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.

BOTOX Award from Allergan

Allergan, Botox, Botox Injectors,

Allergan APP Levels

APP – stands for Allergan Partner Privileges

It’s a program which offers rebates around 4% to 8% regarding on level of purchases.  It’s somewhat complex and involves additional rebates known as Portfolion Bonus Rebates (PBR’s).   I haven’t exactly figured it all out.  But it’s a program that rewards the big purchasers and the practices who buy more than just BOTOX;  Breast implants, Juvederm, Voluma, Latisse, and SkinMedica are involved in the rebate program as well, and combinations of purchases apply.  For me, most of the points I needed to earn “Platinum” status was from BOTOX purchases.  You would log in through this Allergan APP webpage.  And this is a link to more Allergan APP info.

The Certificate to Display

They even give you a certificate to show off your level.  We can display this in our Modesto Botox Practice.

Most of my points to get this "Award" was from BOTOX purchases.
Most of my points to get this “Award” was from BOTOX purchases.

APP levels from Allergan

  • Silver – 20 points needed
  • Gold – top 12% of members, 200 points
  • Platinum – top 6% of members, 400 points
  • Platinum Plus – top 3% of members, 650 points
  • Diamond – top 2% of members, 1000 points
  • Black Diamond – top 1% of members, 1500 points
  • Top 50

How much dollar value is a point worth?

I think a point is about $550 worth of products give or take $100.  This probably changes from year to year.

  • One vial of Botox = 1 point.
  • One box of Juvederm (2 syringes) = 1 point.
  • 1 case of Latisse 5 ML = 3 points.
  • Other products such as Natrelle breast implants and SkinMedical have point values, but I’m not entirely familiar with those values.

Friendly Competition to fuel BOTOX injections

Allergan possibly has this setup because they probably think the Botox practices like to have a little bit of friendly competition to see where they stand.

Here’s a listing of places to get Botox injections in Modesto, California.

What level will I be at in 2015

I think I will probably be in the Platinum Plus level in 2015.  Not a high priority for me but, I think that’s how I will naturally fall into that category with my usual BOTOX growth rate.

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.

 



Monthly Botox Chart – November 2014 update

Botox, Botox Injectors, Brilliant Distinctions, Modesto, statistics, year in review

Botox Patient Charting

Background info

For fun, I like to see trends.  And I like to use the functionality of an old Excel spreadsheet.  I use Excel 2003 – it just seems most comfortable to me.  I have updated version of Excel which I use but I still always seem to go back to the 2003 version.  Just my preference.  I make these charts based on data from Allergan’s Brilliant Distinctions – I also keep track of other Botox Statistics related to our Modesto Botox Practice.  I also have 2013 Modesto Botox Statistics.  I’m getting ready for 2014 Botox Statistics, but 2014 isn’t completely over yet.  In fact November isn’t over yet either, but the next working day is Dec 1, 2014.

The Botox Patient Monthly Chart

Botox Patients Per Month
Botox Patients Per Month.  Click larger.
  • The dip in September 2014 for Botox patients is due to a two week vacation away from the office.  The much of the vacation was work related.  With visits to other Botox practitioners, Acupuncture centers, and Qi-Gong lessons.
  • The orange arrow was drawn in by hand; there was no mathematical method done for the rendering of that line.
  • December 2014 is missing from the chart because December hasn’t come about yet.
  • It’s interesting to see that the growth so far seems to be linear.
  • The chart starts with the very beginning of 2011 where a large part of my practice included General Surgery, Veins, and Acupuncture.

Some generalizations from the BOTOX chart

Regarding our Modesto Botox – Plastic Surgery Practice:

  • In 2011, the average number of BOTOX patients per month was 22.5
  • In 2012, the average number of BOTOX patients per month was 42
  • In 2013, the average number of BOTOX patients per month was 60
  • In 2014, the average number of BOTOX patients per month is 82.9
  • We await December to finalize the 2014 number above.

BOTOX Predictions

This linear growth will start to level off in 2015.  Why?  Because I am totally running out of appointment slots.  That’s fine with me.  I’ve made peace with the idea that I’m not aiming to be busier.  I just am just aiming for higher quality with each visit.  I’m looking forward to December 2014, and a New Year 2015!

 

Botox Report: Number of Patients for the Month

Allergan, Botox, Botox Injectors, year in review

Brilliant Distinctions Analytics Section

I’ ve been playing around with Botox’s Brilliant Distinctions reporting.  Brilliant Distinctions is a rebate/coupon type program run by the Allergan company for our Botox patients.  I pulled up a custom report with the dates in November 2014, and selected it to produce a list of Botox patients.  This is in the analytics section.  Then I look at the reports on an excel spreadsheet.  I also keep my own Modesto Botox and Juvederm Brilliant Distinctions Statistics.

November’s Botox Numbers: 96

The results reveal a grand total of 96 patients seen for the month of November, 2014.  November has typically been a busy month for Botox at our Modesto Botox Practice: Surgical Artistry (Injections by me: Calvin Lee, MD).

96 Patients – well, this hasn’t been our busiest month this year.

I did hit over 100 patients last month.  A while back, I wrote a blog regarding the elusive 100 Botox patients per month goal for my Botox practice.  Botox and Fillers takes up half of my practice; meaning it takes up half of the practice when using time as a measure.  So it takes up half the time – stated more simply.

123 Patients seen in the month of October, 2014

October, which is last month, revealed a large surge of Botox patients into our office with 123 patients seen.  Overall, I think the Botox trend is an upward one.  Perhaps this is a reflection of the overall economy.

Excuses for not hitting 100 Botox patients this month? (with Thanksgiving in it).

Well, there aren’t much excuses except that it isn’t that big of a goal for me anyway.  My main goal is excellent results with Botox – not huge numbers of Botox patients.  But Allergan’s Brilliant Distinctions Analytics does make it fun to extract these numbers.  And… December is another month to look forward to.

Does Botox Hurt?

Botox, Botox Injectors,

Do BOTOX shots hurt?

That’s a better rephrasing of the question of “Does Botox Hurt?”

This is a question I get in my Modesto Botox Practice – Surgical Artistry – almost every single day.  It’s a difficult one to answer because everyone is different.  But I’m going to attempt to answer it in this blog.

The quick answers from me:

It is sometimes tempting to answer with: “Let’s try it and see.”

Or, sometimes I’m tempted to say “It doesn’t hurt me one bit when I’m injecting it.”

EMR frustrations Calvin Lee
Not to worry, I don’t use a hammer when injecting BOTOX.

OK, some serious thoughts on the topic of BOTOX pain:

In general, most people think that BOTOX shots hurt a little bit but is bearable.  I would venture and say that perhaps people even look forward to coming back for BOTOX shots.  Perhaps they forget how painful the shots could be.  I get BOTOX injections myself, and I would say that they hurt a little bit but not enough for me to complain about it.  But I also think that there are variables to what causes pain with BOTOX injections:

What are some causes of pain with BOTOX shots?

I’ve divided these into Injector and Patient factors

– Injector factors

  • Injection technique  – “hands of a woman, heart of a lion, eyes of an eagle” – a strange mantra passed on to me by a surgery mentor while I was a Surgeon-in-training.   There is so much to this topic – it wouldn’t all fit here.
  • Size of the needle.  Smaller is usually better.
  • Did we hit bone? ouch!  But sometimes this is part of the technique to gauge depth.  Not usually necessary though – in my humble opinion.
  • Is the needle dull? – a dull needle causes more pain.  I have found that needles – even from the same batch might be sharper or duller when brand new out of the box.
  • Did the needle become dull?  It could become dull after a few shots (same patient of course!).  The Botox injector could change the needle after a few shots to start “fresh.”  Or the needle could become dull if it was purposefully or inadvertently “banged” against certain anatomic structures such as bone, or it could have been used to extract the Botox from the sterile bottle (not my practice – though).
  • How often are we going to change the needle?  Changing it often is a good thing, especially with the smaller needles.  Smaller needles dull pretty quickly.
  • Did we hit a nerve?  This would hurt.
  • Did we hit a blood vessel?  This would hurt too.

– Patient factors

These are just my thoughts from my experience of injecting Botox patients:

  • Nervous patients usually feel more pain.
  • Tensed muscles usually get more pain.
  • Patients who squirm around during injections usually suffer more pain.
  • Patients who haven’t experienced raising children (or birthing them) usually experience more pain.

Summary about pain with BOTOX shots

Pain is a very individual experience.  But I’m glad to report that lots of patients like their BOTOX visits and come back regularly for more BOTOX visits.  I think that tells me that it isn’t a really terrible pain.  And I consider myself to be the biggest CHICKEN in the world (just ask my wife the Plastic Surgeon), and I think that BOTOX shots are just fine for myself.

My wife, Dr. Tammy Wu, by the way, won the Best Cosmetic Surgeon award this year.

Disclaimer:

I’m vegan, I need to find a different word for “CHICKEN.” – perhaps a future blog.  Please see your own injector regarding Botox Pain Perception questions.  Reading this blog does not automatically make me your doctor.  Read at your own risk.  Do not try this at home.  The FDA has nothing to do with this web page.

Please visit my Modesto Botox Home Page for more important information.

Modesto Botox Home Page