Our new employee asked me on emails:
Regarding blepharospasms, I was wondering if Botox could ever get rid of involuntary spasms if the muscles relaxed enough, or is Botox more of something that decreases the spasms, but can’t fully get rid of them?
So basically everything you said is right.
The answer is: It’s dose dependent.
So If I use high enough of a dose it will all “freeze” up and not move. But it would also look very frozen and weird on the patient. So I’m trying to strike a balance where it just spasms a little bit where it is manageable by the patient (not painful, and not eye-shutting) but it still looks normal without one side of the face being super frozen.
There are also some areas of the face where I don’t want to inject too much Botox for fear of creating ectropion.
My 2016 Botox Statistics
I reached the Diamond level injection status – which is top 4% of Allergan accounts. I’m happy to report that I injected 66,597 units of Botox for the year and almost 900 syringes of filler – I guess I should have just worked harder. I pledge to continue to work harder to improve my skills. Thank you to all those who trusted me with my surgical skills to inject Botox. As expected, Allergan is going to raise their prices on the purchase of Botox for 2017. This is an annual price increase which I’ve come to anticipate.
Care Credit for Surgical Artistry Patients
At Surgical Artistry, we accept Care Credit. It can be used for various things such as Breast Augmentation, Tummy Tucks, Botox and Fillers.
Here is a custom link to apply. We don’t offer all plans and feel free to call our office with questions. Our plastic surgery home page is http://www.SurgeryToday.com
Other Care Credit links:
Volbella is a new filler for the Juvederm family of dermal fillers.
I just had a chance to use it for the first time today. I had chosen to use it off label for tear trough correction. In the picture below, I had chosen to attach the Volbella syringe to a 1.5 inch dermal cannula. Soon I plan to try it for the lines around the lips. Sometimes those lines are called the lipstick lines and recently I heard them called “barcodes.”
Someone just recently asked me this question and I thought I’d share the answer here.
Dr Lee, what is your filler of choice for this tear trough area under the eyes?
I’ll answer this question as if you were asking me as another colleague injector. Most of the time my favorite tear trough filler is either Restylane-L used straight out of the box or a diluted version of it with about .1-.2 cc’s of either lidocaine or saline. I’m most interested in a new Juvederm offering which is not available to the public yet. Belotero was my previous favorite before Restylane-L, but it was on the too soft side and too short of a duration in my own preference. Before that I used Juvederm ultra for under the eyes, and funny thing, before that I used Restylane-L (what was just called Restylane at the time). Now I’m back full circle to Restylane-L – the old favorite. A blended version of Voluma has also worked very well for the area. But the key is a smooth continuous application placed possibly in two layers is my latest technique. Some tear troughs are so deep that two separate layers of fillers is needed separated by the patients own tissue – this is like making a filler “sandwich”. I hope this sheds some light into what I like. but just about any filler could work in this area, but adjustments need to be made due to swelling and clumping characteristics. In the end, I think it’s more the injector’s technique that matters than the actual product. But if I was teaching a beginner injector, I would probably say a product like Restylane SILK or Belotero – great choices to start with because they are very forgiving!! Forgiving is good in this area, especially if the depth chosen isn’t ideal. However “forgiving” products (belotero and restylane-silk) are usually made up of smaller Hyaluronic Acid (HA) molecules and thus don’t tend to last as long as something with larger HA molecules such as Restylane-L/Juvederm/Voluma.
One more aspect to consider is experience with the swelling characteristics of the HA filler chosen. Restylane-Silk, Juvederm Ultra XC, and Juvederm Ultra Plus XC tend to swell more than Belotero, Restylane-L, and Voluma. I have not personally tried Restylane-Lyft yet under the eyes, but I don’t see a reason for me to try unless a patient was strange and wanted me to do that. There are just so many good choices out there for me already. But stay tuned for the new Allergan product coming out in about 1 month. I think it might be a winner in this department as well.
Answers to questions like this tend to be very complicated when we try to break it down to why we choose what we choose. There are factors regarding skin thickness and color that need to be taken into account regarding if I blend a product or dilute a product too.. And there are choices regarding the tools that we want to use – either a straight needle or various different cannulas.
I’ve had many people ask, but I never got around answering this question. But my favorite filler changes from day to day… so today it’s Restylane-L for tear troughs. It is versatile enough to adjust to most skin conditions especially with dilutional methods, and it fits nicely through a 27 gauge 1.5 inch cannula, and it lasts in this area around 7 months to 1.5 years, and it has built in lidocaine for patient comfort, and it has minimal swelling characteristics to deal with after implantation. Fillers choice is highly personal, just like violin choice is for the violinist.
This is at this point a draft only.
July 15, 2016 – Friday.
I was supposed to give a graduation speech in Sacramento for a K-12 school. But instead the date of the graduation got moved earlier, and thus I got the speech out of the way. I had left the day blocked off from patients (from our plastic surgery / acupuncture practice: Surgical Artistry) since it was an opportunity for a day off. I decided to see a dentist. Long story short, I needed a tooth extraction. Tooth got pulled out – Yikes. Funny how things like this happen when you least expect it or when you least want it to happen.
Dr. Tammy Wu, plastic surgeon, & I just became program sponsors for TEENS RUN MODESTO which builds confidence & discipline while training for the SURGICAL ARTISTRY Modesto Marathon. Congratulations to all the participants and mentors.
The Surgical Artistry Modesto marathon is in March, and it 2016, it will be the 7th annual installment. A plastic surgeon sponsored marathon and teen training program!
My dual life at this point
I’ve worked on this Beethoven concerto now for 2.4 weeks. I’m working hard to show respect for the piano teacher who fired me from piano lessons as a child. After that, I quit piano lessons but restarted as an adult, mainly teaching myself piano, after I became a full fledged surgeon – with guidance from special friends who can be considered my teachers – including many of you on FaceBook – thank you. I have a hearing distortion in one ear which makes all that much more interesting. In may ways, my being fired from piano less and my hearing problem have led me to be the person I am today – thus I should be thankful for both of those things too. I appreciate all the encouragement too. Special thanks to everyone around me, especially Tammy, for letting me practice over 9 hours of piano today. Big thanks to Modesto’s Piano Professor, Dr. Yan Yan Chan for guiding me and providing orchestral accompaniment on a second piano Saturday AND Sunday. She wanted to help me even more, this work week, but I don’t get home till after 7pm from work so this won’t work. Now it’s time for me to focus on my other art which involves facial beauty with Botox / Fillers / Kybella and the internal healing arts of Acupuncture. I will have one more weekend to work on the piano and then the weekend after that is hopefully time to show off in Beverly Hills/Los Angeles at the Piano Competition for Teaches and Amateurs. I am hoping that soon, I will be able to work on the beauty of the notes and music – that is my absolute favorite part – it will be in some ways, like playing the violin for me – when it comes to creating a beautiful tone and line.
I’m very honored to be picked as one of the first physicians in the US to be trained on Kybella (an injection that helps with fullness under the chin). I will be undergoing formal training in July, 2015 and I will be perfecting my technique and will be ready to roll out the product at Surgical Artistry in August. I’m currently spending time now studying up on the product.