Who is Qualified to Inject Botox?

I'm thinking about getting Botox injections in my forehead but I don't know what qualifications/education pratitioners need to do Botox injections. 

Doctor Answers 101

3 Signs Your Injector Isn't Qualified

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Listen as Dr. Julius Few, spokesperson for the Physicians Coalition for Injectable Safety, describes warning signs to look for when choosing a cosmetic injectable provider.

According to Dr. Few, anyone buying Botox or other cosmetic injections should watch out for providers who:

Won't disclose which substance(s) they are injecting
Won't openly discuss the risks and benefits of the treatment
Try to pressure you into buying treatments you don't want
Dr. Few also stresses the importance of using extra caution when receiving an injection at a location other than a doctor's office.

Chicago Plastic Surgeon

The important thing is first to recognize that Botox...

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The important thing is first to recognize that Botox injection is a medical procedure, so it must be done by a medical professional.

Some believe that it must be done by a medical doctor, or by a nurse under the on-site supervision of an M.D., but the truth is that there are nurse injectors who are extremely talented and experienced.

There are no uniform standards for training, but it is best to make sure that it is done in a clinic setting, where it is clear who the supervising doctor is, such as we do at Calidora Skin Clinics.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 59 reviews

Botox & other cosmetic injections

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There are good arguments on either side of this issue. My feeling, as a physician and surgeon, is that an adequately trained RN, is more than capable of providing safe and effective cosmetic injections (Botox & Fillers). I also feel that RNs should perform such treatments ONLY with a trained physician present on site.

Although an allergic reaction is not a common reaction from Botox, it certainly can happen with fillers, as can other complications such as intravascular injection with tissue necrosis or blindness. Most states are coming up with legislation addressing the issue of cosmetic injections by RNs and PAs.

Although I agree with the fact RNs administer much more dangerous injectables (narcotics, chemotherapy agents, etc.), they are typically not doing so in a strip mall or in the back room of a Spa.

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 231 reviews

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Who can inject Botox?

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The regulations on who can inject Botox vary by state. Recently the FDA was reporting that there were counterfeit versions of Botox being injected by some injectors. In my practice, I do the Botox injections so my patients know it is being administered in a sterile  setting and that the Botox is legitimate and not counterfeit. 

Francis X. Fleming, MD
Kennewick Plastic Surgeon
4.5 out of 5 stars 18 reviews

Botox, not who CAN, it's who SHOULD inject

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States regulate who can and can't inject.  Generally physicians and those under the supervision of a physician (i.e. nurses or certified medical assistants) can inject.  Aestheticians can not purchase the product and can not inject in most states.  However, the medical director of a spa will sometimes purchase the product and authorize the aestheticians to inject.  This is risky for all involved. 

The bigger question is not who CAN inject, but who SHOULD inject.  Any doctor can call up the Botox rep, they can come in and point to the spots to inject and tell them how much to use.  It's not hard and most physicians can do it with a fairly low risk of causing harm.  If you are the type of patient who gets Botox regularly, you know how much you need and where it should go, go anywhere.  However, most people come in having never had Botox or had it a long time ago.  The patient thinks Botox may help but aren't sure exactly what they need.  If Botox and filler is all the doctor does, that's what you get even if it will be of minimal or no benefit.  Below are keys to look for when considering Botox:

  • The office does more than just Botox (i.e. skin care products, chemical peels and/or lasers) and cosmetic surgery, or they often and readily refer to a surgeon.
  • Cosmetic treatment is an active and frequent part of the practice.  They don't just "do it on the side".
  • Good input from one who has a vision for your total appearance is vital

John Bitner, MD
Salt Lake City Facial Plastic Surgeon
4.9 out of 5 stars 92 reviews

Board certification and experience essential for Botox injectors

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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.

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 95 reviews

Who is Qualified to Administer Botox?

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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.

Arnold W. Klein, MD (in memoriam)
Beverly Hills Dermatologic Surgeon

Botox injections in Toronto

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Botox can be injected by a trained physician or a nurse under a physician's supervision. Look for a reputable clinic and avoid 'Botox shops' to avoid potential complications. Sincerely, Martin Jugenburg, MD

Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 518 reviews

Nurses and Botox

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Under the direction of Dr. Zubowicz our highly trained nurses who have had advanced training (and continue in advanced training) provide injectable service to all of our clients.

Anyone with a medical license can inject botox

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The rules vary by state but MDs, DOs can inject botox anywhere in the United States. In some states Nurse practioners are allowed to inject botox. As long as someone is familiar with the anatomy, it should be fine. Remember, botox wears off in 3-4 months so the risks are relatively small. There are small risks however and I have had to treat patients treated by surgeons, nonsurgeons and nonphysicians who have trouble closing their eyes after overaggressive botox. Granted these patients are rare but it is a possibility in untrained hands.  

Chris Thiagarajah, MD
Denver Oculoplastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.