A practical guide to botulinum toxin injections

As a lecturer, editor, author, and medical reviewer, I have had ample opportunity to evaluate many speakers as well as extensive medical literature. After reviewing this series of books on cosmetic procedures by Rebecca Small, MD, I have concluded that it has to be one of the best and most detailed, yet practical, presentation of the topics that I have ever encountered.

As a physician whose practice is limited solely to providing office procedures, I see great value in these texts for clinicians and the patients they serve. The goal of medical care is to make patients feel better and to help them experience an improved quality of life that extends for an optimal, productive period. Interventions may be directed at the emotional/psychiatric, medical/physical, or self-image areas. For many physicians, performing medical procedures provides excitement in the practice of medicine. The ability to see what has been accomplished in a concrete way provides the positive feedback we all seek in providing care. Sometimes, it involves removing a tumor. At other times, it may be performing a screening procedure to be sure no disease is present. Maybe it is making patients feel better about their appearance. For whatever reason, the “hands on” practice of medicine is more rewarding for some practitioners.

In the late 1980s and early 1990s, there was resurgence in the interest of performing procedures in primary care. It did not involve hospital procedures but rather those that could be performed in the office. Coincidentally, patients also became interested in less invasive procedures such as laparoscopic cholecystectomy, endometrial ablation, and more. The desire for plastic surgery “extreme makeovers” waned, as technology was developed to provide a gentle, more kind approach to “rejuvenation.” Baby boomers were increasing in numbers and wanted to maintain their youthful appearance. This not only improved self-image but it also helped when competing with a younger generation both socially and in the workplace. These forces then of technological advances, provider interest, and patient desires have led to a huge increase in and demand for “minimally invasive procedures” that has extended to all of medicine. Plastic surgery and aesthetic procedures have indeed been affected by this movement. There have been many new procedures developed in just the last 10–15 years along with constant updates and improvements. As patient demand has soared for these new treatments, physicians have found that there is a whole new world of procedures they need to incorporate into their practice if they are going to provide the latest in aesthetic services.