Cosmetic Injections - Proper Training and Injector Qualifications?

I have read there is a proper injection method for the physician to follow to avoid problems. I do not know what the "Depo" or "Depot" method means? Please can a Physician who uses this technique explain the difference in straight injections into the face and a technique to follow? Is there special training? How does the patient / consumer know the recommended application is the one used on an off-label filler? How do you know if your doctor has the "special" training?

Doctor Answers 5

Choosing an Injector and an Injectible

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The question you pose has two good points: picking an injector and determining which injectible to use.

When picking an injector, remember that most of these injections are performed in the face for everyone to see. While there are many people who are able to perform injections, picking someone with experience and training can be more difficult. Dermatologists are trained in diagnosis and treatment of the skin. As such, they have an understanding of skin anatomy and often have training in injectibles during their residencies. Plastic surgeons; facial plastic surgeons; and ears, nose, and throat doctors are trained in surgery. They have a keen understanding of the anatomy of the face as they operate around it everyday.

Choosing between qualified injectors can be difficult. Simply displaying before and after photographs can be deceiving because obviously only the physician's best results are shown. Just because someone injects 'the most' in a particular area doesn't mean that they inject the most well.

There is always the possibility of a complication, even with the absolute best injector. Picking someone who will be able to handle the complications and who is willing to work with you to get the results that you desire is key.

As for picking the injectible - There are many injectibles that can produce the results that patients desire. Most injectibles are used in 'off-label' manners. For instance, Botox Cosmetic is only indicated for use in the lines between the brows but is used in many other cosmetic applications, such as in the crow's feet area and in the forehead. 'On-label' use indicates that the company has done controlled scientific studies that satisfy the controlling FDA that the product is safe and effective for the indication that is noted. This is the only thing that the company can legally indicate that the product treats.

Off-label uses must be disclosed to patients as being 'off-label'. While off label uses can be very safe, they have not undergone rigorous scientific testing to prove both safety and efficacy for that given purpose.

To determine what the indications for a particular medication are, you can visit the FDA's website in the United States or visit the medication's website. The manufacturer will list the approved indications.

Dallas Facial Plastic Surgeon

Michelle, This is an excellent question. There are a...

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Michelle, This is an excellent question. There are a lot of different folks doing injections out there, and it is very difficult to know who to trust.

Here are a few thoughts on how to pick the right doctor:

  • Dermatologists, Ear, Nose and Throat Doctors, and Plastic Surgeons all perform these procedures, as do Family Practice doctors, Ob/Gyns, and nurses, among others. Beware of physicians or nurses who go to weekend courses to "learn how to inject" but do not have any formal plastic surgery training whatsoever. As a Plastic Surgeon, I think that one advantage we have is that we can also offer surgical options if they are required and not waste your time and money with fillers or Botox if they will not improve your problem. Short of that, some type of formal, cosmetic training is a must.
  • The next question is how long an individual has been injecting. Some folks go to formal courses, others don't, but the real key to getting a straight answer is to see some of their work. This will either be posted on their website or be in Before and After Albums in their office.
  • Finally, there is probably no better recommendation than one from a close friend who has been cared for by that doctor. If they had a positive experience and were happy with their results, chances are you will be as well.

Dr. S

Shahram Salemy, MD, FACS
Seattle Plastic Surgeon
4.9 out of 5 stars 155 reviews

Best doctor for Botox or Juvederm

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1)  I wrote an article for RealSelf about how to pick a cosmetic surgeon (you can read it in my profile) which will answer some of your questions.

2)  Start by seeing only a board certified plastic surgeon or dermatologist.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

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Who is injecting your BOTOX

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It is not always easy to know how much training your injector has. However, there are certain persons such as Dermatologists and Plastic Surgeons that have extensive knowledge of beauty and anatomy to be able to consistently inject BOTOX safely and effectively. Dermatologists & Plastic surgeons are also continuously undergoing continuing medical education (CME) to make sure they are at the cutting edge of treatment of the aging face.

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How to pick a Botox practitioner?

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We find that for our patients the best way to choose a Botox practitioner is by word of mouth. Although many consumers do value their privacy, most will let you know if they have "heard of" a quality Botox practitioner.

If you do not have a recommendation from a friend, ask the injectors you visit what they have done to develop their injection skills and to keep them current with best practices. Look for feedback online about the practitioner, ask for before and after pictures and pick several practices to visit. Those practitioners that are willing to take the time to meet with you, thoroughly and clearly discuss your options and educate you about how the procedures work will be your best choices.

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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.