Category Archives: Allergan

BOTOX purchased in 2014 by our Modesto Surgical Practice

Allergan products purchased by our Modesto Botox Practice in 2014.

Allergan has a robust reporting system which can track your purchases throughout the year.  The graphic below represents the amount of Botox, Juvederm Latisse, Voluma and breast implants purchased from Allergan over the 2014 year.  However, not all these products were delivered in 2014.   It is possible that some of these products have a “scheduled” shipment in 2015.  Natrelles listed here are breast implants.  There are other companies which sell breast implants, such as Mentor.  Mentor is the maker of the memory shape implant and is a competitor to Allergan.  In our Modesto Plastic Surgery practice, we carry a whole array of Mentor breast implants and have at our use many Natrelle implants.

Botox Bottles purchased in 2014, along with Juvederm, Latisse and Voluma
Botox Bottles purchased in 2014, along with Juvederm, Latisse and Voluma

In 2014, 365 bottles of Botox were purchased.

As for the Juvederm Ultra and Juvederm Ultra Plus and the Juvederm Voluma – those are boxes of the product.  There is more than one syringe in a box.  More on this topic another day.  As for the Latisse, it is in cases – many many Latisse boxes in a case.

Please feel free to visit us in Modesto.

www.InjectionArtistry.com

Calvin Lee, MD
Calvin Lee, MD

 

Allergan considers a 3% increase in the price of Botox starting in 2015

Botox, Juvederm, Latisse to possibly get a 3% rise in cost for those Botox practices purchasing from Allergan USA

I don’t have this 100% verified.  But I heard a whisper about this as I am a regular Modesto purchaser of Botox, Juvederm, Voluma and Latisse.  I heard that across the board all these three products are going up in price in January except the 5 ML Latisse.  I do recall that last January, Botox had a sudden increase in price which wasn’t announced ahead of time.  I think Botox practices deserve to know ahead of time for planning purposes.

However Allergan is about to merge with Actavis, and many of these practices and policies of price increases are probably going to change

A history of price increases

I remember when we started purchasing Botox in 2006 that every year, the price would go up.  To our humble Modesto practice, it felt like a bit of a struggle to keep up.   When the recession became more of an accepted ambiance, Botox prices stayed the same for a few years.  But starting in 2014, the prices started increasing.  I had a strong feeling that many practices in Modesto, including ours had greater temptation to migrate over to Xeomin and Dysport from Botox.    However, I think as with inflation, there tends to be an increase in just about everything all the time.

How much would Botox Cost at our Modesto Practice?

I think we would consider following the trend of price increases.  If our Botox source goes up 3%, we would probably consider following.  However last year when Botox price increased for us, I elected not to increase our Botox price for patients, yet.  Please call our office for the latest information.  Our phone number is on our Modesto Website.

Such is life in Modesto and life in general

Hopefully Botox’s prices doesn’t skyrocket to the point where we have constantly diminishing returns.   Diminishing returns?  There is pressure, naturally, to lower the price of Botox for patients – there’s competition from other injectors, there’s fake Botox, there’s Botox from other countries, and their’s other products that do similar things to Botox such as Xeomin and Dypsort.

Enter Xeomin and Dysport into the Modesto market?  Belotero and Radiesse?

In general, it’s good to keep an open mind about the possibilities of other products that work in the same areas as Botox, namely, Xeomin and Dysport.  I already like a lot of Non-Allergan products – meaning non-Juvederm.  My personal exploration with these other products were brought about in the early 2014 price increase that was suddenly dropped on me in January 2014.  So good things come out of things that appear bad at first.  I think  I wouldn’t have been such a supporter of Belotero – Belotero Balance – if I didn’t have a kick from the sudden jolt that I received from Allergan in January 2014.

Getting Botox has never been a right, like free speech

Getting Botox injected into one’s glabellar complex or crows feet has always been a choice, not a right.  Thus we can simply choose to avoid this price increase by avoiding Botox altogether.  That could be a choice for the consumer, or it could be a choice for the Botox injector.  For a cosmetic surgeon, there’s a choice to focus more on surgeries.  We can’t complain, as a team, my wife and I have had the opportunity to do many cosmetic surgeries.  In fact in 2014, we were voted Best Cosmetic Surgeon in Stanislaus County (which includes Modesto) from Contentment Health Magazine.

But I’d like to think that I’m trying to keep the prices reasonable for our patients in Modesto, CA.

How is Botox Supplied in the USA?

Botox for USA

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 is available as either 50U or 100U vials
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 Catalog
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 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.

50U Botox vial, Modesto, CA
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.

Calvin Lee, MD
Calvin Lee, MD

 



Juvederm

juvederm

Do you have Juvederm?

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 used today
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

They are made by Allergan.

  • Juvederm Voluma
  • Juvederm Ultra Plus XC
  • Juvederm Ultra Plus
  • Juvederm Ultra XC
  • Juvederm Ultra

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.

Read my blog about the relative thicknesses of dermal fillers.

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.

Feel free to read my blog about toxic doses of lidocaine and how to calculate an estimation of safe limits of lidocaine; and there is a discussion of central nervous system adverse effects: nervousness, tingling around mouth, tinnitus, tremor, dizziness, blurred vision, seizures, depression, loss of consciousness.

Allergan makes Juvederm and Botox

and a host of other products – mostly related to eye care.  And Allergan is going to be merging with Actavis.

Visit us for your Juvederm consultation: Surgical Artistry in Modesto, CA

www.InjectionArtistry.com 

Calvin Lee, MD

Calvin Lee, MD


 

 

A Thank You Letter from Allergan

This letter was sent out to myself, Dr. Tammy Wu, and my Modesto Plastic Surgery staff.  We had sent out one of the original letters of support for Allergan which was mentioned in this letter.

Allergan manufactures and distributes the Botox, Latisse, and Juvederm which we use very often in our Botox practice in Modesto, CA.

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.

Sincerely,

David Pyott


 

Yearly Botox growth 2014

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.

2014 yearly botox growth data without numbers

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.
  • Botox growth percentages.  2012: 53.0%, 2013: 35.0%, 2014: 31.6%
  • Juvederm growth percentages.  2012: 36.5%, 2013: 44.2%, 2014: 46.8%

www.InjectionArtistry.com (please feel free to visit us in Modesto, CA).

How big is your BOTOX needle?

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?

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

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.

BOTOX Terminology: Glabella

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.