Is It Ok for a Medical Technician to Inject Botox or Juvederm?

Question

There is no MD at the 'medical spa' I have used. The technician I go to has 10+ years in the industry and most with Botox or Juvederm. What kind of risk is associated with technician vs MD?

Steven J. Pearlman, MD, FACS · Answer

In a number of states, Botox can be injected by non-physicians. These may include RN's etc. Some are very experienced and some are not. This is a medical procedure with a very safe but strong medication. Do you want to take chances with your face to save a few dollars? I would inquire on the experience of the injector and supervision, if this is in doubt I suggest you seek a qualified physician with experience in Botox treatments. The core specialties include Plastic Surgery, Facial Plastic Surgery, Oculoplastic Surgery and Dermatologic Surgery.

Jerome Edelstein, MD · Answer

Botox and Juvederm are medical products that can only be administered by a licensed doctor or nurse, whatever their speciality may be. However, it's always best to find an injector who is experienced and has knowledge of the skin.

Ron Shelton, MD · Answer

Every state has different rules as to who legally can perform injections. Aside from this authority once given by the state, the individual, whether physician or nurse or physician's assistant (P.A.), should have a thorough understanding of the anatomy of the areas they are treating. Botox is very safe but side effects can happen and they can last for up to a few months. Asymmetry (unequal results from side to side), drooping of the upper eyelid, or even lip, can occur with incorrect placement, volume or dose. These can be very troubling, even though temporary, to the patient. In general, physicians have the best understanding of the anatomy and may be better suited to perform those slightly different injection techniques or use different areas for insertion depending on each individual's nuances.

Scott Trimas, MD · Answer

Different states regulate who can inject fillers like Juvederm and Restylane as well as neuromodulators like Botox. Fortunately, these products are extremely safe so even inexperienced injectors or non-physicians can inject them safely the vast majority of the time. There are some non-physicians who are even better than physicians. The bottom line is who is supervising these services should a problem arise and the reputation of the professional injecting you. Generally, usually a nurse or physician injects these products so I am not sure what the regulations are in your state.

Kenneth D. Steinsapir, MD · Answer

Dear Leistad
If you really want to get to the bottom of this, I suggest you contact the Georgia Composite Medical Board. Generally, most States do not recognize this type of medispa as legal.  In California for example a nurse can perform these injections but only by a good faith examination by a physician who is on the premises. This means that all those medispas with nurses but no doctors are illegal operations. 
What can go wrong? Nurses are not intimately familar with the anatomy of the face.  An injection placed incorrectly could lead to blindness or skin necrosis.  Your "medical technician" is going to have even less knowledge of anatomy. Can you really trust someone who is breaking the law by operating such a practice. If they are will to "bend" the rules is this fashion to make a buck, what else are they are they doing. 
Many of these facilities are not properly licensed medical offices so there is no oversight of how they handle the disposal of the used needles. These are hazardous medical wastes. In a medical office used sharps are carefully packaged into tamper proof containers and removed by certified medical waste haulers so these dangerous materials do not end up in a dumpster in an alley or on a beach some where. This type of waste handling is very expensive but it protects the public.
Not surprisingly, many medispas fly under the radar including the improper handling of these medical wastes. This is just a single example of how these illegal business cut corners.

Cameron Rokhsar, MD, FAAD · Answer

First of all, you are asking a very biased group of people here, physicians...! However, I think you'll likely hear the same answers across the board. While experience is highly important, and certainly ten years is a lot of experience to have under your belt, there is no substitute for knowledge of product on a molecular level, as well as anatomical knowledge about the nerves, vasculature, and muscles of the face. If someone has not been trained in this, they may unknowingly cause permanent nerve damage, drooping facial features, or large bruises. Technicians are a wonderful addition to any practice, but it is my opinion that there is no substitute for a Dr., especially when dealing with something as important as a face.

Martie Gidon, MD, FRCPC, FAAD · Answer

Botox and fillers should be injected by board certified dermatologists or plastic surgeons who have years of experience with these products, buy it legally from reputable companies and know exactly what products they are receiving, and can deal with any side effects should the need arise.

Kris M. Reddy, MD, FACS · Answer

The medical tech may be experienced in the industry but it would unwise on your part to risk your health and looks to someone who is not properly trained or credentialled. Also, in many states including Florida, it would be illegal for a medical tecnician to perform the treatment.

Nissan Pilest, MD · Answer

I would not recommend to have Botox or a Filler injected by a Medical Technician. It is not worth the risk if anything would happen due to lack of experience or training.

Michael D. Yates, MD · Answer

Botox and fillers are true medical procedures and should be performed by an experienced physician with detailed knowledge of facial anatomy and after a careful review of your goals and health. This will give you the best likelihood of a safe and satisfactory result. Additionally, plastic surgeons will be able to advise you of all options, surgical and nonsurgical to help you look your best, and to get the best value for your money.

	All states have their own regulations with regard to who can inject Botox and fillers. The Georgia Composite Board of Medical Examiners appears to provide approval for trained nurses to perform injections under the supervision of a physician. My guess is that it is probably not legal for an unsupervised technician to perform injections.

Is It Ok for a Medical Technician to Inject Botox or Juvederm?

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