Category Archives: Allergan

Latisse as an adjunct to BOTOX eye treatments

December 10, 2014Actavis, Allergan, Botox, Brilliant Distinctions, Latisse, Modesto, ValeantLatisse VideoCalvin Lee

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

December 8, 2014Allergan, Botox, Botox Injectors, BOTOX Questions, ModestoglabellaCalvin Lee

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

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.

BOTOX Award from Allergan

December 8, 2014Allergan, Botox, Botox InjectorsAPP, awardCalvin Lee

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.

Botox Report: Number of Patients for the Month

November 27, 2014Allergan, Botox, Botox Injectors, year in reviewBotox monthly goalsCalvin Lee

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.

Botox Delivery – what it looks like in a box.

November 25, 2014Allergan, Botox, Botox InjectorsBotox DeliveryCalvin Lee

Ever wonder what it looks like when BOTOX is delivered to an office?

Here’s what the boxes look like. Inside these shipping boxes are styrofoam containers with dry ice on one side and individual BOTOX boxes on the other side. These three BOTOX containers added up to a shipment of 50 vials of 100U Botox. I have delivery of this amount of BOTOX before and it came in one large container – so I think it varies from time to time. I don’t see any obvious advantage to breaking up the BOTOX shipment. But perhaps Allergan decided that it was better that way – or they just simply ran out of larger BOTOX shipment boxes.

A tower of Botox! Delivered to our door.

Botox Delivery. No, it's not Pizza Delivery. It's better than Pizza! — Botox Delivery. No, it’s not pizza delivery. It’s much better than pizza!

This is a picture at our Modesto Botox Office of Botox delivery boxes ready to be stocked and recorded (lot numbers). It needs to stay refrigerated.

Lowest price Botox?

November 22, 2014Allergan, Belotero, Botox, Botox Injectors, Juvederm, Modestobest priceCalvin Lee

Lowest Botox Price matching?

We get this question from time to time regarding matching the lowest price of Botox or Juvederm. It isn’t a common question, but it comes up perhaps once per month or so. I figure it’s worth addressing.

This is not a blog about different Botox-like substances or Botox from other countries. We receive our Botox directly from Allergan USA, that ensures that it is genuine. So back to the topic of “Lowest Price for Botox?”

So, do we price match or compete on pricing?

The quick answer is “No.”

But we like to compete on “value”. But in the end, we don’t see this as a competition. We have a lot of respect for everyone. We have set prices that make sense to us.

So the long answer is that we hope that we are considered the “best value.” But all this depends on what patients value. It might be different than what I might value. So I can definitely understand different definitions of value when it comes to Botox injections.

Surgical Artistry doesn’t emphasize or compete with “cheapest” prices.

Our Botox Surgeons (mainly Calvin Lee, MD) value a high level of

results
safety
and comfort.

And the Office values a high level of

customer service
positive attitude
and communication

We hope to win with BEST VALUE. I think we would lose the battle if we were going for price wars on Botox.

But hopefully we might win with best value – that’s our attempt.

Here’s a link to another topic of Botox Wars – The fight for Allergan Ownership.

Email from Allergan about Actavis 11-19-14

November 20, 2014Actavis, Allergan, Botox, Juvederm, Latisse, ModestoCalvin Lee

I got this letter below from Allergan on 11-19-14 (today) addressing the merging of Actavis and Allergan. Allergan wanted to stress that they would continue a high quality of research and development as they had before. Karla from our office sent me a copy of this email which she got, and she wrote that “It looks like Allergan will become part of Actavis soon. This email confirms it and reaffirms their commitment to continuing research and development.”

Here’s the letter from Allergan, the makers of our cherished Botox, Juvederm, and Latisse. For more information about these products, visit our Modesto Botox and Juvederm page.

November 19, 2014

To our valued customers:

As announced in a press release earlier this week, we are pleased to share that Actavis and Allergan have entered into a definitive agreement under which Actavis will acquire Allergan in a deal valued at approximately $66 billion. Bringing our two companies together represents a powerful strategic combination, creating a dynamic, top 10 global pharmaceutical company.

We anticipate that the acquisition will close in 2Q 2015. Until then, it will be business as usual, with no impact to our operations or the high quality of service that you have come to expect from Allergan. Once the transaction closes, we will notify you of any relevant changes, and it is our goal to minimize any possible impact this could have on you, your patients, and our employees.

Like us, the Actavis culture is centered around innovation and customer service, and investment in R&D will remain one of the top priorities of the integrated company. The combined company will offer a broad portfolio of products in Eye Care, CNS/Neurosciences, Medical Aesthetics/Dermatology/Plastic Surgery, Gastroenterology, Women’s Health and Urology and Anti-infective therapeutic categories, as well as the highest quality generic, branded-generic and Over-the-Counter products. The combined company will provide an exceptional level of R&D support, with approximately $1.7 billion invested annually in brands, generics and biopharmaceuticals aimed at delivering high quality products to address unmet patient needs.

We want to thank you for your support and to assure you that we remain dedicated to exceeding your expectations and delivering products and services that make a difference to you and your patients. We look forward to sharing more details of our combined products and services in the future. In the meantime, if you have any questions, please contact your sales representative or visit our websites at actavis.com and allergan.com.

Sincerely,

Brent Saunders, CEO and President, Actavis

David Pyott, Chairman and CEO, Allergan

Allergan Merger / Actavis Takeover

November 18, 2014Actavis, Allergan, Botox, Botox Injectors, Valeantbotox, brent saunders, Dublin, forest labs, merger, researchCalvin Lee

BOTOX wars

The Botox company, Allergan, has consented to be bought by generic pharmaceutical maker, Actavis for $219 a share. This gets in the way of the hostile takeover attempts led by Valeant Pharmaceuticals and hedge fund man, Bill Ackerman of Pershing Square Capital Management. But it might be possible for Valeant to out-bid Actavis?

66 Billion? That’s a lot of Botox.

According to the sources, this take-over by Actavis, is worth $66 billion.

My precious! (picture by Calvin Lee, MD Botox injector in Modesto, CA)

Who is Actavis?

In the past two years, Actavis has purchased Forest Laboratories and Warner Chilcott. Actavis’ CEO is Brent Saunders. He used to run Forest Laboratories. Actavis is headquartered in Dublin, Ireland and has administrative offices in New Jersey.

Who are the losers? Nobody?

Pershing Square Capital Management owns 9.7% of Allergan shares. Valeant indicated that it may not try to beat Actavis’s offer. Bill Ackerman and Valeant stand to benefit from the increased share price for Allergan; thus they wouldn’t lose either way.

My thoughts

This is a win-win-win for the three A’s: Actavis, Allergan, Ackerman. And it also seems to be a win for Valeant who will get 15% of Ackerman’s profits from the price increase in Allergan’s stock (which he owns nearly 10% of Allergan stock). I also think it will be a win for Botox injectors and consumers. Actavis will try to be more efficient with it’s administration of Allergan – with further cost cutting and unification of efforts. And they have pledged to continue to have research and development within the Allergan family of products. And most importantly in the end, I think the consumers (and doctors) will benefit. I feel that the Valeant/Allergan merger (Vallergant – I’ve called it), might have cut too many costs and we’d lose on research/development. Thus the new merger of Allergan and Actvis – there would be a better balance with continued research and developement. So it will be a 6 way win-win-win-win-win-win: Actavis, Allergan, Ackerman, Valeant, doctors/Botox-injectors, and patients. That’s how you do mergers! I certainly hope so. Time will tell, and I hope to be here to talk about it.

Sources:

Link to Allergan goes with Actavis instead of Valeant / Ackerman

Ackerman/Valeant walks away from Allergan

Wikipedia article on Actavis

Juvederm Voluma Injection Notes according to an Expert outside of the US

November 18, 2014Allergan, Botox Injectors, Volumainjection techniques, notes, voluma webinarCalvin Lee

Tonight I participated in a live lecture on the web regarding Juvederm Voluma injection techniques. I guess they call this format a webcast or webinar.

I joined a few minutes late. But it seemed to start with a discussion of facial muscle anatomy followed by a discussion of facial fat compartments.

Here are my notes below for other Botox injectors and Juvederm Voluma injectors if interested. My personal technique is somewhat different because I use a cannula technique and he uses a direct needle technique. Cannula technique at this time is considered off-label FDA usage. But I feel that it is, in my hands, a safer technique.

Some Juvederm Voluma / Cheek filler highlights:

Lateral support is important – at the level of the zygomatic arch.
Females have fuller frontal cheek projection it seems than males.
Anterior cheek injections can unfortunately reinforce the ptosis of the cheek.
Cheeks become lower and more medial when smiling with age – age 40 vs age 50
With volume loss in the submalar area – danger sign for “sausage” look with nasolabial filling
The nasal flare shouldn’t be hidden with injections – avoid medial cheek injections.
People who may look good in the frontal view, might not look good in the oblique view.
Aspirate when injecting deep with Voluma
With infection risk, there is granuloma risk.
He labels the zymatic arch with v1, v2, v3
v4 is the soft area of the cheek below v1, v2, v3.
v=voluma
avoid treating v4 first because of lack of bone support.
He uses a pull upwards and backwards = “pinch traction” so the skin cannot go back to it’s original tendency after placement of voluma
A discussion of J1, J2, J3, J4. These are Juvederm locations.
He talks about J4 as the vertical lip rhytids (lines) and talks about perpendicular injection to avoid elongation he says.
At Voluma injeciton site #4, there are many dangerous sites such as parotid gland, parotid duct, or the transverse artery. He uses a fanning technique for injections.
Look at patients on animation and when looking down. Animation meaning smiling.
Avoid voluma intra-orbit.
Malar crease – you can solve some of the ones which disappear when the patients smile.

Great presentation! There is always much to learn from other Voluma injectors.

Disclaimer: The above notes are not my thoughts. They come from a surgeon who works outside of the United States. They are interesting and I thought I’d share. The talk on Juvederm Voluma was brought to us by Allergan.

Latisse Pricing changes at Surgical Artistry Modesto, California

November 10, 2014Allergan, Botox, Latisse, ModestoLatisse, pricingCalvin Lee

Latisse pricing change to start 11/10/14

We are increasing the price of Latisse at our Modesto Surgical Artistry practice. But it’s only slight – I hope you will understand. We have tried to keep the prices low.

Original Size Latisse is now $100 per kit

The List price of Latisse 3ML is $125, our price is still better at $100.
Our pricing used to be $95

Large size Latisse is now $155 per kit

The List Price of Latisse 5ML is $180, our price is still better at $155 per kit
Our pricing used to e $145
The 5 ML kit, according to some of our Modesto Botox Patients, corresponds better to a Botox Cycle – which is every 3-4 months.

Our Latisse is authentic Latisse purchased directly from Allergan USA

It is not watered down, tampered, or shipped from another country outside of the USA.
Allergan is conveniently located in California.