I use bulking all the time in our elderly population here in Naples, FL (approx 4-8 patients per week). The results are astounding, and overall patient satisfaction is extraordinary when picking the right patients. The patients get to avoid anesthesia and surgery, and in-office procedures like this produce great results, surgeon efficency, maybe better reimbursement if you can negotiate your contracts this way, and allows patients to drive themselves to and from the office. Its a win-win all the way!