Richard O. Gregory, M.D.
Director
Institute of Aesthetic Surgery
The most common procedures in cosmetic surgery now are injectables including Botox to erase the fine muscle lines and fillers to plump up scars and creases. With the public acceptance of these two procedures has come a proliferation of salons and treatment facilities to "pile on the band wagon." Although there is a natural tendency for this considering the enthusiasm by the public, there is also a natural tendency for this to be done by people who are not qualified to do it leading to bad results.
The physician's coalition for injectable safety (www.injectablesafety.org) has studied this problem and offered guidelines to consumers who were seeking the injectable treatments. The question remains: "Who is able to do this?"
Who is able to do injectables is defined by law which generally specifies a broad degree of training. Most states did not enumerate specifically the training or experience necessary for doing injectables. Thus, all physicians are generally able to do this including such diverse specialties as pathologists, anesthesiologists, dentists and generally anyone who is legally able to authorize prescriptions. In addition physician extenders (non-MDs, DOs, etc.) may in specific states legally be allowed to do this.
In addition to "who can legally do it?", an equally important consideration is who has the skill and experience to do the injectables effectively and safely. While injectables generally tend to be a very safe, mistakes and problems are very apparent and troubling. Many times people will take a course from a traveling “guru” perhaps lasting just a few hours, receive a certificate, and consider themselves an expert. I know of no other situation which could be further from the truth. Unfortunately, the plastic surgeons frequently see the problematic patient after the fact. In the case of Botox misadventure it simply may be a matter of letting it wear off which it will do. In the case of fillers however, it can be a long-term curse requiring many operations. I have seen instances which left the patients facing months of antibiotic therapy, multiple operations, and severe, permanent disfigurement. All of this could have been prevented with a little common sense on the part of the patient and a few judicious questions asked before the procedure.
What questions to ask then becomes the next issue. Some of the questions which you might want to ask are as follows: What is your training? What is your experience? Have you treated patients like myself? How many? What complications can be experienced and what is the remedy? What is the cost of the procedure and remedy of any complications? How frequent are complications? What is the pre-treatment and post-treatment regimen including medications? What anesthesia is available or needed? The Physician's Coalition for Injectable Safety has found that 45.3% of complications resulted from unqualified providers doing the injections, and 35.2% resulted from injections which were administered in a non-medical setting.
Any procedure, no matter how safe, can have complications. You should have confidence in your therapist including the ability to handle any complications. You should also feel as though your therapist is interested and ready to help you. Both you and your potential therapist should be ready to terminate your dialogue if you have any concerns or feeling of discomfort about the situation.
Even as experienced as we are at the Institute of Aesthetic Surgery, there is an occasional patient whose result could be improved. The time to achieve optimal resolution of any problems is usually 3 to 4 weeks after the initial treatment. Often times the cause of any concern is insufficient treatment. Simply adding a bit more Botox or filler may be a solution. In this instance the patient should expect to pay for any additional treatment.
At the Institute of Aesthetic Surgery we offer a comprehensive approach to facial rejuvenation. Not only do we do fillers and Botox but frequently combine these with laser procedures including the new fractional lasers, as well as surgery when indicated. In my seminar series, "Mega-Trends in Self Enhancement" I discuss the comprehensive assessment and treatment of the patient's needs. Interestingly enough, statistically across the country less surgery is being done and more noninvasive treatments such as Botox and fillers are taking its place. A recent article in fact, stated that in the current economic situation people were substituting minimally invasive treatments for more surgical oriented approach. In any case, we can assess the patient's needs, outline a comprehensive treatment plan and initiate the treatment needed to give the patient optimal results and enhance the self image. Furthermore, we take great pain to document and record the treatments in order to refine and duplicate the results successfully when the patient returns for further treatment.
As a result of this comprehensive approach we have been recognized for our expertise. I am a member of Allergan (Botox) National Educational Foundation, an elite group of Botox experts chosen to train other therapists and provide feedback and advice to the company. We consistently have been at the top of all users regionally in both Botox and fillers.
In summary, the use of Botox and injectable filler materials can be effective in treating appropriate aspects of aging. The consumers should not be afraid to undertake these treatments but should be alerted to the fact that not all treatments are as safe and effective as they can be. Caveat emptor, or let the buyer beware should always be the watch word of the informed and wary consumer.