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.”
To start with, how about a picture of these 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?
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:
Nasolabial folds
Marionette lines
Cheeks
Pre auricular area
Zygoma area.
Tear troughs
Orbital hollows
Lateral Eye Brow fat pad area – helps to raise the eye brows too.
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.
Disclaimer
These are my thoughts (Calvin Lee). No specific medical information here.
Picture of myself and Dr. Yoelin, the Botox
Master of San Diego
Botox injectors meeting
I think in this world the word meeting, course, and program are used interchangeably.
There was a course offering from a prestigious injection course which is offered in various places nationwide. It’s called the Palette Training program for cosmetic injections – and there are several meetings for different levels of injectors and also specialty sections for things such as tear troughs, cannulas and I believe lip augmentation. There happened to be a higher level course offered in Sacramento. Not too far from my location of Modesto, CA.
The word is neuromodulators – which includes Botox, Xeomin, and Dysport. It’s less brand specific. This was a 4 hour long CME program (I earn credits for continuing medical education). The program I selected was led by Dr. Steve Yoelin of San Diego. He has a super busy Botox and Juvederm (I mean neuromodulator and filler) practice which I’ve heard is booked for many years. I met him before at the Allergan / Latisse speaker’s training program – this was a training session which guided us through the slide deck for our talks. I was very impressed by him – he was very supportive which I felt made him the perfect teacher. While I was on “tour” with my talk for Allergan, I met attendees of my talk who spoke very highly of learning from Dr. Yoelin. So I figured that I should check this course out for myself. He teaches all levels of injectors and I selected the highest level which was called a level III course. I thoroughly enjoyed this course and learned a few tips for my own practice.
Take home pearls on Lip Augmentation and more
I especially appreciated some ideas he gave me for lip augmentation and for filling of temples and lateral eye brow areas. He did say to use the non-dominant hand to help guide the cannulas in injections.
Another great tip I learned from the Tiger Woods of cosmetic injectors (at my recent trip to Sacramento): While injecting Juvederm, he said I had great control, but would be able to take it to the next level if I used my non-dominant hand more to drive the direction of the cannula (special needle).
Yes 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!
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.
PRIOR TO DERMA PEN PROCEDURE:
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.
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.
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!
