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How to Credentialize Your Cosmetic Injector

Why all the fuss about beauty? Why are so many of us in today’s society consumed, if not obsessed with our looks? Why are so many spending thousands of dollars on anti-aging procedures and products to both stop or “turn back the clock” on aging?

The desire for physical beauty is not just a 20th century phenomenon. For proof of that all we have to do is examine 3 quotations from some famous individuals who are considerably older than even me.

“Beauty is a greater recommendation that any letter of introduction”  ARISTOTLE

“The three wishes of every man: to be healthy, to be rich by honest means, and to be beautiful”   PLATO

Asked why people desire physical beauty, ARISTOTLE replied, “No one that is not blind could ask that question.”

As Nancy Etcoff explained in her book “Survival of the Prettiest – The Science of Beauty”, it is really not that hard to understand for the following reasons:

Studies have shown that individuals who feel good about the way they look lead more productive and happier lives and can actually live longer.

Good looking people are more likely to win arguments and persuade others of their opinions. People divulge secrets to them and disclose personal information. Basically, people want to please the good-looking.

Attractive people do tend to be more at ease socially, more confident, and less likely to fear negative opinions; and are apt to be more assertive.

Beautiful people find sexual partners more easily; and are more likely to find leniency in the court and elicit cooperation from strangers.

Beauty conveys modest but real social and economic advantages.

Although most people would say that they no longer believe that “what is beautiful is good”, preferential treatment of beautiful people is extremely easy to demonstrate, as is discrimination against the unattractive.

For these and other reasons it is easy to explain the exponential growth the past decade in the number of cosmetic injectable treatments administered to patients across the globe.

These treatments(Botox and Facial Fillers) tend to be affordable, have minimal side effects, and when administered properly will typically result in the patient’s expectations either being met or exceeded. Although results are temporary, they are nevertheless often dramatic and extremely effective in producing a more youthful appearance as well as in the case of Botox, actually arresting the aging process in terms of wrinkles caused by movement of the muscles of facial expression.

That’s the good news. Now here is the bad. It should be clear what the benefits are to patients receiving these treatments. The benefits to the injector are equally dramatic, but in a different sense. The income generated on an hourly basis can actually exceed that of a heart surgeon doing bypass surgery! This factor, combined with greed, has literally led to an “underground industry” and a highly illegal proliferation of poorly trained, if even trained at all, injectors who are putting patients at risk for complications including permanent disfigurement.

Patients who go to some of these injectors, who are often doing it out of their homes, must assume some of the blame for poor outcomes. In their search for bargain basement prices they are allowing individuals to inject them without checking out their credentials whatsoever. I find it incredulous that anyone would allow someone to inject multiple needles into their face including some within millimeters of their eyes, without verifying the injector’s competency.

What actually is the law concerning who can inject both Botox and Facial Fillers(i.e. Juvederm) in this province? Regardless of their training, it is legal for any physician holding a valid license with the CPSO(College of Physician and Surgeons of Ontario)  to both order the products and administer the treatments. In addition, both nurses and actually non-physician  – non nurses (yes, even you!) can inject, but not order both Botox and Facial Fillers under the following circumstances:

A physician with expertise in these procedures must first see and assess the patient, at which point he can permit someone else (nurse or not) to perform the treatment. He also has to be available in the event of a side effect or complication, as ultimately should things go wrong and there be litigation, he will be named on any statement of claim. This is referred to as a Delegated Medical Act, and a full description is available on the CPSO website as there are other criteria that must be met.

Unfortunately, many individuals, for the sake of the almighty dollar, have turned a blind eye to these laws, which are designed to protect the public; and hence are placing patients at high risk for potentially dangerous complications. I recently saw a patient in my office who had her lips illegally injected by a poorly trained non physician on a dining room table at the injector’s home and the outcome was gruesome; and the patient continues to suffer disfigurement and embarassment. There also obviously exists a “black market” whereby these people are even able to obtain the products as the manufacturers will only sell to physicians.

Mary Garafalo, of the Global Program 16 X 9, recently did a segment on what currently exists in Canada in terms of the use of injectables by unlicensed individuals who are literally “practicing medicine without a license”, and could face criminal charges. Following her expose, she received over 100 calls from patients who had horror stories to tell her concerning their own negative (to say the least) experiences.

This brings us finally to the point of this whole article, namely, how do you, the patient, credentialize the injector whom you are trusting with your face; such that you are one of those whose expectations and goals are totally achieved.

An excellent first approach would be to go to the manufacturer’s website (for example, Allergan Canada, manufacturer of both Botox and Juvederm) and search on their “Find A Physician” page to see who they recommend in your postal code or city. You can rest assured that any physician recommended by Allergan has met their stringent criteria for the privilege of being on their site.

If you have a friend or family member who has been delighted with their treatments on multiple occasions with their cosmetic injector (whether M.D. or nurse), then it is quite reasonable to assume that you will have a positive outcome should they recommend them to you. In our practice, we do no advertising and rely entirely on referrals from existing patients; as there is nothing more powerful than a strong endorsement from a close friend.

For the record, I have nothing against nurse injectors and would go so far as to say that I know at least 6 nurses who I regard as being just as competent as any physician. In fact, my own personal injections are performed by non physician injectors. That being said, should you decide to go with a nurse injector please be advised that you MUST be seen by a physician first, or the procedure is being performed in violation of the guidelines of both the CPSO and the Ontario College of Nurses. In the event of a complication you will have no one to turn to; as neither emergency departments or your family physician may have the training to deal with a situation gone bad. There are occasions, when even in the best of hands, Facial Fillers may have to be dissolved immediately with product known as hyaluronidase in the case of a blockage of a vessel. Only physicians performing cosmetic injections would possess this product as well as the knowledge to use it. Remember – BUYER BEWARE! If it seems too good (or in this case, too cheap) to be true – then it probably is!

If you are seeing a physician for the first time it is not unreasonable to question them in regards to their experience or their training; however whether you get an honest answer or not may be a different story. Someone may have been trained 10 years ago may have less experience than someone with one year of experience if they are only doing a few patients per month. A book of before and after pictures of their own patients certainly adds credibility.

In addition, do not trust any office that gives you a quote over the phone. You must compare apples with apples. You can query as to how much an office charges per unit of Botox (which is the way it is measured) or per syringe of Juvederm; however anyone who tells you how much your treatment will cost over the phone is clearly more interested in your money than your satisfaction. Also, beware of marketing tricks like “Groupons” which offer Botox for $99.00. There is no area of the face that can be done properly for that kind of money. When you are arrive at the office, they will attempt to upsell you more units as well as a variety of other services such as laser treatments, chemical peels and microdermabrasion with huge profit margins.

For those of you who are spa owners and are considering adding injectables to your menu of services, PLEASE DO YOUR HOMEWORK FIRST! Obtain legal advice in regards to your own provincial laws and guidelines such that you are operating both legally and ethically, with your patient’s well being as your primary concern. This will probably mean having either a well trained physician performing the injections and being available at all times in the event of a complication; or a nurse under the guidance and supervision of a physician who assesses all new patients prior to them being injected for the first time. Anything less than this could put you at great risk in the event of a problem, to the extent that your insurance carrier could deny covering a claim such that you could literally lose your business and all the hard work and money that you put into it.

Karyn and I hope that we have provided you with some basic information such that you can make an informed decision concerning whom you allow the privilege of performing cosmetic injectables for you.. Remember, your face is the first thing someone sees when they look at you for the first time, and first impressions can last a lifetime.

Please feel free to e-mail Karyn at info@med-aesthetics.com should  have any questions or if we can be of any further assistance to you.

by Mark Baily and Karyn M. Baily, Brampton, Ontario