Botox and Dysport and all the injectables can only be sold legally in the US only to physicians; these products must be legally approved and labeled by the FDA. Depending on state law, which varies, generally only physicians, nurse practitioners, and nurses may inject these substances. Doctors’ offices are probably the safest place to have such injectables administered; staff are trained in sterile procedures so as to avoid contamination, re-use of needles, and infections. Plus, in the rare case of an allergic reaction, staff and physicians are trained in resuscitative measures and have emergency drugs available. Not too many spas, peoples’ homes, or hotel rooms have the same standards for cleanliness and emergency care that a doctor’s office does!
And the products obtained must come from the US where the FDA maintains safety levels not so strictly adhered to in other countries Importation of cosmetic injectables can be a felony, subject to one year in prison and $100,000 in fines. Recently 5 physicians, a nurse and a practice manager in New York pled guilty to such charges. Therefore patients need to be cautious when injectables are offered at bargain prices, because they may have been obtained through web sites or offshore; they may be counterfeit and there’s no one to assure purity or content! Serious injury or personal harm may result when unknown substances are injected.
Individuals who decide to have their injections in spas may be putting themselves at risk. Even if the spa is overseen by a physician, is he on-site to supervise the injection? In most states the practice of medicine is defined by the diagnosis and treatment of a problem. Is an aesthetician or nurse deciding on their own what injectable is appropriate for you and how much you should get? Or is the physician first seeing you, discussing the options and then deciding, based on your medical history and his exam, what should be done—the preferable route—and is that doctor relaying on alternatives to that injectable? And what kind of physician is doing the injecting or the supervision? Is the physician one who routinely treats such conditions, for example, as would a facial plastic surgeon, plastic surgeon, or dermatologist, whose touch might be more delicate, aesthetic, and precise?
Botox parties at someone’s home are fraught with problems! Some of these parties involve the drinking of alcohol on the premises. Can you truly decide with a clear head if this is what you want to do? Also, before being injected, have you been offered an informed consent form to read and fill out? Did anyone talk with you about risks and possible complications? Did someone go over your medical history to see if you might be allergic to the material to be used? Did someone ask if you are nursing? On immune-suppressant drugs? Have taken aspirin, non-steroidal inflammatory, or herbal drugs recently, that could cause bruising or bleeding? Did someone take any pictures to document what you looked like before so that later the efficacy of the treatment could be assessed?
The DIY or Do It Yourself injections recently seen on the internet are quite simply one of the most bizarre, unsafe and unwise acts I have ever witnessed. Will heart surgery be next? Number one, you want someone with experience to do your injection; someone who’s done it hundreds of times, someone who knows the underlying anatomy and who knows how to avoid problems. Since you can’t yet get a medical degree or residency training over the internet, and you probably don’t have the time for 4 years of medical school and 4 to 6 of additional residency training, you might want to visit your facial plastic surgeon instead. Even with a doctor with an experienced hand there can be problems, albeit small. Bruising, bleeding, asymmetry, migration to unwanted areas are all possible. Who is going to pick you up off the floor when you pass out? Plus, ever try to do something in a mirror, where left to right are transposed? It’s difficult.
What is exciting now are all the FDA approved injectables that we now have (such as Botox, Dysport, Restylane, Sculptra, Perlane, Juvederm, Radiesse, etc.), giving facial plastic surgeons, and patients many choices to individualize the right treatment for them. It’s just wise to have the right physician examining and guiding you to the optimal result!
-Russell W. H. Kridel, MD, FACS
For more information, Dr. Kridel is featured in this article talking on the same topic of DIY injectables and risks on