles) are present even when the muscles are relaxed.  Many dynamic lines are on their way to static lines – it’s just a matter of time.  However BOTOX can prevent the progression.

What is the best filler for glabellar static lines?

I think this question depends on the injector and how they use the fillers.  This would be an  off-label FDA use of fillers.  I personally prefer Belotero for filling Glabellar creases if it becomes a desired option.   The reason I like Belotero to complement BOTOX treatments in the glabellar region is that it is a light-weight filler which doesn’t easily show up as bumps in the glabellar region.  However if the glabellar lines are very deep and the skin is lax, sometimes a thicker filler such as Juvederm would work better.

More questions about the Glabellar BOTOX injections?

Feel free to make an appointment at our office.  Home page here: Modesto Botox Injections.  Botox injections in the glabella is the most popular use of Botox Cosmetic.

Dexterity for Botox Injections – Chopin?

Belotero, Botox, Botox Injectors, dermapen, Juvederm, Modesto, Piano for Dexterity, Radiesse, surgical dexterity, Voluma, ,

Dexterity for Surgery, Piano, and Botox Injections

Surgery depends a lot of dexterity.  So does playing the piano.  And so should Botox injections.

LogoR4_3

I have some unique ideas of developing and maintaining my Botox dexterity with Piano Practice.

  • As with piano playing, I like to keep my wrist supple and flexible when injecting Botox.
  • When injecting fillers, there are times where I have to do finger stretches to be able to maintain tension on the skin with my non-dominant hand, and then I also sometimes have to reach for the plunger which may be in slightly awkward positions for my dominant hand – it depends on the style of the plunger.  Radiesse Volume Advantage is one of the larger syringes due to it’s 1.5 cc volume which is more than some of the other syringes of dermal filler.
  • Timing is also key in Botox injections.  Timing is a big deal in music and performing piano.
  • Then there’s the grace in lifting off from the actual Botox injection.  It would be a shame to waste Botox with a heavy handed lift-off – in that case, the Botox isn’t injected into the muscle – it might even be injected into the air.  Thus a light lift-off is key.  It’s akin to musical phrasing with the tapering that occurs and the lifting off of each note too.

Chopin Etude Op. 25, No. 1 (Aeolian Harp) as Botox Dexterity Practice

Here’s a piano piece which is dedicated to finger dexterity building.  It is also one of the most beautiful melodies I have ever encountered in an finger dexterity etude.  This piece is also known as the Aeolian Harp Etude.

Yes, that’s me.  Recorded at my home in Modesto, California.  Yes, this is one of the great things you can do in Modesto – practice piano!  And record piano for YouTube!  And write this blog… ok, the list goes on and on regarding great things  in Modesto, CA.

Quoted from the wikipedia entry on this piece:

“Technically, the piece requires both dexterity and velocity, good balance and weighting of the arms coupled with flexible finger stretches”.

For me my dexterity and musical challenges are: evenness, flexibility in the wrist, and flexibility with finger stretches, light touch, and musical line phrasing. I hope to continue to work on this to make it even better.

Light touch?

And a light touch is very very important in lightening the sensation of any pain from Botox shots.

Consider getting Botox from us in Modesto, CA

Please visit my Modesto Botox injections home page.  We offer other Cosmetic procedures besides Botox.

Our other Procedures include:

 

 

BOTOX Mailing List growth

Botox, Botox Injectors, Brilliant Distinctions, Modesto, statistics, , , ,

Mail chimp email blasts

I just started using MailChimp as a way to keep in touch with our Botox Patients – and other patients at Surgical Artistry (Veins, Plastic Surgery, Acupuncture, Dermal Fillers).

190 emails added in 4 months = 47.5 emails per month

Here’s just an interesting statistic.  For the months of August, September, October and November of 2014, I was able to add 190 patients to the mailing list.  The mailing list as it stands has 2,712 patients on it.  I guess I always thought we had more patients.  But people frequently unsubscribe or even label our email as “spam” which comes back as a notice that someone complained.

Mail Chimp Costs

Mail Chimp currently costs about $50 per month.  I think it’s convenient and it doesn’t bog down my own mail server.  It keeps track of the duplicate emails, wrong emails, bounced emails, unsubscriptions and complaints.  Mail chimp costs $50/month for 2801-5000 subscribers.  With the current addition of 190 emails.  We now have 2899 subscribers.

I manually remove the unsubscribers from our system

I look at the unsubscribers and complainers and I manually take them off our system.  The reason for that?  Because we have a birthday letter that we send out by ourselves, and we do it once a month and we don’t use Mail Chimp for that purpose.  This way we won’t bother these folks with the birthday letter (email).  What’s the Birthday letter?  I wrote an article about the Botox Birthday Coupon.  It’s our gift to our patients of $50 to use towards BOTOX and fillers if they want.

Keeping in touch

I’m using the email system to keep in touch and to announce current events such as possible Modesto Botox Specials, Brilliant Distinction changes, etc.

Cosmetic Procedures Besides Botox

Belotero, Botox, Botox Injectors, dermapen, Juvederm, Modesto, Obagi, Voluma

Minimally invasive cosmetic and acupuncture procedures I perform in addition to Botox

Some may call minimally invasive as “non-surgical.”  But to me these procedures are surgical.

  • Asclera vein injections – for those spider veins (especially on the legs).  Their slogan is “Enjoy the freedom to show your legs.”
  • Vein laser with the Dornier Diode Laser
  • Radiesse dermal filler injections
  • Juvederm VOLUMA dermal filler injections for cheeks.Voluma Apple
  • Belotero Balance dermal filler injectionsBelotero Box
  • Juvederm Ultra Plus XC, Juvederm Ultra XC, Juvederm Ultra plus (without XC), Juvederm Ultra (without XC).
  • Derma Pen – skin tightening procedure.  Also good for acne scars.
  • Blue Peel Radiance – Obagi product
  • Blue Peel – Obagi
  • Acupuncture for various conditions such as back pain, headaches, stress reduction, fertility, hormonal balance, allergies, etc.

My Surgical Assisting Consists of:

In addition to these procedures I also perform surgical assisting for plastic surgery, and for Spinal Cord Stimulator Implants and Morphine Pump implantations – both for chronic pain.

Spinal cord stimulator implant
Spinal Cord Stimulator Implant

Conclusions

Yes, this is a Botox Blog.  And Yes, this is connected to my Modesto Botox Home Page.   I just wanted to make a brief mention of the other cosmetic procedures I perform.  I recently (probably for frequently than I know) had a patient who didn’t know that I performed a particular procedure.  And it seemed like she would have liked to know that I was available for that procedure – which was Voluma Injections.  Yes, I do Voluma injections.

In the office, I mainly concentrate on procedures which are done with a needle.  One can call these minimally invasive cosmetic procedures.  And from time to time, I wander off to the operating room to perform, guess what?  Some surgeries!  But most of those surgeries are surgery assists.

Other than surgery, this is how I spend time in the office.  “Botox” here means Botox, and Dermal Fillers, and other minimally invasive Cosmetic Procedures:

Botox Pie Chart
2014 data for how my Veins, Acupuncture, and Botox division of office based procedures. Surgery isn’t included here since it isn’t done in the office. This chart is just the division of my patient load in the office.

I didn’t know that you inject Voluma?!

Botox, Modesto, Voluma,

Voluma?

“Yes, I do inject Voluma.  I’ve been injecting Voluma since the end of 2013.  Why do you ask?”

————

Amazing!  This happens to me more often than I care to admit.  I had a BOTOX patient this morning at our Modesto Office (Surgical Artistry).  She had been my BOTOX patient for years.  But she recently received Juvederm Voluma treatment at another office.  She came back to me for BOTOX.  And she wanted to tell me about her Voluma treatment.  I think she had a good job done and I believe that she got a good price.  Then she somehow saw a box of Juvederm Voluma lying on the side of my counter.  She exclaimed – “you inject Voluma also?  I didn’t know that!”

Voluma Apple

Above is the famous Voluma Apple.  Used in most Voluma advertising direct from Allergan, USA.  Do you recognize it? Did Allergan do a decent job promoting Juvederm Voluma directly to the masses?

VOLUMA marketing – I need to do better

Well, I guess, I probably need to do a better job with my own marketing.  Regardless I’m glad she got taken care of well.  I had a previous post where I discovered for myself that there are over 35 other places for BOTOX injections.  And I think most of those places probably inject Voluma as well.  I guess it is possible to be a BOTOX-ONLY type of practice without dermal fillers or without Voluma.

Here’s the listing of the 36 places to get Botox in Modesto (or near Modesto):  It answers the question of “Where to get Botox in Modesto?”

My only Voluma writing in this blog was an off Label usage of Voluma for the lips.  Which isn’t my normal practice, but I hear that it is possible.  I was speculating that Voluma wouldn’t last 2 yeas in the lips.

Concluding Voluma Marketing thoughts

Anyway, I want to get the chance to write in this blog in case anyone is wondering: I love using Voluma and Yes, I am a Voluma injector too.  Please visit my Modesto Botox and Voluma home page and please feel free to visit us in person!

Medical Botox vs Cosmetic Botox, differences?

Botox, Botox Injectors, BOTOX Questions, Crows Feet, eyes, FDA, hyperhidrosis, Modesto, sweating, ,

BOTOX® Medical and BOTOX® Cosmetic

The BOTOX formulations are the same.  But the uses are different.  As the terms say, BOTOX medical is used for Medical purposes.  And BOTOX Cosmetic is used for cosmetic purposes.  There are many OFF-LABEL FDA uses of BOTOX, but here we explore the ON-LABEL uses for medical problems and cosmetic problems.

Medical uses of BOTOX
Sometimes called BOTOX THERAPEUTIC

More specifically, medical uses of BOTOX which are ON-LABEL FDA:

  • BOTOX for Overactive bladder symptoms
  • BOTOX for Urine Incontinence due to neurological disease
  • BOTOX for Headaches, specifically chronic migraines (15 or more days each month, longer than 4 hours each day)
  • BOTOX for upper limb spasticity
  • BOTOX for cervical dystonia
  • BOTOX for strabismus: an eye muscle problem
  • BOTOX for blepharospasm: an abnormal spasm of eyelids.
  • BOTOX for axillary hyperhidrosis
BOTOX Injection sites for Blepharospasm

The BOTOX injection site picture from Allergan.  BOTOX has been the main blepharospasm treatment since FDA approval in 1989.

BOTOX injection sites for Blepharospasm treatment. Picture from Allergan. BOTOX has been the main blepharospasm treatment since FDA approval in 1989.
BOTOX injection sites for Blepharospasm treatment.

Cosmetic uses for BOTOX

  • Glabellar lines = Frown lines between the eyebrows.  Botox was approved for usage for cosmetically reducing the appearance of wrinkles, temporarily between the eyebrows in patients between the age of 18 to 65 years old.  This was approved by the FDA in 2002.
  • Crows feet = Lines on the side of the eyes.  In September 2013, the FDA approved Botox for use in the crows feet area.  Botox for the Crows Feet – a entry in my Modesto Botox Blog

Again all the above mentions are FDA approved – ON LABEL usage.  There are other medical and cosmetic uses of BOTOX but they require a physician to determine the possibility of OFF LABEL-FDA use.

Differences in Dosages in Medical Botox vs. Cosmetic Botox

Usually many more Botox units are needed for medical indications than for cosmetic indications.

Disclaimer for this BOTOX webpage:

Unless you are directly looking at my actual crows feet and my glabellar lines, there is no establishment of a doctor-patient relationship.  Please see your own doctor’s wrinkles in person so that you can get medical advice.  Above is for information only – not to be considered any sort of medical advice.  Furthermore, looking at a picture or video of my crows feet and glabellar wrinkles does not count – it has to be a live and in-person viewing.