Monthly Archives: July 2013

Mobile Devices taking over Computer usage for FaceBook viewers

Is this the death of the computer?

Desktops and Laptop included in the funeral march?

I posted on FaceBook – asking my Modesto, CA friends and friends elsewhere:

Help me with this Poll: What device are you using right now on FaceBook (ie. Laptop, iPhone, iPad, whatever).

Mobile devices vs. Computer – the winner regarding FaceBook is:

A few hours later:

I got 47 responses.

77% Mobile Devices vs. 23% Computer when viewing FaceBook.

Of the Mobile devices, 70% of them were iPhones and 30% were non-iPhones.

I didn’t tally up the tablets:  iPad vs. non-iPad.

Just for the record:

I personally put myself down as Laptop user.

How is this computer vs mobile usage important to Cosmetic Surgeons?

For example if we’re going to advertise Botox, we should probably make sure those ads make it to the mobile devices.

9 Habits of Highly Successful MD Cosmetic Injectors

My list of 9 habits of “Highly Successful MD Cosmetic Injectors.” I’ve spent the last few months hovering around internationally renown MD Cosmetic Injectors.   I participated at a Palette Injectors meeting / training for Level III injectors in Sacramento, and I also at the 2013 Vegas Cosmetic Surgery Meeting.

botox bottles

This is my partial collection of empty Botox bottles.

Here are some success habits I think these great injectors have in common.

1. Most of the MD injectors are the injectors of their practice without delegating to a nurse or PA
2. They are constantly looking for newer and better ways to do things.
3. They are eager to explore new products.
4. They selectively use cannulas for some of their injections.
5. They are very willing to share / talk / publish.
6. They make injections a priority in their practice.
7. They often go back to basics which includes knowing the anatomy, and exploring new anatomical concepts.
8. They are not be afraid to show off their grey hair – but will make some attempt to hide their wrinkles.
9. Most importantly they do not view fillers or Botox as a COMMODITY. In other words, it’s not a Botox per unit price or cost per syringe of Juvederm (the PRODUCTS), rather it’s the injector’s SKILL which is the true value. And this is how they provide the best VALUE – through the best skill and materials.

There are also a great number of amazing Nurse and Physician Assistant injectors. I haven’t had the opportunity to attend sessions and lectures by them (yet – I’d like to see what makes them successful as well, so it’s on my list). All the lectures and meetings and demonstrations that I’ve attended in the past few months were by Surgeons and Dermatologists.

Also, these aren’t necessarily “habits.”  It was just a catchy title.  These are more like “attributes” or “traits.” (209) 551-1888
(209) 551-1888

Flexible Blunt-Tipped Cannulas for Cosmetic Fillers

To start with, how about a picture of these cannulas?

blunt tip cannulas

Why the need for Cannulas in comsetic filler injections?

You might say that Juvederm, Restylane, Radiesse, Belotero, Perlane, Prevelle injections have been just fine with a plain needle.  But why increase the difficulty of the procedure?  The reason?  Less bruising?  Smoother results?  Safer?  Those are excellent reasons for having your injector / surgeon work harder.

What are cosmetic fillers?

Surgical Artistry Calvin Lee, MD Tammy Wu, MD 209-551-1888 2336 Sylvan Ave. Suite C Modesto, CA 95355 Next to Post office on Sylvan

Fillers are like they sound – they fill spaces up to replace volume that we’ve lost as we’ve aged.  Familiar fillers are Juvederm, Restylane, Perlane, and Radiesse.  There are many more brands of cosmetic injectible filler implants.  However these are some of the common ones used in my Modesto office: Surgical Artistry.  Botox isn’t a filler – Botox relaxes muscles.  Here’s a link to my page: Anatomy for Botox.  Both fillers and Botox are used for facial rejuvenation.

Why the opening on the side of a cannula?

The opening is on the side for extrusion of the filler such as Juvederm so that the tip can be made in a blunt fashion.  If the opening was at the tip, there would be sharp ends.  Thus the opening is on the side.  Is this good or bad?  It’s both.  It’s good because now the tip can be blunt.  It’s bad because we lose a bit of the precision which we were used to with the tip of a regular needle.

Why the blunt tip on the cannula?

This is the key ingredient for safety and less bruising.  Because the tip is blunt, it won’t easily go through vital structures such as arteries, veins and nerves.  It glides through fat.  In fact this blunt tip cannula idea is used in surgical liposuction.  The safety is in the prevention of cutting vital structures.  The less bruising is because there’s less internal bleeding due to the cutting of blood vessels.

Cannulas increase the difficulty of the cosmetic filler procedure

Yes, the difficulty is increased and it feels more like a complex procedure.  However, the risks diminish and many of the positive results increase – including patient satisfaction, smoother results, and less downtime.  I think this is worth the increased time and complexity – something surgeons think about all the time.


Needle vs blunt-tipped micro cannula.  Safety is the #1 reason I like cannulas.

Where can cannulas be used?

For most injections where the fillers are introduced below the dermis of the skin. This is a plane where the cannula can glide.  Superficial lines – probably a difficult space for the cannula – I would most likely continue to use a needle in the superficial plane.  Examples of places for cannula use:

Why are cannulas more difficult?

  • It takes longer to do the procedure
  • There’s a need to use a pilot needle (which can still cause a bruise) to create the opening in the skin for the cannulas to slide through.
  • Cannulas are flexible and there can be physical hang ups (getting stuck), and difficulty driving the cannulas from a distance (longer needle).  And because they are flexible, sometimes they are harder to feel their presence under the skin.
  • The hole is on the side of the needle not in the front.
  • Sometimes it’s difficult to gauge the depth of the injection

What’s the main reward for using a cannula?

Patient safety.  When a blunt tipped cannula is used well by an experienced injector, there is much higher patient safety.  Using needles – one could puncture subcutaneous structures which would otherwise like to stay unpunctured.

What are other great benefits of using cannulas?

  • Patient safety (mentioned above as the #1 benefit)
  • Tip is blunt – actually might hurt less.
  • Tip is blunt – won’t injure as much under the skin such as blood vessels and nerves.
  • Less bruising – because there’s fewer injury to blood vessels and thus less internal bleeding.
  • Less swelling – for reason above.
  • Faster recovery.
  • Flexible cannula – allows for safety – the cannula moves or wiggles around some of the stiffer structures within the fatty tissue planes.
  • Longer length – thus fewer skin puncture sites.
  • There’s also the benefit of calling this instrument a cannula rather than a needle – less scary sounding.

What is my favorite cannula?

Cannulas come in many different styles and lengths.  I currently use Magic Needle and Dermasculpt cannulas.  I haven’t had the chance to try other cannulas on the market.  I believe they would be excellent.  The Magic Needle cannuals are more flexible – perhaps a little bit too flexible for my current tastes.  I know my tastes will change with time – it has before – I remain flexible myself in my choices of cannulas.  As for favorite size/length of cannulas.  I like the 27g 1.5 inch cannulas for most of my Juvederm injecting.  I use this cannula mostly for temples and cheek augmentation.

Do I think that cannulas are game changers in the world of injectable fillers?

I think so.  For the sake of patient safety and smoother appearances.  Plus with the added benefits of shorter recovery period (less bruising, less swelling).

Do I use cannulas instead of needles for everything

No.  There’s a role for each tool.


These are my thoughts (Calvin Lee).  No specific medical information here. (209) 551-1888
(209) 551-1888




Lip Augmentation with Cannulas

First what are blunt tipped cannulas for fillers?

Surgical Artistry - Calvin Lee, MD / Tammy Wu, MD

Borrowed over from the world of liposuction and the world of Huber needles for chemotherapy.  There are four benefits of using a cannula for filler (ie. Juvederm) injections:

  1. Tip is blunt, not sharp – so it won’t easily pierce unwanted delicate structures such as nerves and blood vessels
  2. Side exit port for the opening for extrusion of filler.  This is on the side so that the tip can be blunt.  So this reason goes along with the blunt tip reason.
  3. Flexible cannula.  This allows for less injury as well, it has the potential to wiggle around obstructions which are sometimes cause by the vitals structures of nerves and vessels.
  4. Long length.  this allows for fewer puncture sites.

Why do we care about blunt tipped cannulas?

In the end the results are for safety and less bruising.  But are the effects better looking when the swelling goes down?  for the most part I think so, for broad areas such as cheek and temples.

Picture is worth a thousand words

Perhaps a picture would help describe cannulas for injectable fillers:

blunt tip cannulas

blunt tip cannulas

Lip augmentation with cannulas?

Currently, for myself as an injector in Modesto, I’m a fan of cannulas for filling the central part (body) of the lips.  But for precision, I feel that I lose a little bit of the precision needed when working on the border of the lips.  Thus I still find myself gravitating to the regular needle.  I have also used longer needles.  So for now, there’s a role for both cannulas and needles in my practice for lips.  But for the most part, I’m doing most of the lip augmentations with needles.  I like the precision that I get with a short stiff needle.  However, I understand that there is more of a risk of bruising and swelling right after the procedure.  These are just my thoughts at my current level of comfort with cannulas.  For more of what I think, visit: my thoughts on Lip Augmentation with fillers: (209) 551-1888
(209) 551-1888

My thoughts on Lip Augmentation

red lips isolated in white

Picture is not of a an actual lip augmentation patient


Lip Augmentation

I perform lip augmentation with fillers such as Restylane and Juvederm ultra.  I have occasionally used Juvederm Ultra plus for more dramating lip augmentation effects.  This write-up serves it’s purpose for me to put down on paper some thoughts flying around my head regarding excellent lip augmentation.   My thoughts on Cannulas for Lip Augmentation.  Much of the info here is considered off-label FDA usage.  Nothing here is meant to be personalized medical advice – just a generalized discussion here.

Does Lip Augmentation Hurt?

The procedure is done in my office in Modesto, CA.  There is no IV sedation or pill sedation or general anesthesia.  There are options of numbing cream, ice, nerve blocks, mucosal blocks, and lidocaine within the product.  Some lip augmentation patients choose all these options so that they feel pretty close to no pain.  Some patients just choose just one of these numbing options as each one does take time and patients at the office visit.


Demonstration of Lip Augmentation with Juvederm, posted with permission from my patient.

My thoughts on  Lip Augmentation

There are several parts of the lip to consider.  First is the ratio of the upper lip tot he lower lip.  Most patients like their lower lip on the larger side.  Then there’s the part around the lip which needs to be considered.  With some extra support of the white areas around the lips – this area can use a half to whole syringe just to expand out the fine line around the lips.  Volume loss has occured here.  Take all these into consideration, then there’s the best part – augmenting the red part of the lip.

There’s three general locations to consider for injecting into the red part of the lip – my own thoughts:

  • injecting filler right at the edge of the lip to add definition
  • injecting into the belly of the lip to add forward projection and fullness
  • injecting near and at the wet-dry border of the lip to create more vertical curl of the lips.

I’ve come up with these thoughts as I’ve gained more and more experience via lips.

How many syringes of fillers needed for the lips?

considering the three locations for injecting into the lip and the white part of the lip.  One could use 2-3 syringes of Juvederm or Restylane for the project already.  However 1 syringe of Juvederm or Restylane has been the choice of many due to cost concerns and also 1 syringe does a wonderful job for many lips, and not everyone wants all aspects of the lips (definition, fullness, and curl plus the perioral lip lines) to be changed.

So quick answer: Most of the time just one syringe of filler.

There’s much more to this subject of Lip Augmentation

But this is a start.  I wrote down this information mainly for myself to help organize my thoughts on the topic of Lip Augmentation.  A personal consultation regarding lip augmentation would reveal specific personalized information which would be much more useful than this article.

I usually use temporary injected fillers for lip enhancement rather than permanent lip implants

There are many options available for lip augmentation.  I normally choose products which can be reversed and also are precise in the results which we are looking for.  Many patients consider getting lip filler placement ever 4-8 months.

Permanent lip implant options exist.  Perhaps we’ll explore those in the future.  For now, we’ve taken out several of these done by others.  I do think that there is a role in the overall lip enhancement world for these permanent products, but I’ve been personally very happy with hyaluronic acid type fillers for the lips such as Juvederm and Restylane.

What makes Lip Augmentation so difficult?


Lip augmentation is somewhat challenging.  But as surgeons we usually like challenges and are very satisfied to get great results.

There are many different ways to achieve lip augmentation.  The three different locations for fillers and in different ratios of material allows for different effects.  The challenge here stems from having so many variables.  But we have to match these variables to:

  • Patient expectations – what is the patient’s definition of duck lips – do they want to avoid that?
  • Lip symmetry – this is a big importance between left and right sides.  Many patients are not symmetrical to begin with.
  • Lip filler product bumpiness – visible and palpable (able to feel).  We want to try to avoid this as much as possible
  • Lip bruising afterwards – this does happen and is a risk of the procedure.  I think it happens a lot more often than not.
  • Lip area tends to have more pain fibers and thus there’s the challenges and difficulties of achieving comfort for the patient.  Everyone is different when it comes to pain sensation.  But almost everyone would agree that lips are particularly more sensitive.  But we have options to include performing nerve blocks – like going to the dentist.
  • Lip lines around the lips should be addressed too.
  • The issues of infections around the lip. The lips are one the least “sterile” areas of the face to work on.  And some patients even have the challenges of cold sores.  We try to anticipate these problems and have prescriptions available at the office for Acyclovir – a drug that helps to shorten the length of active cold sores.
  • Desired ratio between upper lip and lower lip.
  • Some lips can’t take too much product all at once and a staged procedure might have to be done.  We don’t want complications of lip necrosis (dying off).
  • Another interesting challenge:  When doing fillers on the lips we have to deal with the location of the previous fillers done months ago.  Not all of it disappears and we have to be able to work with the previous filler to blend it all together and not allow the old filler to get in the way of the new filler.  For me, sometimes this is the biggest challenge, especially if the previous techniques used for lip augmentation are different from what I’m expecting.
  • This list goes on and on, but I wanted to list a few challenges which I have on my mind when going through the process of lip augmentation.

If you would like, please feel free to contact us:

Surgical Artistry
Calvin Lee, MD
Surgeon who likes to perform lip augmentation
(209) 551-1888.

Dr. Tammy Wu also does lip augmentation, and in addition she also removes permanent lip implants, lip reduction, mucosal reduction, and lip reconstructive surgeries.  But for the most part if on is interested in lip augmentation with injected fillers, Dr. Calvin Lee (me) is in charge of that part of the minimally invasive facial injections.  Lip augmentation is one of the most satisfying procedures that I have.