Another attempt to answer a public forum question.
My answer:
Preconditioning the skin is key
It is convenient to pre-condition the skin with the OBAGI Nu-derm system. But there are other lines that can precondition the skin. I prefer that the patients precondition the skin with tretinoin and/or hydroquinone (preferably both) for at least 2 months before getting a OBAGI Blue Peel. The reason it’s convenient – both the Obagi Nu-derm system and the Obagi Blue Peel are made by Obagi.
I attempt to answer another public forum question. This one comes from San Ramon, California.
Latisse for under $125 for 5 mil bottle?
I am looking for more latisse, however, it seems as if the price has almost doubled over the last 2 years. Does anyone know of any place around the Bay Area that sells the 5 mil bottle for around 125?
My Answer:
Thanks for the info on the price doubling!
I have a practice in Modesto, California. Not too far from your location. If the price of Latisse had doubled, then I really need to catch up to that. I have kept my prices very close to the same for a long time – meaning since Latisse came out in 2009.
The 5 ML Latisse kit launched around August 2012 with a list price of $179 from the very start. And the suggested price was $120 for the 3 mL Latisse kit from 2009. The prices sold at pharmacies is much higher than these prices I’ve quoted for physicians offices. Perhaps you’ve been looking at pharmacy prices? These prices have always been higher than physician prices with my understanding.
I know a little bit about Latisse and have connections with Allergan who makes Latisse because I was one of the original Latisse speakers for the product – rolling it out for other physicians to carry in their offices. I had the honor of giving Latisse talks in Reno, Fresno, Modesto, Santa Rosa, Walnut Creek, Napa, and other places. But it has been several years since I’ve given a Latisse lecture.
3ML vs 5ML Latisse
There is of course the price difference. But with the 5ML, you are getting 67% more drug, and 133% more brushes. And the suggested usage duraing increases by 150%.
What I charge (if this helps):
Our practice doesn’t often have specials. Thus I try to keep the Latisse price consistent; a good value most of the time.
We charge $100 for the 3mL size Latisse which is the original size. And we charge $149 for the 5mL size Latisse which is the new larger size. From what I understand, the bottles are the same size but the 5 mL is filled up to the top. But there may be different batches with different tops on the Latisse bottles.
We also require that I personally make contact with the buyer of Latisse.
Answering your question:
To answer your question, I don’t know of anyone in the area selling Latisse for $125 or less.
I will look into the price doubling issue. Thank you for your comment and question.
Calvin Lee, MD
Giving Latisse Consultations in Modesto, California
We had a good time dressing up in scrubs and playing the violin at Doctors Medical Center in Modesto, California 6/6/15.
I had an opportunity on Saturday to spend some time with two amazing brothers who have passion for violin and aspire to become surgeons. I heard about them through social media, and I wanted a chance to meet them. Doctors Medical Center and the Modesto Chamber of Commerce helped to set this up. We were able to give them a brief tour of the operating room areas, and we had a private concert in a large operating room which is used for storage and backup in case of disaster trauma. We played some violin for each other. I was especially intrigued that they wanted to become surgeons. I wanted to give them a friendly taste of surgery life. I especially enjoyed giving them a chance to try out our surgical outfits, and I think they enjoyed spending time in an operating room – in a non-threatening way. And I wanted to impart that performing surgery is much like performing musical instruments. Jorge and Sebastian have a great deal of potential. I am honored to be able to spend a few moments with them.
I also got to meet a very talented Modesto Bee writer. She says she normally writes crime stories, but in this case I think she’s wearing a different hat:
Getting interviewed by Modesto Bee’s Erin Tracy.
Below is the article from the Modesto Bee (text copied and texted), please visit the link below for the actual website which has a video and many other pictures. The pictures and videos in this blog are my own. But the article belongs to Erin Tracy and the Modesto Bee.
First, some of what I played that day on the violin:
Modesto Bee Article by Erin Tracy:
Operating room becomes concert hall for two Modesto boys
The operating table became a music stand, surgery lights transformed into stage lights, and forceps and scalpels were replaced with violins and bows for a special concert at Doctors Medical Center on Saturday.
Two Modesto boys – Jorge Mendoza, 12, and Sebastian Mendoza, 8 – had a booming business at the hospital last month during Lemonade Day, a nationwide program designed to educate children about business.
When violin-playing surgeon Dr. Calvin Lee learned the boys intended to use the lemonade stand’s profits for summer music camp and to save for a violin, he was intrigued.
When he was told Jorge also was interested in becoming a surgeon, he decided he had to meet the boys.
“I think playing the violin helps you become a better surgeon,” Lee said. “Because of the dexterity skills and the ability to break complex tasks down to a simple thing.”
He wasn’t able to make it to Lemonade Day, but with the help of hospital staff the doctor arranged for something even better: a concert in one of the operating rooms.
Jorge was dressed for the occasion in a sharp pinstriped suit, and Sebastian looked handsome in a blue plaid shirt.
Before entering the O.R., though, they covered up with green scrubs to match Dr. Lee. He taught them to tuck in the drawstring on the pants.
“Only the TV doctors let them hang out,” he said.
After a brief tour, the concert began in operating room 12.
Jorge and Sebastian first played a duet by Mozart, followed by a Beethoven solo by Jorge and Sebastian’s rendering of “Dragon Hunter” by Richard Meyer.
Then, Lee wowed the boys with Bach.
“As a trauma/general surgeon, Bach meant a lot to me,” he said. “When I hear the music of Bach, sometimes I feel like there’s somebody looking over me, guiding my hands.”
Lee worked as a surgeon at Doctors Medical Center from 2003 to 2006 but since has opened a plastic surgery practice, Surgical Artistry in Modesto, with his wife, Dr. Tammy Wu.
Wu was in the audience Saturday, along with the boys’ parents, Jorge Mendoza Sr. and Erika Mendoza, Modesto Councilwoman Jenny Kenoyer, Modesto Chamber of Commerce president Cecil Russell and hospital spokeswoman Tiffani Burns.
Jorge said he was initially a bit nervous about playing for Lee, “because I could tell he was going to be better than me and I’m so used to being really good since I only play at school.”
On Lemonade Day, he and Sebastian made a gross profit of $933.
After paying back the loan from their mother for overhead costs, the boys donated $125 to the Make a Wish Foundation. Sebastian bought a remote-controlled car, and Jorge used $190 to pay the balance owed for music camp after receiving a partial scholarship.
The remainder was put into savings accounts; Jorge is saving up to buy a violin, and Sebastian will use his to attend music camp with his brother in a few years when he’s old enough.
Same as what I wrote in my last blog. I believe that my Botox Artistry and Filler Artistry is enhanced by looking at nature. Studying the patterns, the colors, the geometry, and even the natural aging process of young plants to old plants. Here are pictures which I took on the last weekend in May 2015 around my home in Modesto, California.
Sunflowers and Bees
The sun plays a role in how we see our subjects. The shadows create an appearance of deeper depth. In my Modesto Dermal Filler practice, we use fillers to lesson some of the shadows and thus create an appearance of a smoother surface.
In this picture, the lighting comes from the back. The subject looks completely different. This is why I have an operating room light in my procedure room where I do most of my Botox and Filler work. The operating room light can be adjusted to come from above, from below, from behind and from the sides. I also like to be in the same room most of the time when I inject – this way I can get a feel of the fixed lighting and have control over a movable light.
A blurry background helps us take out distractions from our best features. This is what I like to achieve with Botox in my Modesto practice. I like to use Botox to help blur out the wrinkles which detract from beautiful features on or face – especially eyelashes and the eyes themselves. Botox works especially great around the sides of the eyes and between the eyes. So this picture to me is very much like performing a Botox treatment around the eyes. With fewer “distractions” the eyes really shine!
Beauty attracts company. Three bees on this beautiful sunflower.
And this is where I took the above photos. At first glance – it doesn’t seem beautiful. But it’s my job with Botox and Fillers to bring out the beauty that is already there. And that’s what I tried to do with the camera.
The next few pictures depict my study of young leaves of a sago palm
This picture shows the “older” but magnificent leaves of our Sago Palm
Beauty up-close is different from beauty from beyond
I have to look at a patient closely for one form of artistry but I have to keep in mind what a patients face looks like from a distance. This concept that I have to keep in my mind while injecting Botox and Fillers is represented by these two pictures which are near and further away:
The next two pictures show two different colored agapanthus blooms in different stages of bloom
Thank you for taking the time to visit my web page.
Out of a Bottle of Botox, comes a Bloom of Beauty.
I feel that what we see in nature is most beautiful. That’s what I try to achieve with my artistry with Botox and Fillers. It’s a sense of creating a natural look which is pleasing to the eye and exciting to the mind. Nature has a sense of symmetry, pattern and colors which relax and excite us all at the same time.
I spent some time in the last weekend of May, 2015 capturing a few glimpses of nature around my home in Modesto, California
Click above on the picture to enlarge. This is a sunflower growing on an empty lot near my house. The sun shines behind the weed-sunflower. I like how the bee is using the flower as sun-protection!
I attempt to answer another public forum question about Botox. This question comes closer to my office in Modesto, California – it is from San Jose, California!
Why do I break out since having Botox?
In the exact same area where the injection was; is where i break out. As if causing a “man made pore” from the needle which then does not close up and gets filled causing an ongoing blemish effect. I ONLY break out now where I’ve had the injections. But why??
My Pimples and Botox Answer:
Wonderful question. I’ve encountered this question about having breakouts in the area of Botox injections in my own practice in Modesto, California about 3 times. So this is rare. The world of medicine is complex, and sometimes it seems strange. I have not had a case of the “man made pore” – so I can’t address that question except to speculate that it may be a scar of sorts or somehow related to a cyst? I’ve had an experience where there was a reddish – pimple like reaction to only one of my needle pokes. I suspect in that patient that there was an underlying infection in that area – such a pimple – which then got exacerbated when I decided to inject Botox too close to that area. Botox injections are tricky, we want our injections to be in strategic places, but sometimes in our patients, blemishes and veins get in the way of an ideal placement – and thus I have to compromise in my decision and Botox strategy.
Regarding the break-outs in the Botox areas. For some of my patients, I’ve come to realize that they are sensitive to some of the antiseptic methods I use to help prevent infections from the Botox procedure. Sometimes they are allergic to the antiseptic. There are various ones available out there and perhaps switching to a different antiseptic could help. Meaning, having your injector/surgeon/doctor/nurse switch to a different agent. And there’s the possibility that the actual needle poke – which is a very mild form of skin trauma – could incite a inflammatory process.
Ironically (to your question of why does Botox cause more blemishes), I’ve found most of the time that Botox helps calm down inflammation in an area of skin. This may be due to reduced sweating or a direct effect on rashes and pimples by Botox. Also, Botox sometimes shrinks pores as with what we’ve seen with meso-Botox.
Thank you for your question, I’m just answer from my own personal experience as a Botox injector. Without having seen you in person, I’m answering the best I can without physical examination info. My comments are meant for a general public discussion to help others who may have similar concerns. I’m also using my answers to build up library of information for my own patients and also to see how my answers compare with other doctors. There is always much for us to learn from each other. My answers are generalized medical information only, not directed medical advice. For medical advice please see your doctor/surgeon in person.
I hope this discussion is somewhat helpful.
Calvin Lee, MD – Botox Surgeon Botox injections Modesto, California
A pubic forum questions which I decided to answer using my own experience in Modesto, California as an injector of Botox for this problem of excessive sweating in the axilla (arpits). The question comes from Kansas City, MO.
Is it uncommon for botox for hyperhidrosis to not work the first time?
I’ve had hyperhidrosis since age 13. I finally had botox treatments about three weeks ago, and was sure that this would be my answer. The sweating has improved some, but I still get sweat marks. Which, for the price I had to pay, is incredibly disappointing. I don’t know if it’s worth it to try again or not. My dermatologist’s office said insurance wouldn’t even allow me to get another treatment until it had been 4-6 months. They also said nobody had ever had the botox NOT work for them. Help!
My Botox and Hyperhidrosis Answer
A great question. I can only speak from my own experience as an injector of Botox for my Modesto hyperhidrosis patients. I have had a few patients where the sweating has reduced somewhat after 50U of Botox injected in each axilla (arm pit area). But then they needed more. A carefully planned approach to the remaining excessive sweat areas by using a starch test or even just observation, could help direct perhaps another 25 units of Botox into each side. That’s what I’ve done with some success in my own practice in Modesto California where it does get over 100 degrees F in the summers. I think that 1 in 5 of my patients would benefit from a higher amount. I’ve also worked with excessive sweating in the palms/feet which can be a lot higher in Botox dose.
You’ve shown that it works with the reduction you noticed, and now it just needs more – probably because everyone is different. And perhaps if you had to wait 6 months – it might work even better because I think there would be some overlap of the Botox injections.
My practice doesn’t accept insurances, so I totally understand that the cost can be a concern. But many of my patients think that it is “a new lease on life” as some of my patients claim.
Thank you for your question. Without having seen you in person, I’m answering the best I can without physical examination info. My comments are meant for a general public discussion to help others who may have similar concerns. I’m also using my answers to build up library of information for my own patients and also to see how my answers compare with other doctors. There is always much for us to learn from each other. My answers are generalized medical information only, not directed medical advice. For medical advice please see your doctor/surgeon in person.
I hope my own experience as an injector helps.
Calvin Lee, MD
For the entire month of May 2015:
110 patients seen for Botox this month, 28 Patients seen for Juvederm,
121 patients getting Botox OR Juvederm. 17 patients getting Botox AND Juvederm.
Using my own data, I can derive that 35.4 units of Botox is the average number of units per patient.
I know quality counts for much more than quantity. But it is always tempting to look at the numbers provided by the Botox company. This is what you can derive from their computer analysis about my Botox/Juvederm practice. I am also big on injecting Radiesse and Belotero which don’t show up in these numbers. I’m not sure if these numbers include Juvederm Voluma. Sometimes Allergan calls Voluma a separate product.
Another public forum question which I will attempt to answer.
Almost total Voluma absorption after only 5 weeks? What caused and does that mean hyaluronic products a no-go for me?
I had 1 vial of voluma–split between both facial cheeks and eye areas, and one perlayne split between both marionette areas 5 weeks ago and already the sunkeness around my eyes is returning–voluma should last at least a year–any suggestions as to why this happened? Does this mean I’m not a good candidate for any hyaluronic acid products? My injections performed by a very experienced plastic surgeon–little bruising, redness or after discomfort; immediate happy results. )-: thank you!
I will attempt to answer your question from a community discussion standpoint. Please see your own doctors in person for personalized medical advice.
Much of what an injector does with fillers is an art, thus the amount, the products, the location, and the method of placement is all different.
I am currently mostly a cannula injector when it comes to Juvederm Voluma and I still prefer the threading methods. And for me, Voluma is not the only filler I use in the cheek. I have found myself layering with Juvederm Ultra Plus XC, and also Belotero when needed for additional superficial shaping. I used to inject this differently – using droplets of filler. But my style changes from time to time and from patient to patient. Thus I am speaking only from my experience, and my methods and thought process could be completely different from your plastic surgeon. Please keep in contact with your plastic surgeon. I think he/she would appreciate an open dialogue. I am answering this question as a public academic exercise for myself to see how my answer compares to others and to personally build up information sheets for my own patients. Thank you for giving me the opportunity to participate.
Your comment about Voluma disappearing in about a month’s period of time is a comment I hear from my own patients in my practice. Much of the time, it isn’t because they were fast metabolizers of Juvederm Voluma. But most of the time it is due to at least these four factors:
1. The Juvederm Voluma softened over that time and lost some of it’s original projection. This almost always happens in what I’ve seen. Then the Voluma spreads out and becomes more of a diffuse appearance – more rounded / less angular. this is what I mean from the title – the Juvederm Voluma evolves over the first few weeks.
2. The Juvederm Voluma, with gravity, sometimes shifts downwards. Thus, it might get somewhat “lost” in the hollows of the cheek. This is what I also mean from the title – the Juvederm Voluma evolves over the first few weeks.
3. Some of the original swelling has gone down from the procedure itself (needles/cannulas/massaging), and thus it appears that some of the material is lost – but in fact the only thing lost is the swelling.
4. Our patients sometimes gets used to the new look and had pleasantly “forgotten” the “before” look. Thus the changes don’t seem as dramatic.
With all those four factors, additional Juvederm Voluma injections might solve the problem. I have found that one syringe is useful in youthful patients with tight skin over their cheek bones. But for most of my other patients, two syringes of Voluma helps me achieve the look (and duration) I want for my patients. It is not uncommon for me to consider 3 or 4 syringes.
You also mentioned in your question about Perlane. The active ingredient in both Voluma and Perlane is hyaluronic acid. If the Perlane results are still evident, this means that you are unlikely to be a rapid metabolizer of hyaluronic acid. It sounds like from your question that you are satisfied with your Perlane results. This means to me, even more so, that another syringe of Voluma might be your best solution before thinking of switching to a different material such as Radiesse or giving up on future Voluma injections.
Calvin Lee, MD Modesto, California Juvederm Voluma Injections
Disclaimer: some of the discussion above involves off-label FDA usage of fillers. And none of what I mentioned above is meant to be personalized medical advice. I am just discussing a hypothetical situation posed by a person I have not examined. Without a personalized examination, I am only guessing at possible solutions which I present above. I am also assuming that the mention of 1 “vial” = 1 syringe.
I got this extremely nice request today. I always have a hard time saying “no”. I truly like to make everyone happy. But I had a chance to think about this many years ago, and I’ve come to the conclusion that I’m just not good enough to inject at Botox parties.
Here’s my response:
Hi! Thank you for writing to me. I don’t do Botox parties – I’m so sorry. Thank you again for thinking of me. I don’t know a lot about Botox parties, but I don’t think I’m good enough to inject in a place which doesn’t resemble a doctors office or an operating room. Oddly, those are my locations of comfort! There’s controlled lighting and controlled height adjustments of exam tables. I think I’m too old fashioned. I like to control every element that I can – including the method of refrigeration of the Botox. So if I was at a “party” I think I wouldn’t be injecting very well. Plus, I get somewhat distracted if more than one person is talking to me at a time. I don’t inject too well when I’m distracted. So it’s my preference to just see one patient at a time at the office. There are probably more than 42 other injectors of Botox in Modesto and the surrounding areas.
Thank you so much for thinking of me for the opportunity. I am truly honored.
