This graphic above is a spreadsheet depicting the amount of Botox units that I injected between 12/14/20-11/16/21. There are 230 injecting days for me between those dates. It’s almost one entire year of injecting. I’m missing a month, but perhaps I’ll get to it in a few weeks.
Take home messages for myself: Continue to prepare 8 bottles of Botox per day which is my norm. But perhaps I could increase it to 9 bottles per day. And fillers, I have another graphic which is a pie chart that reveals each different type of fillers used. Voluma has been the most popular filler used. The data shows approximately how much of each filler I would use on average for each day worked:
Below is a graph of the amounts of Botox in Units injected each month depicted in 2021. In a few days I should have November’s Botox data.
Description: Minimally invasiveprocedure that treats cellulite; it can take about 45mins to 2 hours depending on how many areas are being treated.
What it can do: Cellfina is a procedure that releases the bands that are woven throughout the fat in your thighs and buttocks. When you have cellulite the bands happen to be contracted and tightened which causes the dimples. Once these bands are released the skin bounces back and does not create those dimples anymore, which means the cellulite is gone.
What it’s indicated for: It is indicated for improving the appearance of cellulite in the buttocks and thighs
Candidates: Dr. Wu or her assistant will evaluate your specific circumstances and determine whether you are a candidate for Cellfina treatment. Therefore, the first step is to make an appointment for consultation for Cellfina.
What else is there to know about Cellfina?: Cellfina is a very straightforward and minimally invasive procedure that helps diminish the look of Cellulite. It is done in the office under local anesthesia. Therefore, you are able to drive yourself here and drive yourself home. We do need to have a consultation first to determine if you would be a candidate or not. Once we determine that you are a candidate then we will provide an estimatefor the procedure and you can book a date.
Day of Treatment: The day of the procedure it may be a good idea to take a pain reliever 30-60min prior to the procedure just to help with any discomfort, although it is not required and most patients do well without the pain reliever, but it could be beneficial. We do numb the area with tumescent local anesthetic. This is the part of the procedure that you may feel some pain or discomfort; but after you are done being numbed you will not feel much at all, just some pressure. There is some noise that you will hear so you may bring some earphones with you so you can drown out the noise if this is something that may bother you.
You will need to bring a compression garment for your buttocks and thighs to the procedure. This will be placed on you right after the procedure is done. You will wear this for the first 3 weeks after your procedure. There are not many restrictions after the procedure but the following will be required to abide by after the Cellfina treatment.
First 3 days only light activity
On day 4 you may resume normal activities
Extreme physical activity should be avoided for 30 days following treatment
Other things to keep in mind are:
Acetaminophen will help with any lingering pain
Oozing can occur from the insertion sites for the first 24-48 hours. Make sure you have a towel with you to protect anything you may be sitting on
Soreness, tenderness and bruising are typical symptoms after this procedure
Hello! It’s been a while since I wrote anything in this Botox blog of sorts. Kybella is made by the Botox company (Allergan), and I was recently told that there is going to be a shortage of Kybella. The kybella factories (used to make Kybella) have been converted to making coronavirus drugs – such as Covid-19 vaccines. The Allergan company is not taking orders at this time for Kybella nor do they know when we can take orders.
I love Kybella as a product to treat double chins, and I have about enough for a few more days of Kybella injecting into double chins. I believe I have about 6 vials left as of this writing. Hang in there. Even if you got one session, you can wait a few months or even years before your next session of Kybella because the results are considered to be permanent – a permanent reduction of fat cells.
For further questions, consider calling our office 209-551-1888.
I wanted to recount my experience pertaining to my first time getting lip fillers as a way to help others who may be thinking about getting a lip filler.
As you may know, I was very nervous and hesitant. I have always wanted to get my lips done, especially after assisting in so many of those lip procedures. I just needed to find the courage to actually do it. It was definitely a great experience being on the other side as a “patient” this time around and experiencing it from another point of view.
Before the procedure began, Dr. Lee and I had both agreed on choosing Juvederm Volbella XC as the most suitable filler for my lips. Since my lips were quite thin to begin with, it was important for me to choose a filler in which my lips could handle without it being too overblown. Volbella is known to be a smoother filler, with more of a natural look. Its also known to have the least amount of swelling. Eventually, if I want to have my lips injected again, I can also choose a different filler to coexist with Volbella. Other choices included a newer filler called Restylane Kysse. This filler, Restylane Kysse is a thicker product than Juvederm Volbella XC. There are about 10 different lip filler choices we could have used for lips. But one choice we weren’t going to do is Radiesse – that is a syringe used for growing collagen (hyperdilute radiesse) in areas where there aren’t too much muscle activity. Lips are mostly muscle and have a lot of movement.
I explained to Dr. Lee the type of results I was hoping to achieve. My top lip had a very defined “M” shape to it, while also being very thin. I wanted more volume on the top of my lip border around the cupid’s bow, without the sides looking very elongated.
“Before” photos of my lips were taken. Numbing cream was applied, and left on my lips for about 5 minutes. We went through the cold sores and lip questions. As nervous as I was, I knew I was in good hands with Dr. Lee since he is the lip filler expert! I was completely numb and felt little to no pain for the entire lip filler procedure. The most painful area I think was when he began to inject towards the middle of my lips, specifically, the philtral columns. I would rate the pain level a 4 on a scale from 1-10.
I enjoyed the fact that Dr. Lee would explain what he was doing while injecting. Lupe was also very comforting while she was assisting Dr. Lee. She put her hand on my shoulder which made a big difference in my anxiety level. They would take a moment to ask me how I was doing during the lip procedure, which was really nice and reassuring. The entire process was maybe 8-12 minutes long. The Once the procedure was over, Lupe handed me the mirror to take see my new look. I was so excited! Of course, my first reaction was being a little taken aback at my lips being bigger than they were before, but with that being said, I instantly fell in love with my new look. My lips turned out to be better than I even expected them to be.
Dr. Lee did an absolute amazing wonderful awesome job! I am so happy! I have always been very insecure about my lips being thin as well as having a gummy smile. Now I have so much more confidence and am so beyond happy.
Dr. Lee informed me that I can apply an icepack to help reduce swelling – especially for the first 30 minutes. He educated me on side effects regarding swelling for the next few days. In about 3 weeks, I should see the full results with the bruising gone and swelling gone.
I had an amazing overall lip augmentation experience for my first time getting my lips done. Thank you, Dr. Lee!!
This was a question I got today as someone on the phone asked the question to one of my staff members. I just heard about the question and thought I’d try to answer the question.
There are different types of Restylane as of 9/28/2020
There is:
Restyane Silk
Restylane Refyne
Restylane Kysse
Restylane Defyne
Restylane-L
Restylane-Lyft
That’s 6 different Restylane’s. That’s more than the different types of Juvederms that I have at the moment.
Comparison of Restylane Kysse to Regular Restylane-L
Restylane Kysse is a newer filler that came on in 2020. Restylane L has been around as the original filler but without the lidocaine. It was the first filler that I injected back when I started around 2007.
In general I would say that Restylane Kysse is less stiff, and more flexible than Restylane-L, and the syringe that it comes on is different for the injector – just a different design. Restylane Kysse is specifically designed with the lips in mind, and Restylane L is for Nasolabial folds, etc.
There is still so much to fillers and a lot of is how it is used by the injector. These different filler types are tools for injectors to use to help create the goals they have in their mind, and the different fillers exist to help us get to our goals more efficiently.
Some of what we choose to use is based on experience and comfort. I have used Restylane-L under the eyes (tear troughs) for awhile and I’m very comfortable with it there.
This is Alysha from Surgical Artistry. As some of you may already know Brilliant Distinctions rewards (for Botox, Juvederm, Kybella, Latisse, etc) is switching over to Allē. This switch will be happening on Wednesday September 30th , 2020. There are a few short steps you will need to take in order to merge your Brilliant Distinctions account over to Allē. You will first need to know your Brilliant Distinctions login information (Email or phone number and password). If you do not know your login information you can reset your password at www.brilliantdistinctionsprogram.com or by calling Brilliant Distinctions Customer Support (888) 324-2745 (8 AM-6 PM CT, M-F). Once you know your login information you will go to www.alle.com. Here you will merge your Brilliant Distinctions account by clicking on Join with Brilliant Distinctions. You will now enter in your login information. Once you are logged in, you will need to follow the steps on your screen to merge your account to Allē. Please be sure you follow all instructions until the process says you are complete. If you are having issues merging your account, please call our office at 209-551-1888 and our staff can send an Allē invite link to your Mobile device. We hope you will enjoy the new Allē Rewards Program and we thank you for your patience through this change.
Brilliant Distinctions has been growing – 2019 stats:
In 2019, Brilliant Distinctions grew an additional 6 million members. It is in 25,000 doctor’s offices. There are 60,000 new consumers each month. I had previously estimated that there are 40,000 Allergan accounts in the USA – but that was my own personal estimate based on some statistics I’ve seen a few years ago and my own calculations. I wrote a bit about this estimate in my post about being a Top 250 Allergan Account in the USA.
Lip Injections by Calvin Lee, MD, My thoughts in 2020
This question is a bit like asking what type of how do I like to use for playing the violin. Sometimes it depends on my mood and sometimes it depends on what type of mood I’m trying to create. It also depends on what type of technical challenges I’m up against.
This discussion is limited to the syringes I have at my office.
Above collage are lip before and after pictures of my patients in the 4 weeks leading up to today 9/13/20. Pictures posted with permission. Bottom right pictures are of the Surgical Artistry team.
Dumbells vs Fillers?
Oh another analogy: Picking a filler might be a little bit like picking which kind/type of dumbells one might use for working out. There are different brands of dumbells and different weights.
Juvederm Volbella
Often I choose Juvederm Volbella XC to inject into the lips. The syringe itself is very ergonomic and has a good responsive feel when I inject it when attached to a 32 gauge needle. This needle gives me enough resistence so I don’t just pour it all out in one spot.
It is a soft filler (not very thick – or it has a lower G prime) made of smaller Hyaluronic Acid molecules. The molecules stack on top of each other very smoothly. So if I’m looking for a subtle and more smoother look, I choose Volbella. Many younger patients who have a nice vermillion border and philtral column do very well with Volbella but many times we need two syringes of Volbella for the younger lip. Volbella also has less swelling due to the vycross technology and uses a smaller needle which is a 32 gauge needle. In the older patient, Juvederm Volbella sometimes looks the most natural with softer edges for the lips. The tissue integration of this product is rapid and thus there would be less movement of the product after injection. This is a great filler for patients with thin skin for their lips. Volbella is also a relatively long lasting filler syringe wtih longer duration compared to Ultra and Ultra plus.
This product also doesn’t look too blue under the skin and thus can be used very nicely for those smoker’s lines. This is one of my favorite products to inject into smokers lines.
I recommend this Volbella syringe to the more extremes of age – youngest patients and oldest patients – and in patients who only want a very subtle change but want long lasting results.
Volbella is a medium-high cost syringe in the lineup of Juvederm products.
Juvederm Ultra
This is my most commonly used filler for lips. I have been doing lip fillers since 2008 and this filler just feels very comfortable to me in my hand. I like the way the filler syringe feels and I like the feel extrusion force. This filler is attached to a 30 gauge needle.
This is a filler that makes great borders of the lips, and I like to inject it close to the vermillion border, and use it for philtral column support. The results are beautiful and this tool is in my comfort zone due to my experience with this product. This filler however tends to swell afterwards.
This filler is also very good for lines around the mouth. I will sometimes take a second syringe of Juvederm Ultra and use it for perioral support and reduction of the lip lines. Sometimes patients don’t want fillers in the red part of the lip, they just want the perioral support and lip line reduction (smokers lines – or bar codes).
This is the lowest cost product of the Juvederm lineup of products. I don’t choose it based on cost, but I choose it because in my hands, I feel that the results are predictable and it creates beautiful borders with the versatility of creating a fuller, plumper lip. Overall, I feel that Juvederm Ultra is the most versatile filler product in my hands. It can create a nice body to the lip along with a nice border to the lip.
Juvederm Ultra Plus
I sometimes use this syringe for lip augmentation. I am not entirely used to the light extrusion force when attached to the native 27g needle. The syringe itself is a wonderful tool as with all the other Juvederm products, with rubberized grips in the right places.
This Juvederm Ultra Plus filler is good for creating volume. But in my opinion not that good for creating the borders and many times in my observation it seems to extrude out of the borders. This is a thicker filler like a thick jelly and isn’t great for the fine borders or philtral columns but is good for creating a stiffer and thicker body to the lip.
Juvederm Ultra Plus is the same price point as Juvederm Ultra – they are both on the low end of the price scale.
Juvederm Vollure
The extrusion force is on the lighter side, but I can definitely get used to it. I’m so glad it comes on a 30 g needle so that it is less traumatic to the lip. I love the ergonomics of this syringe. It has a nice violet color to the syringe that lets me know that I’m using the right syringe.
The Vollure Lip procedure is becoming one of my favorites for building a fluffy body to the lip. Vollure is a very spreadable smooth filler that has the Juvederm vycross technology which allows the filler to last longer. This isn’t a great filler for sharpening the borders or defining the filtral column but it is wonderful for volumizing the lip, and giving it a bigger look and having great mobility of the lip without looking stiff. This filler works great going through a cannula as well.
Juvederm Vollure is very versatile and may work well alternating or alongside Juvederm Ultra. Using Vollure for creating a fuller body and using Juvederm Ultra for creating the definition. The swelling is less for this filler than a Juvederm Ultra filler procedure.
This product also integrates quickly into the lip and doesn’t move or swell much afterwards.
Vollure is a medium-high price for the syringe.
Juvederm Voluma
I’ve used this for lips a few times, mostly at patient request. This is for someone who wants a stiff large lip which can sometimes look a bit wider. I usually use this syringe in the cheeks for a stiff filler. This is the stiffest filler in the lineup of Juvederms at this moment in 2020.
This syringe is not good at creating borders, but it is good for creating a stiffer, wider, and fuller look and feel.
Juvederm Voluma is the highest priced syringe in the Juvederm line up at this moment. It is also very long lasting.
Restylane Silk
This Restylane Silk is an incredible syringe for the lips. It creates a very soft look and feel and rarely forms bumps. It does unfortunately create a good deal of swelling afterwards. I like this syringe very much for helping with the lip lines around the mouth. This product also does not look very blue under the skin.
Restylane Kysse
I’ve only injected this filler syringe a few times. I do not have good motor memory with the use of the syringe. I’m not entirely used to the markings on the syringe itself – to give me a visual feedback of how much I’ve injected. This is mainly due to the fact that I’ve injected thousands of Juvederm fillers and very few Restylane Kysse syringes in comparison
The lip filler seems to be a very nice filler which isn’t the best in my hands for creating borders, but it is decent. Not bad for creating philtral column definition, but perhaps a bit thick. It is good at creating a nice fluffy body of the lip and many patients like the results. This product has a lot of potential. I think the thickness falls between Juvederm Ultra and Juvederm Ultra Plus.
Restylane Refyne
This is a lightweight filler that creates a soft change to the lip with flexibility. It is very popular with some of the patients and is asked for by name. I think it is very versatile.
Restylane Defyne
This is the thicker version of Refyne. This is a very versatile syringe and creates a result thicker than Kysse in my limited opinion. The lineup seems to be from thinnest to thickest: Restylane Refyne, Restylane Kysse, and Restylane Defyne. My patients who have gotten Refyne and Defyne for their lips seem to think that Kysse is better and just right for their lips.
Restylane L
This was my original lip filler syringe that I used back around 2006-2008. This syringe is still one of my favorites to use. It creates nice borders and stiffens and lifts the body of the lip. I like the feel of the syringe and it fits into my smaller hand very easily.
Restylane Lyft
I’ve actually not tried this in the lip, but I think it would be similar to my Juvederm Voluma Experience
Belotero
This Belotero syringe does a very nice subtle change to the lip very similar to the Silk and Volbella changes, but the duration is pretty short. I only used it when it first came out, and it doesn’t have lidocaine built inside like all the other syringes mentioned earlier..
In Summary of Fillers for the Lips – how do I choose?
I choose based on familiarity – can I inject it with my eyes closed type of concept.
I choose the filler based on the physical syringe itself – can I visually see what ratios I’ve created easily, and will the syringe fall out of my hand? And when I push the product, will I get good tactile feedback regarding how much I’ve actually pushed? This is somewhat like the gas pedal of our cars. Some have a stiffer pedal and others, you might floor it without knowing – zoom! A lot of this is also based on familiarity too and some of it based on purposeful design.
I choose this based on age of the lip, thickness of the skin, and desired outcome.
For a patient who wants a very stiff thick lip – then Juvederm Voluma.
For patients who wants everything – nice borders, flexibility, more fullness – but is willing to be a little bit on the smaller size and knows that we can just add more syringes of the same product or other products to get a bigger size: then it’s my usual Juvederm Ultra. We can add more in a few months to get to the right size.
For patients who want a subtle change with long duration with less recovery: Juvederm Volbella
For patients who already have a nice vermillion border who knows they want a bigger lip but only wants to do one syringe with longevity then I choose Juvederm Vollure. This syringe creates more of a visual change as seen in pictures.
For my patients whom I’ve had from 2008 and have liked their lip results with Restylane, I continue on the Restylane track. The same for new patients who want to try something new or came from other practices who use more Restylane than I do. Restylane is a fine set of fillers.
There is a new filler which can be used in the lips which is RHA 2 and RHA 3. New to the USA. I’ve tried RHA 3 and it seems very nice too.
My most common to least common ranking of lip fillers used in my own practice:
Most common on top:
Juvederm Ultra
Juvederm Volbella
Juvederm Vollure
Juvederm Ultra with Volbella combination
Juvederm Vollure with Ultra combination
Juvederm Ultra Plus
Restylane Kysse
Restylane Silk
Restylane Refyne
Restylane Defyne
Belotero
In the end, it comes down to four things when I pick a filler to inject lips.
Injector factors – injector’s personal preference, familiarity, predictability of giving the right outcome, reliability and responsiveness of the filler company.
Patient factors – thin skin, age of lip, lack of border, patient desires.
Friends and family factors – what do they prefer when they look at your lips and does it matter to you?
Financial factors – cost to the patient and cost to the injector. Many fillers can give a similar look but can I as the injector make that desired outcome with the least amount of product? I call this efficient use of product.
The one thing I need to know before doing your lip injection
So the topic today is: The one thing I need to know before doing your lip filler injections with Juvederm or Restylane.
Have you ever had cold sores on the outside of your lips?
What is a cold sore? It is caused by the herpes simplex virus. I know now we’re all worried about some other virus right now – the coronavirus, but I still worry about an “older” virus. Cold sores are caused by the herpes simplex virus. There are 2 types and type 1 is the usual cause of the cold sores around the mouth. At least half of all adults are infected with herpes simplex virus type 1 which spreads easily from person to person. Once you have the infection, you have it permanently. The virus lies dormant inside the nerves causing no symptoms most of the time. But it can be woken up by triggers such as stress, sunburn, hormonal changes, exhaustion, fever – this is why they are sometimes called fever blisters, and any trauma around the area where the herpes simplex virus lives. An example of trauma would be needle trauma from lip injection procedure.
By knowing your history of cold sores and how easily you get them, we can have a plan of possibly pre-treating your risk of a flare up by having you take a prescription medication called acyclovir right before your lip procedure or even a few days before your procedure if you are really prone to cold sores. I have pills of acyclovir available in my office and you can take a tablet right before your procedure while numbing up those lips with topical numbing cream. Totally optional and we offer it for free. I joke with my patients when they try to chug down the pill of acyclovir while their lips are getting numb from my special formula numbing cream. When the water drips down the floor because you can’t feel your lips, I pretty much will say, “I see you have a drinking problem!”
I would also write you a prescription for acyclovir tablets to take at home to prevent the flare up.
On another note, cannulas for lip augmentation is something I also do if the risk of swelling and cold sores is severe.
The risk of flare ups with patients who have had previous coldsores is relatively low, but I think it may be 1 in 5 procedures and with pretreatment, perhaps we lower that risk to 1 in 20 procedures. So I would rather have a lower risk, because cold sores are unsightly and can lead sometimes to scars, and sometimes it can even push our lip filler off to the side.
The lip filler experience can be a bit of a roller coaster ride afterwards because of the swelling, and if we can eliminate the added aggravation of having a cold sore – that would be a good thing.
Also if you have a history of swelling a lot with hyaluronic acid fillers such as Juvederm and Restylane, it would be good for me to know too because we can consider an antihistamines or a prescription prednisone series of pills. Prednisone is a steroid which is like a big “off” switch for the body and part of what it can do is turn off the swelling mechanisms. So prednisone, antihistamine (like Zyrtec), and cannulas are options for patients with extreme risk of swelling and cold sores.
But in summary, I will ask before your filler appointment if you have a history of cold sores – mainly because it’s somewhat of a risk with lip fillers, but we can lessen that risk by being prepared. Come visit me for lip fillers in Modesto, CA.
Hyper-Dilute Radiesse, written by Calvin Lee, MD / Surgical Artistry (209) 551-1888
What is Radiesse / Hyper-dilute Radiesse?
Radiesse is made of calcium hydroxyapatite, which you also normally have in your body. Radiesse is a filler that has been around for many years. We took the Radiesse and diluted it down so it’s not as thick. We sometimes take one syringe of Radiesse and add sterile saline to turn it into 2 or 3 syringes. This is the process of diluting it and sometimes we call it hyper-dilute Radiesse.
Why do hyper-dilute Radiesse?
The purpose is to stimulate the growth of collagen and have the skin improve in texture, thickness and tightness. Subtle wrinkles can improve as can skin texture including. The skin can tighten a bit too. Hyper-dilute Radiesse works great for temples (side of forehead), lower cheek, neck, chest, buttocks, knees, arms – basically anywhere skin could use some improvement with stimulated collagen.
How often to do hyper-dilute Radiesse?
Growth phase: Consider 2-4 times the first year (spaced 2-4 months apart). Maintenance phase: Consider 1 time a year.
How many syringes for each session?
Depends on the area. For the lower cheeks – 1 syringe. For the neck – 1 syringe. For the chest – 1-2 syringes. For the Buttocks – 2-10 syringes. For the Arms – 1-2 syringes.
When can you see results?
Immediately you see some changes because Radiesse is a filler. You will see some thickening of the area filled. But the main results that I’m excited about takes about 2-3 months to see when the collagen starts to enhance. In some patients it would be subtle and others more noticeable. Collagen growth is dependent on one’s health, diet, stress level, and many other factors like smoking (smoking is bad for collagen growth / eating lots of fruits and vegetables is good for collagen growth). Patients have seen continued results of collagen growth even after 6 months and perhaps even after 9 months.
How long do the results last?
In general I think patients will want to repeat the procedure every year. The collagen stimulated to grow is your own collagen which you could keep for many years – hard to say specifically how long. But I recommend once a year for maintenance and perhaps even more if one wants to keep improving the area injected.
What to expect afterwards?
I use numbing medicine to help in the comfort of the procedure. The numbing medicine can temporarily cause a lopsided smile for a few hours after the procedure. Some patients have a bit of dull ache in the area injected for about 1 week. Some patients get some swelling which can last 1-3 weeks after the procedure. After a few days, the saline gets absorbed and the swelling goes down. The saline is 50-75% of what we injected. No pain medicine is needed afterwards, but one is welcome to take over the counter medications used for headaches if needed, or apply ice to the areas injected.
Allē is coming! Alle will be the new Brilliant Distinctions which gives you points for Botox injections, Juvederm, Kybella, and Latisse. It will have so much more than Brilliant Distinctions and be easier to use as we are told. We will be switching over around September or October of 2020. Stay tuned for further information regarding Alle.
Allē was named after the first 4 letters of Allergan.
I saw that Allē has an instagram page called Allē Aesthetics. At this point they don’t even have any followers yet.
I also heard that everything counts toward points – even non-Allergan products and services. Patients can come in for our Surgical Artistry laser treatments and earn points for their next Allergan product.
Check out with Allē to take less than a minute!
Carri Strom, Allergan’s Senior Vice President of U.S. Medical Aesthetics says that check out is seamless, and takes less than a minute which will be a huge time savings.
Brilliant Distinctions has been growing – 2019 stats:
In 2019, Brilliant Distinctions grew an additional 6 million members. It is in 25,000 doctor’s offices. There are 60,000 new consumers each month. I had previously estimated that there are 40,000 Allergan accounts in the USA – but that was my own personal estimate based on some statistics I’ve seen a few years ago and my own calculations. I wrote a bit about this estimate in my post about being a Top 250 Allergan Account in the USA.
