Experienced Botox Injector - Even if Not a Dermatologist or Plastic Surgeon?

Question

Do you think an MD (previously Family Practitioner) who had devoted their practice solely to medical aesthetics, and who administers Botox regularly, would be a good choice for this product? I see that a PS or Dermatologist is usually recommended, but do you think experience of injecting counts for a lot--or is a PS a safer choice?

Scott C. Sattler, MD, FACS · Answer

The answer to my question is obvious- $$

	Go and meet the family practice doc- strike up a conversation. Ask the doctor why he or she did not bother to do a residency and become board certified in dermatology or plastic surgery since he/she is obviously interested in facial anatomy, neurotoxin treatment, facial aesthetics and skin care.

Brent Moelleken, MD · Answer

Botox injections involve injecting a substance that relaxes muscular activity.

	There was just a question on this forum about a patient who had a paralyzed hemi-cheek due to administration of Botox into the upper cheek area.

	For routine injection into the crow's feet and glabella, most injectors can do this without harming patients.  More complex cases require greater expertise.  When larger and more aggressive doses of Botox are required, say in a patient who is not quite ready for surgery yet but wants to do the most possible with their injections.  Or the patient with underlying differences from one brow to another.  Or a patient with differences in the set of the eyes.  Of differences in their cheeks.

	To think you can just inject more Botox into the crow's feet and fix all the wrinkles in the eye cheek junction without a consequence is naive.  A surgeon accustomed to operating on the cheek area knows the anatomy and the limitations, and what the consequences of deactivating certain muscles can be.  They can warn the patient and avoid untoward results.  A plastic surgeon can tell the patient when it is time to contemplate surgery, when Botox and fillers have done their maximum.

	An injector should be familiar with the anatomy underlying the wrinkles, not just the effect of placing Botox in a certain area.  They should have the patience to study the patient's face and note its unique features such as muscular weakness or asymmetries.  And they should also have an artistic eye, to know what to do with those asymmetries.

	So the injector should have a knowledge of the anatomy, patience to observe the patient and study their features, and artistic ability to factor all these together.

Eric M. Joseph, MD · Answer

In most instances I would recommend insisting on a board-certified specialist for non-surgical facial enhancement. When it comes to Botox, however, if a physician is doing a lot of it and getting nice results, then it's probably acceptable to use him as a provider. I'd recommend seeing many Botox photos before proceeding.

Jacque P. LeBeau, MD · Answer

There are many instances of family practice and emergency room physicians who have decided to shift their practice into aesthetics without the requisite training to do so.  It does not take very long to actually learn to reconstitute the product appropriately and inject Botox.  On the other hand, to intimately understand the facial anatomy and the precise functions of the mimetic musculature and learn how to treat them appropriately to obtain a safe and natural result takes significant time and training.  Is it really worth the risk of having a suboptimal result with a non core provider?

	Best Regards,

	Jacque P. LeBeau, MD

Martie Gidon, MD, FRCPC, FAAD · Answer

Why would you not want a cosmetic procedure done by an experienced dermatologist or plastic surgeon who has spent years of training to deliver the best possible aesthetic results?

Chad L. Prather, MD · Answer

Even though non-aesthetically trained physicians are offering Botox, fillers, and laser treatments, it is always in a patient's best interest to see a physician who has been properly trained in the area in which they are practicing.  

	After all, who do you really want to trust your face to? Core aesthetically trained physicians (dermatologists and plastic surgeons) spend 4-6 years perfecting their techniques in residency and fellowship. Family practitioners, ER docs, neurologists, urologists, general surgeons, etc.... these physicians decide to take a weekend course and then proclaim themselves as "aesthetic physicians" to make a quick buck.

	Would you hire an electrician to fix the plumbing in your house?  Even one that claims to do a lot of plumbing? Why trust your face to anyone but the experts?

Tomi L. Wall, MD · Answer

Hello,  like Dr. Lupo, I am also a board certified dermatologist, so I do have my bias.  Having said that, I also completed an internal medicine residency before I went back and did a 3 year dermatology residency and I can tell you that you don't receive the appropriate training to be a qualified cosmetic surgeon/botox injector. 

	There are many nuances to aesthetic treatment of the face that I believe plastic surgeons and dermatologists know best.  I have had to "correct" many problems that patients have had by going to someone less qualified.  The analogy that I use is that I am "qualified" to deliver your child because of my medical training, but I don't think you would want me to do that!

Khaled El-Hoshy, MD · Answer

A dermatologist/plastic surgeon/ophthalmologist would be a 1st choice. However, if an MD with extensive knowledge of anatomy of the face & causes of skin aging/wrinkles is avilable. He or she would be a good option, provided he had reasonable experience with botox & you have seen 1st hand some of his results.

Mary P. Lupo, MD · Answer

There may be a rare exception to the rule that a core-trained physician with the background of years of training in dermatology, plastic surgery, facial plastic or oculoplastic surgery is the best choice for an aesthetic procedure. But why risk it? The "core" training refers to the years of background learning during residency and fellowship training. A family practice doctor spent 3 years learning to take care of sore throats and high blood pressure and the like: hardly a background to give you the results you deserve. But then, I am prejudiced as a board certified dermatologist, proud of my residency training and certification, so the choice is ultimately yours to make. Good luck.

Brent Spencer, MD · Answer

Family practitioners have absolutely no formal training in their residencies for cosmetic procedures. Would you take your child to the OB/Gyn instead of the pediatrician? I doubt it. Leave cosmetic procedures (i.e. Botox and fillers) to physicians who receive formal training (dermatologists, plastic surgeons, facial plastic surgeons). While the family practitioner may be cheaper, do you really want to risk it?

Experienced Botox Injector - Even if Not a Dermatologist or Plastic Surgeon?

Answers (11)

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