Tag Archives: botox

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:  https://plus.google.com/102548094439476506081/about?gl=US&hl=en-US

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.


www.SurgeryToday.com (209) 551-1888

(209) 551-1888



Ludwig’s Angina – a serious infection of the floor of the mouth

Ludwig’s Angina – a cellulitis of the face and mouth

  • usually occurring in adults
  • May obstruct airways
  • Might need a tracheotomy
  • Can require surgical management and ICU

Ludwig’s Angina is also called:

  • Angina Ludovici
  • Cellulitis of the floor of the mouth
  • Angina Maligna
  • Morbus Strangularis

History of the name Ludwig’s Angina

Named after Wilhelm Friedrich von Ludwig who is a German physician who first described this condition in 1836.  He died in 1865 of a unspecified neck infection.

Causes of Ludwig’s Angina

  • Dental infections
  • Infection of the gums
  • Immunocompromised patients
  • Tongue piercing
  • Infections from other procedures on the face.  Side note, see my other webpage:  Botox and Juvederm injections in Modesto – sterile technique is important.  Note: Botox and Dermal Fillers have not had any reports of association with Ludwig’s Angina.  But infection prevention and knowledge is always on my mind.

Symptoms and signs of Ludwig’s Angina

  • Cellulitic facial infection (side note: facial peels in Modesto, CA)
  • Bilateral lower facial swelling around the lower jaw and upper neck.
  • Spread to involve submandibular, sublingual, and submental spaces of the face.
  • Difficulty swallowing
  • There may be stridor or difficulty breathing.
  • Can extend into the anterior mediastinum – with some patients presenting with chest pain.
  • diverse in presentation ranging from enlargement of lymph nodes to necrotizing fasciitis.
  • Tongue can be posteriorly displaced – airway concerns.

Radiographic appearance of Ludwig’s Angina

ludwig angina from world journal of radiology

arrow shows multiple abscess in the sublingual space

Treatment of Ludwig’s Angina

  • Getting prescription antibiotic medications
  • Monitoring and protecting the airway
  • Urgent facial surgery or dental consultation to incise and drain infection collections.
  • Fatality rate is about 5%

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.”

www.SurgeryToday.com (209) 551-1888

(209) 551-1888

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.

After BOTOX Instructions

My post-procedure recommendations for Botox

  1. Do not vigorously rub the areas injected with Botox for 4 days.  But you can touch these areas lightly.  I do want you to wash your face gently, wear makeup, wear sunblock, etc.
  2. Do not exercise vigorously for the next 4 hours after Botox injection.

Reasons and more details for the Botox post procedure recommendations above:

  • Rubbing can cause the Botox to move.  It is first injected as a liquid.  When the Botox gets moved by accident – it can cause the relaxations of muscles in areas other than the intended Botox targets.  This may lead to eyelid droop or double vision for example.  However, these risks are rare, but because they are present, I still want patients to take the precautions of avoiding vigorous rubbing after Botox.  Vigorous rubbing includes – rubbing with a knuckle, getting eyebrow waxing, Microdermabrasion, and perhaps using the Clarisonic brush.  Also things that rub the areas of Botox injection include face down massage, face down acupuncture, face down chiropractic manipulation.  The area I worry about the most is the glabellar area (the area between the eyes).  Other areas of Botox injections are reviewed here along with number of units and pricing.
  • Working out can cause the area of Botox injection to bruise more easily.  Four hours seems like a reasonable amount of time to allow any unrecognized subcutaneous bleeding to subside and thus the risk of bruising would become less.  With exercise there is an elevation of blood pressure which can sometimes cause subcutaneous bleeding to recur and thus cause more bruising.  However, with 4 hours of abstinence from exercise, the risk of additional bruising is decreased.

The risk of bruising after Botox injection

I believe that the risk of getting any sort of burise after Botox injection is about 20 percent.

Contact Us for any questions regarding your Botox aftercare

Please feel free to call us.  We would love to hear from you and any questions you may have after your Botox injection.  (209) 551-1888.

Other services that we offer besides Botox:

Our main webpage:  www.SurgeryToday.com


Disclaimer:  These are my part of the directions to my patients.  Please talk to your doctor in person for his or her directions.