32 years of full time work to START my Botox – Acupuncture – Surgeon career

How long does it take to become a doctor?

Quick answer:  For me it took me about 32 years of full time work to become a Surgeon / Acupuncturist / Cosmetic Physician.

I am a Board Certified General Surgeon with a past trauma career who assists in plastic surgeries and spinal cord stimulator / spinal pain pump surgeries.  I am also an Acupuncturist who injects Botox as an extension of Acupuncture.  Many of my Botox point selections are related Acupuncture points for migraine headaches and wrinkle prevention.  40% of my clinical time is spent at work is spent on Acupuncture, and 50% of my time is spent with cosmetic injections for Botox, Fillers, and Veins, and 10% of my time is spent assisting in surgeries.   In a usual clinic day, It is common for me to use 250 units of Botox, 7 syringes of dermal fillers, and see about 6 acupuncture patients.  Outside of my clinical time, I also spend a great deal of time as an administrator of Surgical Artistry – the combined medical office for myself and my wife, Dr. Tammy Wu, Board Certified Plastic Surgeon.

While discussing “life” with another surgeon friend. I sort of wondered why a chunk of my life seemed to be missing; I never caught on with today’s technology (I don’t have a TV or smart phone – yet as of 4/26/15). We calculated how many hours went into my training to become a surgeon/acupuncturist/Botox injector after high school. We came to the conclusion that for me it was roughly 58,000 hours! That’s more than 32 years at a full time job to do what I do as a surgeon/acupuncturist. Yikes – who does stuff like that?? (I guess I did).

Hours spent becoming a doctor.
Hours spent becoming a doctor in the USA.  This cut-off graphic doesn’t take into account fellowships and research time.  Please see the links below for more detail.

 

I did not make this really nice graphic above.

I just found this online which shows that most doctors spend 20 years in full-time work hours to do what they do. I was coincidentally calculating how many hours of formal training it took me to become a Surgeon/Acupuncturist/Botox injector: My conclusion is 32 years at a full time job (58,000) hours. Here’s the website source of the graphic: http://www.bestmedicaldegrees.com/salary-of-doctors/ (warning – it might depress some doctors)

The data for the info seems to come from this webpage: https://benbrownmd.wordpress.com/

Please visit my Modesto Botox home page.

Modesto Surgeons at work
My wife and I work together. Dr. Tammy Wu is wearing the splash guard over her glasses – smart!

 

BOTOX as part of Acupuncture?

Just realized I might be unique. I have known that I might be one of the first board certified General Surgeons to become an acupuncturist in America. And I am probably one of the first acupuncturists to inject BOTOX regularly. And I am probably one of the first acupuncturists who assists in Tummy Tuck surgeries and Face Lifts. So it is possible that I am UNIQUE as a Board Certified General Surgeon who became an Acupuncturist who injects BOTOX regularly and assists in Plastic Surgery – and lives in Modesto, California!

Many of the injection sites for Botox are the same as Acupuncture points

I am starting to see BOTOX as an extension of Acupuncture – most of the injection sites for Botox are acupuncture points – especially points for relieving stagnant/congested feelings in the head which include headaches, depression, sinus issues, allergies, etc.

calvin lee crop from hidden talent contentment health

Average number of units used per patient in my Modesto Botox practice

36 Units.

How much Botox do I need?

We are frequently asked at our Modesto Botox practice:  “How much Botox do I need.”  In fact, we get this question over the phone which makes it nearly impossible to answer.  But one way I thought of to answer this would be to look back in our records and see what the last 40 patients (anonymously) used and perhaps an average number of Botox Units used in these 40 patients would help someone reach an answer to this question over the phone.  The best way to get this answer is to schedule an appointment with me, the surgeon-Botox injector.

Botox Data

Special thanks to Jessica of the Surgical Artistry team who keeps track of this info.  This is practically a chart review.  This data shows a higher number than the last time we did this exercise back in 2012 where I came up with the answer that 29 units was the average number of Botox units a person used in my practice in 2012.  Now it’s 36.  Economy changes perhaps?  I think my most commonly recommended Botox number of units is 40-50 units of Botox for cosmetic Botox.

The answer to the AVERAGE number of units used per patient 2015:  36 Units.

36 units

How is this info valuable?

  • Other Botox injectors can compare their data with ours.
  • Economists can try to use Botox to predict trends in the economy.  Apparently plastic surgeons can predict the economy based on their patient load, etc.
  • And most importantly, patients can use this information to figure out what the average Botox cost might be.   Just multiply 36 by the cost per unit.  If it’s $12/unit then the cost of Botox for 36 units would be: $432.

Average cost of Botox would be $432 if the cost of Botox is $12/unit

But it’s good to keep in mind that many new patients consider 40-50 units very often.

Raw Botox Data

Here’s my most recent listing of Botox patients in Modesto.  Most recent 40 Botox patients – going backwards in time from most recent to 40 patients ago.

Patient #1 44 Units of Botox
Patient #2 62 Units of Botox
Patient #3 32 Units of Botox
Patient #4 50 Units of Botox
Patient #5 20 Units of Botox
Patient #6 32 Units of Botox
Patient #7 36 Units of Botox
Patient #8 12 Units of Botox
Patient #9 12 Units of Botox
Patient #10 20 Units of Botox
Patient #11 42 Units of Botox
Patient #12 56 Units of Botox
Patient #13 30 Units of Botox
Patient #14 32 Units of Botox
Patient #15 22 Units of Botox
Patient #16 20 Units of Botox
Patient #17 34 Units of Botox
Patient #18 36 Units of Botox
Patient #19 38 Units of Botox
Patient #20 24 Units of Botox
Patient #21 38 Units of Botox
Patient #22 20 Units of Botox
Patient #23 28 Units of Botox
Patient #24 38 Units of Botox
Patient #25 44 Units of Botox
Patient #26 40 Units of Botox
Patient #27 44 Units of Botox
Patient #28 34 Units of Botox
Patient #29 58 Units of Botox
Patient #30 24 Units of Botox
Patient #31 56 Units of Botox
Patient #32 44 Units of Botox
Patient #33 42 Units of Botox
Patient #34 36 Units of Botox
Patient #35 20 Units of Botox
Patient #36 50 Units of Botox
Patient #37 44 Units of Botox
Patient #38 40 Units of Botox
Patient #39 52 Units of Botox
Patient #40 20 Units of Botox

Data collected on 4/20/15

Have fun with the Botox data.

Modesto Surgeons at work
Dr. Tammy Wu and Dr. Calvin Lee operating in Modesto, California

 

Which Micro Cannulas do you use for Dermal Fillers?

Why do I use Microcannulas?

Micro-cannulas are mini flexible versions of liposuction cannulas borrowed over from Plastic Surgery.  This could be a long discussion but the brief version of my reason is for: Safety and Results

  • Safety from injuring nerves.
  • Safety from injuring blood vessels.
  • Safety from injuring glands and ducts.
  • Better Results: I can get a smoother and wider fanning result.
  • Better Results: I can usually have less bruising with my patients.
  • Better Pain management:  Patients usually tell me that there is less pain with this technique.
Graphic from DermaScuplt
Graphic from DermaScuplt

Drawbacks to using blunt tipped micro-cannulas?

  • Sometimes it takes more time.
  • It is more costly for sure.
  • It is more complicated.
  • There is a definitely a technical learning curve.  I can say that I am much more adept at this now than compared to two years ago.

What are the differences between brands of micro-cannulas?

  • Price
  • Flexibility of the cannula
  • Location of the opening: some are closer to the tip and some are further back.
  • Packaging of introducer needles with the cannula – some come with the cannula, some come separately.  (Like batteries sold separately).
  • The presence of markings on the hub of the microcannula “needle” which shows the directionality of the opening at the tip.

What I use for micro cannulas

I have been using micro cannulas to inject dermal fillers for several years.  There are differences between the brands but I haven’t yet decided which ones I’d like the best.  I’ve used Magic Needle and Dermasculpt associated with CosmoFrance.  Right now I am mostly using Dermasculpt.  I have the 25G – 2 inch microcannula which I buy several hundreds of these at a time.  I’m starting to use this as my all purpose cannula for Cheeks, Tear Troughs, and Lips.  I have somehow found that this cannula is more comfortable for the patient and the 2 inch reach is very nice to have.  The other cannula I use from time to time is the 27G – 1.5 inch.  This is my usual cannula for tear troughs and for shorter lips.  But my thought process changes from time to time regarding which one I prefer.  I like the stiffness of the 25 gauge microcannula.  There are many options and I think one has to try several of these to see if they are worthwhile.  One should check often with their price policies too, as I got caught once with a surprise in their pricing of microcannulas because I was using an older order form.  I wasn’t too happy when I found out about the pricing / policy changes.  At that point I needed to tell them about a bent 25 guage 2 inch microcannula which I received in the past.  I have only received one bent (still in the package).  If I have time, I’ll post the picture of the bent one.  Regardless the cannulas are great, I don’t have a need for the directional marking of the side opening – that isn’t a feature that is currently useful for me.

I use Voluma, Juvederm, Radiesse and Belotero with all these cannulas.

I hope these ramblings about micro-cannulas for dermal fillers are helpful.  For me they have been a great addition to what I do with Botox and Fillers.  And I should add that I still inject directly with the sharp needles which are supplied in the dermal filler packaging.

Next, I probably need to probably write about a question a Botox trainee asked me recently:  “Which do you inject first, Botox or Filler, if it’s going to overlap in location?”  I have some thoughts on that.  Till next time

Calvin Lee at Desk smiling ss DSC01401

Cities near Modesto, CA

This would be useful for things like marketing campaigns on FaceBook.   Or if someone were moving to Modesto and wanted to see which cities were nearby.  etc.

Cities Near Modesto, CA

  • Salida
  • Riverbank
  • Oakdale
  • Hughson
  • Ceres
  • Ripon
  • Escalon
  • Waterford
  • Denair
  • Turlock
  • Delhi
  • Hilmar
  • Patterson
  • Manteca
  • Lathrop
  • Livingston
  • Copperopolis
  • Jamestown
  • Sonora
  • Tuolumne
  • Groveland

A Listing of Botox Injectors near Modesto, CA

Of course, we hope that you would pick us (Surgical Artistry – Dr. Calvin Lee and Dr. Tammy Wu) to perform Botox.

 

What size / kind of Botox refrigerator would you recommend?

I like to help other Botox injectors and I just got this question on my email today.  I thought I’d share and hopefully help others

Question: How big of a fridge will I need for Botox? Which one do you recommend?

Answer that I emailed back:

Fridge Size:  I use a dorm room sized fridge.  It’s half height fridge which comes up to my waist.  You don’t really need anything big at all for Botox.  Small works just fine.

You could even get a square shaped mini fridge.  But I don’t want to bend down all the way to the ground.

You don’t need a freezer for Botox.  They make refrigerators without a freezer.  This could potentially save electricity and some hassle of freezer issues.  I think if I were to do it differently, I would get a refrigerator without a freezer.  The ice in there messes up the temperature sometimes.

Regarding temperature regulation.  I have two thermometers – one is digital (uses batteries) and broadcasts the temperature, and the other is just a plain analog thermometer (no batteries).  It’s important to keep the temperature of the Botox within the guidelines suggested by the manufacturer.  But sometimes, it’s nice to have a freezer section for the ice packs.  These would be ice packs to hand out to patients for bruising.

I hope this info helps.

obagi-blue-peel-radiance-modesto-california-dr-lee-holding-fan - Copy

www.InjectionArtistry.com – my homepage for my Modesto Botox Practice.

Why do I love what I do?

Featured Modesto doctor of the day March 11, 2015

If you have FaceBook, you can click on this link to see it directly on Doctors Medical Center’s page on FB.  And consider leaving a comment under the video for me!  Thank you!

I was asked to do a brief interview for a publicity event for Doctors Medical Center.  I wrote down what I was saying (hopefully not too much mumbling):

 

Here’s the transcript:

I am Dr. Calvin Lee.  I am a surgeon and I focus my practice on whole body acupuncture and cosmetic injections of Botox and fillers which complement our plastic surgery practice, Surgical Artistry, with my wife Dr. Tammy Wu.

Why do I love what I do?

Beauty and health for my patients is my goal.  Beauty on the outside is health on the inside.  My purpose is to provide educational advice and technical procedures at the highest level possible for my patients.  In addition to feeling good about helping others, it is extremely satisfying for me to be a surgeon especially since I’ve always loved technical dexterity challenges.  There is certainly an abundance of surgical skills used in facial filler implantation, Botox strategy, and acupuncture needle manipulations.

It is a privilege to be here in Modesto, California.  It is a privilege to have the trust of patients.  And it’s a privilege to wake up each morning with a purpose.

Doctors Medical Center Modesto2013 samm mile marker - 22 full - surgical artistry2 - cropped

 

If you have FaceBook, you can click on this link to see it directly on Doctors Medical Center’s page on FB.  And consider leaving a comment under the video for me!  Thank you!


 

Facial Vein Lasering – an adjunct to Botox injections at our Modesto Office

I wrote this email to a Botox patient of mine asking some general questions regarding vein treatment.  I thought I’d share the email here

This is Dr. Calvin Lee responding to your email.

Thank you so much for writing to me. I can’t remember your capillary on the cheek. But I do know that my prices haven’t changed since 2006. Most patients do get away with $50-100 per facial vein lasering visit. I charge $1 per pulse of the laser – per “zap” so to speak.  My laser is a 940nm wavelength diode laser and is made by Dornier, based in Germany.

Regarding your question about sunscreen:  The sunscreen should have zinc in it. The SPF doesn’t matter as much.  But I do care about the zinc. Our office has my approved zinc based sunblocks which cost about $35-50 for a bottle/tube of the sunscreen.

I would like about 2 weeks before and 2 weeks after the facial vein lasering for diligent sun-protection with the zinc based sunscreen and perhaps as much sun avoidance as reasonably possible. But the sun – specifically UV-A light is what causes much of the aging and capillaries on the face – thus sunscreen with zinc could be considered all the time.

Of course, it’s my preference that the patient gets the sunscreen from our office so that I can be sure we have the right formulation for adequate UV-A coverage. But there are Zinc based sunblocks in the stores for about $12 per tube/bottle. These tend to be on the thicker/grimy feeling side than the $50 sunblocks. Life guards seem to like the really thick white paste which is available also in the stores – but most of our patients aren’t into that pasty look – but that’s still acceptable.

As for number of visits, most patients need about 3-5 visits for facial capillaries spaced about 2 weeks apart. However, there are some lucky patients who only need one visit.

I hope this info helps and I hope to see you soon!

– Calvin Lee

2013 samm mile marker - 22 full - surgical artistry2 - cropped

Does BOTOX freeze sensation?

Botox freezes the action of muscles but does it freeze feeling?

I got this question in my Modesto Botox practice about three times this past week.  This gave me the spark to write about it a bit in my blog of Botox Topics.

surgical artistry full page ad never boring
Our ad in a Modesto Magazine back in 2013.

 

Botox does not freeze sensation – it does not make you “numb.”

As you can probably tell from many of the questions I’ve received before, that answers are not always that simple.  If I had to summarize/simplify the answer to the question of Botox making you numb – would be “no” – Botox does not make you numb.  Numb in the sense of getting of numbing shot at the dentist, etc.   However, it is believed that Botox may play a role in diminishing pain sensation – such as those felt in migraines.   Thus Botox most likely doesn’t change your normal sensations, but it may diminish excruciating pain sensations.  As we know from our studies of neuroscience, different sensations such as fine touch, coarse touch, temperature and pain have different pathways in our nervous system.

Botox does not make you numb.

I hope this answers the question.

Please see your doctor in person for a detailed explanation.  There is no medical advice intended here, just a general discussion.

2013 samm mile marker - 22 full - surgical artistry2 - cropped

Restylane or Belotero under the eyes

A tear trough filler question (under the eyes)

A patient recently called me (who lives relatively far away from Modesto) to see if I can give her a second opinion regarding restylane under the eyes.  She has a local injector (local to her) who wants to inject restylane under her eyes and she wanted to know why we don’t do restylane under the eyes.   Here are some thoughts I had.

I would tell her that I think that any product could work well under the eye in the tear trough region with a skillful injection artist.  The more important factor is the artist who injects under the eye.  There are so many things you can do with a filler (off-label FDA) – such as dilute the filler or add lidocaine/epinephrine or inject deep or use a cannula, etc.

The filler product is like the violin without the violinist.

Restylane in my hands is excellent under the eyes – I have even used it before quite frequently and was very happy with the results.  I personally prefer Belotero because in my hands currently because it results in a smoother contour.  The edges are not as aparent to me if I have some superficial injections.  My technique is usually to inject deep.  But some patients need a thicker fill under the eyes, and thus they would be better served with Restylane – which also lasts longer than belotero under the eyes.

Because of the smoother contours, I prefer belotero under the eyes rather than Restylane.  This is only a personal preference and it is my current preference which can/will change with time and further experience and further feedback from patients.

The reason I don’t carry Restylane, it’s because it’s a product that is very similar to Belotero and Juvederm.  Similar enough that I don’t really see a point in having it in my practice, and I have received poor customer service from the Restylane company in the past, and thus I chose not to carry their products for the past 6 years.

Juvederm under the eyes, in my opinion causes a bluish hue (tyndall effect) in the hands of many surgeons/doctors/injectors including myself.  I have rarely experienced this problem, but because other surgeons have reported this more often than I’d like to hear.  Thus I tend to stay away from Juvederm for under the eyes.

The under eye filling with any filler is consider off-label FDA usage, and thus there won’t be a ton of information about this because companies are technically prohibited from advertising off-label FDA uses of products.

I think she would be fine getting Restylane if she trusts her injector.  I am not able to comment on the skills of other injectors because I don’t know how they inject.   Please continue to see your injector in person for detailed information.  I would welcome another visit to our office to continue the conversation if that were convenient.

Disclaimer:  The above is medical information.  It’s not intended to be advice.  Please see your doctor/injector in person for personalized advice.