I know, I know, it is the bad, the evil and the ugly. Aesthetic medicine is one of these fields that is growing steadily up to mainstream while everybody knows about it but nobody has ever done it. Most people will only think about never aging Hollywood straight away. Spoiler alert: it is not true. It is everywhere. And it is not always ugly, neither beautiful.

One of my former colleagues and good friend used Botox injections for treatment of painful and disabling spasms in her Multiple Sclerosis patients, when she discovered, she liked to work hands-on. Unfortunately she already almost finished her specialisation at the time, making it a little too late for a career switch to the operating theatre. When she left our department, she moved on to work in psychiatry. No more Botox. So she thought.

There is evidence for countless uses of botulinum toxin A in medical treatment. Actually the neurologist might have more benefit from it than the aesthetician. Think about dystonia to migraine to detrusor hyperactivity. More recently discovered is its use in the treatment of depression. Yes. Depression.

Several recent double blinded randomized controlled trials found a positive effect of glabellar Botox treatment on depressive symptoms compared to placebo (e.g. Wollmer 2014, Wollmer 2012, Finzi 2014). The results are comparable at an about 50% reduction rate of symptoms according to validated rating scales. This was perfectly suited for her!

She took a 2-day course in aesthetic Botox application which included the glabellar region as well as around the eyes and forehead. The course was given in a specialized dermatologist office in Berlin on 2 separate saturdays. There were lectures first and consequent practice hands-on on each other after. The first day they used saline, the second the real deal. Everyone got one bottle of Botox (300-350EUR) included in the price of the course which comes around 1200EUR.

The course book

She is practicing now. Professionally and private. The good thing is, you can do it too. You do not even need to be a specialist. You do not need an office. If you are a registered M.D. in Germany, you can do a course and start a business on your couch. And if your first volunteering friends show signs of depression you don’t even have to worry about the moral aspects. Maybe start with break-ups or in winter.