My daughter the Doctor

Botox, Juvederm, Dysport, Restylane, Radiesse, and others- there are many products that are pretty easy to inject in an office setting to help reduce wrinkles, make deep folds look better, and improve your overall appearance, all without a trip to the operating room. With all of the products available, you may wonder- who should you trust to inject all of this stuff?

It depends on what state in the US, and what country you may live in, but many injectables are given by nurses and doctors. Even among doctors, there are many different specialties. However, it is my opinion that you should get an injection from someone you trust, who can also deal with the complications arising from these injectables.

In the US, there are the core 4 specialties that have educational, formal training during the post-medical school years. These specialties are Plastic Surgery, Facial Plastic Surgery, Dermatology, and Oculoplastic Surgery. Even if these specialists choose not to do aesthetic surgery, they still undergo training as part of their overall medical education to perform cosmetic procedures. Also, CME/ continuing medical education requirements are still in place, meaning that continued training, seminars, conferences, and lectures are required to maintain board certification in these 4 specialties.

In the US, if you’re a doctor of a different specialty, you won’t get this training in your post- medical school training. You will be forced to take a weekend course, a week long course, or some other alternative education, to learn about cosmetic injectables.

Nurses are allowed to perform cosmetic injectables under the supervision of a doctor. This supervision varies widely, and can mean anything from the doctor being physically present, to the doctor being nearby, to the doctor being available by phone, to whatever the nurse and doctor agree upon. This would explain why some nurses seem to be able to perform injectables with no doctor visible or present during the procedure.

I have written several blog posts about reducing pain during Botox injection, reversing Botox and Juvederm, and there are other tips and tweaks that aid in cosmetic injectables. These are not necessarily trade secrets, but rather, being educated by experts and reading original articles from peer-reviewed, internationally recognized journals. It’s my opinion that many casual injectors outside of the “core 4” specialties are unaware of these methods and ways to avoid complications, reduce risk, and increase patient satisfaction and comfort.

There are subtle procedures within the realm of Botox and Juvederm, such as injecting into the eyebrow areas to achieve an arch, reducing neck muscle strength, getting just the right spot to reduce migraine headache pain, and other more rare and difficult procedures that I believe require more expertise and knowledge to deliver correctly and efficiently.

There’s always the issue of price. Yes, I am probably going to charge more than a nurse for the same cosmetic injectable, because I’m a board-certified Plastic Surgeon. I’m sure my colleagues do the same. You’re not necessarily paying just for the supplies and the cost of the cosmetic injectable- you’re paying for expertise and for the knowledge of how to fix things if they’re not quite perfect. I think that working with a doctor who is well-versed in cosmetic injectables may be more rewarding for you, as the person who has to live with the results.

And of course, there’s the old saying- You Get What You Pay For.

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Should you desire more information about my available services, or want to schedule an appointment, please contact my Patient Care Coordinator at, or call our office at 415-362-1846.

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