It Was Not a Dr Who Did my Lips with Juvederm, Its a Spa Nurse Was Preforming the Tx?

its normal that a nurse is preforming the inyeccion with juvederm?? i just done with her like on saturday at 11, its tuesday and Im super bruised and kind of swollen on the corners... Im kind of worry because my face in chin look kind of out..

Doctor Answers 11

Nurse Injectors

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Some nurses are abel to perform injections if they have studied a course in injectables. However, this does not mean they a an "authority" on injectables. Some injectors have little experience and have only performed the minimum standard of education in order to cash in on the ever growing market of cosmetic injectables. You should always ask your clinician (nurse or doctor) what kind of qualifications they have in regards to facial aesthetics. Your face is a very vascular region, so bruising and swelling can occur and is common immediately post-treatment however this should settle each day and should only take rough a week to ease completely (sometimes just a day or so).

If you are concerned, make an appointment with a facial aesthetics specialist like a Plastic Surgeon to evaluate the injections in a few weeks after they have settled completly, sooner if you have any continuing pain or discomfort.

Sydney Plastic Surgeon

Juvederm Injection by Nurse or PA

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Nurses, Nurse Practitioners (NPs), Physician Assistants (PAs), and of course, Physicians can be trained in injectables.  Obviously, Plastic Surgeons have one of the most advanced training, and are therefore usually the experts when it comes to appreciating the vast amount of knowledge that goes into injecting therapies.  The advanced training required to be a successful injector is often under appreciated by many – thus leading to just about anyone trying to take advantage of the financial boom in minimally-invasive facial rejuvenation. 

The most important things in deciding the competency in your injector will be their formal training (i.e. Medical doctor vs. medical assistant), area at which they practice (i.e. Plastic Surgery), and their amount of individual training and experience in injectables.  In our practice, both myself and my PA safely inject our patients to achieve their desired aesthetic. I have trained my PA to follow my technique of injection.

Your bruises and swelling are not necessarily indications that your injector was incompetent.  Those are very common side effects that even the most advanced injectors can experience with their patients and should not be criteria used to deem the injector incompetent.  Although not desirable results, they are the most common, and often unavoidable side effects that should be very temporary and resolve within a few days following your procedure.  

Your aesthetic and overall results - that can be evaluated appropriately after the minimal swelling and bruising has subsided - is usually a great way to determine your satisfaction level.  Also, openly communicate with your injector about your expectations and desires – if you are able to safely achieve these results together (even if you do have a little bruising and swelling along the way!) this is a great indication that you and your injector are on the same page!

Stanley Okoro, MD
Atlanta Plastic Surgeon
4.7 out of 5 stars 168 reviews

RN injecting Juvederm

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RNs, when they complete appropriate training, are allowed to inject filler in the state of CA. Every state is different. It is important to go to a trained individual that you trust and has the experience/training to do the best for you.

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Nurse injected Juvederm at spa

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There are some nurses who inject fillers, just as there are other people such as GPs and other physicians who inject fillers. Since we're dealing with your health and beauty, and your face, it is always advisable to ensure that you are treated by a highly trained and experienced physician such as a dermatologist or plastic surgeon. Just as I wouldn't drive over a bridge built by a non-engineer, I wouldn't trust my face to a non-dermatologist/plastic surgeon.

Benjamin Barankin, MD, FRCPC
Toronto Dermatologic Surgeon

Yes, RN's and PA's can inject fillers

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RN's and PA's work under the direction of an MD.  When choosing an injector, ask about their credentials, training, and experience.  It is very common for Plastic Surgeons to have RN's and PA's on staff to do non surgical procedures such as dermal fillers, neurotoxins, lasers, etc.  A board certified plastic surgeon will typically have trained their staff and credentialled them for these procedures.  I have personally trained my staff and required a minimum number of supervised treatments before they ever  treat patients.   Because you have swelling and bruising doesn't mean that the injector was not qualified.  These are temporary effects from the procedure and can last for 1-2 weeks.  Followup with your provider if you are unhappy and still concerned.

Dan Mills, MD
Orange County Plastic Surgeon
4.8 out of 5 stars 35 reviews

Injector background

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Depending on the state and medical board, different levels of providers are licensed to inject filler and neurotoxins. Here in CA, RNs, NPs, PAs, and MDs are able to inject. However, it is important to find a trained injector, regardless of their title. Experience and expertise with injectables is of most importance.

George T. Boris, MD, FRCS - Account Suspended
Los Angeles Facial Plastic Surgeon

Doctors versus nurses injecting facial fillers like Juvaderm, Restalyane and Perlane

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I would caution that it is generally the case in my experience that you get what you pay for with Botox and Facial Fillers.  It will certainly be more costly to have a fellowship-trained or otherwise well-trained MD perform your injections, but you may find that this additional cost is worth it for their experience and expertise.  You only have one face! Filler and Botox injections appear quite easy to administer, but there is most certainly an art to it.  Additionally, complications are rare, but when they do occur, you are much better off in the hands of an extensively-trained physician.

In terms of your results, I tell my patients that it can take up to 2 weeks for the swelling and bruising to resolve after facial fillers such that the final results are apparent.  If you are unhappy with your results after your swelling and bruising have subsided, it is possible to dissolve some of the filler with hyaluronidase.  The good and bad part about these fillers is that they are not permanent.

Dara Liotta, MD
New York Facial Plastic Surgeon
4.9 out of 5 stars 31 reviews

It Was Not a Dr Who Did my Lips with Juvederm, Its a Spa Nurse Was Preforming the Tx?

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 Some states do allow RN's to perform filler injections for lips, cheeks etc. depending on the particular state's medical board.  They are supposed to be under the direct supervision of an MD.  

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Nurser injectors for fillers

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There are certainly qualified and capable nurses who perform filler injections under the supervision of a doctor. As for my office, I have been the one injecting my patients.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Cosmetic procedures and regulations

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Unfortunately there are no strict regulations in many states over who performs cosmetic procedures. In my personal opinion, this is a medical procedure that requires understanding of the nerves arteries and veins and skin layers where the fillers are injected. Only a board certified dermatologist, plastic surgeon, facial plastic surgeon get formal training in the anatomy around the mouth. Many other folks will take a weekend course to do these procedure but do not have a detailed understanding of the complexity of the area. Who you decide to trust your face to is a personal decision. I always tell patients, its never worthwhile putting your face at risk to save a few bucks to have injections done at the Medical Spa. 

Omar Ibrahimi, MD, PhD
Stamford Dermatologic Surgeon
4.9 out of 5 stars 28 reviews

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.