Tammy Wu, MD | Calvin Lee, MD
| (209) 551-1888 |
Mon-Fri 8am -5pm • 2336 Sylvan Ave. C, Modesto, CA
95355 (next to the post office)
| Botox |
Written by Dr. Calvin Lee, a Board
Certified General Surgeon who is also an acupuncturist and violinist.
Dr. Calvin Lee,
There's quite a bit of information here.
It probably borders on too much (sorry, I get carried away at times).
Injecting Botox is a combination of science, art, and technique. I placed
much of the
Botox anatomy information on another webpage. I am probably too heavy
on the complications section here, but it's what I worry about so that the
patients don't have to.
What is Botox used for in the face cosmetically?
For the face, Botox is used to treat and prevent
wrinkles by relaxing muscles that cause the wrinkles.
Botox is administered by a healthcare professional
as an injection directed into or around the muscles. It blocks nerve
impulses in the injected locations. This relaxes the muscles that
causes moderate to severe wrinkle lines.
My most commonly requested wrinkle to treat (or
prevent) is the area between the eyes/eyebrows (glabella complex)
Other common areas are crows feet (sides of the
eyes, also called lateral canthal rhytides), and forehead lines.
There are many other areas used as well - see chart
below. Many of these areas are considered
which may be considered appropriate by your Botox injection doctor.
Dr. Calvin Lee, rehearsing Mendelssohn violin concerto as
invited soloist at the Hong Kong Cultural Center in 2009
I was born in New York City. I am a graduate of
Brown University where I studied Neurosciences and got the opportunity to play
violin at Carnegie Hall for the first time. I was kindly offered
admissions to Harvard and all the other Ivy League colleges that I applied to
and I had to make a hard decision to go to Brown University. At Brown, I
met my wife, Dr. Tammy Wu - thus solidifies the good decision making. Then
I went to Brown University Medical School and became a doctor. My wife did
the same except that she graduated top of the Ivy League medical school class
(no small feat!). Six years after medical school, I became a General
Surgeon. Modesto offered me a great initial job in 2003 as a General and
Trauma Surgeon with the McHenry Medical Group. This was my dream job which
I had wanted in a town (Modesto, CA) which would have a need for surgeons to
practice diversified procedures. I later realized that I wanted more
artistry with my surgical skills. Thus I joined my wife, Dr. Tammy Wu,
Plastic Surgeon and created Surgical Artistry in 2006. During the
transition process, I became an acupuncture through Stanford's physician
acupuncture training program. During that time, I got a chance to play
violin at Carnegie Hall for the second time with the YouTube Symphony (as their
only physician violinist), plus did some touring around the globe on solo
Newspaper announcement from 2003 when I first came to Modesto,
I had more hair back then. Modesto Bee.
What to wear to your Botox appointment
For the most part, you can come however you like and
we'll do fine. But here are some pointers to make everything go even more
Wear minimal makeup or none if possible in the
spots that need to be treated (ie. forehead, side of eyes, or frown (glabellar)
area). I will be removing the makeup with alcohol to remove germs.
This is important to prevent infections. If I mess up your makeup
(which I will with the alcohol prep pad), you can reapply with a clean
makeup afterwards, but you have to apply very carefully - don't press too
hard on the botox injection spots.
To do the forehead wrinkles, I will usually need to
see the edge of the hairline. Hair pulled back would be great.
But I've found that clips which prevent you from resting your head against
the headrest of the procedure chair may get in the way of your ability to
relax your head against the headrest. I definitely want patients to
rest their head against the back of the headrest so that they can relax as
much as possible during the procedure and this also prevents any backwards
movement of the head so that I can be as precise as possible.
Many patients go right back to work after their
Botox appointments. But I do not recommend vigorous activity for about
8 hours after the injection because there could be a higher incidence of
What to do after the Botox injection
Each doctor and/or injector will have different
instructions. Here are my suggestions to my patients
Do not rub the botox injected areas too hard for
the next 4 days. Treat them gently. You can wash your face, put
on make up and sunblock, but don't take your knuckle and rub.
Avoid eyebrow waxing for the next 4 days.
Avoid face down acupuncture or face down massage
for the next 4 days.
Skip workout sessions for about 8 hours after the
Botox injection to keep the bruising level to a minimum.
The cost in our office depends on the number of
Currently I (Dr. Calvin Lee) charge $11.70 per unit for Botox
(pricing subject to change, please call our office to check current prices).
The $11.70 came about as a 10% discounting from
$13.00 per unit of Botox.
Dr. Wu (my wife, the plastic surgeon) can also give
Botox injections. She has a different pricing.
The average number of Botox units used by my
patients comes out to 29 Units of Botox. 29 Units is actually a very
strange number to inject, but that's the average number that comes out.
It is common to see many patients getting 20 Units of Botox and 40 Units of
Botox. 29 just somehow became the average when 46 patient charts were
reviewed in sequence.
29 Units of botox would come out to $339.30 (based
on $11.70 / unit of Botox)
Brilliant Distinctions (BD) is a Botox frequent
user program - additional savings!
Pictures of our Office (Modesto, CA)
First picture is part of the lobby. Second picture
is my main Botox injection procedure room complete with operating room light and
comfortable chair. The third picture is the outside of the office.
You can sort of see the edge of the Modesto Sylvan Ave. Post Office.
Botox cost broken down per area
Note: Botox is different from Dermal
Fillers. Dermal fillers (ie. Juvederm) cost about $580 per syringe.
For example for the lips, usually one syringe is what's needed. Botox is
for relaxing muscles. Fillers are for just that - filling with an
injectable gel implant.
Average Age of Botox Patients
How long does Botox last?
Artistic and Skillful Botox Injections
Done by me. I am a surgeon and I consider
these injections to be an extension of my surgical skills.
In addition to being a surgeon, I am also an
acupuncturist - thus I am very experienced and skilled with needles.
I carefully select our injection needles as the
instruments of the procedure. There are many styles and sizes to
choose from. Even within the same specifications, each brand has it's
differences. I recognize that needles make a difference in the
bruising and patient comfort level.
Individualized Botox recommendations
We treat each injection session differently and
evaluate facial muscles at rest and with activation.
We realize that everyone is different. We
have different recommendations for each individual.
We have different goals
We have different anatomy - our muscles are shaped
differently and have varying strengths from one another, and changes
throughout our lives.
patients demonstrate discernable differences in the size and strength of
There are also gender differences. In general men will need more Botox.
We do not use "cookie cutter" Botox templates.
Botox Side Effects with Cosmetic Botox injections
Botox injections are safe and effective aesthetic
treatments. Common adverse effects are mild and temporary. Serious
adverse effects are extremely rare.
We believe that the we can keep the risks and side
effects of Botox low or prevent them by keeping our injection skills at
the highest level we can, having great knowledge of facial anatomy, and
utilizing individualized injection strategies based on our patients'
goals and facial features.
Most common side effect is bruising. Other side
effects are of a very small percentage but they do occur. And yes, they
have occurred in my practice. But I will take great care to try to prevent
them from happening if possible.
I think the risk of bruising is somewhere between
10-20%. Higher part of the range has been found in the crows feet area.
I do apply Arnica gel to areas with bruise potential right after the treatment
to help reduce bruising after Botox.
Incidence of headaches is also similar to the incidence
of bruising (10-20%) as reported by our patients. However, I'm sure there
are patients who don't have a chance to tell me, so the incidence is probably
not very accurate. Most patients tell us (me included - I get a mild
headache after my own Botox injections) that one dose of Tylenol usually treats
the problem. I've had 2 patients tell me that their headaches lasted
longer than 3 days. But both patients said that they would still continue
using Botox. So this headache risk is a possibility.
Eyelid drooping (belpharoptosis, or lid ptosis) - is
most likely caused by migration of Botox through the orbital septum to the
levator palpebrae superioris muscle. This migration could also be caused
by excessive pressure on the injected botox sites. Plus, forhead (frontalis
muscle) treatment with botox can aggravate subtle prexisting lid ptosis.
This risk in our practice is less than 1%. To keep this complication
low. Dr. Wu and I keep our injections of the glabella region (area between
the eyebrows) at least 1 cm above the bony orbital rim and we don't cross the
midpupillary line. We also avoid high volume botox dilutions for
injections in this area.
Eyebrow drooping (brow ptosis) - is most likely due to
low frontalis treatment or overtreatment of the forehead. I usually
encourage patients to get a lower dose of Botox for the forehead to prevent this
complication. I think our risk of this complication is less than 5% of the
patients who get forehead injections of botox. We take steps to keep this
complication low by encouraging lower doses of Botox for the forehead for
patients who already have a lower-set eyebrow, injecting at least 2 cm above the
orbital rim, and we consider adding injections to the crows feet area to help
elevate the brows.
Double Vision (diplopia) - is most likely due to medial
migration of toxin to the lateral rectus muscle. I take steps to avoid
this by keeping crows feet injections on the shallow side. So far...
(hopefully I will not have to revise this statement), I've had one patient
complain of blurry vision after Botox, but she also had eye surgery the week
after Botox injections. She wasn't sure which to blame the blurry vision
upon. She continues to get Botox from me, but has not had any blurry
vision since. But I will always remain cautious.
Botox before and after pictures
Seeing is believing
website from the makers of Botox. These pictures are for the glabella
complex of muscles (area between the eyebrows).
Everyone's wrinkles are different. Some
results are best seen after multiple sessions with Botox. And many
patients are interested in keeping dynamic wrinkles from becoming static
Dynamic Wrinkles vs. Static Wrinkles
Dynamic wrinkles are wrinkles which appear when
muscles are activated. Static wrinkles are present when the muscles
are as relaxed as possible. Dynamic wrinkles naturally tend to become
Botox works right away on dynamic wrinkles.
Botox takes time to work on static wrinkles and may
never "erase" them.
Botox treatments done by the surgeon injectors at
Surgical Artistry, Modesto, CA
I (Dr. Calvin Lee) am the main injector. Dr. Tammy
Wu can also inject with special request. She was the one who originally
trained me to inject Botox. I have since taken on the art of injecting
Botox with passion (bordering on obsession). In 2010, I have surpassed Dr.
Wu's lifetime number of Botox units injected. As mentioned above, many of
these injections are considered "off-label" FDA uses of Botox. The list
here is for informational purposes only.
Pregnancy or breast feeding?
Dysport? Xeomin? generic names?
We don't carry Dysport
(abobotulinumtoxin A) or Xeomin (Incobotulinumtoxin
A) at this time.
We are very satisfied with the results and
expectations with Botox (onabotulinumtoxin
A). And we provide our patients with the
opportunity to sign up for the free
program which allows patients to earn points and significant coupons,
rebates, and discounts on Botox.
Source of Botox and safety
Surgical Artistry (Dr. Lee and Dr. Wu) obtains
Botox directly from Allergan, USA. We understand that there is press
regarding unapproved or counterfeit products. In fact, we get
solicitations from various shady sources, so we know that these products
exist. It is our goal to provide only the highest quality product,
thus our distributor is the company that makes and owns Botox (Allergan).
In fact we are given the platinum level from Allergan. This is based
on the amount of products ordered from Allergan each year. They tell
me that Platinum level is their top 1%.
Brilliant Distinctions Botox Discount (for Juvederm and
I do not operate this
program. The page describes what is known about the program and it changes
from time to time.
We are members of
distinctions because we want our patients to get the best value for
their Botox, Juvederm, and Latisse purchases. The discount/rebates are
offered through Allergan - the makers of Botox, Juvederm, and Latisse.
Earn points for each Botox
Currently you get points worth
about $20 per visit, which you can earn/redeem every three months. Three
months is roughly how long Botox effects last.
Want even more information?
Silly picture but Serious results
I have been told by my patients that I would scare away
new patients with this picture (I hope not, I am not a scary person - usually
not). But I figure I have to impart some fun while I poke about 500
needles into patients in the course of a day. My goal is for my
patients to say that they look forward to visiting my procedure room.
Don't try this at home, I got in a whole lot of trouble with my wife for messing
up the iron with oils from my face. Plus if the iron is hot (which it
isn't in the picture), you would burn yourself very badly and permanently.
Thank you for reading my blurb on Botox above. I
hope you will consider my botox injections a "jab" well done.
Calvin Lee, MD
Dr. Lee's Credentials / Awards
Botox Muscle Names |
Surgical Artistry webpage is for information
only, not medical advice. Dr. Calvin Lee on
www.surgerytoday.com homemade website
by Calvin Lee, MD and Tzuying Tammy Wu, MD, Modesto, CA
Date of edit: