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Because of the exponential developments in the clinical use of botulinum toxins (BoNTs), the need for a third edition quickly became a foregone conclusion. Maintaining the original mission of an instructional manual, this completely revamped and updated third edition attempts to record the phenomenal progress that has evolved in the use of BoNTs in clinical medicine over the past seven years. Updates of the literature, expanded indications, improved clinical photographs and illustrations, and newer and innovative ways to utilize the different BoNTs that are presently available worldwide are presented in this newly formatted third edition. It also has become strikingly obvious that BoNTs are injected in a variety of novel ways that differ from East to West. Therefore, a concerted effort has been made to include a profile of as many of the different BoNTs currently available around the world, including how they are utilized in a clinical aesthetic setting in both Western and Eastern cultures. In the United States, glabellar and lateral canthal lines remain the only areas of the face that are approved by the FDA for the cosmetic use of onabotulinumtoxinA (OnaBTX-A) or BOTOX Cosmetic. The other BoNTs available in the United States, abobotulinumtoxinA (AboBTX-A), incobotulinumtoxinA (IncoBTX-A), and rimabotulinumtoxinB (RimaBTX-B), have their own similar, but very specific, FDA indications. Consequently, except for glabellar and lateral canthal wrinkles, all the cosmetic injection techniques described in this third edition, as in the previous editions, apply to non-approved, off-label indications, which makes this book unlike most other textbooks in medicine. It is sobering to realize that throughout human existence women and men have always sought ways to improve their appearance. To commence the in-depth and diverse discussions in this third edition on beautification and rejuvenation with BoNTs, Nina Jablonski, PhD, professor of anthropology at The Pennsylvania State University, and a world-renowned biological anthropologist and paleobiologist, provides us in her Prologue with a brief introduction to the evolutionary and anthropological perspectives on the importance of human facial attractiveness and expressivity. She cautions both patients and treating physicians in the over-use of face altering procedures that can effectively inhibit one’s ability to express oneself accurately and in a completely natural manner. Chapter 1 is written by Jean Carruthers, MD, to whom the world is indebted for her prescient identification of the cosmetic uses of the BoNTs. Dr. Jean Carruthers commences our venture through the fascinating evolving world of the BoNTs by presenting a historical account of the chronological events that led to the discovery, identification, isolation, and eventual synthesis of BoNTs for clinical use. Included is her seminal work in the development and advancement of the clinical uses of BoNT-A in ocular therapeutics, and her serendipitous discovery of its cosmetic properties. Jean describes the role she and her dermatologist husband, Dr. Alastair Carruthers, played in their provocatively sensitive introduction and promotion of the cosmetic uses of BoNT-A to the medical community.
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