Category Archives: Modesto

Cosmetic Fillers compared in terms of thickness

Each cosmetic dermal filler is like a paint-brush

There are all these terms to describe the different properties of fillers including G prime, lift, thickness, hardness, and much more.

I have some thoughts about the projecting capabilities of the fillers and I feel that it is related simply to thickness.  These are my own thoughts about these cosmetic fillers.  I have been doing Botox and Fillers since 2006.  Please consider looking at other sources if you are seriously needing to compare thicknesses of these fillers.

The empty boxes of the dermal fillers used today
The empty boxes of the dermal fillers used in one day at my office in Modesto, CA.

From thinnest to thickest:  Comparing Dermal Fillers

  • Belotero Balance (Merz product) – thinnest
  • Juvederm Ultra XC
  • Juvederm Ultra Plus XC
  • Radiesse diluted with some added liquid lidocaine
  • Juvederm Voluma XC
  • Radiesse – straight out of the box. – thickest

I know integral lidocaine is currently being considered in Belotero Balance and Radiesse, but at the time of writing this blog – they have not been available.

Radiesse, Juvederm Ultra XC, and Belotero Balance cosmetic syringes - complement Botox injections very well
Radiesse, Juvederm Ultra XC, and Belotero Balance cosmetic syringes – complement Botox injections very well

 

I hope you can visit us at our office in Modesto for Botox and Dermal Filler Appointments.

Botox Related Products at Surgical Artistry

We carry products from Allergan (makers of Botox), Merz, Valeant, and others

We don’t have any contracts with any one company to be exclusive.  Botox belongs to the Allergan family of products: Latisse, Botox, and Juvederm.  These are the products we carry at Surgical Artistry.  We also carry aesthetic products from Merz, Mentor and Valeant.

These are the Botox related products we carry:

Not necessarily made by the Botox company, Allergan.

  • Asclera, injected for vein sclerotherapy.
  • Botox – Botox is supplied to us directly from Allergan USA in the form of 100U vials
  • Juvederm Ultra (without lidocaine)
  • Juvederm Ultra Plus (without lidocaine)
  • Juvederm Ultra XC
  • Juvederm Ultra Plus XC
  • Juvederm Voluma XC
  • Belotero Balance (Merz product)
  • Radiesse Volume Advantage (Merz product, this is 1.5 cc’s)

This list changes from time to time.  Feel free to call us.  Our contact info is at our Botox Home Page.

belotoro balance shelf

Above is a picture of our Belotero Balance Shelf

 

Radiesse, Juvederm Ultra XC, and Belotero Balance cosmetic syringes - complement Botox injections very well
Radiesse, Juvederm Ultra XC, and Belotero Balance cosmetic syringes – complement Botox injections very well

Above picture was taken on our conference table which has that rough texture on top.

We do not currently carry:

  • Xeomin
  • Dysport

Please take time and visit us on the web and in person.  www.InjectionArtistry.com

Botox, Veins, and Acupuncture: How my time is broken up in the office

Office time is divided up among three main procedures:  Botox, Veins, and Acupuncture

I had a chance to do some data analysis from January 1, 2014 to June 30, 2014.  This is the first half of 2014.  I get the question from time to time regarding what part of practice involves Botox or Acupuncture or Veins?

I’m happy to report the results.  Basically it says that Botox is the biggest chunk of the office practice coming in at 47%, and Acupuncture is a close second at 45%.  Veins occupies 8% of the practice.

What about Surgeries?

That wasn’t included here.  It would be harder for me to figure out surgery vs. these office based procedures because the time required for surgery is usually much longer.  These numbers here (and percentages) are based on the total number of patients coming in for these procedures.  It is not based on time spent.  It is just based on “patient load.”

So here’s the graphic that shows the division of office based procedures:

Botox Pie Chart
2014 data for how my Veins, Acupuncture, and Botox division of office based procedures. Surgery isn’t included here since it isn’t done in the office. This chart is just the division of my patient load in the office.

Why a patient would choose Surgical Artistry – Staff View

Why a patient would choose Surgical Artistry, in Modesto, California

My staff last week sat down in the conference room and over lunch with our Botox / Allergan Representative, they brainstormed (without me) a list some ideas on why we are worth considering for Botox injections.  I have my own thoughts about why choose Surgical Artistry (Calvin Lee, MD) for Botox.  But these are theirs, and I just cut and pasted their summary email which they came up with all by themselves.  I think it’s pretty nice!

Botox is a high priority in our practice and we talk about it often at work.

  • -Dr. Lee is an Ivy league trained general surgeon that has been trained in minimally invasive cosmetic procedures
  • -Dr. Lee highly knowledgeable in facial anatomy
  • -Dr. Lee has been working with needles for over 15 years!
  • -Experience: a patient could not find an office with a better in office experience
  • -longer specialized appointment times
  • -Higher level of service
  • -more consultation time, better experience, better outcomes

Disclaimer:  These are their own opinions.  I have a very enthusiastic team at Surgical Artistry.   I personally have very high regard for other Botox practices and I know I have a lot to learn from others.

 

Visit our home-made Botox web page:  Modesto Botox by Calvin Lee, Surgeon – our telephone number and other methods of contact are listed there.

 

Allergan and Valeant – Letters against the possible “Vallergant” merger

On April 24, 2014, Dr. Tammy Wu wrote a letter against the idea of the possible merger of the Allergan Botox giant along with the skin care / cosmetic giant Valeant.  This was 2 days after Valeant had proposed a merger with Allergan – or possibly a hostile takeover?

While this merger may make some sense since there is many crossover items – basically competition could be eliminated with this type of corporate merger.  But we have been afraid that customer service will be hurt as will future research and development.  Esepcially with our beloved Botox.

Allergan just published on their website about 100 of the 500 letters they have received from their physician customers.  This is the link to the letters from physician customers to Allergan – all of these are against the idea of the “Vallergant merger”.  I figured it’s a cute name for combining the companies.

Dr. Tammy Wu’s letter is among those 100 published.  In fact, I think in reading them, she was the first one to write.  Perhaps she sparked a flurry of letters to Allergan.

This is her letter:

Dear Mr. Schaison:

As a physician who has experienced the “Valeant” service, I have to say that I am not impressed with them.  Specifically, our office had enjoyed a great relationship with Obagi Medical Products (OMP) and have done business with them for many years. As you may be aware, Obagi was acquired by Valeant last year.

Since the merger/ acquisition, every aspect of OMP has gone down the tubes. Customer service, billing service, product quality control (we receive leaking products and broken products almost with every order – which had never happened before when Obagi was independent), shipping control, timing of delivery of products, etc. have all been negatively affected. The poor OBagi representative has to backtrack and apologize almost on a regular basis for all the mishaps that have happened since the merger.

Allergan has been a leader in aesthetic products and more, and I hope that Allergan will stay independent and have no affiliations with Valeant. I respect Allergan for its research and development aspects, and I believe the future is quite bright for Allergan as an independent company.

I hope that the Board of Directors will take into consideration as much as possible the implications of this merger and what it will do to the reputation of Allergan – in my opinion, if it’s the same as Obagi and Medicis, it will only be negatively affected. We stopped using Medicis products as a result of bad customer service, and we are currently considering eliminating Obagi from our office as a result of all the mishaps.

Thank you for reaching out to us physicians. I know that I am not the only physician hoping for a positive outcome from this, which would be Allergan Independence, no Valeant involvement.  Thank you for listening.

Sincerely,

Tammy Wu, MD

Diplomate, American Board of Plastic Surgery

Surgical Artistry, Inc.

2336 Sylvan Avenue, Suite C

Modesto, CA 95355

Some Background info:  Allergan has the products that we carry: Latisse, Juvederm, and Botox.  It also has SkinMedica.  Valeant has Obagi, Restylane, Perlane, and many other dermatologically related items.

I would like to mention that Obagi has tried to improve on it’s customer service since we had initially complained, but it is a different culture, it seems at Valeant, and I do think that some change is unavoidable.  But we hope to adapt and get used to the new culture.  And we’ll probably adapt too, if Allergan and Valeant were to become combined.

Visit our Modesto Botox home page.

Actavis update

UPDATE: Valeant didn’t end up merging with Allergan.  Actavis ended up being the company which merged with Allergan.

Radiesse is back at Surgical Artistry

Radiesse is available again at Surgical Artistry, Modesto, CA

I took a brief break from Radiesse to become excellent with injecting Juvederm, but I’ve come to realize the unique niches filled by having Radiesse, a demal filler.  Radiesse acts as a scaffolding, providing structure for your own natural collagen to grow.  Radiesse is comprised of Calcium Hydroxylapatite (CaHA).

I know many of you have requested Radiesse by name and now I have it back in stock and ready to go.  I have both the 0.8cc and the 1.5cc syringes available to inject.

Feel free to call us to set up an appointment with me:  209-551-1888, Modesto, CA.

For more information about Radiesse, volumizing dermal filler, please visit www.radiesse.com.

Visit our semi-personalized Radiesse website on www.radiesse.com

Of note, the makers of Radiesse also makes Belotero.

Radiesse Brochure says:

  • Get better results from your filler.
  • Clinical studies of Radiesse patients show that they were more staisfied with the results they received from treatment with RADIESSE than with other leading dermal fillers.
  • 33% more Juvederm injectable gel may be needed to achieve full correction compared to RADIESSE volumizing Filler.
  • RADIESSE Volume Advantage syringe contains 50% more product vs. Juvederm injectable gel syringes.

 

Modesto Radiesse Injections
Modesto Radiesse Injections
Visit our Modesto Radiesse and Botox home page.

Modesto Botox 2013 in review

Some Fun Statistics about my Modesto Botox Practice

by Calvin Lee, MD

I love to share information, and I wanted to be transparent about my Botox experience.  I’ve been injecting Botox since around 2006.  We started having more detailed tracking available to us starting in 2010 by having patients enroll in Brilliant Distinctions.

How the Botox statistics were obtained

The Botox statistics were obtained from Brilliant Distinctions Analytics.  This is a free service included with our participation in Allergan‘s Brilliant Distinctions program which is a “frequent flyer rewards” type program.  It is a free program for our patients to enroll.  I’ve been keeping simple statistics of my Modesto Botox practice before by looking at total number of patients enrolled and looking at the total amount of coupons redeemed.  Most of our Botox patients are enrolled in the Brilliant Distinctions patients.  As are our Juvederm and Latisse patients.  We do not currently have SkinMedica which is part of the Allergan family.  But feel free to call us to see if we have encorporated SkinMedica into our collection of skin care products.  (209) 551-1888.

Possible faults of the data collection

  • Not all of our patients are enrolled in the Brilliant Distinctions program.
  • More and more existing patients enrolled in Brilliant Distinctions as the program became more familiar to us.  This means that any increases in the number of patients “seen” for Botox, may actually be lower than the reported number because the numbers we have reflect Botox patient enrollment into Brilliant Distinctions, not necessarily patients who have received Botox.  Thus we are using Brilliant Distinctions registered visits as a surrogate for actual Botox visits.  But i think the estimate is pretty close because we try to enroll all Botox patients into Brilliant Distinctions.

Here are the Botox Related Statistics of my Modesto based Practice which I have with my wife Dr. Tammy Wu, Plastic Surgeon

  • 724 separate patient visits over the year for 2013.  This represents a 43% increase over 2012 where I had 505 separate patient visits.  In 2011 we had 270 patients registered.  But I think this number might be “artificially” lower because many of our patients at the time weren’t signed up for Brilliant Distinctions.  How is this calculated?  I went through the Analytics part of Brilliant Distinctions and had the computer program extract out the patient data one month at a time.
  • Averaging 60.3 Botox Visits per month.  60.3 Botox visits per month is the average number of visits per month for 2013.
  • 374 unique patients seen for Botox Cosmetic injections who are registered in Brilliant Distinctions in 2013.  In 2012 we had 278 unique patients seen for Botox injections.  In 2011 we had 180 Botox different patients.  Unique, or different, patients means that these patients were counted only once even if they came to the office several times over the year.
  • I couldn’t seem to find too many monthly trends with our Botox Visits.  But from what I can see over three years of data, it seems that there is a consistent increase in patients in March and November.  I’m not sure about these seasonal changes, but this may be specific to our town of Modesto, CA.
  • We grew to have about 245 new Brilliant Distinctions Signups in the last year.  This also includes Juvederm-only and Latisse-only-patients.  This averages about .67 new Botox/Juvederm/Latisse patients per day (365 days per year).
  • We reached 702 unique patients on Brilliant distinctions.  This growth in the number of unique patients is very steady – it doesn’t seem to be increasing exponentially, just a direct increase which is steady.

Financial analysis and comparison with the other components of my medical and surgical practice.

I have many medical colleagues and students who ask is a profession of doing Botox worth it?  They mainly ask from a standpoint of does Botox make money?

Without going into gory details.  I can say that  the other parts of my medical practice was more profitable than the Botox part of the practice.

As with any other medical practice there’s the personal satisfaction aspect.  For me is very satisfying to be injecting Botox.  I enjoy the process and having wonderful patients who value appearance and beauty.  And most of all, I enjoy working with my wife who is a plastic surgeon.  I have been working with her since we moved to Modesto in 2003.  However, it became an every-day work experience together since 2006 after we founded Surgical Artistry in Modesto, CA.

Another financial rewards related Botox question:  How much overhead does one have when injecting?  I guess one way to answer this question would be to look at my Botox and Dermal Filler practice in a vacuum.  Botox and Fillers (ie. Juvederm Voluma, Juvederm Ultra, Juvederm Ultra Plus XC, Belotero Balance, etc) are expensive for the practice to buy.  These are the most expensive products I have ever had for my surgical practice.  Expensive in terms of price for size of product.  In my estimation, I think a Cosmetic Injectible practice’s overhead with lasers (I have one laser) would be about 75%.  Meaning there’s a 25% profit margin.  This is without a surgical practice, vein practice or acupuncture practice.   I don’t use our laser all that much, and this figure of a 25% profit margin on a Botox/Filler/Laser non-invasive cosmetic practice is for my practice.  I’m sure it would vary.  I’m factoring in the cost of the products and the overhead costs of the office – staffing, malpractice insurance, rent, utilities, supplies (syringes, etc).  And this figure would be before tax – which will of course, take out another chunk!  I hope this information helps.  I’m thinking that most of the people reading up to this point are Botox injectors of sorts or interested in becoming one.

Graphical Representations of Botox Data

Modesto Botox Monthly Statistics
Number of Unique Botox Visits to my Modesto Botox Practice broken down by Month
Botox patients per month with actual numbers
The graph shows the Botox Patient Visits for the past consecutive 35 months. It is missing December 2013’s data. But for 35 months before December, it is shown above.

Conclusions and predictions.

Botox is growing at our practice in Modesto.  There is definitely room for even more growth for my practice.   724 separate Botox visits is certainly a good “start.”  I think my practice could handle twice that.  I guess we shall see what 2014 holds – this is hard for me to predict.  I think our growth will slow percentage-wise for 2014, I think it will be lower than  the 43% growth we achieved this year.  I think I would be happy with a 15% growth in the amount of Botox appointments.  A 15% growth for next year will reveal 833 patients.  So perhaps that’s my prediction for 2014.

We currently have 702 different patients signed up for Brilliant distinctions.  If I were to be ambitious, I would hope to break 1000 new patients in our Modesto Practice’s Brilliant Distinctions program.  But a conservative estimate based on calculations over the past 3 years would be 947 members signed up.

Good luck and Merry Christmas!

Please visit our main Modesto Botox home page

Update: Please see a new Blog entry:  Botox Charting of 2011-November 2014: BOTOX patients per month

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.

botox-bottles-botox-blog-2.jpg

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.

BTXC-color

Other Botox related links

Botox Development built into Brilliant Distinctions

The Best of Brilliant Distinctions for the practitioner

Calvin Lee happy with computer
I’m the kind of guy that gets frustated easily with computers, but I’ve found some great features from Brilliant Distinctions which is a computer driven program which brings Botox customers back with coupons and rebates.

Please feel free to view our Modesto statistics with Botox and the Brilliant Distinctions Program.

I like how Brilliant Distinctions emails the patients reminders

  • After a certain period of time, and from time to time, Brilliant Distinctions emails customers reminders regarding Botox, Juvederm, Latisse, and other Allergan products.
  • They will sometimes mail reminders when a patient is about due for their Botox cycle.
  • They will sometimes mail special rebates.  This, I know our Botox / Juvederm / Latisse patients enjoy getting.    These rebates are somewhat intelligent and can target a population who hasn’t tried a particular product.
  • They also sometimes mail reminders if they have coupons or points which are about to expire.
  • In a way, Brilliant Distinctions, keeps the patients connected with these products which I carry in my office.

I like the discounts Brilliant Distinctions gives patients

I sometimes tell patients that BD stands for “Botox Discounts”.  But as we know BD stands for Brilliant Distinctions.  As the owner of a medical office, I personally dislike sporadic discounts because I think our prices should be a great value all the time.  But BD takes that work out of my hands and gives discounts to the patients for me.  The patients love discounts.

I like how it ties one product to another

When someone likes the results of Botox, they would most likely like the results of other aesthetic related products such as Juvederm and Latisse.  The coupons from Brilliant Distinctions act as a bridge introducing other products we carry in our office.  The coupons are the bridge, the products are the gateway to other excellent products which make our patients happy and confident.

My favorite part: BD Analytics

With analytics, we can easily see which patients might benefit from a nudge from our practice.  I personally appreciate nudges from coaches.  In many ways, we are the beauty coaches for our patients.  Using the analytics section, we can identify patients who have “slacked” off from a routine maintenance program of restoring youthful appearaces at our office.  Once identified, we consider giving the patients a phone call to see if we can help.  Or perhaps we need to find out about some things we need to improve upon.  It’s a diligent disciplined approach to life that yields the best results – the same can be said for achieving and maintaining health and beauty.  BD analytics is very customizable, and allows one to find patients who have expiring coupons, or who haven’t been to the office in a certain period of time.   Calling these patients will improve our retention rate, and by contacting these patients, we will improve their outcomes from having a disciplined approach to Botox, Juvederm, Latisse, and skin care.

If you have basic spreadsheet (ie. Excel) skills you can manipuate the data to further assist you in your practice.  For example, I wanted to show my staff how we grew, we were able to use BD analytics to show how many unique patients we see per year for Botox and for Juvederm:

Growth of my Botox and Juvederm practice over the last three years since we started with Brilliant Distinctions, a program for coupons developed by the Botox company - Allergan.
Growth of my Botox and Juvederm practice over the last three years since we started with Brilliant Distinctions (BD).  These graphs were drawn in Excel using data from Brilliant Distinctions Analytics.  Click to see a larger version of the graph.

Overall, Brilliant Distinctions can grow our practices.

There’s automatic growth by using Brilliant distinction, and there’s purposeful growth by putting energy into the program and using BD analytics.  Once you start building up patients in the program, BD analytics eventually becomes one of the most valuable parts.  The more you put into Brilliant Distinctions, the more you’ll get out.  You need staff training, time, and the opportunity to sharpen your spreadsheet skills.  All is worthwhile.

My patients love the coupons, they love crossing over into other products in the Allergan family, and we have become better practitioners for allowing them to get a lower cost, giving them chances to try other excellent products, and with this tool, we can also monitor patients who might become “lost to follow up.”

Calvin Lee, MD
Modesto, California.

a use for calvin lee  profile picture DSC08729 -brighter

Calvin Lee, MD is a graduate of Brown University Medical School.  He is a General Surgeon who works with his Plastic Surgeon wife, Dr. Tammy Wu in a practice called Surgical Artistry in Modesto, CA.

Links related to Brilliant Distinctions by Calvin Lee, MD

  1. Please feel free to view our statistics with Botox and the Brilliant Distinctions Program.
  2. Add Allergan’s Brilliant Distinctions Program to your Website’s Social Media Buttons – an article about Brilliant Distinctions written by Calvin Lee, MD for MedicalSpaMD publication.  Brilliant Distinctions program created the custom sized logos found in that article.
  3. Modesto Botox Home Page