Category Archives: Crows Feet

Allergan considers a 3% increase in the price of Botox starting in 2015

Botox, Juvederm, Latisse to possibly get a 3% rise in cost for those Botox practices purchasing from Allergan USA

I don’t have this 100% verified.  But I heard a whisper about this as I am a regular Modesto purchaser of Botox, Juvederm, Voluma and Latisse.  I heard that across the board all these three products are going up in price in January except the 5 ML Latisse.  I do recall that last January, Botox had a sudden increase in price which wasn’t announced ahead of time.  I think Botox practices deserve to know ahead of time for planning purposes.

However Allergan is about to merge with Actavis, and many of these practices and policies of price increases are probably going to change

A history of price increases

I remember when we started purchasing Botox in 2006 that every year, the price would go up.  To our humble Modesto practice, it felt like a bit of a struggle to keep up.   When the recession became more of an accepted ambiance, Botox prices stayed the same for a few years.  But starting in 2014, the prices started increasing.  I had a strong feeling that many practices in Modesto, including ours had greater temptation to migrate over to Xeomin and Dysport from Botox.    However, I think as with inflation, there tends to be an increase in just about everything all the time.

How much would Botox Cost at our Modesto Practice?

I think we would consider following the trend of price increases.  If our Botox source goes up 3%, we would probably consider following.  However last year when Botox price increased for us, I elected not to increase our Botox price for patients, yet.  Please call our office for the latest information.  Our phone number is on our Modesto Website.

Such is life in Modesto and life in general

Hopefully Botox’s prices doesn’t skyrocket to the point where we have constantly diminishing returns.   Diminishing returns?  There is pressure, naturally, to lower the price of Botox for patients – there’s competition from other injectors, there’s fake Botox, there’s Botox from other countries, and their’s other products that do similar things to Botox such as Xeomin and Dypsort.

Enter Xeomin and Dysport into the Modesto market?  Belotero and Radiesse?

In general, it’s good to keep an open mind about the possibilities of other products that work in the same areas as Botox, namely, Xeomin and Dysport.  I already like a lot of Non-Allergan products – meaning non-Juvederm.  My personal exploration with these other products were brought about in the early 2014 price increase that was suddenly dropped on me in January 2014.  So good things come out of things that appear bad at first.  I think  I wouldn’t have been such a supporter of Belotero – Belotero Balance – if I didn’t have a kick from the sudden jolt that I received from Allergan in January 2014.

Getting Botox has never been a right, like free speech

Getting Botox injected into one’s glabellar complex or crows feet has always been a choice, not a right.  Thus we can simply choose to avoid this price increase by avoiding Botox altogether.  That could be a choice for the consumer, or it could be a choice for the Botox injector.  For a cosmetic surgeon, there’s a choice to focus more on surgeries.  We can’t complain, as a team, my wife and I have had the opportunity to do many cosmetic surgeries.  In fact in 2014, we were voted Best Cosmetic Surgeon in Stanislaus County (which includes Modesto) from Contentment Health Magazine.

But I’d like to think that I’m trying to keep the prices reasonable for our patients in Modesto, CA.

How many Botox Units for Crows Feet?

How many units of Botox are good for treating the crows feet around the eyes?

Quick answer?  8-12 units of Botox per side.  Because we usually want to treat both sides of the eyes, we would double that number and that would be 16-24 units.

8-12 units of Botox per side? (16-24 units of Botox)

Yes, about 8-12 units of Botox could be injected per crows feet (left or right).  However, everyone is different.  I have done more and I have done less.  This depends on Male vs Female, young vs old, and of course on personal preferences and experiences with Botox.

Another consideration is eyebrows.  Eyebrows can also be lifted with a certain style of crows feet injection, or even an extension of the crows feet injection.  Women and men have different eyebrows.  Women have more of an arch, which complements a certain style of crows feet Botox injections – these injections hug the eye a bit closer – especially toward the eyebrow region.

And yet another consideration is swelling under the eyes.  Sometimes too much injection in the crows feet can lead to temporary swelling under the eyes.  These are things to discuss with your personal Botox injector – preferably in person and at an appointment (face-to-face).

What to do for really deep Crows Feet lines?  Static lines.

Fillers may be an option.  I like to use Belotero as a filler for crows feet if needed.   Juvederm could also be used, but in my hands it tends to be a little bit bumpier.  But it is usually my preference to try Botox alone first.

That’s the beauty of Botox.  It is customizable.

Everyone will have different preferences and have a different response to Botox.  It becomes a science and art – this injection of Botox.

I hope I helped to answer the question of how many units of Botox are needed to help with crows feet around the sides of the eyes.


Let’s say we just wanted one number to be the answer.  Perhaps hang on to the number 20.  It’s a nice round number, and it’s between 16-24 units of Botox (for both sides).  I would say that 20 units of Botox is a nice treatment for many people’s crows feet!

Please feel free visit our Botox practice in Modesto.



Bumps after Botox?

“I have horns!”

Horns right after Botox injections?   I heard this exclamation after a Botox injection today.  And I thought to myself – what a great topic for my Modesto Botox Blog.

They aren’t horns, they are bumps.

Well, that sounds almost as bad.  But these bumps are from the injection of Botox under the skin and sometimes into the muscle (depending on the location of Botox injections).  Botox is reconstituted as a liquid (from a powder), and then injected as a liquid in these locations.  Liquids will naturally take up some space, and they look like little bumps.  Probably a little bit bigger than those TB testing shots that we get from time to time in our forearms.

The bumps usually go away in about 15-30 minutes.

Fortunately the Botox bumps usually go away in a few minutes.  Sometimes by the time a patient drives home.

The Botox bumps I’m discussing in this blog are the ones that can be seen immediately after a Botox injection.  I’m not discussing bumps that occur hours after or days after the Botox injection.

What else could it be?

If these Botox horn or Botox bumps don’t go away, it could be something else like a hematoma.  A hematoma is a collection of blood – from bleeding, which could happen after injections with a needle.   And the collection of blood could cause the bump.  Hematomas will also resolve with time, but ideally, I try to avoid large hematomas by observing the injection site during and after my Botox injections.  Sometimes hematomas can’t be avoided.  But I would try to minimize them.  A smaller Botox needle might help, too.   Hematomas usually will result in bruises which will also resolve.  At least this is what I do in my Modesto Botox Practice.

Below is a picture of me, not a picture of Botox bumps.
Calvin Lee, MD
Calvin Lee, MD

If you haven’t looked directly at my crows feet or glabellar lines – in person and at my office – then we have not established a formal doctor-patient relationship.  Please see your own doctor.  There is no medical advice here, just medical information for general use – nothing here is directed at any specific person.

Botox Vials

Botox Vials


Skin Aging Infographic from Colorescience

Skin Aging Explained – and how to fight it

I got this infographic about Skin Aging from Colorescience.  It was sent over in an email.  I posted it to our facebook accounts and it started getting some shares.  I think that’s an indication that skin aging is a pretty populr topic.

infographic on Skin Aging - need Botox
Skin Aging Explained and what to do about it. Click to enlarge.


Highlights from the infographic on Skin Aging from Colorescience:

  • Sun Damage – more than 90% of age-related skin changes are caused by the sun.  Use sunscreen – in particular it says, use their product called Sunforgettable.  And we carry that product at Surgical Artistry, Modesto.
  • Dehydration – use hyaluronic acid.  We have many products with hyaluronic acid made by Obagi and SkinCeuticals.
  • Acne Treament – spot treatments dry out the skin.  Use products for the whole face.
  • Food – sugars, sweets and saturated fats increase the likelihood of a wrinkled appearance.  Solution:  avoid processed food, eat plenty of fresh fruits and veggies.
  • Exercise: only 18% of women meet the recommended amounts of exercise
  • Sleep: Getting insufficient sleep ages the skin prematurely and fosters eye area puffiness.  Solution:  ban bright electronics at least 90 minutes before bed to improve quality of sleep.
  • Makeup Removal.

What is Sunforgettable?

It is a powdered mineral sunscreen with Zinc and Titanium dispensed with a brush, and it comes in 3 different skin tints.

sunforgettable sunprotection

What? No mention of BOTOX wrinkle prevention?

BOTOX, to me is one of the most effective treatments to receive to help prevent wrinkles.  It has received FDA approval for the Glabella area and Crows Feet areas.   Botox has also received approval for cosmetic use in wrinkle prevention in other areas of the face.   I guess BOTOX wasn’t mentioned in this article because Colorescience isn’t the manufacturer of Botox.  Otherwise, of course they would have included Botox in this discussion of skin aging.

And Smoking? even more important than BOTOX or Sunscreen.

It’s tops on my list to quit smoking – as a top thing to do to slow down skin aging.

My top three for Anti-Aging skin?

  1. Stop smoking
  2. Use Sunscreen with ZINC
  3. Consider BOTOX use

Slowing down the aging skin is a passion of ours at our Modesto Botox Practice:  Surgical Artistry.

Visit my blog from a few years ago about Zinc and Sunscreen

Hawaii picture by Calvin Lee, MD
Hawaii picture by Calvin Lee, MD


I didn’t write this infographic.  Please visit us: Modesto Botox, Plastic Surgery, Veins, and Acupuncture.  Please verify all ideas presented here with your doctor.  I am not your doctor unless you have seen me in person.  We carry Colorescience skin care products in addition to NIA 24, Obagi, and SkinCeuticals.

Medical Botox vs Cosmetic Botox, differences?

BOTOX® Medical and BOTOX® Cosmetic

The BOTOX formulations are the same.  But the uses are different.  As the terms say, BOTOX medical is used for Medical purposes.  And BOTOX Cosmetic is used for cosmetic purposes.  There are many OFF-LABEL FDA uses of BOTOX, but here we explore the ON-LABEL uses for medical problems and cosmetic problems.

Medical uses of BOTOX
Sometimes called BOTOX THERAPEUTIC

More specifically, medical uses of BOTOX which are ON-LABEL FDA:

  • BOTOX for Overactive bladder symptoms
  • BOTOX for Urine Incontinence due to neurological disease
  • BOTOX for Headaches, specifically chronic migraines (15 or more days each month, longer than 4 hours each day)
  • BOTOX for upper limb spasticity
  • BOTOX for cervical dystonia
  • BOTOX for strabismus: an eye muscle problem
  • BOTOX for blepharospasm: an abnormal spasm of eyelids.
  • BOTOX for axillary hyperhidrosis
BOTOX Injection sites for Blepharospasm

The BOTOX injection site picture from Allergan.  BOTOX has been the main blepharospasm treatment since FDA approval in 1989.

BOTOX injection sites for Blepharospasm treatment.  Picture from Allergan.  BOTOX has been the main blepharospasm treatment since FDA approval in 1989.
BOTOX injection sites for Blepharospasm treatment.

Cosmetic uses for BOTOX

  • Glabellar lines = Frown lines between the eyebrows.  Botox was approved for usage for cosmetically reducing the appearance of wrinkles, temporarily between the eyebrows in patients between the age of 18 to 65 years old.  This was approved by the FDA in 2002.
  • Crows feet = Lines on the side of the eyes.  In September 2013, the FDA approved Botox for use in the crows feet area.  Botox for the Crows Feet – a entry in my Modesto Botox Blog

Again all the above mentions are FDA approved – ON LABEL usage.  There are other medical and cosmetic uses of BOTOX but they require a physician to determine the possibility of OFF LABEL-FDA use.

Differences in Dosages in Medical Botox vs. Cosmetic Botox

Usually many more Botox units are needed for medical indications than for cosmetic indications.

Disclaimer for this BOTOX webpage:

Unless you are directly looking at my actual crows feet and my glabellar lines, there is no establishment of a doctor-patient relationship.  Please see your own doctor’s wrinkles in person so that you can get medical advice.  Above is for information only – not to be considered any sort of medical advice.  Furthermore, looking at a picture or video of my crows feet and glabellar wrinkles does not count – it has to be a live and in-person viewing.


Neotensil is now Available at Surgical Artistry

Botox for Crows feet now has a companion: Neotensil for under the eyes!

In addition to Botox around the side of the eyes, we now have Neotensil for under the eyes.

Neotensil is a liquid film which tighten under the eyes.
Neotensil is a liquid film which tighten under the eyes.

Info about Neotensil, now available in Modesto, California

The Neotensil info below was put together by Karla, who works in our Modesto Plastic Surgery Office:

Do we have anything nonsurgical that helps under the eyes?  Why yes we do, I’m glad you asked. We have a revolutionary new product called Neotensil.  Neotensil is great because it is a daily invisible film which shapes and tightens the bags and wrinkles under the eyes.  It is the only non-invasive, at-home procedure that reduces the appearance of under eye puffiness and wrinkles.  We saw the results for ourselves, and it’s really impressive.  It’s a great option for patients who are not interested in surgery, but would like eyes that look younger and refreshed.  Neotensil is exclusive to Obagi and doctor’s offices.  It’s only sold by physicians, so you will not find this product at Sephora or Ulta.  Finally, there is a non-surgical solution for the unwanted baggy eyes.  We are excited to be able to offer it to our patients.

How do you use it?  The application process takes about 5 min.  It’s an easy two-step topical application that you can use every day or for special occasions.  You put the products on and it starts tightening after about ten minutes, and it keeps tightening for the first few hours.  So, if you have an upcoming important event, and you’re worried about under eye puffiness, Neotensil will make you look even better in the matter of an hour!  It feels like liquid “Spanx” for your eyes.  The results last 16 hours and you just take it off with your makeup at the end of the day.

What does it do?  It is made with technology developed at MIT and Harvard.  They call it “shape-wear” – which lifts, smoothes, and tightens.  It not only helps reduce under eye puffiness, but it helps tighten the appearance of loose, sagging skin, reduces the appearance of wrinkles.  It also moisturizes up to 2x better than the leading over-the-counter cream, improving hydration.  While you have it on, it hydrates your under eyes and can help improve the hydration of your eyes over time.

How many applications come in the kit?  The kit comes with 50 applications, so it will last you about four months if you use it 3-4 times a week and almost two months if you use it every day.  When used once a week for special occasions, it could last a year.   The kit is $500 + tax.  When your eyes look good, it really brightens your whole face.

Can you wear your own concealer or make up over it?  Unfortunately not, customers are discouraged from wearing make-up under the eyes before or after the application.  Neotensil will improve the appearance of your under eyes but you cannot use your own makeup over it.  The Neotensil concealer has not been released, but check back with us.

How does it compare to Plastic Surgical Eyelid Surgery (blepharoplasty)?  Neotensil will not replace lower lid surgery, but rather is a therapy for those who are not ready for surgery or for some reason are not surgical candidates.


For more information about us or Neotensil:

Feel free to visit our Modesto Botox Home Page (  On that page we have our contact information, please call us for more info!


Juvederm before and after picture for cheeks

Juvederm and Belotero Before and After
Juvederm ultra plus xc and Belotero injected via Cannula Technique by Dr. Calvin Lee

This is not done with Juvederm Voluma.  As of November 2013, I do not have experience with Juvederm Voluma.  Juvederm Voluma, however, is on it’s way to the office in Modesto, CA and I will soon have experience with this new dermal filler.  [update: I’ve used my first syringe of Juvederm Voluma on 12/24/13.  It was a very satisfying and positive experience.   I look forward to having even more experience with Juvederm Voluma.  I was able to use my 27g 1.5 inch cannula for Juvederm Voluma injections].

To improve my cosmetic dermal filler craft, I’m analyzing my past week. 95% of this result was performed with CANNULAS as an instrument of liquid implant delivery and a whole bunch of other secrets. There’s more that I would like to do with fillers for her, but my instructions were only to work on under eyes (tear troughs) and cheeks.

Background info:

Patient had lost a good deal of weight and it is showing in her face.  Options include face lift.  However, she chose to use Juvederm, Belotero, and Botox.  In the before picture she had Botox and Juvederm expertly done at another plastic surgery practice in our town of Modesto, CA.  I added upon that work to get the 13 day “after” picture using only Belotero and Juvederm.

Info about Brilliant Distinctions in our Modesto Cosmetic Injections practice.

Picture used with permission.  Thank you very much for letting me share this experience.  This is an off Label, FDA usage of Juvederm ultra plus XC for cheek fillers.

BOTOX is now approved by the FDA to treat Crows Feet

It’s official:  Botox approved by FDA for the cosmetic treatment of crows feet

Hot off the press:  Today:  9/11/13.  These are my views as a Botox injector in Modesto, CA.

Botox for Crows Feet? No, crows do not stop walking after treatment, and No, it’s not something that veterinarians can do for your pet bird.

Crows feet are those wrinkles around the corners of the eyes.  Sometimes these are even called “fish tail”.  Medical folks are somewhat inclined to call this area lateral canthal lines.  The original cosmetic approval of Botox was in 2002 for the treatment of glabellar lines which are cause by a complex of muscles involved in frowning between the eyebrow area.  Botox now has FDA approval for effectiveness and safety in the crows feet area after studying over 800 patients.


But haven’t doctors been treating crows feet for awhile?

Yes, doctors have been using Botox to treat crows feet wrinkles for many years.  This is called using it off-label FDA usage of Botox – and based on a doctor’s professional discretion.  FDA website.

How Long does Botox last in the Crows Feet?

Botox typically has an effect in my experience and Modesto based practice from 1 to 6 months.  But the results are usually dose dependent.  Meaning that the higher the dose, the longer it lasts.  But there are some minor factors which depend on Botox injection technique and patient factors – but for the most part it is dependent on the amount of Botox injected.

What’s all this about eyelid swelling after Botox?

There’s the risk of eyelid droop.  Then there’s the well known risk of eyebrow droop.  And there’s another complication of eyelid swelling.  The periorbital muscle is the muscle which causes most of the crows feet.  It has the function of closing the eye shut which also serves to squeeze fluid and edema out of the area.  Theoretically if too much Botox was injected into the periorbital muscle – obicularis oculi, it can hamper this mechanical function of squeezing out excess fluid and thus swelling can dwell in the eye area.  However, this is not to be confused with a temporary (few minutes) swelling that appears with the injection site of Botox.  These are small temporary blebs/bulges in the skin which appears as the Botox is injected in a liquid under the skin.  Confusing?  Yes, but these risks are unusual and injectors worry about them so the patients don’t have to worry about them as much.

How about competitors to Botox?  Do they have Crows Feet Approval?

Not yet, the other neuromodulators, which are Xeomin and Dysport do not yet have approval for crows feet.  It is up to the manufacturers whether they want to obtain this type of approval from the FDA.

How will this new FDA approval change my Botox practice?

  1. I think it gives the patients a greater feeling of safety for this product.  Thus I think it is useful.
  2. It becomes easier to pick a product which is FDA approved for the desired effect.  ie.  When deciding between the different neuromodulators available to the Modesto, CA, USA market:  Dysport, Xeomin and Dysport.
  3. I think we would see more advertisements coming from the Allergan company regarding crows feet Botox.  Allergan has historically been very good at advertising directly to the public.


Other Botox related links