Who's Injecting You at your Local MedSpa?

In the past 6 months, I have been contacted numerous times by nurses,  aestheticians, and non-plastic surgeon physicians for cosmetic injector training. Some of these folks I have known or interacted with in the past through our local hospitals and other medical facilities, but most of them I have no idea who they are. This represents a disturbing trend that has developed over the past few years, with the burgeoning medspa concept (and decreasing insurance reimbursements), which has been largely made possible by the number of injectable cosmetic treatments which have become available in the past five years. Since treatments such as Botox, injectable fillers, lipodissolve and laser hair and anti-aging skin treatments are fairly ‘easy’ to do (compared to real surgery), many medical and allied health personnel as well as day spas and hair salons want to jump on the bandwagon. They see these treaments s cash up front, fun and interesting to do, and part of the expanding public’s desire for beauty and anti-aging treatments.

While there are some concerning and adverse statements that could be made as a plastic surgeon about this trend, our commentaries are usually viewed as self-serving, territorial, and economically repressive. Personally, I don’t care what others do, inside or outside of medicine. I have enough to worry about in my plastic surgery and spa practice and I prefer to focus on honing my own skills and providing the best possible cosmetic care that I can. The cosmetic marketplace is not like traditional medicine…it is really let the buyer beware. There are few regulatory agencies or guidelines for a burgeoning field that is not behest to federal and private insurance rules of reimbursement. In this market, only the attorneys and the threat of malpractice and liability issues (and perhaps one’s good conscience ??) keep it from spinning completely out of control.

What I find most troubling, however, is the complete disregard or lack of concern about patient safety…..all in the pursuit of the almighty dollar. Here in Indianapolis, I know of aestheticians who regularly perform Botox in their own home, cosmetologists doing injectable fillers in hair salons, nurse assistants doing lipodissolve injections, Internists performing threadlifts and ENT surgeons doing breast augmentations in their own surgery centers. Providers performing procedures for which they have little training and and no formal background, not to mention being well outside what their licenses and certificates would permit, treating patients as study subjects. (when you are training on someone without supervision by a qualified provider in an educational setting….you are a study subject!) And I wouldn’t call visiting someone for a few hours in their office or watching a DVD by a manufacturer bona fide training either! The providers aside, I am not sure exactly what some patients are thinking…..is it the allure of a more convenient or cheaper service…..or is it the appeal of a well-crafted advertisement or website?

Equally disturbing….and the genesis of this rant is……that physician (and yes some dentists too) and other allied health and beauty care providers will contact me in the hope of providing them with some training. The very fact that this is done is highly reflective of some deeper problematic issues……..and not just that they obviously don’t respect my time and plastic surgery experience. (I got my training the old-fashioned way… what would be my motivation to give that knowledge away for free for their benefit?) Such requests for quick and easy on-site training indicate that they have no appreciation for the subtle nuances and complexities of aesthetic medicine. Just because you can take a needle and inject something doesn’t mean you know whether this is the appropriate treatment for the patient’s problem and whether an injection or other more sophisticated form of treatment might not be better. The simplicity of a treatment doesn’t always equate with overall effectiveness. Fortunately, most of these aesthetic treatments don’t carry high risks of medical complications but they do carry significant risks of poor ‘value’. The concept of value is a very valuable one in aesthetic medicine which is often unappreciated, although it will ultimately be perceived by the patient. What do you get…for what you are paying for? For example, the use of injectable fillers, may not be so inexpensive if poor results are obtained…and the patient later learns that they would have been better off with a facelift from the beginning. Several thousands dollars of lipodissolve treatments for a 10% improvement in a body area is very disappointing when twice that amount of money for liposuction would have produced a much better result a lot faster.

The point is…..aesthetic treatments, like traditional medical therapies, require a diagnosis, treatment planning, and a review of treatment options. That is not something you can learn in a few hours of observation, reading a manual, or watching a DVD.