Category Archives: Cosmetic Surgery

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.

Derma Pen Recommendations

dermapen with logo

For our Modesto Plastic Surgery Practice, I’ve come up with these guidelines.

Derma Pen is a modality for improving:

  • Rosacea
  • Scars
  • Lax Skin
  • UV Damage
  • Stretch marks

Is the DermaPen a New Invention?

before-after-1Yes and No.  The makers of Derma Pen thinks it’s a new invention.  However, I’m an acupuncturist who does cosmetic acupuncture.  This idea of wounding the skin with a needle to cause more collagen growth is not new.  From what I know, this needling concept has been used thousands of years ago in acupuncture.  Most acupuncturists today don’t know the art of cosmetic acupuncture.  It requires additional training.  However, I (Dr. Calvin Lee) was very interested in cosmetic acupuncture because it complements our Modesto Plastic Surgery practice.

But I must say the concept of attaching 11 cosmetic acupuncture needles to the end of a machine is a new concept.  What this can do, I cannot do by hand.  I am simply not patient enough to cover as much ground as this machine can.  Finally after 5000 years, there is an improvement to acupuncture!

The Boston Channel website regarding Cosmetic Acupunture – interviews Dr. Calvin Lee (me)

Derma Pen Rivals Lasers?

Article on Automated Microneedling Rivals Energy-Based Tx

Cost of Derma Pen Procedure:

  • MD model (deeper) of the Derma Pen, not the Aesthetician Model (less deep)
  • Done by a Surgeon who is trained in aesthetic injections for the face, who is also an Acupuncturist who is also trained in Cosmetic Acupuncture (um, that’s me).
  • Includes addition of Kerotinocyte Growth Factors with no additional cost – right where the skin is most absorbent.  Yes, growth factors is another craze in the skin care industry.

$400-$500 per session.  Prices change, please call us for more info.


1) Stop Tretinoin/Retin-A x 2 days before procedure
2) Avoid prologned / direct sun exposure or sun burns to the treatment area for 2 days
3) Skin should be clean and makeup free before coming for the procedure
4) We will place numbing cream containing Lidocaine 15 minutes before the procedure.

How often can the Derma Pen be done?

ANSWER: You should see an improvement in your skin after the first visit. You can have them as close as once per month. At this time we are recommending, once per month for the first 5 months, the after that possibly every third month to continue to show improvements.

How long does Derma Pen results last?

I’m going to answer this based on what I’ve seen with my Cosmetic Acupuncture practice. With Cosmetic Acupuncture, after about 10 sessions, we have seen patients keep their changes for about 2 years. I think we’ll get to that result after 4 treatments with derma pen. But the reason people keep getting treatments after 4 sessions is that improvements continue on and I think folks would be excited to see the clock turn backwards even more.

Post operative care after DERMA PEN:

1) Stay away from sun exposure x 7 days
2) Wear hat x 7 days (wear as much as you can)
3) Do not wear sun screen x 12 hours (we don’t want this to absorb into your skin)
4) Do not wear make-up x 12 hours
5) Cold sore patients may want to take medication
6) Use your serums: Phyto, B5 Gel, Vitamin C gel right away and daily afterwards to take advantage of the greater penetration after Derma Pen
7) Your skin will be dry and a bit red for the next 2-3 days after the procedure. Moisturize with Phyto, B5 Gel, and/or any other favorite moisture product of yours.


Can DermaPen be used for darker skin?

Yes, Derma Pen can be used on skin of all colors.

womanlipsdermapen (209) 551-1888
(209) 551-1888

Day 3 Vegas Cosmetic Surgery Aesthetic Dermatology Conference

Today’s highlights involved meeting the worlds most prolific injector of Botox.  He works in Singapore.  He gave a great lecture about injecting Botox in a certain way which could work for some Keloid scars.  The protocol is detailed and he shared it with the attendees of the Vegas Cosmetic Surgery and Aesthetic Dermatology Conference.

I attended a few sessions on laser and Cool Sculpting.  Cool Sculpting is a method of non surgical fat reduction.  It uses the idea of cryolipolysis.  CoolSculpting is a trademark owned by Zeltiq.  They hosted a cocktail hour at the conference at around 6:15pm tonight.

I got a chance to greet the reps for Allergan at the Convention.  What was interesting today for me was getting more information about doing virtual patient follow ups.  I didn’t think I was ready for such a thing, but it’s out there.  It’s kind of like recording your post op visit on a secure youtube website and then having the doctor review it later and write you some secure email.

I particularly liked the sessions on TCA peeling.

We also spent some time with another cosmetic plastic surgeon from Modesto, CA.  It was good to see another familiar face at the meeting.

In the evening, there was a dinner program put together by Valeant – the owners of Restylane, Perlane, Sculptra, Dysport, Obagi, and Renova (a form of Tretinoin).  We saw some live amazing cosmetic injection techniques by some legendary doctors.

I am getting so overloaded with all this great information!


Day 2 Vegas Cosmetic Surgery Aesthetic Dermatology 2013

Advanced Dermatology Section

This was a one of the best days of this educational program for me.  I spent the entire day in the advanced dermatology portion.  There was three sessions going on at the same time.  Most of the lectures I heard were about fillers (Juvederm, Radiesse, Perlane, Restylane, Belotero) and neurotoxins (Botox, Xeomin, Dysport).  This was one of my main goals of this course was to absorb as much as I could about the topic.  I was thrilled to see the European and Russian experiences with Botox, Fillers, etc.  There were also sections on ethnic skin and hyperpigmetation.  It was an eye opener to see a bunch of discussions on the complications of fillers and Botox.  We’re glad we have hyaluronidase in our office as part of a kit for filler emergencies.  There was also a lot of info about hydroquinone and tretinoin.  Did you know that there’s hydroquinone in coffee?  I also saw a lecture where they used ultrasound to help guide decision making regarding filler placement.  There was also a brief discussion of fake filler products.  I liked the idea of using ultra sound gel as a substance to help massage fillers.  There were also a ton of information regarding using blunt cannulas for fillers which is something I’ve been doing.

Factors that affect Different Neurotoxins

  • Dilution
  • Manipulation
  • Physician technique
  • Storage

Key words

  • Retrograde threading
  • Malar flattening
  • Sandwich Volumetry

It’ll be great to bring back all this international information to our cosmetic plastic surgery practice in Modesto, CA.

And after the lectures:

We went to another lecture sponsored by Merz Aesthetics, the makers of Belotero and Xeomin (and Asclera for veins).  The talk was Innovations in Facial Aesthetic Medicine, Mastering the Art and Science of Injectables.  Amazingly it was produced by Paradigm Medical Communications, located in Orangeburg, NY.  Their telephone number is 845-398-5100.  They said they were located on 303.  I have friends who live in Orangeburg, New York and I have a personal connection to that location.  This CME program was 3 credits.

New Silicone Gel Breast Implant Approved by the FDA

Mentor’s Memory Shape Breast Implant

Date: June 13, 2013

  • FDA announced it’s approval on June 14, 2013
  • These are manufactured in the USA by Mentor Worldwide LLC
  • It is called the Memory Shape breast implant
  • More silicone cross linking
  • Firmer
  • FDA approved for women at least 22 years old for breast augmentation
  • For Breast reconstruction it would be for any age.
  • Post approval studies are pending for Mentor.
  • Teardrop shaped breast implants

With this breast implant approved there are now five FDA approved silicone gels implants manufactured by Allergan, Sientra, and Mentor.

From the Mentor website

  • The implant features SILTEX (R) Texture, a gentle imprinting of the surface to keep the breast implants in place.
  • Thinner on top of the implant and thicker on the bottom, creating the tear drop shape in this breast implant.

Other breast implant webpages


Consider a breast augmentation consultation with Dr. Tammy Wu. (209) 551-1888
(209) 551-1888, Modesto, CA