who is doing your injections? should they be? what is bill AB252?
The Medi Spa. Who doesn’t want to have medical procedures done in a spa? The soothing lights, smell of lavender, and cucumber ice water. Sounds much better than a doctor’s office. Oooh, and it is in the mall? Maybe I can go get a pair of shoes afterwards.
The issue is no one should inject who is not trained. That means the injection should be done by a doctor (plastic surgeon, dermatologist, or facial plastic surgeon), or a “nurse under the direct supervision of a doctor.” I do all the injections myself: botox, fillers like restalyne and juvederm, sculptra. I don’t use nurses. Be careful! Many offices do have nurses, but many of those nurses surely are not under “direct supervision” by the doctor.
We seem to forget injecting medications and substances into the body isn’t something to be done lightly. It is not as one article said “changing your hair color.” There are things which can happen: if botox is injected poorly, you can get eyelid droop. I have seen photos at our national meetings of people who lost skin on their face from a bad injection of soft tissue filler. Devestating to see or fix.
I am a surgeon. I know anatomy. I do eyelifts and facelifts and browlifts, so yes, I am better at injecting. I can visualize in my mind where I am, what is important nearby, and what is safe. I recently went to a CME (continuing medical education) workshop where we dissected cadaver heads (yes yes, I know it isn’t how you would like to spend an afternoon). It was fantastic. But I was amazed at the number of physicians with busy injectable practices who were not surgeons, and didn’t know their anatomy like we plastic surgeons do. They do not know exactly where they are when they stick the needle through the skin. I was surprised.
The bill AB252 is to stop the medispas from running amok. These are medical procedures with real risks. When done well, those risks are low. But we shouldn’t forget we are doctors. I like the California Medical Board’s Synopsis:
‘Medical Spas . The increasing popularity of cosmetic
procedures or treatments, and the lucrative business they
offer have given rise to a new model of providing cosmetic
services outside the traditional physician settings and
into malls and local spas. Medical spas or popularly known
as “medspas” are increasingly becoming the destination for
various cosmetic procedures or treatments.
has posted on its web site a fact sheet. The fact sheet
indicates that “medical spas are marketing vehicles for
medical procedures. If they are offering medical
procedures, they must be owned by physicians. The use of
‘medical spa’ is for advertising purposes to make the
procedures seem more appealing. In reality, however, it is
the practice of medicine. There is no harm in seeking
pampering or in wanting to look better. A visit to a spa
may provide a needed respite for our stressful lives, and
treatments that make us look better often make us feel
better. The Medical Board, however, is concerned when
medicine is being marketed like a pedicure, and consumers
are lead to believe that being injected, lasered, and
resurfaced requires no more thought than changing hair
color. According to the MBC’s fact sheet, cosmetologists,
while licensed professionals and highly qualified in
superficial treatments such as facials and
microdermabrasion, may never inject the skin, use lasers,
or perform medical-level dermabrasion or skin peels. Those
types of treatments must be performed by qualified medical
personnel. In California, that means a physician, or a
registered nurse or physician’s assistant under the
supervision of a physician. Patients must know the
qualifications of persons to whom they are entrusting their
health. Those seeking cosmetic procedures or treatments
should know that the person performing them is medically
qualified and experienced.
SO. Who is doing your injections? Clearly my bias is a plastic surgeon doctor. Board certified by the American Board of Plastic Surgery. Next would be other doctors trained specifically to do injections, dermatologists and facial plastic surgeons. Then it falls apart a little for me. I know of nurses who are excellent at what they do…but how are they trained? do they know the anatomy? and more importantly do they get complications? how do they treat them? The true test of someone is not what they do when all goes well. It is what they do when it doesn’t.
