Modesto Botox Current Topics

Favorite part of owning your own Plastic Surgical practice

“What’s your favorite part of owning this practice?” I got this question today from an employee. I think it’s a great question!

Here’s my response and I thought I’d just share:
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It’s OUR plastic surgical practice.

First, I don’t really feel that I “own” the practice alone. I hope the employees can see that they own a piece of this too through their hard work.

I feel that this is all of ours together. I would love to share the successes of the practice. But I would take all the blame.

I work for the “employees” of the practice.

There is so much that I love about this practice so one favorite is hard to pin down.

I like the FREEDOM to do what I think is BEST for our patients

I love what we do for our patients. I like having our own practice so that we can go beyond the “standard of care.” Others might strive to achieve the standards of care. For us – the standards are the minimum level. I like being able to go the extra mile and not have someone tell me that I’m wasting time.

And I love to be generous with my time with the patients when possible.
I like being able to make my own decisions that would result in outcomes which would be the very best for our patients.

I like to GIVE BACK to those who believe in us.

And for the employees and our representatives who believe in us, I are very grateful for having them put their trust in us, and spending time with us. I hope to give back. I personally take a lot of pride in watching our team grow. And sometimes I do take pride in watching our team move on. Although sometimes sad for me on one level, but happy for me on another. I do want to prepare the team to be able to move on beyond what we do if they choose to do so – like become a nurse or doctor or work at another office. It is important for me to be able to give back to those who choose to believe in what we do.

Surgical Artistry is a reflection of WHO I AM.

I also have a lot of growing to do, and as I improve, I like watching the practice improve as well.

Botox Drift Question

Hi office,

Hannah asked this Botox eye-droop question on email which I’d like to share with the rest of the office.

In the case of an eye droop due to the Botox drifting, why is it that the eye droop only lasts for 2 weeks if the Botox is active in the system for 3-4 months?

It’s because the Botox wasn’t injected directly into the eyelid.  When a Botox droplet drifts into the eyelid muscle (Levator palpebrae superioris muscle) from the corrugator glabellar muscle  it would only be a tiny droplet and wouldn’t last very long because it wouldn’t be a full dose.  The lower the dose of Botox, the shorter the duration.  Sometimes when I inject (with the patient’s urging) with a very high dose of Botox, I’ve notice that Botox can last 5-6 months!  I’ve found in my own Botox practice that Botox duration of action is dose dependent.

Avoiding this shifting of Botox is why we have our patients refrain from rubbing or pressing on the Botox injected areas for about 4 days after the Botox injection.

I hope my explanation is clear.

Great Botox question!

Hand Rejuvenation FAQ with RADIESSE

Patient Questions for Hand Rejuvenation

How is this procedure performed?

I have been doing this procedure successfully with a blunt tipped micro-cannula.  Most patients are relaxed and having a conversation with me while I’m doing the procedure, and are pleasantly surprised when I’m done because it didn’t take as long or hurt as much as they expected.  The procedure is done in our procedure room at Surgical Artistry – the same room where we do most of our Botox injections.  Care is taken to make sure the procedure is safe and comfortable.  I make it a priority to use the Radiesse filler efficiently with no wasted product.  Radiesse is carefully injected into the back of the hands to plump up that area to restore a youthful fullness to that area.

Is it painful?

Most of our patients say that this procedure isn’t very painful.  We do use a numbing injection and mix numbing medicine into the filler syringe of Radiesse.  I can usually do the procedure with one entry site – much like laparoscopic surgery.

How does it work?

Radiesse is a filler that is able to plump up the skin and subcutaneous space on the back of the hands and as an added bonus – promote collagen production.  Thinning of the back of the hands reveals veins and edges of bones which can be a sign of aging.  By thickening this area, the veins and bony appearance lessons as does the signs of aging.

How much does it cost?

There is a special going on at Surgical Artistry at the moment which is $1000 for two syringes of Radiesse, specifically reserved for the back of the hands.  This is a significant discount.  We normally charge $750 for a syringe of Volume Advantage Radiesse.  This is the large sized Radisse syringe.  There exists a smaller syringe, but we don’t carry that syringe currently at Surgical Artistry.

How soon will I see results, and how long will they last?

You will see the results right away.  At first there may be some mild swelling, but after about 7-10 days the slight swelling resolves.

Will I need the same amount of filler the next time I get this procedure after the first round has worn off?

In my opinion, most patients will need the same amount of filler the next time.  But because there is the possibility of collagen growth, it is entirely possible to get the same results with fewer syringes.  I believe that most patients need 2 syringes, and some need three.

What are the side effects?

The side effects are minimal and mostly related to bruising, mild swelling, mild redness, and some mild dull ache for about a day or two afterwards.  The active ingredients of Radiesse are naturally occurring substances in the body. Thus, the risk of allergic reaction is very small.

Who is this treatment for?

This treatment is for patients who are concerned about the thinning of the back of their hands due to aging.

Is there anyone who should not get this treatment?

I wouldn’t recommend this procedure in patients who have an active infection on the back of their hands.  I also wouldn’t recommend filler procedures on patients who are pregnant or breastfeeding.  Furthermore, I wouldn’t recommend this procedure on patients whom I feel are not appropriate candidates due to extremely thin skin or patients who don’t seem to need the procedure based on my assessment.

What filler is used for this procedure and what is it made of?

Radiesse is the filler I like to use for this procedure.  The active ingredient is calcium hydroxylapatite which is a naturally occuring substance in our body

What is the recovery like?

Most patients go back to normal activities.  But there is most likely some mild dull ache for the next day or two after the procedure.  There is numbing medicine which I add to the syringe which can last up to 4 hours of numbness after injection.

Is there swelling after treatment and if so, how long does the swelling last?

Yes, there is some swelling after the procedure.  For most patients it is for about 1-2 days.  But I have heard up to a week for some patients as well.  But the swelling is mild and just about all the patients go right back to work.

If I work with my hands, will I still be able to immediately after treatment?

For many things, such as typing, it is possible to go back to work immediately after treatment.  But the numbing medicine might slow you down for the next 4 hours or feel a bit awkward.  Furthermore, many report a very slight dull ache, which might affect performance a bit when it comes to lifting or working out, but most patients go right back to work after the procedure.  In general, most patients consider this procedure a “lunch time” procedure where they take an hour off of work and then return immediately.

 

 

Questions written and thought up by Hannah, and answers written by Calvin Lee, MD, Botox Surgeon at Surgical Artistry.

Blepharospasms and Botox

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.

Working out after Botox injections

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.

More about Dr. Calvin Lee

Calvin Lee, MD

Written for Del Rio Magazine (Modesto, CA).

One of Dr. Calvin Lee’s goals is to continually improve Modesto.  He is proud to help start the Surgical Artistry Modesto Marathon in 2009 and be a founder of the Gallo Center for the Arts. Recently, he was involved with starting Modesto Moves and Ripon-Manteca Moves – training groups for runners.  Soon there will be a new half marathon called Ripon’s Run, and he is proud to be able to be the initial title sponsor along with DMC. Dr. Calvin Lee is a board certified General Surgeon who lives with his Plastic Surgeon wife, Dr. Tammy Wu, in Rancho Del Rio. He came to Modesto in 2003, joining the McHenry Medical Group as a trauma and general surgeon. In 2006, he formed Surgical Artistry with his wife.  Now at Surgical Artistry, his practice involves a specialty of needles – for acupuncture, Botox and cosmetic injections.

With acupuncture he specializes in treating back pain.  His Botox practice is at the “Top 500 level”, a designation given by the manufactures as one of the busiest 500 accounts in the country out of an estimated 30,000.  With Botox he specializes in cosmetic injections, injections for plantar fasciitis, sweating under the arms, muscular trigger points, and headaches.  With fillers, he enjoys working under the eye lid area, an area called the tear trough.  He considers acupuncture, Botox, and cosmetic filler implants to be surgical procedures.

Most Surgical Artistry patients are not from Modesto.  It’s an honor to have patient traffic come to Modesto.  After visiting our office, many of our recurring patients tell us that they like coming here to shop because of the relatively lower tax rate – especially the patients from San Francisco.

Dr. Lee was born in New York City and had the honor of being accepted to all the Ivy League Schools and Stanford.  He decided to enroll at Brown University where he met his wife in 1989.  They were both part of a eight-year program which combined undergraduate with medical school.  After that he went to Case Western Reserve and Southern Illinois University for Surgery training for the next 6 years.

He is also a violinist.  He was soloist and concertmaster of orchestras at Brown and Harvard Universities and various orchestras in New York.  He has played at Carnegie Hall twice on the violin.  In 2009, YouTube in conjunction with the San Francisco Symphony had a contest and he one of two non-professional violinists who won a spot in the YouTube Symphony. This resulted in world wide media attention. He also toured as a violin soloist throughout parts of Asia. He thought about becoming a professional violinist, but in college, he developed a hearing problem; thus he decided that it was a sign that he needed to dive in wholeheartedly into medicine. He is teaching himself piano these days.  Recently he participated in a piano competition in Beverly Hills which involved competing with piano teachers, and he won and performed a Beethoven Concerto with orchestra in Los Angeles. He loves his Los Angeles audience and plans to perform in Los Angeles again next year. He has a violin recital lined up in Modesto in September with music professors at Modesto Junior College.

For fun he enjoys making websites, blogging, spending time on FaceBook, marketing, eating vegan, and running.

 

 

 

 

I love going to Botox and filler training sessions

As a board certified surgeon, I know that there are many ways to get surgeries done and every surgeon has their own developed tips and tricks over years of experience.  It’s always good to learn from others – especially in other parts of the world.

In the past few weeks, I’ve participated in two national-type training programs for Botox and Juvederm fillers.  I especially enjoyed watching other great injectors approach lip augmentation challenges.

Later today I am going to San Francisco to attend an international training program for Botox and Fillers/Juvederm.  The speaker is from Australia.

Here’s an interesting certificate that I got after one of the training programs – they sent it to me via email, but they used the bosses’ name on our practice.  Well, it’s the plastic surgeon wife, but I did the training program.  It’s worth mentioning that her full name is Dr. Tzuying Tammy Wu.  And you can visit her plastic surgery webpage here: www.SurgeryToday.com.  And you can visit my Botox webpage here.

Ethnic Botox for my Asian patients

I attended a Botox lecture yesterday in Fresno that included a small section on ethnic differences in use of Botox, fillers, and Kybella.

This made me think of my Asian patients.  I live in an area of California where there aren’t a huge population of Asian patients, but I have a good handful of Asian patients coming in for Botox and fillers.

Botox differences that I’ve observed

Compared to caucasian patients, our Asian patients are asking more for Botox for slimming the face, and there is more of a preference placed on crows feet botox over glabellar botox.  Glabellar area is the “11’s” between the eyes.  I’ve noticed that my Chinese patients are usually requested a lower dose for the glabellar botox, but the opposite is true for my Indian patients who frequently request or need more glabellar botox for the same effect.

I’ve also seen much more request from Asian patients regarding jaw slimming botox procedures.

Filler differences – Voluma

I’ve actually learned a few things from my Asian Botox / Filler patients who have received cosmetic injectables in Asia.  They tell me and teach me about rounding out the glabella and forehead and filling up the bridge of the nose.  This has helped me observe that this area tends to flatten with age in some Asians.  Also most of the cheek augmentation tends to be in the anterior direction more than in the lateral direction.  Thus the apple cheek result is what they are asking for with Juvederm Voluma injection – rather than more of an angle with the zygomatic arch.

Well, that’s what I’ve observed so far, and I hope to observe and learn more from my patients and I hope to continue to improve.

 

New Kybella webpage

I made a new Kybella webpage.  It is actually mobile-friendly, unlike most of my other webpages.  I guess it’s time to modernize for me.  I have been making webpages since the 1990’s, and I’ve been pretty much making them the same way as when I first started.

Modernized Modesto Kybella webpage

http://www.modestokybella.com/ 

I made it 1/8/17.

My staff is tired of listening to me say that I made the world’s first Plastic Surgery webpage back in 1996 – although this is a self made claim.  I guess that isn’t too impressive these days anymore.  I actually found a copy of that webpage:  World’s first plastic surgery webpage designed by me.

 

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What’s new with Botox for 2017

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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.