Category Archives: Botox Injectors

Dexterity for Botox Injections – Chopin?

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

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

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.

Medical Botox vs Cosmetic Botox, differences?

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 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

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?

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

Botox Delivery – what it looks like in a box.

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.

What is Botox FDA approved for cosmetically?

Glabella and Crows Feet

As of the writing of this Botox blog which is November, 23, 2014.  Cosmetic Botox on the face is FDA approved for use in the glabellar complex and the crows feet.  The glabellar complex is sometimes known as the “11’s” or the frown lines between the eyes.  It is made up of more than one muscle – thus it’s a complex of muscles.  And the crows feet, sometimes called fish tail, area of the eyes is the lateral wrinkles to the sides of the eyes.

How about other areas of the face for Botox Injections?

These two areas constitute the FDA approved areas for facial Botox in a cosmetic sense.  There are other areas on the face – in fact many other areas – which have not received FDA approval, but these have been commonly done for the past decade.  And Botox injections in these other areas of the face is considered off label FDA for Botox usage.

Getting Botox in Modesto, CA

Please consider visiting your Botox injector for one-on-one discussions.  If you are near us, consider visiting our Botox practice in Modesto, CA.  And if not us (Surgical Artistry), then there are these other places in Modesto to get Botox.  The Botox listing of injectors is not an endorsement; it is just a courtesy listing of other practices in Modesto who offer Botox.

Belotero Balance Injection Technique – a unique method

Belotero Serial Puncture or Serial Killer?

Belotero offers a dual cross-linking process of the hyaluronic acid which offers a natural-even integration into the dermis.

This Belotero page is for Botox/Belotero injectors.  And I’ve decided to call this Belotero injection method the “aerial dive bombing technique.”

I have my own version of this technique, but it’s more of a “submarine missile attack” (more on this someother day).  Actually I personally think that my idea is superior – well at least in my small hands.

Injection technique with BELOTERO BALANCE is simple and accurate

When injecting using the serial puncture technique, it is important to remember the following:

  • Penetrate the dermis just until the bevel of the needle is hidden.10
  • The needle’s bevel measures 0.75 mm in length.*
  • Typically, the dermis measures approximately 1.8 mm in depth.
  • Once the bevel is buried, filler can then be deposited accurately within the dermis.
  • Then repeat the process multiple times per wrinkle line.

*Bevel measurement based on the needle included with the BELOTERO BALANCE syringe kit.

Superficial injection of Belotero works!
Superficial injection of Belotero works!

For Killer results, consider the techniques above

and consider visiting us at our Modesto Surgical Artistry Botox Injection Center by Calvin Lee, MD