Tag Archives: juvederm

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

www.SurgeryToday.com
(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%

Belotero Balance a new Dermal Filler from the makers of Radiesse

BELOTERO

Belotero Balance vs. Juvederm – initial thoughts in Modesto, CA

Today I used two syringes of Belotero Balance and two syringes of Juvederm in today’s line of work.  I’m happy to report that Belotero didn’t disappoint.  I’ve done many tear troughs before with Juvederm and I’ve always injected deep.  For Belotero, I injected more superficially.

For both syringes which I’ve used, I mixed in a small amount of Lidocaine with Epinephrine.

Belotero is a dermal filler which was recently approved by the FDA in December of 2012.  Belotero FDA approval.

The Belotero Balance Syringe

belotero-syringe

This is much smaller and much more ergonoic than their Radiesse syringe also made by Merz.

There was no cracking or splitting of the syringe which I’ve sometimes seen when I attach the Juvederm to my 3 way valve.  I could probably get a better connector; however, the three way valve is something that is handy in my office because I use it  for vein sclerotherapy in it’s foamed version.

The syringe itself is smaller than the the Juvederm syringe; thus it made it somewhat easier to inject initially where the thumb doesn’t have to stretch out as far.  It’s a small advantage for those with small hands – such as me.  I think this was done on purpose – to make the syringe shorter.

There were, however, some parts of the syringe that snap off – perhaps this is on purpose.  The luer lock itself came off when I first connected it to the 3 way valve.  The flanges for the syringe itself also slides off, and when playing with the syringe after injecting the product, the rubber tip of the plunger can also become dislodged.   Regardless, these are very minor issues – which mostly arise because I like to fiddle with the syringe itself.

Initial Conclusions on Belotero in my Modesto practice

On injection, it feels smooth, and can be easily molded after injection into the skin.  I used one syringe on tear trough and the other syringe on the accordion type lines around the side of the skin.  I used a superficial approach to these lines – in attempt to use less product.  It seems to work well.

It is on the opposite spectrum of their other product – Radiesse – which is a harder substance.  Belotero is very soft and pliable but lacks the intense hardness and lift capacity of Radiesse.

I believe that Belotero has a place in the palette of “paintbrushes” we use in our cosmetic injection craft.  But I think that more than one syringe is necessary to fill out fine line wrinkles in faces.

Disclaimer:  Much of what is discussed above is considered off-label FDA usage of Belotero and Juvederm Dermal Fillers.  More info about my Belotero Dermal Filler practice.  Belotero has been mispelled – sometimes as Boletero, Bolotero, Belotora, Belatoro.  “Belotero” is the correct spelling.  An example of a dermal filler consent form, see an example of the Radiesse consent form.

www.SurgeryToday.com (209) 551-1888

www.SurgeryToday.com
(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.

Brilliant Distinctions Changes – Botox, Juvederm, Latisse

Brilliant Distinctions

Recent Changes to the Brilliant Distinctions Program

Update:  See updated section on the bottom – info directly from Allergan and the changes start May 15, 2013.

I heard some things about changes to the Brilliant Distinctions Program by our Botox Representative (from Allergan).  I’m not 100% sure of these changes, as I don’t operate the Brilliant Distinctions program (BD), but of course, our plastic surgery practice accepts the coupons and rebates generated from the BD program.

SkinMedica – get points for purchasing

  • Allergan acquired SkinMedica – a skin care product company – prescription and non-prescription based products.  You can now earn points for purchasing SkinMedica products.   Our office currently does not carry Skin Medica products.  I guess I wished it could have been easier / great if Obagi was somehow absorbed by Allergan, because we are a Obagi retailer and a user of Allergan products.  But that merger  didn’t happen.  Instead Valeant purchased Obagi for $348 million dollars in April 2013..  Valeant is based in Montreal.  Valeant has a dermatology portfolio.  Obagi is based in Long Beach, California, and posted revenues of $120 million in the year 2012.  Valeant Pharmaceuticals in September 2012 purchased Medicis for 2.6 billion.  Medicis makes Dysport, Perlane, and Restylane.
  • Around December 2012 Allergan purchased SkinMedica for $350 million

New Brilliant Distinctions Mall

  • Get points for shopping online
  • Similar to a program offered by Chase.
  • Many many vendors online, and shop as you normally would except click through a link from the Brilliant Distinctions website.

Bonus points are going away

  • As fast as it came, it is going away:  There was a bonus points program for the frequent users, in fact after about 12 visit, the bonus points added up to almost double the original amount which was originally $25 coupon after each Botox visit, and for those coming in on the 13th time and beyond, the $25 coupon got a bonus of another $25.  However this is bonus is going away I heard.

The $25 coupon per Botox visit or $25 per Juvederm syringe is dropping down to $20

  • I also heard that the $25 is dropping down to $20.  But the added ability to earn points from the BD Mall is supposed to more than make up for this difference.  I’d like to know if this works out for folks in the future.  Regardless, it is nice to have a program such as BD, so I guess we shouldn’t complain too much about the $25 dropping down to $20.

There’s the ability to print out a $10 coupon

  • This wasn’t available before.   I think this is to help the Latisse-only users use their coupons, because Latisse purchases used to take longer to build up to a coupon.

I just checked with several patients today regarding Brilliant Distinctions.  Most of these changes have taken place yet, but I know they are coming very soon – perhaps at the end of this month (May, 2013).

These changes the program summarized:

  • SkinMedica
  • BD Mall
  • Bonus Points going away
  • $25 return on each visit or each syringe is going down to $20
  • New!, ability to print out $10 coupon (half of the points required to print a $20 coupon).
  • New 9 month expiration period instead of I think it was 2 years before.

We’ll stay tuned and see how these changes take place and hopefully they will continue to keep our Botox / Juvederm / Latisse patients happy.

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

Surgical Artistry | Calvin Lee, MD | Tammy Wu, MD
209-551-1888 | www.SurgeryToday.com
2336 Sylvan Ave. Suite C | Modesto, CA 95355

 

UPDATE:

We got this notice from Brilliant Distinctions.

Starting May 15, 2013:

Points Values: In simplifying the points structure, the values will alter slightly. We’ve added a new coupon value. You can now create a $10 coupon for 100 points. For 200 points, the coupon value will now be $20.

Expiration Period: Points will expire after 9 months of inactivity from earning. We will send you reminders if you are getting close to your points expiring.

Bonus Points: All bonus points accrued to date will remain in your account; however, no more bonus points will be issued. If you have questions, the Brilliant Distinctions® Customer Support line is a phone call away: 1-888-324-2745 (9am-8pm EST. M-F).

 

Summary:  See summary above also.  But there are some great added features ($10 coupon, BD mall, SkinMedical) and some things taken away (bonus points, $5 taken away from 200 points, and the expiration period ahs been shortened)