Is It Recommended or Safe for Nurses to Administer Botox?

I've noticed that many offices have nurses administer Botox. Is it recommended/safe for nurses to administer Botox or should a physician complete the procedure?

Doctor Answers 8

Nurse Injectors

It is OK for a nurse to inject Juvederm and Botox under the guidance of a physician. Some nurses are better than some doctors and it comes down to experience and attention to detail.
To find out if your injector is qualified, check out how many patients that the nurse/doctor has done, if they inject often or just occasionally and do they seek out continuing education.

Portland Plastic Surgeon
4.7 out of 5 stars 36 reviews

Nurse Administration of Botox - is it safe or recommended?

There's safe and safer.

I'm sure there are many nurses who are quite adept at placement of Botox for the effects you want and some are excellent walking medical encyclopedia that many doctors would envy. The important issue is - in the rare event that some kind of adverse response occurs, will a nurse have the know-how to handle it correctly?

I've always performed all Botox and dermal filler injections in my practice because I know what steps would need to be taken in the event of any unusual event. Personally I think the levels of training, residencies required to complete an MD and ultimately the responsibility of being the one in charge tend to make physicians just a little more aware of signs of possible adverse outcomes.

That said, I'm well aware of many practices who solely use nurses for Botox treatments who have never had an issue. I'm assuming there will always be available physician backup on site who can attend to any surprise response from an injection (Botox or anything else)

A rule of thumb is: "If you aren't comfortable with anyone other than an MD performing your injections, then make sure the person holding the needle is an MD."

It's certainly your right as a patient to choose who you are willing to let perform your treatments.

Nissan Pilest, MD
Irvine Dermatologic Surgeon
4.7 out of 5 stars 19 reviews

Botox, Nurse or Physician Injector?

Hi Gidge,

I must echo Dr. Waldman's comments. I inject all of my patients. Of the thousands of injections I have performed, there was one that required a rapid response that prevented a severe complication. I (and my patient) am most thankful that I was there to treat my patient and avoid any long term problems.

Although it seems that "anyone" can perform injections, for the "one in a million (or thousands in my case)" occasion, I would want a very experienced physician in the room and treating me. Injecting the face is a medical procedure, not to be taken lightly.

Good luck and be well.

Dr. P

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 36 reviews

Provided that certain conditions are met, it is legal in California

Dear Gidge

Nurses in California can perform BOTOX injections. It has to be under the supervision of a physician. In California this mean that the doctor needs to perform a good faith examination prior to treatment. They need to make an order for the treatment, and they need to physically be in the office when the treatment is performed. This means that if you go to your hairdresser and you are offered treatment by a nurse and there is no doctor present, this is not legal. Even if the nurse tells you that she is "supervised" by a physician director, the situation is still bogus.

A better question is given the choice of treatment by a physician or a nurse, who does a better job. Unfortunately in some offices, you may be better off being treated by the nurse. However, these treatments are art forms. The doctor will have a much better understanding of the muscle groups to be treated. I personally would never turn this type of treatment over to a nurse.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

I want a Doctor working on Me!

Considering the money that is typically charged for injectable treatments I personally would want a physician working on me! Most doctors I know will do the treatments themselves. But I do find it fascinating that some that scream the loudest about making sure that you go to a Board Certified Specialist are the same ones that will then turn you over to an RN with two years of education following high school. This nurse is certainly not a Board Certified Specialist! This is simply one of those strange facts that never made sense to me.

S. Randolph Waldman, MD
Lexington Facial Plastic Surgeon
4.9 out of 5 stars 18 reviews

Nurses can be expert injectors

Your question hits a touchy subject for some folks. Since Botox (and Dysport) are only legally dispensed to a physician, nurse injectors must work under the supervision and authority of an MD, who is ultimately responsible. The laws vary by state but most allow nurses to do it if these criteria are met. The reason it is sensitive is that one school of thought holds that only physicians are truly qualified; however, the reality is that in some clinics nurses do far more injecting than the average dermatologist or plastic surgeon. It comes down to individual experience and training, and whether there is a true focus on cosmetic medicine. I would prefer to be injected by a nurse who specializes in it and is well-trained and supervised than by an MD who only does it as a sideline.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 52 reviews

Nurses tend to do better at Botox injections than plastic surgeons as a general rule

Dermatologists tend to be the very best when it comes to injecting things into the skin such as botox and fillers or cortisone injections for scars. Plastic surgeons don't do so well so they tend to have their nurses do the shots for them but some can do a decent job . Experience is very important when you want good results.

David Hansen, MD
Beverly Hills Dermatologic Surgeon
4.7 out of 5 stars 42 reviews

Experience is important for your Botox injector

The real key is the experience of your injector. The laws vary by state. In some states registered nurses, nurse practitioners and physician assistants can inject Botox under the supervision and protocols provided by a licensed physician. A physicians license is necessary to purchase Botox(legally).

I would ask about your injectors experience. How long has he/she been doing it? How many patients are injected on a weekly basis? Who is the supervising physician and are they available if necessary?

You may also ask to speak to some of the injectors patients.

Many nurse injectors have a wealth of experience and get great results with lots of happy patients

John E. Gross, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 2 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.