Jeuveau was just FDA approved in the USA as the newest Neuromodulator to join Botox, Dysport and Xeomin.
Initially I’ve had some trouble spelling Jeuveau – is it spelled Jeauveau, Jeaveau, or is it Jeauveaux. This is the first time I’ve gotten to hear about it.
I’ve been pretty much a Botox injector. I’ve tried Xeomin and Dysport before, and I look forward to trying Jeaveau as the newest neuromodulator. Though, I have to say, that I have been extremely happy with Botox so far.
Jeuveau is made by the Evolus company. Welcome to the club! I look forward to figuring out if I like it, if my patients like it, safety, storage ease, comfort, how it looks, and how long it lasts.
The above video made by me on YouTube explains “how to make Botox“, well, we’re not making the Botox, we are reconstituting it from a dry Botox form to a liquid Botox injectable form. You could mix it with as much saline as you like. Some would call this dilution, but I prefer the word reconstitution. Dilution implies that we are taking a known dose of Botox and making it a lesser dose.
I like 1cc = 4U of Botox
But it works well for me to place 2.5 cc’s of saline into the 100U bottle. This way every 1.0 cc of saline results in 4 Units of Botox.
Much of how Botox is injected now involves 4U of Botox in each injection site. Thus this would be 0.1 cc’s of Botox – and conveniently this shows up on the line in our syringes.
Some tips: When inserting a needle into the rubber top of the Botox container, consider using a 21 G needle rather than 18 G needle. Because the 18 G needle might damage the self-sealing aspect of the rubber top.
There are always subtleties and the video might give you more insight into the way I do it, which has worked well for me.
If you are curious, there are some questions in the comment section of the video. Someone asked where I get my medical degree. It was at Brown University. And someone asked why I wear a mask. I usually don’t talk when I’m reconstituting Botox, and I consider it to be a medication that I’m making that gets injected into a patient, I wanted to make sure I treat it like a surgery – for much of the same reasons – keep the work area from potential contamination. Extra talking creates microdroplets from our mouth into the air. And thus… I prefer to wear a mask if I’m doing some extra talking – for the camera or with a patient while working with Botox. It may be a surgeon thing. It makes me more comfortable knowing that I offered the best for my patients.
Hi, I just saw your message. Sorry I missed this. This is Dr. Calvin Lee writing back. I don’t offer eyelid surgery or brow lift surgery. But my wife does for the surgery side. My wife is Dr. Tammy Wu. She isn’t on Yelp or social media at this time, but we are at the same office (209) 551-1888. Her consultation fee is $200 (price subject to change). Dr. Tammy Wu is the plastic surgeon and I am a surgeon who mainly does Botox and acupuncture. With Botox, I try to achieve a bit of brow lifting, but sometimes you need the surgery. I do something else called threadlifting which does lift the eyebrows a little bit, but it isn’t the same as surgery and doesn’t do much for the eyelid. Best wishes, and I hope some of this answers your questions. Regarding a list of Surgery and Injection services on a website you can consider trying www.SurgeryToday.com – on the home page there is a partial listing of what we do. Thank you for writing
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.
Surgical Artistry’s newest employee asks today “why refrain from working out for 4 hours after Botox.” This is a rule that I’ve imposed on my Botox patients.
Here’s my answer:
Working out causes a lot of blood flow – and with the working out – the increased blood flow leads to increased blood pressure – which leads to possible bursting of some internal blood vessels which I may have just “poked” – which will then lead to possibly more bruising and more swelling.
So the answer is – to help avoid bruising.
But there is some added benefit of keeping swelling down.
I came up with the 4 hours, mainly because I think it’s enough time for the blood vessels to seal themselves completely by then. I don’t have an actual scientific study that mentions 4 hours as an optimal amount of time, but it seems to have worked well for me and my Botox patients.
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.
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.
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.