What’s the difference between Restylane Kysse and Regular Restylane?

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.

I hope that helps answser the question.

Here’s a link to the different types of fillers and which fillers I choose for lips and why. Kind of a: How to choose the right filler for your lip.

In general, I still say, don’t focus too much on the syringe type or brand. Let your injector pick the one that works the best for your goals.

Here’s a rundown of what I think of the different Restylane fillers that I have

Restyane Silk – soft filler, but isn’t very flexible

Restylane Refyne – supersoft filler with a great deal of flexibility

Restylane Kysse – medium firm filler with a good deal of flexibility designed for lips

Restylane Defyne – firmer filler than Kysse with a bit of flexibility

Restylane-L – firm filler with minimal flexibility

Restylane-Lyft – Firmer than Restylane-L filler with minimmal flexibility

What fillers do I use in the LIPS for injections and why?

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.

Image may contain: 13 people, inclu

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:

  1. Juvederm Ultra
  2. Juvederm Volbella
  3. Juvederm Vollure
  4. Juvederm Ultra with Volbella combination
  5. Juvederm Vollure with Ultra combination
  6. Juvederm Ultra Plus
  7. Restylane Kysse
  8. Restylane Silk
  9. Restylane Refyne
  10. Restylane Defyne
  11. Belotero

In the end, it comes down to four things when I pick a filler to inject lips.

  1. Injector factors – injector’s personal preference, familiarity, predictability of giving the right outcome, reliability and responsiveness of the filler company.
  2. Patient factors – thin skin, age of lip, lack of border, patient desires.
  3. Friends and family factors – what do they prefer when they look at your lips and does it matter to you?
  4. 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.

Feel free to find me for a consultation regarding lip fillers in Modesto, CA: 209-551-1888.

Before Lip injection – answer this one question

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.

How long have you been injecting Botox in Modesto?

I got this question today via social media.

The quick answer as of today (11/5/18) is about 12 years.

I guess it’s a question regarding my experience.  I now see about 200+ patients per month for Botox injections in my Modesto office: Surgical Artistry.

Here’s sort of a timeline for my life in Modesto.

2001:  Interviewed in Modesto and accepted job with the McHenry Medical Group as trauma and general surgeon

2003:  Started my surgery career in Modesto.  I actually had my first job Modesto as a surgeon was with the Sutter-Gould Medical Group affiliated with Memorial Hospital.  I worked there for a few weeks to help fill in for a surgeon who had to leave suddenly for his military duties.

2003:  Started with the McHenry Medical Group as trauma and general surgeon

2006:  Started Surgical Artistry with Dr. Tammy Wu, Plastic Surgeon.  Went to obtain more education in AcupuncturePlastic Surgery was our big focus for Surgical Artistry.

2006:  Started practicing acupuncture and started doing Botox.  I had a slow start.  It seemed to be about 1-3 patients per week even for Botox and acupuncture.  I continued doing General Surgery till about the year 2010.  But starting in 2006, I started assisting in the world of pain pumps and stimulator spine implants which I still do today.

2013:  Reached platinum level for Botox injections and Filler injections with the Allergan company.  This is based on amount of Botox purchased from Allergan.

2014:  Reached platinum plus level for Botox and Filler injections.

2015:  Selected as one of the first surgeon injectors of Kybella – a injectable product to help dissolve the double chin.

2016:  Reached Diamond level for Botox and Filler injections.  At the time, this seemed to be the highest level there was for Botox purchased from Allergan in the USA.

2017:  I was honored by being awarded the Top 25 most loved injectors in the USA by RealSelf.com.  I got a featured advertisement in Glamour magazine.

2017:  Reached the Top 500 level for Botox injections / Filler implantations.  This was a level that I didn’t know existed till I got the award.  It comes with certain benefits like a priority customer service telephone number.

2018:  Started doing thread-lifting which I also call Suture-Lifting.

2018:  Maintained Top 500 level for Botox injections (and other Allergan products).  At this point, I realize that I started by seeing about 4 Botox patients per month in 2006 and now I have the privilege of seeing over 200 Botox patients per month.

I still have much more to improve regarding my skills, communication, and results.  Thank you everyone for trusting me with your injections.

 

Calvin Lee,  MD

What cosmetic services do you offer, Dr. Lee?

I got this question today on Yelp and perhaps this post will help others.

I am interested in hearing about the services you offer and setting up a consultation.

Mr. Bear wearing my name tag and he is with acupuncture needles in his head.

Here’s my brief answer:

Thank you for your inquiry via a message on Yelp. We are closed for the weekend. But Feel free to call (209)-551-1888 on Monday- Friday 8am-5pm for more information about what we offer at Surgical Artistry. The Botox / Filler consultation with me (Dr. Calvin Lee) is free so you can hear more about what I may be able to do and customize information and treatment for you.  Heres a brief listing of what I do:

Threadlifts

Threadlifts for building collagen and lifting.  These are dissolving PDO threads.  Sometimes I call this Suture-Lifting

I do Botox

I do Botox for wrinkles, headaches, jaw pain, gummy smile, shrinking pores, sweat reduction, trigger points.

Juvederm Fillers

I do fillers for lips and wrinkles, acne scars.  I really enjoy working on lips and tear troughs as some of my favorite things to do.  I also sometimes use Radiesse and Restylane.  I do hand rejuvenation fillers and also tear trough off label fillers under the eyes.  I am fond of working with a cannula for cheek augmentation and for tear trough.  I also regularly do chin augmentation with fillers and jaw augmentation, temple filling (by the forehead), ear lobe wrinkle filling, nipple projection for inverted nipples.  I also fill various indentations in muscles or the body from various trauma/scar or from steroid injections.  I see fillers as a surgical implantation which needs to be done with surgical care.

Dermapen – Microneedling

I do dermapen microneedling to help with acne scars, and wrinkle reduction / prevention, and to help grow collagen.

Kybella

Kybella injections for double chin.  Permanent fat reduction in the FDA approved neck area.  Visit my Kybella website for more information.  I’ve done some off label Kybella for bra roll and knee area.

Chemical Peels

To help with collagen growth, brightening the skin, tightening, and wrinkle prevention.  I do the Obagi blue peel radiance and the blue peel chemical peel – both these peels are by Obagi.

Acupuncture

I do acupuncture for back pain, fertility, stress, and many other issues. There is a branch of acupuncture known as cosmetic acupuncture.  Actually threadlifts and dermapen are just extension of cosmetic acupuncture.

Vein procedures

I laser veins on the face, chest, and legs.  I have a laser and I also do cosmetic sclerotherapy – which are injections into the small veins.  On the face, the laser is my favorite modality, but on the legs, the injections of sclerotherapy is my favorite vein treatment method.  I also do ultra sound examinations of the greater saphenous vein and lesser saphenous veins to assess reflux.

Mole removal

I do cosmetic mole removal from various parts of the body using surgical excision, and I try for the smallest and least obvious scar.  I feel that surgical excision is usually best – rather than burning off a mole.

Trigger point deactivation

Trigger points are tender points in the muscle. I can do dry needling, acupuncture ah-shi, lidocaine/marcine injections

Steroid injections into over-active scars

Some scars are overactive with redness, itching, and have a raised character. I can inject a steroid solution into the scars to make them less “angry.”

More

I actually do more items than what is listed on here, but this is a short description of what I can do.

 

Botox Anatomy Terms

Key anatomical highlights of the face and neck for Botox injectors (injectors of Kybella, Juvederm, etc)

Muscles

Procerus

Corrugator supercilii

Orbital part of Obicularis Oculi

Palpebral part of Obicularis Oculi

Frontalis (frontal belly of epicranius muscle)

Occipitalis (occipital belly of epicranius muscle)

Nasalis

Levator Labii superioris alaeque nasi

Levator Labii superioris

Zygomaticus minor

Zygomaticus major

Risorius

Masseter

Obicularis oris

Depressor anguli oris

Depressor labii inferioris

Mentalis

Platysma

 

Bones / foramens

Zygoma

Zygomatic

Temporal

Supracilliary arches

Supraorbital notch (Supraorbital nerve and artery)

Infraorbital foramen

Mandible

Mandible – mental protuberance

Mandible angle

 

Glands

Parotid

Submandibular gland (known also as submaxillary)

 

Arteries

Supratrochlear (from ophthalmic artery)

Supraorbital (from ophthalmic artery)

Facial – Angular

Transverse facial

Superficial temporal artery

Carotid

External Carotid

 

Nerves

Supratrochlear

Supraorbital

Zygomaticotemporal

Infraorbital

Marginal mandibular (branch of facial nerve)

Trigeminal

Facial

 

 

Skin folds / Surface anatomy

Jowls

Prejowel sulcus

Nasolabial folds

Marionette lines

Nasojugal sucus

Tear Trough defromity

eyelid lateral sulcus

festoon

Dorsum of nose

Bridge of nose

Ala of nose

Apex of nose

Tragus (of ear)

Glabella

Filtrum

Filtral Columns

Glogau-Klein Point (G-K point)

Vermillion Border

tubercles of lip

Oral commissure

Mental crease

ergotrid

Vertical rhytids

 

 

Terms

Neocollagenesis

Blepharoplasty

I love going to Botox and filler training sessions

As a board certified surgeon, I know that there are many ways to get surgeries done and every surgeon has their own developed tips and tricks over years of experience.  It’s always good to learn from others – especially in other parts of the world.

In the past few weeks, I’ve participated in two national-type training programs for Botox and Juvederm fillers.  I especially enjoyed watching other great injectors approach lip augmentation challenges.

Later today I am going to San Francisco to attend an international training program for Botox and Fillers/Juvederm.  The speaker is from Australia.

Here’s an interesting certificate that I got after one of the training programs – they sent it to me via email, but they used the bosses’ name on our practice.  Well, it’s the plastic surgeon wife, but I did the training program.  It’s worth mentioning that her full name is Dr. Tzuying Tammy Wu.  And you can visit her plastic surgery webpage here: www.SurgeryToday.com.  And you can visit my Botox webpage here.

Ethnic Botox for my Asian patients

I attended a Botox lecture yesterday in Fresno that included a small section on ethnic differences in use of Botox, fillers, and Kybella.

This made me think of my Asian patients.  I live in an area of California where there aren’t a huge population of Asian patients, but I have a good handful of Asian patients coming in for Botox and fillers.

Botox differences that I’ve observed

Compared to caucasian patients, our Asian patients are asking more for Botox for slimming the face, and there is more of a preference placed on crows feet botox over glabellar botox.  Glabellar area is the “11’s” between the eyes.  I’ve noticed that my Chinese patients are usually requested a lower dose for the glabellar botox, but the opposite is true for my Indian patients who frequently request or need more glabellar botox for the same effect.

I’ve also seen much more request from Asian patients regarding jaw slimming botox procedures.

Filler differences – Voluma

I’ve actually learned a few things from my Asian Botox / Filler patients who have received cosmetic injectables in Asia.  They tell me and teach me about rounding out the glabella and forehead and filling up the bridge of the nose.  This has helped me observe that this area tends to flatten with age in some Asians.  Also most of the cheek augmentation tends to be in the anterior direction more than in the lateral direction.  Thus the apple cheek result is what they are asking for with Juvederm Voluma injection – rather than more of an angle with the zygomatic arch.

Well, that’s what I’ve observed so far, and I hope to observe and learn more from my patients and I hope to continue to improve.

 

What is it like to be a doctor?

dr-calvin-lee-cropI was recently asked to answer these questions as part of a student’s assignment for school.  She wanted a surgeon to interview.  I have elected to answer these questions as the surgeon that I am today which is different from a decade ago when I was a trauma/general surgeon.  Now I am a surgeon who does acupuncture and cosmetic injections (Botox, Fillers, Kybella – neck, Asclera – veins).  For more information, consider visiting my other webpages www.InjectionArtistry.com and www.SurgeryToday.com 

  • Describe your work environment.

I am a surgeon with additional training with acupuncture and cosmetic injections.   I have worked as a general surgeon and trauma surgeon.   In 2006, I decided that I was going to dedicate my surgical skills to working with needles for the majority of my work as a doctor.  I became an acupuncturist and learned cosmetic surgery from my wife, Dr. Tammy Wu, who is a plastic surgeon.  Our practice is Surgical Artistry, and one of the main focuses of the practice is cosmetic surgery.  About once or twice a month, I have days where I assist the entire day in surgeries with Dr. Wu or other surgeons in our area.  For the most part, I am now mostly an office based doctor – as opposed to one who sees patients in the hospital.  I use three different acupuncture rooms to see patients with varying problems ranging from back pain, neck pain, headaches, athletic injuries to fertility acupuncture.  And then I have one large procedure room where I see my cosmetic injection patients.  The lighting and space design is different in each of these rooms based on the procedure intended for the room.  Surgical Artistry has two physicians – myself and my wife, and at this time 4 full time employees.  We like to keep our work environment clean and neat and be a sanctuary for health and wellness.  It has an open feel to the environment for our employees as we want to foster good communication with our team.  We believe in having our patients be beautiful both with health and appearance.

  • What’s a typical day at work like?

As a surgeon who focuses on acupuncture and cosmetic injections, I see patients from 8am-5pm.  I try to start on time as much as possible and I try to stick to the schedule.  I dislike having patients wait.  Half of my usual day is dedicated to acupuncture and the other half to cosmetic injections.  I go from room to room with no break in between.  I find time for my “breaks” when patients don’t show up or are late to the office.  That is when I prepare a batch of Botox, catch up on emails, enjoy some facebook (my facebook page), maybe even grab a quick bite.  I don’t take a formal lunch break.  I usually work till about 5:05pm.  That’s when I start to have time to write my office medical charts which are important to document the day’s work.  This allows me to record for future medical use when the patients come back, and thus, I can improve on their care.  The medical charting usually takes me about 1-3 hours.  Then I go home.  But sometimes I have to take care of business matters especially since Surgical Artistry is my business.  Sometimes there are employee matters, bills that need to be paid, or leaking roof issues.  So at times I don’t go home till 1am in the morning.   This is pretty much most of my days Monday-Friday.  There are a few days per month which I reserve for surgery assisting where I give my staff a break from my daily grind; I am not at the office on that day, I would spend my day at the hospital going from surgery to surgery.  And my staff spends that day catching up on their paperwork in the office.  The hospital and my office are not connected.  I think there are some lucky doctors who have an office inside a hospital.  Or maybe they consider themselves unlucky because they never get out of that work environment.  Regardless, I have to drive to the hospital from my office and I work at a handful of hospitals such as Stanislaus Surgical Hospital, Doctors Medical Center in Modesto, and Sutter Memorial Hospital in Memorial.  on Stanislaus Surgical Hospital’s home page, they actually have a picture of me as the operating surgeon on their header!

  • What are the three most important responsibilities of your job?

First most important responsibility is getting the patient the best results that I can.  Second most important responsibility is to do this as safely as I can.  This involves good technique and good knowledge.  The third most important responsibility is managing patient expectations – which means that I should spend the time communicating well with the patient and letting the patient ask questions, and I should try to think of questions that the patient might not have thought of himself/herself.

  • What technical skills do you need to do your job?

A tremendous amount of technical skills are required.  Skills involved in navigating around anatomy so that needles are placed accurate.  Steady hands are involved to insure precise delivery of Botox or filler.  Plus there is technique involved which help prevent injury to the patient if the patient were to flinch.  And there are techniques involved which ensures a sense of 3D space and tactile feedback at the tip of each finger.  These are skills which I think take many years to develop and I’m still trying each day to get better.  I became a surgeon because I am attracted to technical skills with my hands.  I received my MD degree in 1997 and every day since then, I’ve been continually trying to improve.

  • What people skills do you need to do your job?

To be a surgeon, acupuncturist, or cosmetic physician.  One has to love people and have a passion for other people’s health.  We are teachers to begin with and we need to teach patients about their current state of health and teach them how to improve upon it.  We have to be convincing as well to help steer them in paths which may not be apparent or easy to them – such as quitting smoking or eating more veggies.  We have to have people skills to communicate well.  And we have to have people skills to not only manage expectations, we have to manage our complications.  Surgeons are only as good as the complications that we’ve managed.  But those complications doesn’t just involve technical skill, they involve all sorts of people skills;  We have to listen, empathize, have compassion, instill confidence, communicate effectively, and most of all have patience.

  • Describe a recent problem on the job and how you solved it.

There are always problems, but by being a cosmetic physician and acupuncturist, my problems may not be as life threatening as a trauma surgeon’s problems.  I realize that it is somewhat less stressful for me since 2006.  But I have the same passion for making sure I focus completely on patient problems.  I’ll just describe something from yesterday’s line of work.  I had a patient come into the office for what seemed to be a routine cosmetic mole removal.  However, on examination and further questioning, it was revealed to me that it was a vascular type of lesion which had a history of bleeding.  The patient was worried that it was going to bleed further because when it did bleed, it was very severe.  I decided that I had to postpone some of my patients for a bit of time and take care of this bleeding mole like structure right away.  I first fired a vascular laser at the base of this lesion and then removed it like a mole and found the bleeding artery – which continued to bleed – but I was able to place an old fashioned figure of eight stitch around the bleeding artery and closed the skin incision which I purposely made.  We sent the mole like structure to pathology to rule out the possibility of cancer.  I discussed with the patient that if this lesion continues to bleed at home that he was to call me on my cell phone and I would meet him immediately at my office even if it was the middle of the night.  It bled more than the usual skin lesion removal because this lesion was in my opinion mostly vascular in nature.

I had anticipated this problem and thought the laser would stop the bleeding before I even began, made a decision to act on it right away, and encountered more bleeding which I had a plan which was my old fashioned stitching.  Then, I made plans for aftercare and in case other problems arise after he leaves (having the patient contact me and meet me at the office).  I’m glad I have a background in trauma surgery and bleeding is really not a big deal to me.

  • What kinds of information do you need use, analyze, and/or stay up to date on how to do your job efficiently?

There are medical journals pertaining to acupuncture and cosmetic injections which I read from time to time.  There are also national/international meetings on acupuncture and cosmetic surgery which I attend regularly.  There’s the collective wisdom of many doctors who can share experiences and ideas which will help my patients in Modesto.  Having the latest info helps me with another aspect of being a doctor – advising my patients on alternatives, even alternatives which I do not have.

  • How do you think your job will change over the next 10 years? Why?

I think for the most part the acupuncture will stay the same and perhaps become more popular with patients.  More and more people in the world seem to be exposed to acupuncture and the idea of healing with less side effects.  The art of acupuncture began about 5000 years ago, and I think much of the practice of acupuncture will stay the same.  But I do think that more points will be discovered as physicians are now more open about sharing.  Regarding cosmetic injections.  I think they will become more popular in the next 10 years as patients are looking for quicker procedures, less invasive and less downtime.

  • What technology and special tools are used by you and others at your workplace?

As a acupuncturist, I don’t think I have any special tools except my hands and a collection of acupuncture needles.  For the cosmetic side, there are many tools such as lasers which help with little red veins on the face, etc.  However, in my own preference of what I do at work, I try to rely mostly on my hands connected to instruments which do not require too much technology, except for the technology which rendered the instruments.  I like special needles for all of my work in acupuncture and cosmetic injections.  There is a lot to the property of a needle.  It is very much like a violin bow.  Needles may all look alike, but they have different characteristics – weight, flexibility, length, angle, sharpness, consistency from one batch to another, and the ability to stay sharp throughout the procedure.

  • What written materials are used at the workplace?

We have written materials on the safety of chemicals at the workplace.  We also have written protocols which I follow for some of the procedures that I perform.  Plus we like checklists.

  • What impact dose the workplace have on the local and global communities?

I particularly like it when I get patients who come from other cities and then get to spend some time enjoying our local economy here in Modesto.  For example, I had a patient from San Francisco, who said that she did all her Christmas shopping in Modesto and got to enjoy our lower sales tax rate.

In general, I think I am here to mainly help our patients in Modesto get the best care that they can.  Globally, I don’t think I’ll have much of an impact unless others want to learn my techniques.

  • What academic skills do you need for your job?

The most important academic skill is the ability to keep learning and improving.  My knowledge of the human body and experience with operating on the human body are at play every day in my work.

  • What are at least two ways you apply mathematics at the workplace?

One way is when I have to calculate the cost and dosage of Botox every day.  This is simple addition and subtraction.  But it is in play all the time.  Even when drawing Botox out of the bottle.  Then there’s the mathematics of injecting it out of the syringe.  You have to make sure you push and stop your thumb at the right moment and that’s math.  Botox arrives as a powder and precise but simple math skills are used to convert that powder into a liquid.  I also use math skills to determine how to best use 1 syringe of filler in a patients face.  The filler is a limited resource and we have a job to do which involves symmetry.   Then there’s more abstract and intuitive math which involves angles – especially when using a long needle.  Then there’s the mathematics of getting the procedures done under the price budget laid out by the cosmetic patient.

  • What are at least two ways you apply communication skills at the work place?

I like to have a detailed conversation with the patient in trying to understand their vision of beauty.  I have my vision, and many times the patient has their beauty.  I need to spend time understanding if my vision and their vision align.  If not, I need to really try harder to understand.  Then I have to communicate what I am capable of doing – which sometimes may not be enough for the patient.  And if I get the feeling that I can’t get my message across, or I can’t understand the patient, then I need to communicate that I am not the right person for the job.

  • What are at least two ways you apply scientific principles or social studies concepts in your work?

In cosmetic medicine, there’s the economical social studies concept of meeting the patient’s budget, and dealing with the supply and demand of Botox/fillers.  We also have to deal with the history of the patients responses to various treatments.  In the end, I want to have high yielding efficient results for the patients which they can afford.

We live in a world of science.  And medicine is the artful application of that science.  So I would say that all that I do as a doctor has a foundation in science which ultimately is an explanation of how things are in the universe.  However what we know of science at this point is just small window into how things are in the universe and sometimes we are misled of what we know of science.  But I would say that science is the best of what we know at this time.  As a surgeon, our main science disciplines is the science of anatomy, the science of physiology, and the science of physics.  The anatomy is the science of having identified body parts.  Naming these parts allows us to communicate efficiently with others.  physiology is the science of how these body parts function.  And as for physics, it is the nature of the interaction between surgeon, instrument, anatomy, and its impact on physiology.

  • What opportunities are there to use creativity or art in your job?

There is always creativity and art in my world of acupuncture, surgery, and cosmetic injections.  Every human being is different and every problem is somewhat unique.  Thus almost every solution for a patient requires creativity and art.  This is why I’ve called my medical practice: “Surgical Artistry.”  There are so many different instruments to use, so many different fillers, different needles, different angles, different locations.  Plus with limited budgets for cosmetic procedures, we have to think creatively to get the work done.  Compromises need to be thought of, but always without sacrificing safety.

As for Acupuncture. There are creativity needed in picking effective points for the patient.  Each problem has a unique set of problems.  Back pain patients sometimes even have the problem of not being able to lay on the table a certain way.  So we have to think of ways to get the patient comfortable – perhaps in a chair or perhaps with rolls under their knees, etc.

  • How long were you in school?

First 12 years got me past high school.  Then I did 4 years of college.  Then I did 4 years of medical school.  At this point I got my MD degree – but that’s without any formal surgery training.  Thus to continue on to become a surgeon,  I did 1 year of surgery internship, then I did 5 additional years of surgery residency.  At this point I became a board-eligible Surgeon.  As for acupuncture, I did 1 additional year after all the surgery training.  I think I took the short route compared to other surgeons.  There are many surgeons who spent more years in school.  I consider all those years to be formal schooling for me.  But in many ways I am still in “school” as my patients are my teachers.

  • How does your job affect your life?

My job is my life.  I think I don’t really have much of a life outside of my job.  It was much more this way when I was doing trauma surgery, but I got in the habit of living the job – always.  I married a surgeon too and we love what we do.  I initially picked surgery because I wanted to live that way of life.  Surgery isn’t a job, it’s a way of life.  But I think I need to start learning to live my life in a different way.  Perhaps it isn’t the healthiest way of life for me – I’m starting to realize that and I’m almost 50 years old.  In fact, I don’t really respond to my first name – which is really part of a person’s normal life.  I respond more to “Dr. Lee.”  As that’s who I am and the majority of my life I’ve been called “Dr. Lee.”  I know many people go through customer service and say that people feel comfortable when they hear their first names.  Not so much in my case… it’s usually my parents or my wife who call me by my first name, and usually if they are using my name, it might mean that I was in trouble.  But hopefully as I change my lifestyle and have a life outside of the medical world, I’ll regain my recognition for my first name again.

  • Why did you want this job?

I was drawn to the world of surgery.  I believe it was some sort of calling.  I think I liked it because it requires great responsibility and the capacity to make others happy.  Perhaps also, it was the ability to fix a problem rather quickly.  I also feel that I have a gift of using my hands and wanted to use my gift.  In addition, I was drawn to the world of acupuncture because I wanted to have medical solutions with low cost in terms of side effects – I wasn’t happy with some of the side effects created by medications.  But in the end, I came to realize that acupuncture is just another branch of Surgery.  Blade or needle, either way, we heal with steel.

 

 

Cosmetic Annual Growth by patient visits

Acupuncture, Botox, Juvederm, vein annual growth for Calvin Lee, MD

I am very thankful and proud. In 2006, I reinvented myself from General/Trauma surgeon to Acupuncture/Cosmetic Surgeon. In the operating room, I have been assisting in Tummy Tucks, Face-Lifts & breast surgeries done by my wife, THE Plastic Surgeon for the past 10 yrs. This graph shows the growth of what I do OUTSIDE the operating room, in our SURGICAL ARTISTRY office: Acupuncture & Cosmetic Injections. I use hundreds of needles per day. I started my practice with only 58 office visits in 2006. Last year I exploded to 3371 visits with one of the highest retention rates of patients in the country according to Allergan. I am so grateful to my patients for trusting me. I am also so grateful to my supportive parents, Dr. Tammy Wu, her parents/brothers and to those who have directly helped me grow this new world for me:

Jeannine M, Andrew M, Ken T, Christine Donham Landrum, Jacquie A,Jessica Vargas, Annabeth Ghiglia Allan, Lorena Redula, Katherine Ruth,Karla A Valente, Lynne C, Sarah S, Lea S.

Surgical Artistry Modesto Marathon, Heidi Ryan, Karen Kopecki Hodges Lozano, Vickie Chu-Hermis

Sutter Gould Medical Foundation, McHenry Medical Group (First Choice Physicians), Doctors Medical Center, Memorial Medical Center

Alyssa Petrino, Chris W, Jeran Wadlow, Suleika Bauer, Tadra Rex, Nicholas Eichhorn, Jennifer M, Brooke Cramer, Joe K, Jenny D, Tom Z, Cherise P.,Bree Alexander

Kempton Stephens, Katherine Barton, Paul B, Charles Cherrie Suntra,Enoch Choi

It has been a tremendous first 10 years at Surgical Artistry and I’m looking forward to the next 10.

Number of patients seen per year Calvin Lee - text - Botox

 

a botox 2015 statistics sign IMG_1370 - 4th version

a botox what we do sign IMG_1370Botox Retention Analysis

cumulative botox 2014 2015 with title

cosmetic acupuncture botox bar graph

quarterly comparison of botox units 2014-2015 - with frame

a shadow IMG_1036 - with text