SkinWrinklesAgingbotox

ON a busy section of East 59th Street in Manhattan, a half block from Bloomingdale's, two plastic surgeons are preparing to open a new kind of cosmetic medical entity: a Botox-only storefront office. No appointment necessary.

Dr. Andrew I. Elkwood, left, and Dr. Michael I. Rose of Smoothmed.

Smoothmed, scheduled to open next month, will offer only one procedure: Botox injections to smooth wrinkles around the forehead, eyes, lips or neck. Its owners said the idea is convenience, competitive pricing and standardized care.

"Botox-on-the-go is the way we like to think of it," said Dr. Andrew I. Elkwood, an owner of Smoothmed. He and his business partner, Dr. Michael I. Rose, are plastic and reconstructive surgeons who practice in Manhattan and in Shrewsbury, N.J.

Botox Cosmetic, a diluted form of botulinum toxin, is used to temporarily paralyze the muscles underlying wrinkles. Dr. Rose said that making injections easily available would expand the market.

"It will appeal to people who took a few hours to shop at Bloomingdale's, to secretaries on their lunch hours, to people who live and work in the neighborhood, and we will be getting visitors who think on a whim, ‘I wouldn't normally do this at home, but we're in New York, so let's try it,' " Dr. Rose said.

A patient's first visit to Smoothmed should take about 30 minutes or less, and follow-up appointments will take 15 minutes or less, he said. "People just need to be educated that it's fast, it's cheap and it's not intimidating."

In an age-conscious society that has already accustomed itself to Botox parties, Botox house calls, Botox in spas and Botox at malls, the idea of a Botox specialty retailer akin to Starbucks seems inevitable. With more than 4.5 million treatments performed in the United States last year, Botox is the most popular nonsurgical cosmetic medical procedure in the country, according to plastic surgery associations. But that number amounts only to about one million patients who regularly seek wrinkle injections.

To expand the demographic, pharmaceutical companies like Allergan Inc., which makes Botox, are stepping up their marketing and advertising. And, independently, physicians are devising strategies for expanding their client bases. Dr. Rose predicted that the Smoothmed model would be successful because Botox lasts about four months, engendering repeat business.

"Botox is the female yuppie heroin," Dr. Rose said. "It's like electricity: If you want to keep it on, you have to keep paying."

But the idea of a drop-in injection center raises the question of whether, in the course of mainstreaming, Botox is destined to become the new manicure, an impulse purchase readily available at local storefronts.

Some doctors who specialize in administering such injections contended that convenience and pricing are inappropriate criteria for choosing a cosmetic medical provider.

"This may be trivializing the procedure the way the teeth-whitening center on the corner trivializes dentistry, taking it out of the context of overall teeth health and maintenance," said Dr. Fredric S. Brandt, a dermatologist who practices in Manhattan and Coral Gables, Fla.

Dr. Elkwood disagreed, saying that medical care will not be compromised just because Smoothmed brands itself as a Botox convenience center.

"We are approaching it as a serious medical procedure, but that doesn't mean we have to flaunt the serious nature of it," Dr. Elkwood said.

Dr. Elkwood and Dr. Rose specialize in microsurgery, including the reattachment of limbs and breast reconstruction after cancer. Half their practice is devoted to cosmetic surgery, with Botox injections an adjunct treatment, Dr. Rose said.

Dr. Elkwood said they wanted to create a new, simpler model of Botox delivery that would set itself apart from some "medi spas," where nurses may administer injections. At Smoothmed, physicians who are general practitioners will give Botox.

"Botox should not be done in a spa where you don't always know exactly who is injecting you and where it is presented in the same context as a hot stone massage or a facial scrub," Dr. Elkwood said. "Nor should it be done in someone's house where the doctor can't control the cleanliness or the lighting."

Smoothmed is a 1,100-square-foot medical office with golden walls, large plate-glass windows and three treatment rooms. Dr. Elkwood said first-time patients will have a consultation with a doctor who takes their medical history, examines their faces and explains the benefits and risks of Botox. Patients will also have their faces photographed and, if appropriate, receive a pregnancy test, he said.

Doctors will use a syringe gun to control the amount of each injection, Dr. Elkwood said. He added that he and Dr. Rose have developed their own computerized system; it will impose a grid over a patient's photograph and record the exact locations and amounts of the Botox injections so that it is easy for a doctor at Smoothmed to replicate the treatment on a patient's subsequent visits.