Category Archives: Voluma

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.

My personal Modesto Botox injection statistics 2014

34,234 units of Botox injected & 443 syringes of dermal fillers implanted in 2014.

2014 collection of empty Botox bottles
2014 collection of empty Botox bottles

Much of the data here comes from my own recording of each day’s usage of Botox.  I have Jessica to thank for entering this data every day at our Modesto plastic surgery office, Surgical Artistry.

Every patient is unique

Patients are not statistics.

By using these statistics, I am hoping that other Botox injectors will find them useful, and I will also use them to find ways to improve.  Every Botox patient is unique and special to me – the statistics here is a look at my practice, not a look at an individual patient.

“Measure it to Improve it”

But for me, to be an excellent surgeon, it is my belief that my best surgical outcomes come from consistent practice, a good volume of injections, along with diligent purposeful thoughts of improvement.  Thus I keep track of many things in my practice of medicine.  These statistics are just one of them.  There’s a saying which I put to practice from my surgery residency days: “You can’t manage what you don’t measure.”  Although the phrase was first presented to me as “If you can measure it, you can improve it.”  I prefer thinking the second iteration.  It just sounds more positive to me.

2014 Year End Botox Statistics

  • Number of Botox visits to us in Modesto, CA for the year:  1009.  This is up from last year where I had a total of 724 visits.  (there were still 2 more days left in the year when this was written and compiled), so these numbers will be even higher.
  • 503 different patients were seen for Botox in 2014.  This is up from 374 last year.
  • Average number of patients per month: 84 patients per month.
  • Total number of Botox units used per year: 34,234 Units.
  • Dermal syringes injected over the year: 443 syringes of filler!  I had no data on this last year.  I do not have data on which type of syringe was used (ie. Belotero, Voluma, Radiesse, or Juvederm).
  • As before, about half of my time is reserved for Acupuncture.

    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.

Average number of Botox units used per session.

Average number of Botox units used by patients per visit is 33.9 U.

Background in general for Calvin Lee, MD

Calvin Lee, MD
Calvin Lee, MD

Written by Calvin Lee, MD

Botox Statistic Links

Who is Allergan?

Allergan is the Company who makes BOTOX

Allergan is the company who makes BOTOX, Latisse, and Juvederm.  These are three popular products offered at Surgical Artistry.  Latisse is a take-home product, unlike BOTOX and Juvederm which are injected (by Dr. Calvin Lee).


Allergan cosmetic products

Allergan is also regarded as an ophthalmic (eye) pharmaceutical specialty company

Allergan makes many other pharmaceutical products – many of them are for the eye – conditions such as dry eye.

Eye Products include:

  • Restasis
  • Lumigan
  • Acuvail

How many Billions in sales for Allergan?

  • It is estimated that Allergan has $7 billion in sales in 2014

Advertising spending for Allergan?

  • In 2012, it is estimated that Allergan spent 162 million in advertising.

Allergan Location?

Headquarter is in Irvine, California

Allergan Merger?

Allergan plans to merge with Actavis.  The battle for Allergan started in April 2014 when Valeant made a bid for Allergan.  Actavis plans to pay $66 billion for Allergan.  Brent Saunders is the CEO and president of Actavis.

For more information about Allergan including the CEO’s BLOG.

  • Allergan home page – this is a great place to start learning about Allergan.
  • AllerganViews: The CEO of Allergan has a blog.  “Our Pursuit, Life’s Potential.” That is Allergan’s vision, and every day, around the globe, our more than 11,000 employees work to deliver on this vision.  David Pyott is the current CEO, as of the writing of this blog which is Dec 10, 2014.
  • Allergan on Twitter
  • Allergan also runs the Brilliant Distinctions program.  Click here to log in direction to Brilliant Distinctions.

Links For Physicians and Nurses who inject Botox and perform Breast Augmentation

Visit Surgical Artistry in Modesto, CA

That’s our BOTOX and Plastic Surgical Practice in Modesto, CA

Dexterity for Botox Injections – Chopin?

Dexterity for Surgery, Piano, and Botox Injections

Surgery depends a lot of dexterity.  So does playing the piano.  And so should Botox injections.


I have some unique ideas of developing and maintaining my Botox dexterity with Piano Practice.

  • As with piano playing, I like to keep my wrist supple and flexible when injecting Botox.
  • When injecting fillers, there are times where I have to do finger stretches to be able to maintain tension on the skin with my non-dominant hand, and then I also sometimes have to reach for the plunger which may be in slightly awkward positions for my dominant hand – it depends on the style of the plunger.  Radiesse Volume Advantage is one of the larger syringes due to it’s 1.5 cc volume which is more than some of the other syringes of dermal filler.
  • Timing is also key in Botox injections.  Timing is a big deal in music and performing piano.
  • Then there’s the grace in lifting off from the actual Botox injection.  It would be a shame to waste Botox with a heavy handed lift-off – in that case, the Botox isn’t injected into the muscle – it might even be injected into the air.  Thus a light lift-off is key.  It’s akin to musical phrasing with the tapering that occurs and the lifting off of each note too.

Chopin Etude Op. 25, No. 1 (Aeolian Harp) as Botox Dexterity Practice

Here’s a piano piece which is dedicated to finger dexterity building.  It is also one of the most beautiful melodies I have ever encountered in an finger dexterity etude.  This piece is also known as the Aeolian Harp Etude.

Yes, that’s me.  Recorded at my home in Modesto, California.  Yes, this is one of the great things you can do in Modesto – practice piano!  And record piano for YouTube!  And write this blog… ok, the list goes on and on regarding great things  in Modesto, CA.

Quoted from the wikipedia entry on this piece:

“Technically, the piece requires both dexterity and velocity, good balance and weighting of the arms coupled with flexible finger stretches”.

For me my dexterity and musical challenges are: evenness, flexibility in the wrist, and flexibility with finger stretches, light touch, and musical line phrasing. I hope to continue to work on this to make it even better.

Light touch?

And a light touch is very very important in lightening the sensation of any pain from Botox shots.

Consider getting Botox from us in Modesto, CA

Please visit my Modesto Botox injections home page.  We offer other Cosmetic procedures besides Botox.

Our other Procedures include:



Cosmetic Procedures Besides Botox

Minimally invasive cosmetic and acupuncture procedures I perform in addition to Botox

Some may call minimally invasive as “non-surgical.”  But to me these procedures are surgical.

  • Asclera vein injections – for those spider veins (especially on the legs).  Their slogan is “Enjoy the freedom to show your legs.”
  • Vein laser with the Dornier Diode Laser
  • Radiesse dermal filler injections
  • Juvederm VOLUMA dermal filler injections for cheeks.Voluma Apple
  • Belotero Balance dermal filler injectionsBelotero Box
  • Juvederm Ultra Plus XC, Juvederm Ultra XC, Juvederm Ultra plus (without XC), Juvederm Ultra (without XC).
  • Derma Pen – skin tightening procedure.  Also good for acne scars.
  • Blue Peel Radiance – Obagi product
  • Blue Peel – Obagi
  • Acupuncture for various conditions such as back pain, headaches, stress reduction, fertility, hormonal balance, allergies, etc.

My Surgical Assisting Consists of:

In addition to these procedures I also perform surgical assisting for plastic surgery, and for Spinal Cord Stimulator Implants and Morphine Pump implantations – both for chronic pain.

Spinal cord stimulator implant
Spinal Cord Stimulator Implant


Yes, this is a Botox Blog.  And Yes, this is connected to my Modesto Botox Home Page.   I just wanted to make a brief mention of the other cosmetic procedures I perform.  I recently (probably for frequently than I know) had a patient who didn’t know that I performed a particular procedure.  And it seemed like she would have liked to know that I was available for that procedure – which was Voluma Injections.  Yes, I do Voluma injections.

In the office, I mainly concentrate on procedures which are done with a needle.  One can call these minimally invasive cosmetic procedures.  And from time to time, I wander off to the operating room to perform, guess what?  Some surgeries!  But most of those surgeries are surgery assists.

Other than surgery, this is how I spend time in the office.  “Botox” here means Botox, and Dermal Fillers, and other minimally invasive Cosmetic 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.

I didn’t know that you inject Voluma?!


“Yes, I do inject Voluma.  I’ve been injecting Voluma since the end of 2013.  Why do you ask?”


Amazing!  This happens to me more often than I care to admit.  I had a BOTOX patient this morning at our Modesto Office (Surgical Artistry).  She had been my BOTOX patient for years.  But she recently received Juvederm Voluma treatment at another office.  She came back to me for BOTOX.  And she wanted to tell me about her Voluma treatment.  I think she had a good job done and I believe that she got a good price.  Then she somehow saw a box of Juvederm Voluma lying on the side of my counter.  She exclaimed – “you inject Voluma also?  I didn’t know that!”

Voluma Apple

Above is the famous Voluma Apple.  Used in most Voluma advertising direct from Allergan, USA.  Do you recognize it? Did Allergan do a decent job promoting Juvederm Voluma directly to the masses?

VOLUMA marketing – I need to do better

Well, I guess, I probably need to do a better job with my own marketing.  Regardless I’m glad she got taken care of well.  I had a previous post where I discovered for myself that there are over 35 other places for BOTOX injections.  And I think most of those places probably inject Voluma as well.  I guess it is possible to be a BOTOX-ONLY type of practice without dermal fillers or without Voluma.

Here’s the listing of the 36 places to get Botox in Modesto (or near Modesto):  It answers the question of “Where to get Botox in Modesto?”

My only Voluma writing in this blog was an off Label usage of Voluma for the lips.  Which isn’t my normal practice, but I hear that it is possible.  I was speculating that Voluma wouldn’t last 2 yeas in the lips.

Concluding Voluma Marketing thoughts

Anyway, I want to get the chance to write in this blog in case anyone is wondering: I love using Voluma and Yes, I am a Voluma injector too.  Please visit my Modesto Botox and Voluma home page and please feel free to visit us in person!

Juvederm Voluma Injection Notes according to an Expert outside of the US

Tonight I participated in a live lecture on the web regarding Juvederm Voluma injection techniques.  I guess they call this format a webcast or webinar.

I joined a few minutes late.  But it seemed to start with a discussion of facial muscle anatomy followed by a discussion of facial fat compartments.

Here are my notes below for other Botox  injectors and Juvederm Voluma injectors if interested.  My personal technique is somewhat different because I use a cannula technique and he uses a direct needle technique.   Cannula technique at this time is considered off-label FDA usage.  But I feel that it is, in my hands, a safer technique.


Some Juvederm Voluma / Cheek filler highlights:

  • Lateral support is important – at the level of the zygomatic arch.
  • Females have fuller frontal cheek projection it seems than males.
  • Anterior cheek injections can unfortunately reinforce the ptosis of the cheek.
  • Cheeks become lower and more medial when smiling with age – age 40 vs age 50
  • With volume loss in the submalar area – danger sign for “sausage” look with nasolabial filling
  • The nasal flare shouldn’t be hidden with injections – avoid medial cheek injections.
  • People who may look good in the frontal view, might not look good in the oblique view.
  • Aspirate when injecting deep with Voluma
  • With infection risk, there is granuloma risk.
  • He labels the zymatic arch with v1, v2, v3
  • v4 is the soft area of the cheek below v1, v2, v3.
  • v=voluma
  • avoid treating v4 first because of lack of bone support.
  • He uses a pull upwards and backwards = “pinch traction” so the skin cannot go back to it’s original tendency after placement of voluma
  • A discussion of J1, J2, J3, J4.  These are Juvederm locations.
  • He talks about J4 as the vertical lip rhytids (lines) and talks about perpendicular injection to avoid elongation he says.
  • At Voluma injeciton site #4, there are many dangerous sites such as parotid gland, parotid duct, or the transverse artery.  He uses a fanning technique for injections.
  • Look at patients on animation and when looking down.  Animation meaning smiling.
  • Avoid voluma intra-orbit.
  • Malar crease – you can solve some of the ones which disappear when the patients smile.

Great presentation!  There is always much to learn from other Voluma injectors.

Disclaimer:  The above notes are not my thoughts.  They come from a surgeon who works outside of the United States.  They are interesting and I thought I’d share.  The talk on Juvederm Voluma was brought to us by Allergan.

Juvederm Voluma for the Lips?

Interesting Botox Questions and Filler Questions

Question #1 (first of a series I hope to compile).

Today our office got asked the questions from a patient who called the office:  “Can Juvederm Voluma be used for the lips?”  This is a great questions.   Lately it seems that I never have a straight forward answer.  But I’ll try to be straightforward with this Botox/Filler question.  The quick and dirty answer is: “YES.”

Can Juvederm Voluma be used for the lips?

The reason that this is an interesting question is that it is an off-label FDA usage question which can’t be answered legally by the drug company, Allergan who makes Botox, Latisse, Juvederm, etc.  However, I can attempt to answer the question as a doctor who injects Botox and Juvederm of all sorts including Voluma.  I have a practice in Modesto, CA.  And I would recommend that people see me in person before taking any of what I type here as personal advice.  Disclaimer:  The information here is just for general information purposes, it’s not meant to be medical advice.  Please visit my website for contact information so that I can see you as a patient in my office, in person, if you are seeking medical advice.  Website is: – my Botox injection home page.

In general Juvederm Voluma is used in the cheeks

Cheek volumization with Voluma is the FDA indicated usage.  It has a possibility of lasting up to two years.

Two year indication in the cheeks

This is the main motivation for many people to ask if Juvederm Voluma can be used anywhere else – such as nasolabial folds or marionette lines – areas where Juvederm ultra or ultra plus has been used.  This includes the question about Voluma for lip augmentation.

The Duck Look for lips

If you are looking for very big duck-look for the lips, Juvederm Voluma could possibly be an excellent choice.

Lip augmentation with Voluma? How else could it be done.

There’s also the possibility of diluting down the Voluma with Saline – this would possibly gives the lips a softer look.

My personal preference for Lip Augmentation:

I prefer to use either Juvederm ultra or Juvederm ultra plus for the lips.  The XC versions of these products are excellent.  I would prefer not to use,  in my own practice Juvederm Voluma for the lips.  But in the hands of another injector,  Voluma might just be great for the lips.

2 years for the lips with voluma?

I would doubt that Juvederm Voluma would last that long in the lips.  Thus I’m not sure that I’m sold on the idea of using this product in the lip location.  But with the proper dilution, I think we could find ourselves a very versatile product for the the whole face!!

Summary on Voluma for lips:

  • No, it’s not usually used for lips, Voluma is usually used for cheeks
  • No, I don’t think it will last two years in the lips.  Probably more like 7-10 months?  That’s just an educated guess.
  • I think if it’s used on the lips, Voluma could be diluted
  • Voluma, if diluted could be used on many other parts of the face
  • My personal preference for Lip augmentation fillers is Juvederm Ultra or Ultra plus, especially the XC versions of those products.

Parting words

I do have a rambling style of writing – I think.  But this is my blog and I write however I want.  This page is meant to be a discussion about Juvederm Voluma and Lip augmentation.  This is not meant to be an advertisement in any way nor is this deemed to be medical advice of any sort.  And much of the discussion here is off-label FDA usage of Juvederm.

I hope you have found this page to be somewhat useful – especially if you are a colleage Botox/Juvederm injector.  Please feel free to visit my Botox Modesto WebPage.