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Small’s Practical Guide to Botulinum Toxin Procedures, Second Edition, is the highly anticipated revision of the
best-selling step-by-step guide to performing minimally invasive botulinum toxin procedures.

With over four hundred 5-star reviews online, the First Edition established itself as the go-to resource for providers
looking to enhance their practice by performing medical aesthetic procedures.

In the Second Edition, insights from Dr. Small’s additional 10 years of clinical practice, research, and teaching create an even more valuable resource, whether you are new to aesthetic medicine or an experienced practitioner.
Small’s Practical Guide provides you with the latest information and techniques, best practices for risk reduction,
and expert guidance for optimal results.

Up-to-Date Knowledge: Stay informed on the newest products and high-dose toxins, along with new chapters on advanced procedures such as masseter, Nefertiti lift, necklace lines, chest lines, and nasal tip elevation. Learn how to treat multiple areas in one visit for the best effects and how to combine toxin with other medical aesthetic procedures.

Illustrated Photographs and Procedural Guidance: Patient photos overlayed with anatomically precise artwork and Safety Zones along with detailed instructions minimize complications and improve results.

Enhanced Learning Experience: New instructional videos of Dr. Small demonstrating key techniques refine your skills and move you from classroom to practice faster.

Quick Reference Tools: Quick Guides to Dosing for all procedures, Overview Illustrations for injection location and dose for each treatment area, Concise Technique Instruction,
as well as Summary Tables for injection volumes save valuable clinic time.

Real-Life Application: Over 20 patient cases and guidance on cultural, generational, and gender preferences provide invaluable insight into treating diverse patient populations.

Patient-Centered Approach: Updated comprehensive patient assessment, follow-up care,
and complication management strategies to ensure the best procedure experience for your patients—plus discussion
on achieving a natural pattern of aging and facial harmony.



Section 1: Anatomy
Section 2: Introduction and Foundation Concepts
Facial Aging
Anatomy
Functional Anatomy
Mechanism of Action
Botulinum Toxin Products
Dosing Ratios
Botulinum Toxin Units
Onset and Duration of Action
Standard versus High-Dose Botulinum Toxin
Patient Selection
Glogau Classification of Photoaging
Aesthetic Consultation
Patient Intake
Procedure Terminology
Treatment Plans and Timing
Informed Consent Process
Photodocumentation
Beauty Norms
Treatment Goals
Achieving a Natural Look
Considerations for Specific Populations
Millennials
Asian Considerations
Darker Skin Type Considerations
Gender Considerations
Advantages of Botulinum Toxin Treatments
Disadvantages of Botulinum Toxin Treatments
Indications
Contraindications
Basic, Intermediate, and Advanced Treatment Areas
Basic
Intermediate
Advanced
Equipment for Botulinum Toxin Reconstitution
Equipment for Botulinum Toxin Treatment
Reconstitution Concentrations
Reconstitution Method
Conversion Tables for Injection Volumes
Diffusion
Handling and Storage
Preprocedure Checklist
Procedure
Anesthesia
Botulinum Toxin Treatment Doses
General Injection Techniques
Aftercare
Results and Follow-Up
Learning the Techniques
Complications and Management
Injection-Related Complications
Botulinum Toxin–Related Complications
Treatment of Multiple Muscles
Other Common Applications
Microtox
Depression
Scars
Headache
Current Developments and New Products
DaxibotulinumtoxinA (DBTX)
Combination Therapies
Reimbursement and Financial Considerations
Putting It All Together
Section 3: Section 3: Treatment Areas
1 Frown Lines
Anatomy
Patient Assessment
Contraindications
Eliciting Contraction of Muscles to Be Treated
Treatment Goals
Reconstitution
Starting Doses
Anesthesia
Equipment for Treatment
Procedure Overview
Technique
Results
Duration of Effects and Treatment Intervals
Follow-ups and Management
Complications and Management
Botulinum Toxin Treatment of Other Areas
Combining Aesthetic Treatments and Maximizing Results
Other Considerations
Pricing
Case Studies
2 Horizontal Forehead Lines
Anatomy
Patient Assessment
Contraindications
Eliciting Contraction of Muscles to Be Treated
Eliciting Relaxation of Muscles to Be Treated
Treatment Goals
Reconstitution
Starting Doses
Anesthesia
Equipment for Treatment
Procedure Overview
Technique
Results
Duration of Effects and Treatment Intervals
Follow-ups and Management
Complications and Management
Botulinum Toxin Treatment of Other Areas
Combining Aesthetic Treatments and Maximizing Results
Other Considerations
Pricing
Case Studies
3 Crow’s Feet
Anatomy
Patient Assessment
Contraindications
Eliciting Contraction of Muscles to Be Treated
Treatment Goals
Reconstitution
Starting Doses
Anesthesia
Equipment for Treatment
Procedure Overview
Technique
Results
Duration of Effects and Treatment Intervals
Follow-ups and Management
Complications and Management
Botulinum Toxin Treatment of Other Areas
Combining Aesthetic Treatments and Maximizing Results
Pricing
Case Studies
4 Lower Eyelid Wrinkles
Anatomy
Patient Assessment
Contraindications
Eliciting Contraction of Muscles to Be Treated
Treatment Goal
Reconstitution
Starting Doses
Anesthesia
Equipment for Treatment
Procedure Overview
Technique
Results
Duration of Effects and Treatment Intervals
Follow-ups and Management
Complications and Management
Botulinum Toxin Treatment of Other Areas
Combining Aesthetic Treatments and Maximizing Results
Pricing
Case Studies
5 Eyebrow Lift
Anatomy
Patient Assessment
Contraindications
Eliciting Contraction of the Muscles to Be Treated
Treatment Goal
Reconstitution
Starting Doses
Anesthesia
Equipment for Treatment
Procedure Overview
Technique
Results
Duration of Effects and Treatment Intervals
Follow-ups and Management
Complications and Management
Botulinum Toxin Treatment of Other Areas
Combining Aesthetic Treatments and Maximizing Results
Pricing
Case Studies
6 Bunny Lines
Anatomy
Patient Assessment
Contraindications
Eliciting Contraction of Muscles to Be Treated
Treatment Goal
Reconstitution
Starting Doses
Anesthesia
Equipment for Treatment
Procedure Overview
Technique
Results
Duration of Effects and Treatment Intervals
Follow-ups and Management
Complications and Management
Botulinum Toxin Treatment of Other Areas
Combining Aesthetic Treatments and Maximizing Results
Pricing
Case Studies
7 Lip Lines and Lip Flip
Anatomy
Patient Assessment
Contraindications
Eliciting Contraction of Muscles to Be Treated
Treatment Goal
Reconstitution
Starting Doses
Anesthesia
Equipment for Treatment
Procedure Overview
Technique
Results
Duration of Effects and Treatment Intervals
Follow-ups and Management
Complications and Management
Botulinum Toxin Treatment of Other Areas
Combining Aesthetic Treatments and Maximizing Results
Pricing
Case Studies
8 Gummy Smile
Anatomy
Patient Assessment
Contraindications
Eliciting Contraction of Muscles to Be Treated
Treatment Goals
Reconstitution
Starting Doses
Anesthesia
Equipment for Treatment
Procedure Overview
Technique
Results
Duration of Effects and Treatment Intervals
Follow-ups and Management
Complications and Management
Botulinum Toxin Treatment of Other Areas
Combining Aesthetic Treatments and Maximizing Results
Pricing
Case Studies
9 Marionette Lines
Anatomy
Patient Assessment
Contraindications
Eliciting Contraction of Muscles to Be Treated
Treatment Goal
Reconstitution
Starting Doses
Anesthesia
Equipment for Treatment
Procedure Overview
Technique
Results
Duration of Effects and Treatment Intervals
Follow-ups and Management
Complications and Management
Botulinum Toxin Treatment of Other Areas
Combining Aesthetic Treatments and Maximizing Results
Pricing
Case Studies
10 Chin
Anatomy
Patient Assessment
Contraindications
Eliciting Contraction of Muscles to Be Treated
Treatment Goal
Reconstitution
Starting Doses
Anesthesia
Equipment for Treatment
Procedure Overview
Technique
Results
Duration of Effects and Treatment Intervals
Follow-ups and Management
Complications and Management
Botulinum Toxin Treatments of Other Areas
Combining Aesthetic Treatments and Maximizing Results
Pricing
Case Studies
11 Masseter
Anatomy
Patient Assessment
Contraindications
Eliciting Contraction of Muscles to Be Treated
Treatment Goals
Reconstitution
Starting Doses
Anesthesia
Equipment for Treatment
Procedure Overview
Technique
Results
Duration of Effects and Treatment Intervals
Follow-ups and Management
Complications and Management
Botulinum Toxin Treatment of Other Areas
Combining Aesthetic Treatments and Maximizing Results
Other Considerations
Pricing
Case Studies
12 Anterior Neck Bands
Anatomy
Patient Assessment
Contraindications
Eliciting Contraction of Muscles to Be Treated
Treatment Goals
Reconstitution
Starting Doses
Anesthesia
Equipment for Treatment
Procedure Overview
Technique
Results
Duration of Effects and Treatment Intervals
Follow-ups and Management
Complications and Management
Botulinum Toxin Treatment of Other Areas
Combining Aesthetic Treatments and Maximizing Results
Pricing
Case Studies
13 Nefertiti Lift: Lateral Neck Bands
Anatomy
Patient Assessment
Contraindications
Eliciting Contraction of Muscles to be Treated
Treatment Goals
Reconstitution
Starting Doses
Anesthesia
Equipment for Treatment
Procedure Overview
Technique
Results
Duration of Effects and Treatment Intervals
Follow-ups and Management
Complications and Management
Botulinum Toxin Treatment of Other Areas
Combining Aesthetic Treatments and Maximizing Results
Pricing
Case Studies
14 Axillary Hyperhidrosis
Anatomy
Patient Assessment
Contraindications
Treatment Goal
Reconstitution
Starting Doses
Anesthesia
Equipment for Minor’s Iodine-Starch Test
Equipment for Treatment
Procedure Overview Minor’s Iodine-Starch Test
Minor’s Iodine-Starch Test
Procedure Overview
Technique
Results
Duration of Effects and Treatment Intervals
Follow-ups and Management
Complications and Management
Botulinum Toxin Treatment of Other Areas
Combining Aesthetic Treatments and Maximizing Results
Pricing
15 Necklace Lines
Anatomy
Patient Assessment
Contraindications
Treatment Goals
Reconstitution
Starting Doses
Procedure Overview
Technique
Results
Duration of Effects and Treatment Intervals
Follow-ups and Management
Complications and Management
Botulinum Toxin Treatment of Other Areas
Combining Aesthetic Treatments and Maximizing Results
Pricing
Case Studies
16 Chest Lines
Anatomy
Patient Assessment
Contraindications
Treatment Goals
Reconstitution
Starting Doses
Anesthesia
Equipment for Treatment
Procedure Overview
Technique
Results
Duration of Effects and Treatment Intervals
Follow-ups and Management
Complications and Management
Botulinum Toxin Treatment of Other Areas
Combining Aesthetic Treatments and Maximizing Results
Pricing
17 Nasal Tip Lift
Anatomy
Patient Assessment
Contraindications
Eliciting Contraction of Muscles to Be Treated
Treatment Goals
Reconstitution
Starting Doses
Anesthesia
Equipment for Treatment
Procedure Overview
Technique
Results
Duration of Effects and Treatment Intervals
Follow-ups and Management
Complications and Management
Combining Aesthetic Treatments and Maximizing Results
Pricing
18 Facial Asymmetry
Anatomy
Patient Assessment
Contraindications
Safety Considerations
Treatment Goals
Reconstitution
Starting Doses
Anesthesia and Equipment for Treatment
Procedure Overview and Technique
Hyperdynamic Asymmetry Case
Hypodynamic Asymmetry Case
Duration of Effects and Treatment Intervals, Follow-ups and Management, Complications and Management
Botulinum Toxin Treatment of Other Areas
Combining Aesthetic Treatments and Maximizing Results
Pricing
Case Studies
19 High-Dose Toxin
Patient Assessment
Contraindication
Reconstitution
Starting Doses for High-Dose Treatments
Equipment for Treatment
Procedure Overview
Technique
Results
Duration of Effects and Treatment Intervals
Complications and Management
High-Dose Botulinum Toxin Treatment of Other Areas
Combining Aesthetic Treatments and Maximizing Results
Treatment of Other Conditions
“Ceiling” Effect
Natural Looking Results
Pricing
Section 4: Cases
Cases: Applying the Techniques
Injection Key
Section 5: Appendices
Appendix 1 Botulinum Toxin Treatment Tables
Appendix 2 Aesthetic Intake Form
Appendix 3 Patient Information Handouts
3A. Botulinum Toxin Cosmetic Treatments
3B. Botulinum Toxin Treatment of Underarm Sweating
Appendix 4 Consent Forms
4A. Informed Consent for Botulinum Toxin Treatments of the Face and Neck
4B. Informed Consent for Botulinum Toxin Treatment of Underarm Sweating
Appendix 5 Procedure Notes
5A. Botulinum Toxin Procedure Note for Cosmetic Treatments
5B. Botulinum Toxin Treatment Note for Axillary Hyperhidrosis
Appendix 6 Supply Sources
Botulinum Toxin
Topical Anesthetics
Syringes
Bibliography
Overview
Anatomy and Facial Aging
Botulinum Toxin Mechanism of Action
Reconstitution and Storage
Onset of Effect and Duration of Action
High-Dose Botulinum Toxin
Consultation
Millennials
Asian and Darker Skin Types
Gender-Specific Considerations
Beauty Norms
Contraindications
Consensus Recommendations for Botulinum Toxin Treatments
Upper Face
Frown Lines
Horizontal Forehead Lines
Crow’s Feet
Lower Eyelid Wrinkles
Eyebrow Lift
Mid and Lower Face
Bunny Lines
Lip Lines and Lip Flip
Gummy Smile
Marionette Lines
Chin
Masseter
Neck Bands and Nefertiti Lift
Necklace Lines
Nasal Tip Lift
Chest Lines
Axillary Hyperhidrosis
Asymmetry
Advanced Techniques
Aftercare
Safety
Complications and Management
Antibody Formation
Botulinum Toxin Reversal Agent
Combining Aesthetic Treatments
Microtox
Depression
Scars
Headache
Botulinum Toxin Products Daxxify (daxibotulinumtoxinA)
Dysport (abobotulinumtoxinA)
Jeuveau (prabotulinumtoxinA)
Xeomin (incobotulinumtoxinA)
Product Package Inserts
Comparison of Toxins

Index