Welcome to Dermatologic Surgery and Cosmetic Procedures in Primary Care Practice!
It is with great pleasure—and a healthy dose of excitement— that I compose this preface. This book was designed to fill a gap, providing a specialist perspective on procedures for a nonspecialist audience. With the democratization of knowledge and the push to promote best practices, my hope is that this book fits squarely within such a framework, as it is (to my knowledge) the first time a book of this kind was created from the perspective of a surgical dermatologist for the benefit of a nonspecialist audience of primary care practitioners.
This book benefits from including the broadest range of techniques for the clinician, including chapters on ethics, photodynamic therapy, body contouring, sclerotherapy, neck rejuvenation, and hand rejuvenation—all approaches that have never before been explored in a text for this audience—not to mention the most detailed chapters on excisions and linear repairs, flaps, anatomy, and suturing techniques ever presented to a nonspecialist audience.
Where to start? Each chapter begins with an infographic page designed to summarize key takeaway points and outline important areas for the clinician, including both beginner tips and expert tips—as well as billing tips and words of warning. I have chosen to include a fairly comprehensive head and neck anatomy chapter at the beginning of this book; while some readers may be tempted to elide over it, its focus on three-dimensional anatomy and tissue planes should be of particular interest to both those who perform repairs on the head and neck as well as those using soft-tissue fillers, where a detailed understanding of anatomy is of critical value. At the very least, it should serve as a useful reference point.
The key chapters in this book for the clinician looking to incorporate straightforward procedures into daily primary care practice are those on biopsy approaches (Chapter 11), suturing techniques (Chapter 10), and excisions and linear repairs (Chapter 16). While clinicians often think that they need to incorporate cosmetic procedures to survive and thrive financially, this is often not the case, and the nonfinancial rewards of performing medically necessary procedures with skill and finesse on grateful patients cannot be overstated.
Many of the chapters in this book are closely based on similar sections in my (much longer!) textbook for the specialist, Dermatologic Surgery. Indeed, the impetus for this book was in part the warm reception of that text and the numerous requests to create a similar textbook sized, priced, and geared for a less specialized audience.
I would be remiss in not thanking not only the authors of the original chapters in the full-length textbook (some of whose work has largely been re-created here verbatim), but also the section editors from the first edition of Dermatologic Surgery—John G. Albertini, Jeremy S. Bordeaux, Leonard M. Dzubow, Naomi Lawrence, and Stanley J. Miller. That original team includes some of the luminaries of the field who are not only experts in their respective areas but also helped forge many of the techniques described in this book.
For cosmetic procedures, I have largely eschewed cookbook approaches based on device type, particularly for devices where in-class heterogeneity means that the required training performed by the manufacturer (with their associated charts, protocols, and tables) is likely more useful to the practicing clinician than any chapter could hope to be. Instead, the book focuses on approaching problems as a cosmetic patient comes to the office, with concerns regarding dyspigmentation, wrinkling, hand appearance, and the like. Even with the chapters on botulinum toxin and fillers, the goal is to move beyond the plain vanilla techniques taught by trainers and on to an appreciation of the finesse needed to elegantly meet and exceed patients' expectations through a three-dimensional understanding of volumizing.
On a global level, the primary care clinician should always pause before any procedure—and cosmetic procedures in particular—to decide whether they are comfortable and expert enough to perform the procedure in a competent and expeditious way. Patient care is the ultimate arbiter of appropriateness, and there is no substitute for training, mentorship, and experience. Performing a straightforward procedure that goes according to plan can be done by anyone; preparation for the exceptional circumstance when things deviate from the expected is when training and experience truly kick in. It is important to have a mentor (or ideally a team of mentors) and a backup plan in the event that a procedure does not go as planned. Dermatologists and plastic surgeons have the luxury of years of graded and supervised training, and while some primary care clinicians have similar experience, this is not always the case. Unfortunately, bad things can happen to good patients—and clinicians. An untoward outcome at the hands of someone specialized in these techniques may be perceived by the patient as an unavoidable risk of the procedure, while for a clinician with less training or experience, the default may be to assume the worst and that a true medical error occurred. Therefore, seeking out as much training and experience as possible before embarking on procedures is always the best approach for clinician and patient alike.
Finally—and importantly—a special and heartfelt thank you goes out to the brilliant Karen Edmonson of McGraw Hill, who has consistently gone above and beyond on our books; she is a model editor, scholar, and friend, and without her, this book would not be a reality.
Jonathan Kantor, MD, MSCE, MA