Several considerations when choosing Botox providers

This is a great question!  I agree with my colleagues responses - obviously training, experience, and knowledge of the facial anatomy are important. There is one other point that needs to be made. 

There is a growing problem in California (and probably in other States as well) with regards to the "Corporate Practice of Medicine" which is made possible, in large part, by the administration of Botox. Botox was the #1 cosmetic procedure in 2008 - more than the top two cosmetic surgical procedures combined! The Corporate Practice of Medicine, in effect, removes the physician from the care and decision making of patients getting Botox treatments. 

Increasingly, physicians are being disciplined by the Medical Board of California for  "Aiding and Abetting the Unlicensed Practice of Medicine". This means that physicians allow themselves to be "hired" as a "Medical Director" for medi-spa franchises or small nurse or physician assistant-owned spas that administer Botox and they do not actively participate in the care and treatment of these patients.

It has been my experience that the nurses and physician assistants that administer Botox under these circumstances have a tremendous amount of experience, and are probably good botox injectors. However, the physicians that lend out their license to these medi-spas without owning over 51% and actively participating in the care and decision making of these Botox patients could be aiding and abetting the unlicensed practice of medicine.  

While Botox is usually much cheaper at these facilities, I think it is in the greater public interest that patients check to see if their facility is in compliance with state laws. I also recommend that you ask to meet with the physician who operates the facility.

In the state of California, Botox may be administered to a patient by an MD, Physician Assistant (PA), or Registered Nurse (RN).

PA's and RN's must work under the medical direction of a physician in order to inject Botox. RN's may inject Botox only after the patient has first been seen by the physician or physician assistant.

This is an answer as to the regulatory qualification. From the perspective of who is most qualified, you should consider the training and experience of the professional that you choose to administer your Botox.

Because Botox is as much about facial shaping as it is about relaxing wrinkles the provider should be well trained in facial anatomy. A board certified plastic surgeon is highly qualified to teach and train physician extendors (PA's and RN's). The most qualified provider is one who uses their knowledge to safely and individually consider each person's facial shape and animation in deciding on the treatment.

In my practice, I administer Botox as well as my PA's and RN's. Each of the PA's and RN's must complete a formal training with me in the use of Botox as well as dermal fillers. They are taught directly by me and are required to inject under my direct supervision during the training.

Continuing education is also important as we are constantly trying to improve our skills.

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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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