Board certification and experience essential for Botox injectors

In Los Angeles, the cosmetic market is inundated with medical spas performing Botox injection. Experience is key and the best advice is to defer to an experienced and board certified surgeon in your area.

The technique of injection is very important in the overall effect of Botox injection. There are many nurse practitioners and nurses who can inject, but this is dependent on the state you live in.

Always look at credentials of the physician's clinic you are going to for Botox. Ask a lot of questions. Also, ask for board certification from your surgeon.

This is an interesting question and comes at a time when we are seeing doctors from many different specialties providing Botox treatments, and sadly, we are seeing many non-doctors and in some cases, beauty and skin technicians giving Botox!

Botox is an amazing and revolutionary drug and, when used correctly and by properly trained specialists, is wonderful. However, when it is not used by properly trained and educated specialist physicians, it can cause severe adverse events and has even been reported to cause death.

While it may look easy to administer Botox, this is a specialized medical procedure that requires medical education in the anatomy and physiology of the facial muscles, nerves, blood vessels, etc. You must know exactly where to place it and how much to use. You must know that if you place it in the correct location, it will correct wrinkles, but if you are off by a quarter inch, you can cause the eye to close or the eyebrow to droop. If used incorrectly, the patient can look as if they have had a serious stroke and if used in the neck improperly, it can cause the inability to swallow.

It is very important that when you seek Botox treatment, you select a well-qualified, well-trained specialist physician/surgeon. Among the specialists who are considered experts in the administration of Botox (providing they have been trained) are plastic surgeons, dermatologists, head and neck surgeons, occulplastic surgeons, facial plastic surgeons, and cosmetic surgeons.

This is probably not a procedure you should have administered by a pediatrician or OB-GYN or skin care technician.

Too many people are motivated by money. Some doctors are motivated to make it and some patients are motivated to save it.

Hi Nicole,

Botox injections are a medical procedure. You will find that just about anyone with a nursing, dental, or medical degree (and even some without a degree of any sort) is injecting Botox and other facial fillers. There have been unscrupulous providers who have even used "Botox for Experimental Animal Use".

The recent stir about the safety of Botox has nothing to do with the cosmetic use of the anti-wrinkle miracle drug. It is still as safe as ever to have a few of your wrinkles erased by Botox. We have used Botox over the past 30 years without any of these recent adverse effect reports.

The FDA is reviewing botulinium-based drugs used to treat cerebral palsy and other ills. There have been reported cases of breathing and swallowing problems in pediatric cerebral palsy patients, and even a reported death in a CP child who subsequently died of pneumonia. These patients are receiving Botox in doses that are many, many times larger than the small dose that is used for cosmetic treatments. Botox is used in these unfortunate CP patients to relieve muscle spasms in their legs, arms, and necks. Even the physicians who use Botox to help CP patients are saying that the overdoses are likely from injectors who don't know how much to use and are using the wrong dosing of the drug.

This news is a reminder that Botox is a potent drug and that injecting it is a medical procedure that should be performed by a board certified physician in a medical setting - not in a salon, spa, hotel room, or friend's house. There is also other advice on RealSelf regarding this.

Stay safe.
Dr. P

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There are a lot of excellent answers regarding this question.  Obviously there are some differences from state to state as each state regulates which practitioners are allowed to perform the injections.  While title is clearly important from a regulatory standpoint, some of the most skilled injectors in our area are nurses.  In many cases this is because the physician at the practice is performing surgery or some other higher margin procedure and injections are left to the nurse, nurse practitioner or physician assistant. 

One other point about the regulatory environment. Any advanced practitioner in California - a nurse practitioner, physician assistant or physician, can perform the initial exam required for the Botox to be authorized (prescribed). Many consumers and even physicians are not aware that other advanced degree practitioners outside of physicians are able to perform the initial exam.  The exception is that Nurses in California are NOT allowed to provide this initial exam as they do not have the ability to provide a prescription in the absence of an good faith exam. The reason this is important is that there are many spas, medical spas and other types of non-traditional medical offices offering Botox, Restylane, Juvederm, etc. without an initial exam. Any facilities that are practicing like this (with no initial exam) are in violation of California law.

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