A Practical Guide to Botulinum Toxin Procedures

Book Preface

After the publication of the American Family Physician article “Aesthetic Procedures in Office Practice”

(December 2009 Vol. 80 No. 11), I have received an overwhelming amount of inquiries and requests for aesthetic training from primary care providers and residents. The common thread of these inquiries has been a need for educational resources and quality training in aesthetic procedures that can be readily incorporated into office practice.

As the trend in aesthetic medicine shifts away from surgical procedures that can radically alter appearance, toward procedures that have minimal recovery time and offer more subtle enhancements, the number of minimally invasive aesthetic procedures performed continues to increase. These procedures, which include botulinum toxin and dermal filler injections, lasers and light-based technologies, and exfoliation treatments, have become the primary modalities for treatment of facial aging and skin rejuvenation. This aesthetic procedures series is designed to be a truly practical guide for physicians, physician assistants, nurse practitioners, residents in training, and other health care providers interested in aesthetics. It is not comprehensive but is inclusive of current minimally invasive aesthetic procedures that can be readily incorporated into office practice, which directly benefit our patients and achieve good outcomes with a low incidence of side effects.

This botulinum toxin injection book is the first in the aesthetic practical guide series and is intended for both novice practitioners learning a new aesthetic procedure, and for more seasoned practitioners seeking advanced procedures. Providers-in-training and teachers can benefit from the step-by-step approach and the online videos of each procedure performed by the author. Also included are suggestions for management of the most commonly encountered issues seen in follow-up visits. Seasoned practitioners may appreciate the concise summary of each procedure’s complications and up-to-date suggestions for management, combining aesthetic treatments to maximize outcomes, current product developments, and reimbursement recommendations.

The Introduction and Foundation Concepts section in this book, provides basic aesthetic medicine concepts essential to successfully performing aesthetic procedures.

Each chapter is dedicated to a single botulinum toxin procedure with all relevant anatomy reviewed, including the target muscles and their functions, as well as the muscles to be avoided. Injection points and the injection safety zones are highlighted to help the providers perform the procedures more effectively and minimize complications.

I have profound gratitude and respect for Dr. Dalano Hoang, my associate editor and husband. He has been with me at every step of the way as the clinic director of our aesthetic practice, and much more. Although he personally does not perform aesthetic procedures, his knowledge of the multiple aspects of aesthetic medicine is extensive and invaluable. His clear, concise writing style combined with my knowledge of minimally invasive aesthetic procedures yielded this straightforward procedure book.

A special thanks to Drs. John L. Pfenninger and E. J. Mayeaux, who have inspired and supported me, and taught me much about educating and writing.

The University of California, San Francisco and the Natividad Medical Center family medicine residents deserve special recognition. Their interest and enthusiasm for aesthetic procedures led me to develop the first family medicine aesthetics training curriculum in 2008. Special recognition is also due to the primary-care providers who participated in my aesthetic courses at the American Academy of Family Physicians’

national conferences over the years. Their questions and input further solidified the need for this practical guide series.

I am indebted to my Capitola office staff for their ongoing logistical and administrative support, which made it possible to write this series.

Special acknowledgments are due to those at Wolters Kluwer Health, who made this book series possible, in particular, Kerry Barrett, Sonya Seigafuse, Freddie Patane, Brett MacNaughton, and Doug Smock. It has been a pleasure working with Liana Bauman, the gifted artist who created all of the illustrations for these books.

Finally, I would like to dedicate this book to my 5-year-old son, Kaidan Hoang, for the unending hugs and kisses that greeted me no matter how late I got home from working on this project.