Should You Get Botox From A Nurse, Dermatologist or Plastic Surgeon?

Henry M. Spinelli, MD, PC Plastic & Reconstructive Surgery 875 Fifth Avenue New York, NY Interview with:
Henry M. Spinelli, MD, PC
Plastic & Reconstructive Surgery
875 Fifth Avenue
New York, NY 10065

Medical Research: What are the main findings of the study?

Dr. Spinelli: Briefly, we polled approximately 26,000 plastic surgeons by way of membership in the International Society of Aesthetic Plastic Surgeons (ISAPS), American Society for Aesthetic Plastic Surgery (ASAPS) and American Society of Plastic Surgeons (ASPS) and collated this data and published it in Aesthetic Plastic Surgery (the Blue Journal), the official journal of ISAPS. This preliminary study was initiated given the current and past healthcare and cosmetic medical/surgical care climate both in the United States and worldwide. As a background, when it comes to injectables (botox and fillers) there is not a united consensus on a state by state basis in the USA and from country to country worldwide. Additionally, the regulations and laws governing the administration of botox and injectables is in a constant flux. For instance, the UK allowed beauticians in the past to administer these substances however they are now banned from legal administration of these products. Alabama, only allows physicians (dermatologists and plastic surgeons) to purchase and administer botox and injectables whereas the medical board of California states that physicians can perform the procedure or oversee licensed registered nurses, licensed vocational nurses, or physicians assistants. Similarly, dentists in some states are permitted to administer these agents. It would be a bad idea for any physician working with botox to take Advanced Botox Training to reduce the possibility of medical misdemeanors.

At the present time few studies have directly assessed the capability of various providers to administer cosmetic injections. When people schedule a consultation for plastic surgery, they are often looking for things like a younger face or a nicer body. The answer to the previous question will become more important as the demand for these procedures continues to grow and an increasing number of practitioners and different Plastic Surgeon from a variety of backgrounds enter the field to meet demand. This study aimed to help define the role of various practitioners in an increasingly more competitive environment for injectables and to explore the relationship between patient and injectable provider in order to improve patient satisfaction and outcomes.

When asked to rank patients’ perceptions of various providers according to their expertise in administering Botox and dermal fillers, responders ranked plastic surgeons and dermatologists as most capable (96%) then nurses in plastic surgery and dermatology (3%). Gynecologists (<1%), dentists (<1%) and nurses in other fields (<1%) all received nearly equivalent numbers of “most capable” rankings. When asked to rank patients’ perception of various providers according to their inability to administer Botox and dermal fillers, nurses in other fields were most frequently ranks as least capable (63%) followed by dentists (26%), gynecologists (12%), plastic surgeons and dermatologists (2%) and nurses in plastic surgery and dermatology (1%).
Medical Research: Were any of the findings unexpected?

Dr. Spinelli: Yes, we found these findings unexpected and at the same time consistent with the current economic pressures facing all medical care providers. The responses by plastic surgeons in deeming themselves and dermatologists as being most capable of administering these injectables (botox and fillers) followed by nurses trained by these physicians as incongruous with the concept of other medical specialists (i.e. gynecologists and dentists) as not being as capable of the plastic surgeons, dermatologists and nurses trained by these groups seems incongruous with what one would expect in experienced hands no matter what the background. Yet, plastic surgeons responded to this survey in a rather dichotomous fashion when the same questions were posed concerning vaccine administration.

Medical Research: What should clinicians and patients take away from your report?

Dr. Spinelli: Firstly this study poses more questions than it answers. However, our preliminary results demonstrate there is a need for standardization and regulation as to who, what, and where can administrate botox and injectables. At the present time, the national health services in various countries are exploring these very questions. Clearly, economic, political and patient safety issues have to be reconciled with the latter being paramount. As a first step, recognized board certification and/or rigorous training with hands on experience should be standardized and demanded by the public and the medical community at large.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Spinelli: We would like to see a compilation of data in a controlled group of patients, preferably randomized, to confirm a minimum training background and expertise in order to corroborate and formulate a set of uniform standards.


Are nurse injectors the new norm?
Small K1, Kelly KM, Spinelli HM.
Aesthetic Plast Surg. 2014 Jun 20. [Epub ahead of print]

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