My personal Modesto Botox injection statistics 2014

Botox, Juvederm, Modesto, Radiesse, Voluma, year in review

34,234 units of Botox injected & 443 syringes of dermal fillers implanted in 2014.

2014 collection of empty Botox bottles
2014 collection of empty Botox bottles

Much of the data here comes from my own recording of each day’s usage of Botox.  I have Jessica to thank for entering this data every day at our Modesto plastic surgery office, Surgical Artistry.

Every patient is unique

Patients are not statistics.

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.

2014 Year End Botox Statistics

  • 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.

    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.

Average number of Botox units used per session.

Average number of Botox units used by patients per visit is 33.9 U.

Background in general for Calvin Lee, MD

Calvin Lee, MD
Calvin Lee, MD

Written by Calvin Lee, MD

Botox Statistic Links

Collection of empty Botox Bottles

Botox

In one of our private waiting rooms at Surgical Artistry, I have displayed a bowl of empty Botox bottles used up in 2014. I’m happy to report that 503 patients helped me use up these bottles of genuine Botox over the course of the year. However, I have two more days of the year to go! My wife, Dr. Tammy Wu – Modesto Plastic Surgeon, says I am a hoarder (hopefully not compulsive).

I am very thankful for all those who have trusted me with their cosmetic injections.

2014 collection of empty Botox bottles
2014 collection of empty Botox bottles

The framed print in the back is from the Modesto Symphony Orchestra where we had sponsored a season.  The tray is from the Bombay Company.  This link shows the tray which can be purchased online.

I will probably need new ideas on where to store these Botox bottles in the future.  Perhaps it will soon be time to throw them out.

Related link: How is Botox supplled?




How is Botox Supplied in the USA?

Allergan, Botox, Modesto

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

 



Can Botox be reversed?

Botox, Botox Complications, Juvederm, Modesto, ,

Can we undo the effects of Botox?

Unlike hyaluronic acid fillers such as Juvederm, Botox cannot be reversed by injecting another agent into the same area.

Using Botox to fight Botox

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.

All the topics mentioned here is considered off label FDA usage of Botox.

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.

Modesto Piano Playing – dexterity challenges

Modesto, surgical dexterity, ,

A drive through car wash in Modesto – video

A Botox injector is should have some time off.  Not only to have time to work on a Botox Blog, but to do other fun things…

Driving through the first few minutes of the Modesto Sparkles Car Wash on Coffee Road. It’s in the northern part of Modesto, and it has a PET WASH component too. I just got this Patriot CT7 camera made in Taiwan, and this is the first video that I’ve processed. I think this is like a Go Pro camera, but I’m not sure, because I’ve never owned a Go Pro camera.

This is my first day with this Patriot CT7 camera, and I just noticed that there is a date/time stamp which I hadn’t set yet – thus the date and time is wrong.

Modesto Sparkles car wash video with Patriot CT7 Dash Camera

But it is an exercise in surgical dexterity – the background music is very technical

For fun, I’m sharing this on YouTube.  Background music is Chopin’s Minute Waltz which I played a few months ago.  I’ve been having this obsession with Chopin.

I’m still working on improving upon it and I actually feel that it getting better – still.

My Day Job: A Botox injector and a bit more

I work in Modesto, CA as a BOTOX injector, acupuncturist, and surgeon. I assist in many plastic surgical procedures with my wife, Dr. Tammy Wu, Board Certified Plastic Surgeon.

 

Accurate, precise, deliberate dexterity for typing and Botox

Botox, Botox Injectors, Modesto, Piano for Dexterity, surgical dexterity, , ,

Typing, Surgery, and Botox – all demand dexterity

I have always valued accurate, precise, deliberate dexterity. Typing is one of those things that demands a certain amount of dexterity.

An incredible Christmas gift

I got a Christmas gift from a relative when I was probably around 9 years old; it was a how-to-type book. I remember devouring that book up with our family’s type-writer in the basement. Yes, an old fashioned type-writer. The keys got stuck, and I used much ink practicing every page in that book. I think it was one of the best gifts and best memories. Today, I want to thank my relatives for that awesome gift about 35 Christmases ago. I think it helped lead me to a life where dexterity was of utmost importance – especially as a surgeon and Botox injector.

121 words per minute screenshot Calvin Lee Modesto California
Online typing test

Excuses, excuses, excuses

If I could make excuses, for the result above (121 words per minute) I’m typing on an uneven surface, at an unreasonable height. One of these days, I’ll try to find a stable surface to type upon – or a different keyboard for that matter – one that doesn’t squeak and doesn’t bounce around, and I hope to have an even better result. I believe that the height of my typing speed was back in high school, and it’s been somewhat slowed down on purpose because of respect for carpal tunnel syndrome -which I somewhat suffered from during my Surgery training years. My carpal tunnel is just about gone, but I know part of that was from watching the way I type. So I typed this whole paragraph probably at 100 words per minute which is a relaxed pace for me.

– Calvin Lee, MD
Performs surgery and injects Botox in Modesto, California.
Also other things with needles:  Voluma, Radiesse, Juvederm, Asclera (vein), Acupuncture,

Disclaimer: Be careful typing.  It can cause problems if there is too much strain.  There is no medical advice here.

How many Botox Units for Crows Feet?

Belotero, Botox, BOTOX Questions, Crows Feet, eyes, Juvederm, Modesto,

How many units of Botox are good for treating the crows feet around the eyes?

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.

Summary

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!

Please feel free visit our Botox practice in Modesto.

 

 

Bumps after Botox?

Botox, Botox Anatomy, Crows Feet, Modesto, Modesto Botox Blog, ,

“I have horns!”

Horns right after Botox injections?   I heard this exclamation after a Botox injection today.  And I thought to myself – what a great topic for my Modesto Botox Blog.

They aren’t horns, they are bumps.

Well, that sounds almost as bad.  But these bumps are from the injection of Botox under the skin and sometimes into the muscle (depending on the location of Botox injections).  Botox is reconstituted as a liquid (from a powder), and then injected as a liquid in these locations.  Liquids will naturally take up some space, and they look like little bumps.  Probably a little bit bigger than those TB testing shots that we get from time to time in our forearms.

The bumps usually go away in about 15-30 minutes.

Fortunately the Botox bumps usually go away in a few minutes.  Sometimes by the time a patient drives home.

The Botox bumps I’m discussing in this blog are the ones that can be seen immediately after a Botox injection.  I’m not discussing bumps that occur hours after or days after the Botox injection.

What else could it be?

If these Botox horn or Botox bumps don’t go away, it could be something else like a hematoma.  A hematoma is a collection of blood – from bleeding, which could happen after injections with a needle.   And the collection of blood could cause the bump.  Hematomas will also resolve with time, but ideally, I try to avoid large hematomas by observing the injection site during and after my Botox injections.  Sometimes hematomas can’t be avoided.  But I would try to minimize them.  A smaller Botox needle might help, too.   Hematomas usually will result in bruises which will also resolve.  At least this is what I do in my Modesto Botox Practice.

Below is a picture of me, not a picture of Botox bumps.
Calvin Lee, MD
Calvin Lee, MD
Disclaimer:

If you haven’t looked directly at my crows feet or glabellar lines – in person and at my office – then we have not established a formal doctor-patient relationship.  Please see your own doctor.  There is no medical advice here, just medical information for general use – nothing here is directed at any specific person.

Botox Vials

Botox Vials

 

Juvederm

Actavis, Allergan, Botox, Juvederm, Modesto, , , , ,

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

Actavis, Allergan, Botox, Juvederm, Latisse, Modesto, year in review

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