Monthly Archives: November 2013

A Recent Botox and Dermal Filler Review for Calvin Lee, MD in Modesto, CA

Botox and Dermal Filler review for Calvin Lee, MD Modesto, CA

Botox and Dermal Filler review for Calvin Lee, MD Modesto, CA. November 2013.

The review can be found here:

I have saved other (older) plastic surgery and botox reviews here.

Thank you very much for the Botox and Juvederm and Boletero review. It’s very much appreciated. And I will continue to do my best to improve and live up to those high standards written in these very kind reviews. (209) 551-1888
(209) 551-1888



My first surgery

Back in the days of Surgery Residency

My first ever surgery: about 16 years ago (from 11/17/13), this (brachial basilic arterio-venous fistula) was my very first surgery I’ve ever done in my life. It was a strange way to start because the technical aspects of this surgery is high – I still consider it difficult. But I was a lowly surgical intern in Cleveland, and highly respected transplant surgeon, Dr. James Schulak, was doing the surgery. I was just retracting (Surgical Interns didn’t operate, they just held things), but during the case, Dr. Schulak was time-pressed and accidentally I got showered in the face with blood – blood dripping down my face, luckily it didn’t hit me in the eye (I love wearing glasses). He told me to get out, clean up. When I leisurely (I took my time getting all the blood off) made it back to the surgery after wiping off my face and changing. I saw that he was just waiting for me without having made any progress in the surgery. He was just sitting there without moving – bizarre. He said he had a policy: if he splashed a resident with blood, the resident gets to do the entire case. So, that’s how I did my first surgery. It took about 2 more hours, and I didn’t even know how to hold the specialized vascular instruments (given that I hadn’t even done any surgeries at all), but he guided me expertly through it, I managed to do it, and the patient had a great result. In Modesto, the operation would have taken me about 30 minutes – but we all had to start somewhere.

One stage vs. two staged surgical procedure

I sorta miss these cases (and my crazy method I personally innovated for laparoscopic peritoneal dialysis catheters). Now, with a cosmetic surgery practice, I’m focused on my Modesto Botox Patients, Veins and Acupuncture.  When I used to make these brachiobasilic AV fistulas, I did them in one stage which included a pretty long incision from axilla to antecubital fossa, my theory was that I would spare the patients two trips to the operating room. There’s a theory out there that separating the operation into 2 stage approach is better in case the fistula doesn’t mature. Stage One: make the anastamosis (connection between vein and artery), and Stage Two: mobilize the basilic vein to the surface (because it is deep and not easily accessible from a dialysis standpoint). Dr. Fung of Modesto very kindly helped me improve my technique for these vascular procedures – he is the master.

brachial basilic


2 Degrees of separation from Mr. Quinton, inventor leading up to these surgeries:

My nurse practitioner friend Jaimee wrote on 11/17/13:

I was on a small-ship cruise a few years ago, and my family became friendly with this older couple. The woman asked what I did for work, and I told her I was an NP. She said her husband had created some medical devices – his name was Wayne Quinton. He also invented the first dialysis machine. He’s up in his 90s now and still tinkers with inventions.

My thoughts on buying a plastic surgery practice

Below is something I shared with a person who wrote me regarding finding a plastic surgeon to buy a practice.  I thought I’d just share what I wrote in this blog – not sure if it’s helpful for others or may give others some ideas – or perhaps you can contact that person for plastic surgery recruitment purposes.  In my attempt to help and share, here’s the text of my email:



Thanks for making contact.  I’ve been in the plastic surgery “business” with my wife for about 7+ years at this point.  I’m not sure this makes me any sort of expert, but I’m willing to try to answer your question and help.

I know a plastic surgeon who was thinking about selling his cosmetic plastic surgery practice in Walnut Creek. He had sent us a letter with his intent to sell his practice. But it looks like you’re looking for a surgeon who wants to buy a practice. We just mailed just about all the plastic surgeons in California because we’re trying to get them to consider a Medical Malpractice Company:

My thoughts on places:

1. Kaiser – plastic surgeons who might want to see what’s “out there”
2. Sutter Plastic Surgeons – who also might want to explore new avenues.
3. Beverly Hills plastic surgeons – so competitive there – they might want to buy another practice.
4. Plastic Surgeons graduating from residency (ie. Stanford Univ.) – they might have rich relatives?

The reason plastic surgeons would want to buy another practice is to get a foothold on Cosmetic surgeries. There’s a life cycle / phases of a plastic surgeon’s life. It usually starts with reconstructive surgery then moves on to cosmetic surgeries. So by buying another person’s practice, one would get a better footing (faster too) into cosmetic surgery.

With insurances getting stranger and stranger these days – I think more plastic surgeons would want to move over to a cosmetic focused practice. However, that being said, I know a bunch of plastic surgeons who love reconstructive surgery and dislike cosmetics.

Buying a cosmetic/plastic surgery practice, in my mind, is beneficial for buying the building, location, equipment, furniture, instruments, and perhaps reputation and possibly repeat patients if the new surgeon is introduced.

Also from what I’ve seen, most plastic surgeons like to slowly grow their own practices; thus the era of buying medical practices is slowly going away. But I still definitely see the value of a seasoned surgeon mentoring a younger surgeon and introducing that person into the environment.

When I was about to leave my previous general surgery practice in Modesto, CA, I was given an opportunity to join a well established general surgeon in Orange County, California. And with reimbursement arrangements, it would be similar to “buying” a practice.
Good luck to you! Let me know how it goes.

– Calvin Lee


—–Original Message—–
From: Lois Shanks []
Sent: Fri 11/15/2013 12:02 PM
To: Calvin Lee
Subject: MD Recruitment

Dr. Lee,

I just now read your blog and was facinated by the content. I think it is wonderful that you took the time to impart this information to others.

I am a medical Practice Administrator and Physician Recruiter. I love what I do and I live in Medford, Oregon. I recently left my position as the Administrator of a three site Retina practice and am doing strictly MD recruitment. Could you give me a few pointers on the best places to look for a Plastic Surgeon seeking to buy a well established practice? I am on a mission because I need to fill this position by July 2014.

Any assistance or guidance you could share would be greatly appreciated.

Thank you very much!

Lois Shanks
MD Recruiter<><>

Airway burns from surgical fires – relevance to cosmetic surgery

Smoke Inhalational Injury from Burns


Background info on what happens with burn related inhalation injury:

  • Inhalation injury is the most important prognostic factor for mortality after burn injury
  • Total Body Surface Area (TSBA) or patient’s age doesn’t matter
  • After significant smoke inhalation, ciliary function ceases
  • Epithelial cells separate from the basement membrane
  • Edema of the airway
  • serious pulmonary injury may exist without endoscopically apparent changes
  • Fibrin casts form, may be revealed with repeat bronchoscopy.
  • Surfactant is diminished resulting in decrease in lung compliance.
  • Pulmonary fibrosis and airway stenosis is a late finding.

More background information on Inhalational Injury

How is this related to our plastic surgical practice in Modesto, California?

Surgical Procedures on the face which require the use of the Bovie

We need to be aware that inhalational injury exists.  When working on the face, the risk of a surgical fire is present in the operating room when there are anesthetic gases which can be flammable.  Oxygen is one of the main culprits for a surgical fire.  There are precautions to take by the surgical team when a surgeon uses the electrocautery device on the face for any surgical procedure – including cosmetic mole removal.

Consider evaluation by ENT colleagues.

Bronchoscopy can be done as part of the evaluation by ENT specialists (Ear, Nose, Throat) – along with follow up to rule out or manage smoke and thermal related airway injury.  A bronchoscopy could also be done by a General Surgeon colleague who has the experience.  Inhalational injuries may require ventilatory support.

Keep inhalational injury in mind

I think inhalational injury and ventilatory health is something to consider with any burns which occurs on the face, even with what seems to be a short duration burn with a small area injured.

My uses for Hypertonic Saline

Normal Saline was invented in 1896 by Mr. Hartog Hamburger in Holland. Yes, this was at one point called Hamburger’s solution. Normal saline is a close approximation to the osmolarity of blood – thus there are tons of uses for normal saline. So how about HYPERTONIC Saline? What are the uses of something that has a higher osmolarity of blood? There are multiple uses but in my career it has been used for reducing brain swelling in trauma patients (more specifically to lower intracranial pressure, where maintenance of cerebral perfusion is key as it relies on blood pressure being high enough above intracranial pressure.)

The other use of HYPERTONIC Saline is in the COSMETIC treatment of spider veins. Now it’s less popular for this indication because POLIDOCANOL has been shown to be a superior product for spider vein treatment (and more expensive), but safety and superiority trumps cost for the most part. We use Polidocanol at Surgical Artistry, in Modesto, CA.