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.
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.
By using these statistics, I am hoping that other Botox injectors will find them useful, and I will also use them to find ways to improve. Every Botox patient is unique and special to me – the statistics here is a look at my practice, not a look at an individual patient.
“Measure it to Improve it”
But for me, to be an excellent surgeon, it is my belief that my best surgical outcomes come from consistent practice, a good volume of injections, along with diligent purposeful thoughts of improvement. Thus I keep track of many things in my practice of medicine. These statistics are just one of them. There’s a saying which I put to practice from my surgery residency days: “You can’t manage what you don’t measure.” Although the phrase was first presented to me as “If you can measure it, you can improve it.” I prefer thinking the second iteration. It just sounds more positive to me.
Number of Botox visits to us in Modesto, CA for the year: 1009. This is up from last year where I had a total of 724 visits. (there were still 2 more days left in the year when this was written and compiled), so these numbers will be even higher.
503 different patients were seen for Botox in 2014. This is up from 374 last year.
Average number of patients per month: 84 patients per month.
Total number of Botox units used per year: 34,234 Units.
Dermal syringes injected over the year: 443 syringes of filler! I had no data on this last year. I do not have data on which type of syringe was used (ie. Belotero, Voluma, Radiesse, or Juvederm).
As before, about half of my time is reserved for Acupuncture.
Average number of Botox units used per session.
Average number of Botox units used by patients per visit is 33.9 U.
Like using fire to fight fire. Well, probably more effective than that. Botox injected in other parts of the muscle or an opposing muscle might lessen the undesirable original Botox effect.
Injecting Botox into the antagonistic muscle
But sometimes, Botox effects can be offset by additional injections of Botox into the opposing muscle (antagonistic muscle). Most of the structures in our body are affected by muscles on a push and pull balance. Botox affects that balance, but we can again re-establish a new balance point by working on the opposing muscle. However Botox only works to relax a muscle. For example if an eyebrow looks like it has dropped, then we can further inject Botox in the muscles which normally depress the eyebrow such as the corrugator muscle or the obicularis oculi muscle – this could help spring the eyebrows back up.
Injecting Botox into the compensatory part of the same muscle
Another way to help with Botox problems is the consider relaxing other parts of the same muscle. Sometimes we get a particular “surprised” look in the eyebrows with Botox. This is the look where the eyebrows on the side go way up when we try to raise the eyebrow. Sometimes this is called the “M” look or the “Spock” look and there are other names to this such as the “Mephisto” look. I think the Spock look explains it quite well – with the pointed eyebrows. This is usually caused by an unequal weakening for the frontalis muscle (forehead muscle) at the central component of this muscle. When the central part of the frontalis muslce is weaker the lateral part tries to compensate by becoming eve more active. We can compensate for this by injecting the lateral parts of the frontalis muscle with more Botox.
What about eye drops for lid ptosis (droop)?
If there is a eyelid droop, there are certain medications that can help the lid raise. But there are other side effects associated with this technique. I hope to come back to this topic in another blog.
Time heals Botox
With time, Botox effects wear off. Fortunately some of the ill-effects of Botox are due to drifting of small quantities of the injected Botox. Thus a few weeks might be all it takes for some of the effects to wear off.
The info here is just for informational discussion
This info isn’t meant as some sort of personalized medical advice. Please see your Botox doctor or injector in person to have a discussion regarding Botox and any need for Botox correction.
My Botox practice is in Modesto, CA. I respect Botox injections as challenging procedures. I’ve had my share of Botox problems and need for corrective Botox solutions. I look at each of these Botox problems as an opportunity to improve for my Modesto, California patients.
Quick answer? 8-12 units of Botox per side. Because we usually want to treat both sides of the eyes, we would double that number and that would be 16-24 units.
8-12 units of Botox per side? (16-24 units of Botox)
Yes, about 8-12 units of Botox could be injected per crows feet (left or right). However, everyone is different. I have done more and I have done less. This depends on Male vs Female, young vs old, and of course on personal preferences and experiences with Botox.
Another consideration is eyebrows. Eyebrows can also be lifted with a certain style of crows feet injection, or even an extension of the crows feet injection. Women and men have different eyebrows. Women have more of an arch, which complements a certain style of crows feet Botox injections – these injections hug the eye a bit closer – especially toward the eyebrow region.
And yet another consideration is swelling under the eyes. Sometimes too much injection in the crows feet can lead to temporary swelling under the eyes. These are things to discuss with your personal Botox injector – preferably in person and at an appointment (face-to-face).
What to do for really deep Crows Feet lines? Static lines.
Fillers may be an option. I like to use Belotero as a filler for crows feet if needed. Juvederm could also be used, but in my hands it tends to be a little bit bumpier. But it is usually my preference to try Botox alone first.
That’s the beauty of Botox. It is customizable.
Everyone will have different preferences and have a different response to Botox. It becomes a science and art – this injection of Botox.
I hope I helped to answer the question of how many units of Botox are needed to help with crows feet around the sides of the eyes.
Let’s say we just wanted one number to be the answer. Perhaps hang on to the number 20. It’s a nice round number, and it’s between 16-24 units of Botox (for both sides). I would say that 20 units of Botox is a nice treatment for many people’s crows feet!
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.
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
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.
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.
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.
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.
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.
Listing of my Botox Blogs in reverse chronological order
I figured, I should start by listing my blog posts, then select the best out of it and post them in BOLD. I’m writing this to you from Modesto, California.
I discovered that there are a lot more Blog posts than I had ever remembered. This is a work in progress – not done yet. I am just linking these pages by hand. There’s probably a quicker way. But this works for me too. It allows me to practice typing!
Typing abiliity related to Botox injections? Showing off a bit of typing speed. Typing this blog helps my typing speed too. Although I’m really not trying that hard to type with tension or even that fast for that matter.
Dexterity for Botox injections – Chopin? Chopin Etudes for exercising those delicate fingers required for Botox injections. You can take many things to a higher level. This is my attempt as a Botox injector. This isn’t a blog about getting Botox in the fingers of pianists. That might be another topic another day.
Botox mailing list growth – I use mail chimp. This mailing list is more than just Botox, it has plastic surgery patients too. Conclusion – it’s about 47 patients added per month to the mailing list for all of Surgical Artistry. The post title is a bit misleading.
Cosmetic procedures besides Botox. I wrote this because I had patients who were surprised that I do other things besides Botox. So here’s a few other things which I do which include Asclera, Belotero, Derma Pen, Obagi Blue Peel Radiance, Voluma.
Best cosmetic Surgeon Award. Stanislaus’ Contentment Health Magazine had a first ever voting in the community of “bests” and we were given this award for Best cosmetic surgeon. Congratulations to everyone!
Botox in Modesto – where to get Botox? This is a list of 36 possible places to get Botox in Modesto. It seems that Modesto is Botox Central! I’m sure the list will continue to grow. I used lists from Find-a-provider from Botox, Dysport, and Xeomin. Just compiled this as a response to a question which I received in my office in Modesto, CA. The questions I receive are often inspirations for Botox blog postings.
Attributes of Highly Effective Botox Injectors. I decided to stalk famous injectors as if they were celebrities. For the past 2 months. I went around the country to participate in lectures, courses and conferences regarding Botox, Juvederm, and other cosmetic injections. I also made it a point to personally get to know some of these injectors.
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.
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.
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.
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.
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.
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).
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.