How can I know in advance how good a doctor is with injections?

I'm concerned with quality of Botox and how good a doctor is with fillers. How can I know that they know how and where to inject for the best look. Not just shooting it in.

Doctor Answers 20

Good doctors treat injection treatments like surgery, and also do so with anatomic knowledge and an artist's touch

Thank you for your question. You’re asking a very good and somewhat controversial question. You’d like to know if there’s a way you can know in advance as to how good a doctor is with injectables, and how to know if they really know how to inject the material, where it should be placed,  and that they’re not just shooting it in.
I can certainly give you some guidelines and recommendations in answer to your question, and I can also share with you how I have advised people regarding choosing a doctor for any cosmetic procedure. To give you a little about my background — I’m a Board-certified cosmetic surgeon and a Fellowship-trained oculofacial plastic and reconstructive surgeon, practicing in Manhattan and Long Island for over 20 years. I have been doing injectables for the same amount of time, and was actually one of the first doctors to use Botox® back in 1993.
First and foremost, it is important to understand that physicians who do these treatments have different perspectives and approaches to the treatment. Essentially, when it comes to the ideal outcome, you’ll want someone with a good sense of artistry, someone who is creative, and someone who has a good grasp of proportions. Excellent technical skills are also a must, as are good hands. You also want someone who is committed to precision, detail, and quality in the delivery process, which entails maximizing sterility and comfort of the patient. In addition, I feel it is also important to choose someone you are comfortable with and can give you long-term guidance before, during, and after the procedure.
On the other hand, there are certain red flags you need to be aware of. Some red flags would include advertisements offering very cheap injectables, or getting some type of incentive which commoditizes the treatment. From my perspective, injectable treatments are no different than surgery, because you are essentially breaking through the skin barrier and entering the body with a needle. You want a doctor who is extremely skilled, who will take the time to discuss what your desired outcome is, and won’t be rushing through the consultation or the procedure. At the end of the day, if the doctor is simply rushing through your treatment, your results will likely not be as good as they could be.
One of the best ways of choosing a doctor is by talking with people who have actually been treated by that doctor. Within a certain social group, there is a particular aesthetic that is consistent within that social group. I personally believe in a very natural aesthetic that preserves the unique character of people’s faces, and a youthful appearance that is not exaggerated. This is what resonates for me and what resonates with my patients, and many people come to me because they are attracted to this particular style. Very often, those patients will have friends or family members who also share the same preferences, and so they’ll refer their friends or family. Word-of-mouth is certainly very important to look into.
If you don’t have any contacts that could get you a referral, you may simply want to do consultations and meet with various doctors. When you do go on consultation, get to know the doctor, get to know their style, and listen to how they evaluate your appearance. When patients consult with me, one of the first things I do is take photos of them,  then review them together. I asked them what bothers them most about their appearance, what their concerns are, and what they’d like improved. It is important for me to understand what is important to them, what their expectations are, and what end result they want to achieve.
Beyond listening and providing my patients with solutions, it is also my job to educate them about other options. Most of the time, patients are simply confused about brand names, products, and what they can do. Most people will know what certain products can do, but not how they do it. My role is to also educate them and give them some perspective so they can make better, more informed decisions.
There is also a distinction in methods. For example, when we perform a procedure called structural volumizing, we’re basically adding volume to the deeper structural level of the face – at the level of the bone – which is very different from what 99% of doctors do. It is a unique approach to facial rejuvenation which further expands the idea of collateral procedures, because if someone wants to have improvement in volume, they may also want improvement in skin quality.
Education is certainly a process. The way I see myself for many of my patients is being their beauty doctor. I don’t just perform procedures for them, but rather, I am their primary care doctor for their aesthetic needs for the long run. Nowadays, patients are bombarded with too much information from talk shows and radio commercials, so I feel it is my job is to educate them and show them where the hype ends and where the facts begin.
That said, I think you should meet with different doctors and see what you’re comfortable with, or you may just let the doctor you’ve already met do something and see how your experience goes. Ultimately, I doubt that any doctor that does injectable treatments just “shoots” the material in. It is basically more of a matter of differences in style, technical skill, and aesthetics, and which matches your preference.
I hope that was helpful and I wish you the best of luck!

New York Oculoplastic Surgeon
4.3 out of 5 stars 70 reviews

How to find a good injector

Thank you for your question Cablanda. Botox and fillers are injectable products used to enhance the face. It is important to find one with good experience. Some people say that it is important if a doctor is board certified in dermatology or plastic surgery. The truth is that there is almost zero training on such cosmetic treatments in such residency programs, although some programs provide more cosmetic training than others. Also, just because a doctor is a specialist in certain surgeries does not guarantee that they have significant experience with non-surgical rejuvenation. Further there are many nurses, nurse practitioners, and physician's assistants who have years of experience with injectables and are outstanding at such treatments. It is important to look for experience with this technique, training, before and after pictures, videos, and patient testimonials. Any authority who answers questions on Real Self is qualified as evidenced by their answers to questions. Please consult with a specialist for specific recommendations. Good luck!

Alex Eshaghian, MD, PhD
Encino Physician
5.0 out of 5 stars 3 reviews

Botox And Filler Expert

The most important thing is that you have a properly trained, highly skilled injector. Who is from one of the four cosmetic medicine groups Plastic Surgeon, Dermatologist, Facial Plastic Surgeon or Ocular Plastic Surgeon that are Board Certified. These professionals are all very capable of injecting Botox and fillers. I would ask each of them if they have the Experience and Expertise, can show you Excellent results, and are able to obtain the results you desire in a high majority of cases.     #plasticsurgery#drrodrohrich#fillers

Rod J. Rohrich, MD
Dallas Plastic Surgeon
4.9 out of 5 stars 63 reviews

Before/after photos

the most objective and best way is to look at before/after photos and have them show you a lot of them and you judge if you like the results.  Next, ask them to provide you the name of the last 3 patients that they performed injections on and speak to them in person or over the phone.

Andre Aboolian, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 60 reviews

Botox and Fillers

Botox and fillers are an art and you should look for a board certified dermatologist with experience with these fillers and other cosmetic procedures.  Best, Dr. Green

Michele S. Green, MD
New York Dermatologist
5.0 out of 5 stars 76 reviews

Botox/Filler Injectors

Thanks for your question. It is very important that you thoroughly research your injector before committing to any procedures. It is a good idea to research your injectors educational background, online reviews, before & after pictures, and speak with anyone who you may know who has had treatments with that injector. During your consultation, make sure that you don't feel rushed and make sure that you have adequate time with your injector and not just their patient coordinator or nurses. If the majority of your consultation is spent with someone other than the injector, this is usually not a good sign. The most important aspect is to find an injector you are comfortable with. For the best results please consult a board certified dermatologist with experience with botox and dermal filler injections.

Alim R. Devani, MD, FRCPC
Calgary Dermatologist
4.9 out of 5 stars 14 reviews

Botox - How to Choose Your Physician

Board certified plastic surgeons with years of experience are more than qualified to administer fillers and Botox. In my opinion, check out reviews online from patients that had treatments, look at the physician's website and before and after photos of their work. A consultation may also help you decide, most physicians will charge a consultation fee and deduct the fee from your treatments should you choose to receive Botox that day or within a few months. 

Omar Fouda Neel, MD, FRCSC, FACS
Montreal Plastic Surgeon
5.0 out of 5 stars 22 reviews

An expert physician injector will have many before and after photos showing his/her work, ask to see them.

Expert physicians who have many years of experience injecting fillers will also have many before and after photos of patients who them have treated.  Ask  to see a lot of before and after photos especially of areas that you are concerned about (e.g. lips, laugh lines etc.).  Also check the online reviews and see what other patients are saying.

Mark Taylor, MD
Salt Lake City Dermatologic Surgeon
4.2 out of 5 stars 18 reviews

Expert Injector

Thank you for your question. It's best to check reviews, before and after pictures and websites when looking for an injector. You should also look for Expert Injectors. These are qualified doctors recommended by the American Society for Aesthetic Plastic Surgery to perform injections. Of course have consultations with board certified plastic surgeons or expert injector PA's and discuss your concerns.

Kevin Tehrani, MD, FACS
New York Plastic Surgeon
4.8 out of 5 stars 95 reviews

Botox expertise

Here are some Do's and Don'ts that can help you. 

Avoid shopping for Botox and fillers by price. Cheap Botox / fillers equals poor results. Experienced injectors who know the ins and outs of Botox and fillers have honed their craft. Expertise and finesse make for a great experience and are never available at cheap prices. Those with limited experience offer treatments at prices that reflect that.  The cliche "You get what you pay for" definitely applies here. 

Look for a board-certified cosmetic dermatologist. A cosmetic dermatologist has a special interest in Botox and fillers.  A doctor with a special interest usually makes a commitment of time and money to attend more specialized courses related to Botox and fillers, and learning advanced injection techniques. Botox is not a cheap offering just to bring people in for cosmetic surgery. You may, sometimes, find a "Circle of Excellence" rating for a cosmetic dermatologist on the ASDS (American Society for Dermatologic Surgery) website. That would be a plus but there are great injectors who do not pursue this rating because they're already busy. Today, there are many practitioners, including non-physicians, who have a superficial knowledge of Botox, fillers and facial muscle anatomy.  When you schedule a consultation and meet the doctor you will get a better idea of the level of professionalism of the practice.

Word of mouth referrals from patients who have had a great experience can guide you to the right doctor. Many of my patients tell me that they were referred to me by multiple people who have seen me. 

Once you choose a doctor, start with treatment of one area to assess the results. Hyaluronic fillers can be reduced or reversed, if the results are unsatisfactory. This is a safety feature that is worth having. I would start with hyaluronic fillers only. Ask the doctor if he / she has Hyaluronidase (to dissolve the filler, for unsatisfactory results or potential complications, if needed) on hand. Someone who does not, would not be my choice. 

Do your research and ask questions! Good luck!

Renuka Diwan, MD
Cleveland Dermatologic Surgeon
4.8 out of 5 stars 20 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.