February 2015 – Modesto Botox, Dr. Calvin Lee

Does BOTOX freeze sensation?

Botox freezes the action of muscles but does it freeze feeling?

I got this question in my Modesto Botox practice about three times this past week. This gave me the spark to write about it a bit in my blog of Botox Topics.

surgical artistry full page ad never boring — Our ad in a Modesto Magazine back in 2013.

Botox does not freeze sensation – it does not make you “numb.”

As you can probably tell from many of the questions I’ve received before, that answers are not always that simple. If I had to summarize/simplify the answer to the question of Botox making you numb – would be “no” – Botox does not make you numb. Numb in the sense of getting of numbing shot at the dentist, etc. However, it is believed that Botox may play a role in diminishing pain sensation – such as those felt in migraines. Thus Botox most likely doesn’t change your normal sensations, but it may diminish excruciating pain sensations. As we know from our studies of neuroscience, different sensations such as fine touch, coarse touch, temperature and pain have different pathways in our nervous system.

Botox does not make you numb.

I hope this answers the question.

Please see your doctor in person for a detailed explanation. There is no medical advice intended here, just a general discussion.

Restylane or Belotero under the eyes

A tear trough filler question (under the eyes)

A patient recently called me (who lives relatively far away from Modesto) to see if I can give her a second opinion regarding restylane under the eyes. She has a local injector (local to her) who wants to inject restylane under her eyes and she wanted to know why we don’t do restylane under the eyes. Here are some thoughts I had.

I would tell her that I think that any product could work well under the eye in the tear trough region with a skillful injection artist. The more important factor is the artist who injects under the eye. There are so many things you can do with a filler (off-label FDA) – such as dilute the filler or add lidocaine/epinephrine or inject deep or use a cannula, etc.

The filler product is like the violin without the violinist.

Restylane in my hands is excellent under the eyes – I have even used it before quite frequently and was very happy with the results. I personally prefer Belotero because in my hands currently because it results in a smoother contour. The edges are not as aparent to me if I have some superficial injections. My technique is usually to inject deep. But some patients need a thicker fill under the eyes, and thus they would be better served with Restylane – which also lasts longer than belotero under the eyes.

Because of the smoother contours, I prefer belotero under the eyes rather than Restylane. This is only a personal preference and it is my current preference which can/will change with time and further experience and further feedback from patients.

The reason I don’t carry Restylane, it’s because it’s a product that is very similar to Belotero and Juvederm. Similar enough that I don’t really see a point in having it in my practice, and I have received poor customer service from the Restylane company in the past, and thus I chose not to carry their products for the past 6 years.

Juvederm under the eyes, in my opinion causes a bluish hue (tyndall effect) in the hands of many surgeons/doctors/injectors including myself. I have rarely experienced this problem, but because other surgeons have reported this more often than I’d like to hear. Thus I tend to stay away from Juvederm for under the eyes.

The under eye filling with any filler is consider off-label FDA usage, and thus there won’t be a ton of information about this because companies are technically prohibited from advertising off-label FDA uses of products.

I think she would be fine getting Restylane if she trusts her injector. I am not able to comment on the skills of other injectors because I don’t know how they inject. Please continue to see your injector in person for detailed information. I would welcome another visit to our office to continue the conversation if that were convenient.

Disclaimer: The above is medical information. It’s not intended to be advice. Please see your doctor/injector in person for personalized advice.

Does music relax you?

“It must relax you to play music,” one of my Modesto acupuncture/Botox patients said to me today. I’ve always wondered what that means. For the most part, I think I disagree. But it’s not wrong either. I think perhaps it’s that very rare feeling when all the hard work comes together and then all of a sudden one loses themselves and becomes the music. It’s as if one takes their own sense of “self” and all of its worries and transforms that into the soul of the music and thus a sense of relaxation is achieved. But that’s a rare moment for me.

For the most part, it’s the frustration, challenges and the eventual achievement of musical understanding which attract me to the practice of piano.

Music and the Brain

Gosh, I got asked some of these question as part of a student’s Modesto school assignment. I’m not sure I answered them well enough, but I thought I’d share here. It was supposed to be an interview, but due to time constraints, I thought it would be best as an email type conversation.

Here’s what I wrote:

John Houghton

Mrs. Dillon

English II cp

1-28-15

Interview Questions

1: Do you believe music has a significant effect on the brain? If so could you please explain.

Definitely in both listening to music and producing the music.

I think that we all have experienced changes in mood from listening to music. Perhaps even reduction of stress, or even a feeling of excitement or even violence. These changes are present when listening to the music.

I think further changes are found when producing the music – such as playing an instrument. I think at any age, playing an instrument challenges the brain to form new connections. Perhaps for youngsters, this could lead to better math skills or better communication skills. And perhaps for adults it could be a way to keep our minds young. There has been scientific studies regarding physical changes in the brain produced by learning musical instruments at a young age – such as cortical thickening in certain focal areas of the brain. And there has been research which mentions that a person’s sense of sound discrimination may resist decline if one was exposed to some sort of early musical education.

For me, I think just the challenge of playing music has made my mind sharper. I played violin while I was younger and kept it up till I was in my mid 20’s. I probably tried to practice about 1-2 hours per day. The practicing started dwindling when I got closer and closer to medical school. I personally developed a hearing problem in my college years and that made violin practice somewhat unpleasant. For me practicing the violin just became a way of life. But I gradually replaced that time with time spent studying medicine.

2: How does age and gender play a role in in music and the brain?

I’m not entirely sure that gender plays a role in music. I have not personally done laboratory research on brain difference between genders. But I do think that a younger brain can adapt, change, and benefit more from an early music education.

I’m not sure if you’re asking about playing music or listening to music. But either way, I’m not sure. This is a very interesting question. But I think gender questions are always tricky and there will always be exceptions in either gender – all we can make are generalizations in this research. There is some discussion about the differences between women and male surgeons. My wife, Dr. Tammy Wu, who is a plastic surgeon often feels that women make better surgeons because of smaller hands, but she’s probably just saying that to annoy me. My hands are quite small too – perfect for many surgeon options. I can make smaller incisions! In the end, it’s probably similar to asking about math or language and the brain and gender. There are differences. But in the end – I don’t think it matters – it just becomes an academic observation and debate.

3: What role has music played in your life?

I think it helped open doors to connections with other very interesting people. This networking via a common hobby has become very useful. I think opportunities are more abundant this way. I am now learning piano, an instrument I played briefly when I was a child. It helps give me a sense of satisfaction – where I’m improving and learning new pieces. I enjoy learning new pieces of music and making them my own. It’s especially satisfying when I have the pieces memorized and I can play it for others. I also feel that I am on a mission to spread music to others – especially classical music.

My violin playing gave me a sense of who I am, or who I was. I was the concertmaster at Brown University for several years. I was also concertmaster of an orchestra at Harvard. It gave me a sense of accomplishment and confidence. I think this confidence exudes into other aspect of my life. It made me happier and ready to tackle challenges.

4: Do you play music in your office, for your patients at all to affect their recovery in any way?

I haven’t gotten that sophisticated. I think it would be interesting to do. But sometimes we play music for the acupuncture patients and for the Botox patients while they are getting treatment. I have chosen music that soothes and perhaps they would feel less anxious and ultimately less pain while in our surgical / Botox / acupuncture office. And with less pain, the recovery is usually much better (faster, less complaints, etc).

Do you prefer to be addressed as Doctor Lee or by first name?

Botox office question today: How to address a doctor at the office and in real life (outside the medical setting).

Someone asked me at the Botox office today, do you prefer to be called “Dr. Lee” or “Calvin”. Well, naturally, for sure, while I’m working, I prefer to be called “Dr. Lee.” If it has anything to do with work my work as a Doctor, I prefer to be addressed as “Dr. Lee.” I’m used to it that way. In fact, I frequently refer to my wife as “Dr. Wu” rather than Tammy. I think other doctors would be used to that as well especially in a medical type setting. But what about “Dr. Calvin” – referring to my first name. That’s just “odd” to me. Perhaps this is just a personal preference.

In a medical setting – for sure it’s “Dr. Lee”, otherwise I think it’s just bizarre to be called by my first name or even “Dr. Calvin.”

So it’s “Dr. Lee” for sure as my preference when it’s in a medical office or in a medical setting.

My mother and my wife call me “Calvin” – I’m now in trouble…

Then the question comes about, what if it’s at a random setting like a bank or a party. In that case, I don’t really mind which one. But the funny thing is that I have been called “Dr. Lee” for more of my life than “Calvin” now. And I have grown somewhat more accustomed to “Dr. Lee” as my name. I think this is partly because I became a trauma/general surgeon and I didn’t have much of a life (I still don’t) outside of being a doctor. I frequently have a “guilty” type reaction when I’m called “Calvin” – because that’s what my wife and my parents call me – especially when I’ve done something wrong – I’m just slightly joking here. Thus for personal reasons, not for any stuck up type reasons, it’s my preference to be called “Dr. Lee” anywhere.

But perhaps there’s hope for me to get used to my own first name.

But as I get out more into the real world. I think there’s hope for me to get used to my given first name “Calvin.”

What does my wife, Dr. Wu think?

I know that my wife, prefers “Dr. Wu” – at least with office mail. I’ve seen her immediately trash letters that say “Dear Tammy” instead of “Dear Dr. Tammy Wu or Dr. Wu” – especially our frequent resume letters from people looking to work in our office. I think she thinks that they aren’t serious enough about getting a job at the office.

– Calvin Lee, MD – Modesto Botox Surgeon.