This may be an unpopular opinion, but I feel that all injectors should have a solid medical background. When I say this I mean that anyone who is not a registered nurse, physician's assistant, nurse practitioner, or a doctor has no business injecting you. In some states, who can practice medical procedures including injecting neurotoxins or dermal fillers is regulated and there are laws in place on who qualifies get trained based on medical licensing. However, many states (including Colorado) do not have these regulations. A non-medically trained individual can also become an injector. After an 8 hour introductory course to Botox and fillers, an individual can start injecting. Now, I don't know about you, but I don't want someone trained on a service solely in 8 hours to give me a tattoo, wax my legs, cut/color my hair, or much less inject substances into my face. Let's get to the reasons this is so important.
Understanding the anatomy of the face and neck is crucial when injecting neurotoxins and fillers. The skin covers a vast network of blood vessels (arteries and veins), nerves, glands, ducts, muscles, bones, and layers of tissue. The art of injecting is done blind, and by that I mean that we rely on our knowledge of these structures because we don't have X-ray vision. It is so important to have a deep understanding of the anatomy to obtain accurate placement, follow safe techniques, and to fully comprehend the consequences that can occur from injecting.
Neurotoxins are injected into muscles to restrict movement for various purposes. Accurate placement is key to prevent paralyzing the wrong muscle group. For example, if an injector was aiming for a DAO muscle (depressor anguli oris -- the pesky muscle that pulls the corners of your mouth downward and creates marionette lines) but accidentally went a little too deep and hit the DLI muscle (depressor labii inferioris) this could result in a crooked smile.
It is also important that an injector explain the importance of aftercare instructions to a patient for this same reason. If an injector places Botox in the glabella (the muscle group responsible for 11s or your angry face) and the patient immediately leaves and gets a facial massage, the risk of the Botox migrating to another muscle (ESPECIALLY THE EYELID!) is high. Actually, most of the time if there is a neurotoxin complication it is because aftercare instructions were not followed properly. The frightening thing is that this is such a preventable issue but I have personally been to 3 separate injectors who gave me no aftercare instructions (verbally or written).
Having a neurotoxin complication is usually solely cosmetic but it will last until the toxin wears off which could be up to 4-6 months. This can be upsetting and affect self-esteem negatively. As injectors it is our job to educate and be accurate and safe. If we aren't able to do this, we shouldn't be injecting.
Where things get really concerning is when it comes to dermal fillers. If filler is accidentally injected near to or in to a blood vessel, major issues can occur. Compression or blockage of a blood vessel, especially an artery, can be devastating. When blood flow to tissues and organs is blocked, cells do no get the oxygen they need and start
to die. This leads to tissue necrosis (or the death of layers of skin and underlying structures). If not dealt with quickly, tissue necrosis can lead to infection, scarring, pain, and disfigurement. If that isn't bad enough, if filler blocks an artery that leads to the eye blindness can occur and can be irreversible. The highest risk areas to get dermal filler injections are in the forehead, between or around the eyebrows, or on the nose. At HD Aesthetic Wellness, we do not inject filler into any of these areas. The risk is too high and the results aren't worth it.
Hyaluronic acid fillers can be dissolved with hyaluronidase although it is painful and time-consuming to do so. At some point in time, all injectors will likely have a vascular occlusion event occur. The key here is that the injector recognizes what is going on, why it occurred, and what to do to fix it. There are protocols in emergency situations that your injector should be well aware of and ready to act quickly on. Your injector should have emergency protocols in place and know the correct resources. The saying "time is brain" is often heard when someone has a stroke. Same thing here, "time is tissue." Swift interventions are key. Unfortunately, if a filler like Sculptra or Radiesse was the cause of a blockage, there is no reversal agent like hyaluronidase which makes it even more important your injector is an expert.
Now before I get anyone upset, I have certainly met "aesthetic injectors" who are very good at their jobs and have done a lot of work and training to be safe injectors. But at the end of the day, when there are a lack of rules and regulations in place that say that someone must put in time/effort and prove that they are safe injectors with a good track record, issues are bound to arise. Aesthetic injectors without medical-specific degrees can be paid at a lower rate and are hence very attractive candidates to larger MedSpas as they will profit more off of these injectors.
At the very least, you should make sure that your injector has a medical degree and license that comes from a line of education proving that they are competent and trained in anatomy. Key phrases to look for when finding a medically trained aesthetic provider are "aesthetic nurse" or "nurse injector." Credentials should be listed on social media platforms, websites, booking platforms, etc... If they aren't then you should ask! You wouldn't let a non-medically credentialed individual perform a medical procedure on you, right? This is absolutely no different.
Murray, G., Convery, C., Walker, L., & Davies, E. (2021, May 1). Guideline for the management of hyaluronic acid filler-induced vascular occlusion. JCAD The Journal of Clinical and Aesthetic Dermatology. Retrieved April 18, 2023, from https://jcadonline.com/cmac-guideline-hyaluronic-vascular-occlusion/
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