Injectable cosmetic medications such as Botox and fillers are a hot commodity for physicians. With the decreasing reimbursements provided by insurance companies, a wide variety of practitioners have entered the injectables market as a way to bring in extra revenue. Laws vary by state, but you may find your dentist, oral surgeon, family practice doctor, Ob-gyn, or medical spa offering Botox and fillers. Many states also allow nurses to do injections if overseen by a physician.
With the wide variety of locations available for treatment, which is really the best option? For the purposes of this discussion, I’m going to divide medical practitioners into two broad groups: those that learn injectables as a natural part of their training, and those that add injectables to their practice later as an additional revenue stream.
Into the first group would fall Plastic Surgeons and Dermatologists; these specialties learn how to inject Botox and fillers as a routine part of their training. Otolaryngologists (ENT) learn injectables to a varying degree as well, and some otolaryngologists actually do extra training in a cosmetic fellowship. Finally, oculoplastic surgeons, who are ophthalmologists that did additional training in cosmetic surgery, are trained in injectables as well.
The second group, practitioners who add injectables to their practice as an additional revenue stream, would include everybody else. From a purely technical perspective, injecting Botox or fillers is not difficult. And doctors and dentists all learn how to perform injections of other medications while training. So what makes cosmetic injectables different? For one thing, performing cosmetic injections requires having a sound understanding of facial anatomy. Understanding how the facial muscles interact and how the soft tissues and bony framework change with age, allows for more effective treatment. So although a dentist or Ob-gyn may be able to safely inject Botox, I would argue that a Plastic Surgeon or Dermatologist would be able to use Botox more effectively.
So what about nurse injectors at either a physician’s office or medical spa? I think it really depends on who is over seeing the nurse injector. Most nurse injectors I have worked with are very well-trained, but ultimately they learn from and use as a resource the physician that oversees them. So if you go to a nurse injector overseen by a Plastic Surgeon or Dermatologist, the nurse injector has that person’s experience to draw upon if there are any questions or concerns. A nurse injector overseen by a Primary Care physician, on the other hand, may not be as good a choice to go to.
Where was the strangest or most surprising place you saw offering Botox or fillers? We’d love to hear about it! (The most surprising place for me was on a cruise- for some reason I just didn’t expect that.)