Question about Dentists and Botox

I got this Botox question today and I thought I’d share:

I have a question after reading your list of injectors in your area and out of curiosity why would a DDS need to do Botox injections?

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My Botox Answer:

Hi!  GREAT question!! Some of the best injectors of Botox I know in this world are Dentists!! They know facial anatomy very well. But one of the biggest roles that Dentists play with Botox is injections for TMJ / Jaw pain. Some of the injections are outside the mouth and some of those injections can be inside the mouth. So out of the concept of doing their jobs very well, many dentists have Botox in their stock, and it’s probably convenient for them to consider injecting cosmetic Botox in addition to Botox for pain. But I think due to the cost of Botox and short acting efficacy of reconstituted Botox (meaning it doesn’t stay fresh for a long time), it probably doesn’t seem to be financially a worthwhile thing to do for Dentists (and surgeons for that matter). So most Dentists and Surgeons choose not to focus on Botox at work. I do, because it compliments my wife’s practice very well, and I’m all for supporting my wife’s plastic surgery practice. But if a dentist or surgeon wanted to inject Botox – I think they would do a very very good job, especially if they made it their primary focus at work for whatever reason. I hope this helps answer the question.

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Why did I pay double price for OBAGI?

I got this question today:

“I purchased Obagi 7 piece Nuderm kit and 0.05 tretinoin cream from you guys for 600$ and online it is anywhere from 250 to 330 dollars. Unfortunately I did not do any research prior to purchasing but I want to know why I have paid double the price”

This is a good question.  Thank you for asking and giving me an opportunity to answer.

First, apologies for any confusion and it is always my goal to provide best value.  I try to subscribe to the idea that price is what you pay, but value is what you get.

Second, I don’t personally have any experience ordering Obagi from any websites.  Thus I can only comment on our own Obagi products on our physical shelves.

Third, if for some reason the pricing makes no sense from us.  Just return it.  No problem.  Hopefully we’ll all be happy – that’s always my main goal is to have happy patients.

Here’s what I know:

  • $407.70 is the actual price of the Nu-Derm Obagi kit from our office.  This is the original Obagi kit, not the FX kit (which removes the prescription products)  The full size Obagi Nuderm set has 7 products and has a list price of $453.00 plus tax.  We have it priced at 10% off all the time (as of the writing of this blog).  Thus our price is $407.70 plus tax.  (as of 8/2/15 – prices subject to change)
  • 10% off from us on Obagi.  We offer 10% off all the time and sometimes at special events we offer 20% or 25% off.  I can definitely see that the internet might offer 20% off or even 30% off?  But for my medical office to carry Obagi, I feel that it isn’t worth my effort to have more than 10% off all the time for Obagi.  Otherwise, I would just encourage my patients to buy Obagi elsewhere.  But I carry Obagi, so I can be responsible for the outcomes and ensure good results.
  • Free OBAGI follow ups with your MD or our office staff.  I’m hoping what accounts for a better value at our physical location (Surgical Artistry, Modesto, CA) is that we will take the time to explain the products and adjust the usage of the products.  Patients follow up with me (Dr. Calvin Lee) or with Dr. Wu.  Most of these follow ups have no added charges.  I think visits to the doctors office has some value – especially if we can make continued adjustments to the usage.
  • Easy Returns / exchanges.  I also have a hassle free return policy on the patients who purchased Obagi after talking to me about it (Dr. Calvin Lee).  I would say that if you feel the internet is a good purchase, then just return the products to us.  My goal of having Obagi in the office is to help our patients look their best with Botox and Juvederm.  Botox and Juvederm (and now Kybella) are my primary passions in the office.  OBAGI is an adjunct.
  • REAL OBAGI.  We know that our Obagi products are genuine.
  • Doctor’s Presciption for Obagi is included when purchasing from me (Dr. Lee).  We also know that we are following the rules regarding prescription products.  Clear and Blender which are two of the products in the normal kit and some kits have SunFader.  These three products require a prescription from a doctor.  I think there are some foreign countries where a prescription isn’t needed for these products – I am not sure.
  • Travel Size Nuderm Kit?  Sometimes people want the Travel sized Nuderm Obagi Kit.  But we don’t currently carry that.  I don’t have the pricing on that kit, but I believe that it is in the $200’s.  Sometimes the internet pricing is confusing and they might be touting the travel size rather than the full size?
  • Because there are 4 additional key products which we sometimes add to the kit, sometimes people think they paid $800 for the “kit”.  But the Nu-Derm full sized kit at our office costs $407.70.  Then you have to add these other products – which we also consistently take 10% off.  There are four (4) add on products that people like to get.  For our office, we take 10% off the list price which we revealed below
    1. Elastiderm eye cream ($112.  10% off would be $100.80)
    2. Tretinoin 0.05% or 0.10% – ($91-$102 depends on strength)
    3. Vitamin C serum 15% or 20% ($93 – $115)
    4. Professional C Peptide Complex Serum ($113)

But I do agree that the internet has great prices, and I myself have bought many other products from the internet.  But I haven’t purchased Obagi over the internet and I wouldn’t be a good person to ask about how that would go.  These would be my own personal concerns if I were to purchase them (and other skin care products) on the internet.  The pricing is so good sometimes that the prices are cheaper than if I bought it wholesale directly from Obagi:

  1. First, I am concerned about the prescription legality issues.
  2. Second, I am concerned about the genuine vs. counterfeit versions.  Especially if the prices are lower than my own wholesale pricing directly from Obagi.  We have had several experiences with patients who have brought in counterfeit Obagi and patients who have suffered damages from counterfeit “Obagi” products.
  3. Third, I am concerned about return policy.
  4. And Fourth, I am concerned about the ability to follow up with a skin care professional and make continued adjustments if needed – especially if the products require prescription.

Those are just my own hurdles if I were thinking about purchasing skin care items (ie. Obagi) over the internet.  I have to admit, that I have done for other skin care lines for myself (I have bad skin and am guilty of experimenting) and I will admit that I’ve learned (for myself) to regret it.  I also purchased a washer and dryer over the internet – that was a BIG mistake for myself.

I will also agree that sometimes our prices “seem” high – this goes for Plastic Surgery, Botox, Veins, etc.  But with a higher price, I hope to offer higher skill (such as better advice), follow up, better safety, less pain (in this case, less pain in the return process), better attitude from us, better communication and in the end, better results.  That’s my dream practice is to offer these things at the highest level.  I’ve built this practice of ours on highest quality with best value, not on lowest price, and I hope it’s worth it.

Thank you for reading about the Surgical Artistry version of the Obagi Nu-derm Kit.


 

Please feel free to visit my other web pages:

 

Did I go to high school in Modesto, California?

Someone asked me on my BOTOX FaceBook (not a super popular page, I only have 596 likes): “Did you go to grade school or high school here in Modesto?”. I’ve gotten this question a few times already. I wonder if they are wondering if I am another person with the same name.

Here’s my answer on FaceBook: When I came to Modesto, I had no connections. I didn’t grow up here nor did I have relatives that I knew about nearby. Same for my wife Dr. Tammy Wu. I grew up in New York City and I went to school in the suburbs there!! I picked Modesto to settle down for our medical practices because it seemed like a place that needed good doctors. It was somewhat random when I picked this place. But much of the decision making had to do with my Trauma Surgery career. There were plenty of trauma with car accidents and stabbings in this town for some reason. After a few years here, we decided we liked it enough to stay. Thanks for asking!!

I think I went into some more detail about how we picked Modesto in my Modesto Botox home page.

Thank you again for asking.

 

Kybella news: Allergan to aquire Kythera

Allergan to take over Kythera who makes Kybella for the neck.

Here’s an open letter I got from Allergan (the makers of Botox):

June 17, 2015

Dear Aesthetic Provider:

I am delighted to share with you that on June 16, 2015 Allergan and Kythera Biopharmaceuticals reached a definitive agreement under which Allergan will acquire Kythera. Kythera, headquartered in Westlake Village, CA, is focused on the discovery, development and commercialization of novel prescription aesthetic products.

The acquisition of Kythera would immediately enhance Allergan’s facial aesthetics portfolio with the addition of KYBELLA™ (deoxycholic acid) injection, the first and only approved non-surgical treatment for contouring moderate to severe submental fullness commonly referred to as a double chin. KYBELLA™ was approved by the U.S. Food and Drug Administration (FDA) on April 29, 2015.

This combination continues Allergan’s rich history of bringing innovation to you and your patients. KYBELLA™ will join a facial aesthetics offering which includes BOTOX®, JUVÉDERM®, VOLUMA, LATISSE® and SKINMEDICA providing you with a more complete offering of products to your patients. In addition, KYBELLA is a pivotal entry point for expanding the use of facial aesthetic products in men.

We are committed to keeping you informed as the combination of Allergan and KYTHERA progresses and are committed to working with you to ensure a smooth transition. We would expect that this acquisition will be completed by the third quarter of 2015. In the meantime, we will continue to operate as two separate companies and so there are no changes in current practices. Any information you require regarding the KYBELLA™ product or training, please visit mykybella.com or contact your local Kythera representative. More information is available on our website, www.Allergan.com.

If you have any questions or concerns, please contact me at IR-AllerganCommunications@Allergan.com.

Sincerely,

 

Philippe Schaison
President Allergan Medical Aesthetics

Allergan to Buy Kythera Biopharmaceuticals for $2.1 Billion

Allergan Plc, the maker of wrinkle treatment Botox, agreed to buy Kythera Biopharmaceuticals Inc. for about $2.1 billion to add treatments for double chins and male pattern baldness.

At Surgical Artistry, we hope to have Kybella in our office soon.

 

Actavis name change to Allergan!

Actavis purchased Allergan but is changing their name to Allergan.

Please visit our Modesto Botox page for more information.

Botox Blooms 2 - Calvin Lee

Do you have to be an Obagi user to have the Blue Peel?

Another attempt to answer a public forum question.

My answer:

Preconditioning the skin is key

It is convenient to pre-condition the skin with the OBAGI Nu-derm system.  But there are other lines that can precondition the skin.  I prefer that the patients precondition the skin with tretinoin and/or hydroquinone (preferably both) for at least 2 months before getting a OBAGI Blue Peel.  The reason it’s convenient – both the Obagi Nu-derm system and the Obagi Blue Peel are made by Obagi.

Calvin Lee, MD
Botox Artistry in Modesto, California

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Latisse pricing in the Bay Area?

I attempt to answer another public forum question.  This one comes from San Ramon, California.

Latisse for under $125 for 5 mil bottle?

I am looking for more latisse, however, it seems as if the price has almost doubled over the last 2 years. Does anyone know of any place around the Bay Area that sells the 5 mil bottle for around 125?

My Answer:

Thanks for the info on the price doubling!

I have a practice in Modesto, California.  Not too far from your location.  If the price of Latisse had doubled, then I really need to catch up to that.  I have kept my prices very close to the same for a long time – meaning since Latisse came out in 2009.

​The 5 ML Latisse kit launched around August 2012 with a list price of $179 from the very start.  And the suggested price was $120 for the 3 mL Latisse kit from 2009.  The prices sold at pharmacies is much higher than these prices I’ve quoted for physicians offices.  Perhaps you’ve been looking at pharmacy prices? These prices have always been higher than physician prices with my understanding.

​I know a little bit about Latisse and have connections with Allergan who makes Latisse because I was one of the original Latisse speakers for the product – rolling it out for other physicians to carry in their offices.  I had the honor of giving Latisse talks in Reno, Fresno, Modesto, Santa Rosa, Walnut Creek, Napa, and other places.  But it has been several years since I’ve given a Latisse lecture.

​3ML vs 5ML Latisse

​There is of course the price difference.  But with the 5ML, you are getting 67% more drug, and 133% more brushes.  And the suggested usage duraing increases by 150%.

​What I charge (if this helps):

Our practice doesn’t often have specials.  Thus I try to keep the Latisse price consistent; a good value most of the time.

​We charge $100 for the 3mL size Latisse which is the original size.  And we charge $149 for the 5mL size Latisse which is the new larger size.  From what I understand,  the bottles are the same size but the 5 mL is filled up to the top.  But there may be different batches with different tops on the Latisse bottles.

​We also require that I personally make contact with the buyer of Latisse.

​Answering your question:

​To answer your question, I don’t know of anyone in the area selling Latisse for $125 or less.

​I will look into the price doubling issue.  Thank you for your comment and question.

​Calvin Lee, MD
​Giving Latisse Consultations in Modesto, California

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Operating room becomes concert hall for two Modesto boys

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We had a good time dressing up in scrubs and playing the violin at Doctors Medical Center in Modesto, California 6/6/15.

I had an opportunity on Saturday to spend some time with two amazing brothers who have passion for violin and aspire to become surgeons.  I heard about them through social media, and I wanted a chance to meet them.  Doctors Medical Center and the Modesto Chamber of Commerce helped to set this up.  We were able to give them a brief tour of the operating room areas, and we had a private concert in a large operating room which is used for storage and backup in case of disaster trauma.   We played some violin for each other.  I was especially intrigued that they wanted to become surgeons.  I wanted to give them a friendly taste of surgery life.  I especially enjoyed giving them a chance to try out our surgical outfits, and I think they enjoyed spending time in an operating room – in a non-threatening way.  And I wanted to impart that performing surgery is much like performing musical instruments.  Jorge and Sebastian have a great deal of potential.  I am honored to be able to spend a few moments with them.

I also got to meet a very talented Modesto Bee writer.  She says she normally writes crime stories, but in this case I think she’s wearing a different hat:

Getting interviewed.
Getting interviewed by Modesto Bee’s Erin Tracy.

 

Below is the article from the Modesto Bee (text copied and texted), please visit the link below for the actual website which has a video and many other pictures.  The pictures and videos in this blog are my own.  But the article belongs to Erin Tracy and the Modesto Bee.

First, some of what I played that day on the violin:

Modesto Bee Article by Erin Tracy:

Operating room becomes concert hall for two Modesto boys

The operating table became a music stand, surgery lights transformed into stage lights, and forceps and scalpels were replaced with violins and bows for a special concert at Doctors Medical Center on Saturday.

Two Modesto boys – Jorge Mendoza, 12, and Sebastian Mendoza, 8 – had a booming business at the hospital last month during Lemonade Day, a nationwide program designed to educate children about business.

When violin-playing surgeon Dr. Calvin Lee learned the boys intended to use the lemonade stand’s profits for summer music camp and to save for a violin, he was intrigued.

When he was told Jorge also was interested in becoming a surgeon, he decided he had to meet the boys.

“I think playing the violin helps you become a better surgeon,” Lee said. “Because of the dexterity skills and the ability to break complex tasks down to a simple thing.”

He wasn’t able to make it to Lemonade Day, but with the help of hospital staff the doctor arranged for something even better: a concert in one of the operating rooms.

Jorge was dressed for the occasion in a sharp pinstriped suit, and Sebastian looked handsome in a blue plaid shirt.

Before entering the O.R., though, they covered up with green scrubs to match Dr. Lee. He taught them to tuck in the drawstring on the pants.

“Only the TV doctors let them hang out,” he said.

After a brief tour, the concert began in operating room 12.

Jorge and Sebastian first played a duet by Mozart, followed by a Beethoven solo by Jorge and Sebastian’s rendering of “Dragon Hunter” by Richard Meyer.

Then, Lee wowed the boys with Bach.

“As a trauma/general surgeon, Bach meant a lot to me,” he said. “When I hear the music of Bach, sometimes I feel like there’s somebody looking over me, guiding my hands.”

Lee worked as a surgeon at Doctors Medical Center from 2003 to 2006 but since has opened a plastic surgery practice, Surgical Artistry in Modesto, with his wife, Dr. Tammy Wu.

Wu was in the audience Saturday, along with the boys’ parents, Jorge Mendoza Sr. and Erika Mendoza, Modesto Councilwoman Jenny Kenoyer, Modesto Chamber of Commerce president Cecil Russell and hospital spokeswoman Tiffani Burns.

Jorge said he was initially a bit nervous about playing for Lee, “because I could tell he was going to be better than me and I’m so used to being really good since I only play at school.”

On Lemonade Day, he and Sebastian made a gross profit of $933.

After paying back the loan from their mother for overhead costs, the boys donated $125 to the Make a Wish Foundation. Sebastian bought a remote-controlled car, and Jorge used $190 to pay the balance owed for music camp after receiving a partial scholarship.

The remainder was put into savings accounts; Jorge is saving up to buy a violin, and Sebastian will use his to attend music camp with his brother in a few years when he’s old enough.

Erin Tracy: (209) 578-2366, @ModestoBeeCrime

Screenshot from the Modesto Bee Newspaper 6/7/15

 

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We can behave and pose for the camera. Yes we can!

 

Walking into the operating room areas at Doctors Medical Center in Modesto, California
Walking into the operating room areas at Doctors Medical Center in Modesto, California

Doctors Medical Center Modesto

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I seem to always have something to say

 

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Look at that intensity!

 

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Young violinist surgeons in the making.

 

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There we go, I need some Botox for sure.
There we go, I need some Botox for sure.

 

modesto bee facebook with comments

 

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Thank you for visiting this page.  Consider visiting my Modesto Botox home page.

Modesto Nature Photography last weekend in May

Same as what I wrote in my last blog.  I believe that my Botox Artistry and Filler Artistry is enhanced by looking at nature.  Studying the patterns, the colors, the geometry, and even the natural aging process of young plants to old plants.  Here are pictures which I took on the last weekend in May 2015 around my home in Modesto, California.

Sunflowers and Bees

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The sun plays a role in how we see our subjects. The shadows create an appearance of deeper depth. In my Modesto Dermal Filler practice, we use fillers to lesson some of the shadows and thus create an appearance of a smoother surface.

 

a sunflower sky
In this picture, the lighting comes from the back. The subject looks completely different. This is why I have an operating room light in my procedure room where I do most of my Botox and Filler work. The operating room light can be adjusted to come from above, from below, from behind and from the sides. I also like to be in the same room most of the time when I inject – this way I can get a feel of the fixed lighting and have control over a movable light.

 

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A blurry background helps us take out distractions from our best features. This is what I like to achieve with Botox in my Modesto practice. I like to use Botox to help blur out the wrinkles which detract from beautiful features on or face – especially eyelashes and the eyes themselves. Botox works especially great around the sides of the eyes and between the eyes. So this picture to me is very much like performing a Botox treatment around the eyes. With fewer “distractions” the eyes really shine!

 

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Beauty attracts company. Three bees on this beautiful sunflower.

 

 

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And this is where I took the above photos. At first glance – it doesn’t seem beautiful. But it’s my job with Botox and Fillers to bring out the beauty that is already there. And that’s what I tried to do with the camera.

 

The next few pictures depict my study of young leaves of a sago palm

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This picture shows the “older” but magnificent leaves of our Sago Palm

 

Beauty up-close is different from beauty from beyond

I have to look at a patient closely for one form of artistry but I have to keep in mind what a patients face looks like from a distance.  This concept that I have to keep in my mind while injecting Botox and Fillers is represented by these two pictures which are near and further away:

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The next two pictures show two different colored agapanthus blooms in different stages of bloom

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Thank you for taking the time to visit my web page.


 

Botox Blooms 2 - Calvin Lee
Out of a Bottle of Botox, comes a Bloom of Beauty.

Botox Blooms 1 - Calvin Lee

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January 2015 Modesto Nature Pictures – owls, goats, lady bug

New Zealand January 2015 Pictures – a chance to get away from Modesto for a Modesto Botox injector.

Calvin Lee, MD

Modesto Botox Artistry

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Modesto Flower Photography – Botox/Filler concepts

I feel that what we see in nature is most beautiful.  That’s what I try to achieve with my artistry with Botox and Fillers.  It’s a sense of creating a natural look which is pleasing to the eye and exciting to the mind.  Nature has a sense of symmetry, pattern and colors which relax and excite us all at the same time.

I spent some time in the last weekend of May, 2015 capturing a few glimpses of nature around my home in Modesto, California

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Click above on the picture to enlarge. This is a sunflower growing on an empty lot near my house. The sun shines behind the weed-sunflower. I like how the bee is using the flower as sun-protection!

 

Click here to see the rest of my Modesto nature photos around our home.

Pimples after Botox

I attempt to answer another public forum question about Botox.  This question comes closer to my office in Modesto, California – it is from San Jose, California!

Why do I break out since having Botox?

In the exact same area where the injection was; is where i break out. As if causing a “man made pore” from the needle which then does not close up and gets filled causing an ongoing blemish effect. I ONLY break out now where I’ve had the injections. But why??

My Pimples and Botox Answer:

Wonderful question.  I’ve encountered this question about having breakouts in the area of Botox injections in my own practice in Modesto, California about 3 times.  So this is rare.  The world of medicine is complex, and sometimes it seems strange.  I have not had a case of the “man made pore” – so I can’t address that question except to speculate that it may be a scar of sorts or somehow related to a cyst?   I’ve had an experience where there was a reddish – pimple like reaction to only one of my needle pokes.  I suspect in that patient that there was an underlying infection in that area – such a pimple – which then got exacerbated when I decided to inject Botox too close to that area.  Botox injections are tricky, we want our injections to be in strategic places, but sometimes in our patients, blemishes and veins get in the way of an ideal placement – and thus I have to compromise in my decision and Botox strategy.

​Regarding the break-outs in the Botox areas.  For some of my patients, I’ve come to realize that they are sensitive to some of the antiseptic methods I use to help prevent infections from the Botox procedure.  Sometimes they are allergic to the antiseptic.  There are various ones available out there and perhaps switching to a different antiseptic could help.  Meaning, having your injector/surgeon/doctor/nurse switch to a different agent.  And there’s the possibility that the actual needle poke – which is a very mild form of skin trauma – could incite a inflammatory process.

​Ironically (to your question of why does Botox cause more blemishes), I’ve found most of the time that Botox helps calm down inflammation in an area of skin. This may be due to reduced sweating or a direct effect on rashes and pimples by Botox.  Also, Botox sometimes shrinks pores as with what we’ve seen with meso-Botox.

​Thank you for your question, I’m just answer from my own personal experience as a Botox injector. Without having seen you in person, I’m answering the best I can without physical examination info. My comments are meant for a general public discussion to help others who may have similar concerns. I’m also using my answers to build up library of information for my own patients and also to see how my answers compare with other doctors. There is always much for us to learn from each other. My answers are generalized medical information only, not directed medical advice. For medical advice please see your doctor/surgeon in person.

​I hope this discussion is somewhat helpful.

​Calvin Lee, MD – Botox Surgeon
Botox injections ​Modesto, California

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