In the state of California, Botox may be administered to a patient by an MD, Physician Assistant (PA), or Registered Nurse (RN). PA’s and RN’s must work under the medical direction of a physician in order to inject Botox.
RN’s may inject Botox only after the patient has first been seen by the physician or physician assistant. This is an answer as to the regulatory qualification. From the perspective of who is most qualified, you should consider the training and experience of the professional that you choose to administer your Botox.
Because Botox is as much about facial shaping as it is about relaxing wrinkles the provider should be well trained in facial anatomy. A board certified plastic surgeon is highly qualified to teach and train physician extendors (PA’s and RN’s).
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The most qualified provider is one who uses their knowledge to safely and individually consider each person’s facial shape and animation in deciding on the treatment. In my practice, I administer Botox as well as my PA’s and RN’s.
Each of the PA’s and RN’s must complete a formal training with me in the use of Botox as well as dermal fillers. They are taught directly by me and are required to inject under my direct supervision during the training.
Continuing education is also important as we are constantly trying to improve our skills. (Dan Mills, MD, Orange County Plastic Surgeon)
Several considerations when choosing Botox providers
Obviously training, experience, and knowledge of the facial anatomy are important. There is one other point that needs to be made. There is a growing problem in California (and probably in other States as well) with regards to the “Corporate Practice of Medicine” which is made possible, in large part, by the administration of Botox.
Botox was the #1 cosmetic procedure in 2016 – more than the top two cosmetic surgical procedures combined! The Corporate Practice of Medicine, in effect, removes the physician from the care and decision making of patients getting Botox treatments.
Increasingly, physicians are being disciplined by the Medical Board of California for “Aiding and Abetting the Unlicensed Practice of Medicine”.
This means that physicians allow themselves to be “hired” as a “Medical Director” for medi-spa franchises or small nurse or physician assistant-owned spas that administer Botox and they do not actively participate in the care and treatment of these patients.
It has been my experience that the nurses and physician assistants that administer Botox under these circumstances have a tremendous amount of experience, and are probably good botox injectors. However, the physicians that lend out their license to these medi-spas without owning over 51% and actively participating in the care and decision making of these Botox patients could be aiding and abetting the unlicensed practice of medicine.
While Botox is usually much cheaper at these facilities, I think it is in the greater public interest that patients check to see if their facility is in compliance with state laws. I also recommend that you ask to meet with the physician who operates the facility. (Daniel Reichner, MD, Newport Beach Plastic Surgeon)
Who can inject Botox
In most states qualified medical professionals who can inject Botox include MD’s, Physician Assistants, Nurse Practitioners and Registered Nurses. Always make sure whoever is doing your injections has one of these credentials. When looking for a provider, I recommend asking questions about the injectors credentials, their training, and how often they inject Botox.
There are many people qualified to inject Botox who do it infrequently. And other providers who treat 5-10 patients a day, 5 days a week. If any place makes you feel wrong for asking questions, it is a sign that it’s not a good place to go for injections. (H. George Brennan, MD, FACS, Newport Beach Facial Plastic Surgeon)
Botox Injectors
Your best option to get the full result possible with Botox and avoid potential complications is to have your treatment performed by a well trained and experience physician with extensive experience with Botox. The first husband and wife team who discovered the cosmetic utility of Botox were a dermatologist and oculoplastic surgeon.
In general, your best best are dermatologists, oculoplastic surgeons, plastic surgeons, but make sure that the doctor has extensive experience in your procedure and my patients prefer that the doctor be the one performing the treatment. (Andrew Kaufman, MD, Los Angeles Dermatologic Surgeon)
Who is allowed to inject Botox
There are a lot of excellent answers regarding this question. Obviously there are some differences from state to state as each state regulates which practitioners are allowed to perform the injections. While title is clearly important from a regulatory standpoint, some of the most skilled injectors in our area are nurses.
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In many cases this is because the physician at the practice is performing surgery or some other higher margin procedure and injections are left to the nurse, nurse practitioner or physician assistant. One other point about the regulatory environment.
Any advanced practitioner in California – a nurse practitioner, physician assistant or physician, can perform the initial exam required for the Botox to be authorized (prescribed). Many consumers and even physicians are not aware that other advanced degree practitioners outside of physicians are able to perform the initial exam.
The exception is that Nurses in California are NOT allowed to provide this initial exam as they do not have the ability to provide a prescription in the absence of an good faith exam. The reason this is important is that there are many spas, medical spas and other types of non-traditional medical offices offering Botox, Restylane, Juvederm, etc. without an initial exam. Any facilities that are practicing like this (with no initial exam) are in violation of California law. (Harold J. Kaplan, MD, Los Angeles Facial Plastic Surgeon)
Who Can Inject Botox For Crows Feet
Who is qualified to inject BOTOX?
Who is qualified to inject and who can inject are both excellent questions. The answer for who can inject BOTOX is determined by the laws in each particular state. Foe example, in the State of California, a registered nurse or physician assistant, under a physician’s supervision can legally inject BOTOX.
So long as they are a licensed practitioner working under a licensed MD it is allowed. The issue of supervision is a gray zone. In my opinion, a spa owned and operated by an RN or PA that sells BOTOX but never sees the supervising physician is not adequately supervised.
The issue of who is qualified to inject is a subjective one. For me and my family, I would want someone who has experience injecting and knows how to and is able to manage any forseeable complications.
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In my biased opinion that would be an MD-preferrably one with formal training in dermatology, ophthalmology, ENT or plastic surgery. (Barry Stuart Handler, MD, San Diego Plastic Surgeon)
Who can administer Botox
Botox is a purified protein used to address wrinkles associated with facial expression. Laws on who can administer Botox vary from state to state. In California physicians, nurse practitioners, physician’s assistants, and nurses are allowed to administer Botox.
It is important to find a good provider. Look for experience, before and after photographs, and testimonials. (Alex Eshaghian, MD, PhD, Encino Physician)
Who is qualified to inject botox and fillers?
In general, nurses, nurse practitioners, physician assistants, and physicians typically inject botox and fillers. Every state has regulatory requirements which vary — it is generally agreed that it is best to have injections performed by those injectors who are under physician supervision (assuming the overseeing physician is properly trained). (Jeffrey D. Pollard, MD, San Jose Facial Plastic Surgeon)
Is your Botox injector qualified?
This is normal concern that patients have in their minds before undergoing Botox. Remember that Botox injection is a treatment requiring a patient to undergo a medical procedure. In this light, it should only be done by a medical professional.
It can be done by a medical practitioner like a doctor or it can also be done by a licensed nurse who is under the expert supervision of an on-site doctor. That said, there really are no uniform standards in terms of training for this procedure.
However, it is always best to ensure that this medical procedure is done in a clinical setting rather than anywhere else since the in a clinic setting there will always be a supervising doctor around.
Moreover, you would also want your medical practitioner to fairly disclose the substances that they will be injecting and discuss the possible risks as well as benefits of the procedure. If your Botox injector veers away from these, you should steer clear from them. (Robert W. Sheffield, MD, Santa Barbara Plastic Surgeon)