Do Injectors Matter When It Comes to Botox® Results?

Although it was once the subject of controversy, Botox® has been verified as safe for long-term use by multiple studies. Nonetheless, patients need to remember that nearly all cosmetic treatments have the potential to go wrong if they’re not administered correctly. Choosing a poorly trained Botox® injector can have consequences that range from underwhelming results to dangerous side-effects. In the guide below, we’ll cover everything you need to know in order to have a safe, successful Botox® experience.

What is Botox®?

To fully understand why Botox® must be injected with care, you’ll need to know how Botox® works. Botox® is made of purified proteins isolated from botulinum bacteria, which was a frequent cause of food poisoning prior to the implementation of modern food safety standards. Researchers discovered that compounds within this bacteria could be used to temporarily disrupt nerve signals, halting muscle movement in treated areas without causing illness. (Botox® is therefore classed as a neuromodulator, along with several similar compounds). They also developed important medical uses for Botox®; we now know that it can cure migraine headaches and sweating disorders for several months, for example.

Cosmetically, Botox® can treat and possibly even prevent dynamic wrinkles. As we grow older, our skin becomes weaker as a result of collagen depletion, and this causes wrinkles to form in areas of high stress. (The forehead and area around the eyes, for instance, are creased and pulled every time we squint or make a facial expression. This is why crow’s feet and forehead lines are usually the earliest visible signs of aging.) Botox® smooths these crease lines by eliminating the stress that causes them: By relaxing small groups of muscles in specific areas, Botox® stops them from stretching and compressing the skin.

When Botox® is administered correctly, it doesn’t interfere with the patient’s ability to make facial expressions. Skilled plastic surgeons like Dr. Silverton make sure to avoid targeting the major muscle groups that allow patients to smile, frown, etc. Furthermore, properly utilized Botox® doesn’t cause adverse reactions in the vast majority of patients, making it a low-risk treatment. Still, the toxic potential of Botox® means that this compound should only be handled by those with the appropriate training.

The Problem with Botox®: High Availability, Few Regulations

In the United States, Botox® laws vary considerably from one state to the next. In some states, like Georgia, only plastic surgeons, licensed physicians, physician assistants, and registered nurses can administer Botox® injections. In other states, such as Oregon, would-be injectors need only attend a day-long seminar before they start providing Botox®. Beyond this, they are not legally required to have any medical training or certification.

These lax regulations have combined with plummeting neuromodulator prices to allow a number of unscrupulous individuals to profit off the demand for Botox®—at the patient’s expense. Today, Botox® has become so commonplace that it’s administered at tattoo parlors, dentists’ offices, and spas. There have even been reports of Botox® being given away at fundraising events and parties.

Unfortunately, because injecting Botox® properly is far more complex than administering a routine vaccination, even doctors and nurses frequently struggle to use this compound correctly. When patients take the risk of trusting completely unqualified providers, the side-effects can be painful, disfiguring, and potentially even dangerous.

The Top 4 Risks of Having Botox® Administered by an Unqualified Injector


1. Muscle Damage

The small doses of Botox® that plastic surgeons use to temporarily relax your muscles won’t harm them. Botox® that is applied in moderation wears off on its own within three or four months, allowing treated muscles to resume their prior functionality. By contrast, injecting very large amounts of Botox® into muscle tissue (a mistake frequently made by unqualified injectors) can cause widespread “freezing.” This paralysis leads to muscle atrophy, and over time, affected muscle tissue can waste away. This can cause dents to appear in the patient’s face, or make his or her features lopsided. Sometimes, it results in a permanently droopy eyelid that obstructs the patient’s vision. These problems cannot be fixed without reconstructive surgery.

2. Bruising, Pain, and Other Uncomfortable Sensations

Patients who have had Botox® administered by unqualified injectors have reported long-lasting bruising, particularly around their eyes. Others have experienced soreness, tingling sensations, or “heavy” feelings (injecting too much Botox® into the muscles across the forehead can lead to this unsettling symptom).

3. A Temporarily Altered Appearance

To create subtle, attractive results when using Botox®, an injector must have excellent knowledge of facial anatomy. He (or she) must know exactly which muscles to relax in order to smooth wrinkles without compromising the patient’s ability to make facial expressions. This is why it’s wise to have a board-certified plastic surgeon administer your Botox® injections: Facial plastic surgeons must study the muscles, skin, and connective tissues of the face in great depth before they begin practicing. In the United States, becoming a board-certified plastic surgeon requires at least ten years of education and training.

When Botox® is administered too liberally, the patient usually ends up with the dreaded “frozen” look that’s associated with this treatment. Their face may also become lopsided, with one side appearing normal, and the other droopy and immobile. These unwanted changes will (mostly) disappear after three or four months, but in the meantime, they can cause patients a great deal of misery.

4. The Possibility of Being Injected with Counterfeit Botox®

As far back as 2013, the FDA started issuing warnings about the presence of counterfeit Botox® on the black market. Sold in packaging that is identical to Allergan’s, vials of counterfeit Botox® may contain neuromodulators manufactured in foreign countries (where regulations are more lax) or even compounds intended for use on animals. Some of these counterfeit products have landed patients in hospital with severe breathing difficulties. In one notable case in Florida, a doctor who injected himself and two other people with counterfeit Botox® required months of hospitalization.

How to Identify a Trained, Experienced Botox® Injector

As the case highlighted above demonstrates, even doctors and nurses are not always reliable injectors of Botox®. To safely enjoy beautiful results, you should have Botox® administered by either a board-certified plastic surgeon or a board-certified dermatologist. Having Botox® injected by a highly trained nurse working under the direct supervision of a plastic surgeon may also be acceptable. You should not, however, permit a nurse to inject you with Botox® if a plastic surgeon is not in charge. It’s also important to take all of the steps outlined below:

1. Review Your Plastic Surgeon or Dermatologist’s Qualifications.

Anyone can say they’re board-certified, but this doesn’t necessarily mean they are. Sometimes people who claim to be board-certified plastic surgeons or dermatologists are certified by boards unrelated to cosmetic medicine, such as state medical boards. These individuals don’t have the specific training and expertise needed to administer Botox® properly.

When choosing a plastic surgeon, make sure he or she is certified by the American Board of Plastic Surgery. When selecting a dermatologist, verify that he or she is certified by the American Academy of Dermatology (this certification is indicated by the presence of FAAD after the dermatologist’s name). Ideally, the plastic surgeon or dermatologist you choose should also be a member of several reputable societies. Dr. Silverton, for example, is a member of the American Society for Aesthetic Plastic Surgery, the American Society of Plastic Surgeons, the California Society of Plastic Surgeons, and the San Joaquin County Medical Society.

2. Avoid “Too Good to be True” Prices

Botox® is one of the most affordable cosmetic treatments in use today, but patients should still expect to pay at least $250 for Botox® injections. Prices far lower than this usually signify a poor level of care. Patients must remember that reputable injectors have significant overhead costs that factor into the price of Botox® injections: They’re paying to maintain a fully staffed office, and they invest in the latest state-of-the-art technology and ongoing education. Unscrupulous injectors, by contrast, often have no office at all (beware of any doctor who offers to make Botox® “house calls”), no medical equipment, and no staff.

3. Ask to See “Before and After” Pictures

Not all board-certified plastic surgeons have a lengthy history of administering Botox® injections. As such, you should always ask to review your surgeon’s portfolio before committing to treatment. Seeing examples of Botox® treatments he or she has performed in the past can give you an accurate idea of the results you’ll receive. Reading patient reviews can further clarify the level of care you will experience at a given practice.

4. Know that Your Plastic Surgeon Should Review your Complete Medical History Before Proceeding with Treatment

Though Botox® is considered a low-risk treatment, a good care provider will still take the time to review your medical history when you come in for a consultation. This step is important because certain medical conditions can impact your ability to have Botox®. Some medications, including over the counter medications and supplements, also have the potential to interfere with this treatment. Finally, women who are pregnant or nursing should not have Botox® injections.

5. Look for a Plastic Surgeon Who will Give you an Honest Opinion

Botox® is highly effective for treating crow’s feet and forehead lines, but it cannot do everything. Botox® can’t tighten loose skin, nor can it treat static wrinkles (lines that have already become so etched in the skin that they’re visible even when your face is at rest). If you wish to treat more complex signs of aging, you may need multiple different treatments, or you may need facelift surgery. A good plastic surgeon will take the time to listen to your aesthetic goals and recommend the best treatment, or treatments, to achieve them. Someone who only provides Botox® injections, on the other hand, usually will not inform you of your other options. Remember: It’s ultimately much more satisfying to budget for the procedures you actually need than it is to be let down by ones that can’t help you.

Making the Most of Botox® with Complementary Procedures

One of the primary reasons why Botox® appeals to so many people is its promise of a non-surgical solution for wrinkles. When you ask a board-certified plastic surgeon to administer your Botox® injections, you will probably have the option of enhancing the benefits of Botox® with other non-surgical anti-aging treatments.

At Silverton Plastic Surgery, we have the equipment and experience required to provide our patients with a complete non-surgical facelift. We use dermal fillers to add volume to the lips and cheeks and fill in hollows, and we use Ultherapy to tighten loose skin on the face and neck. All of these procedures are painless and require absolutely no downtime, making them the ideal solution for those who can’t (or don’t wish to) have surgery. To learn more about how non-surgical treatments can reverse the early signs of aging, contact Dr. Silverton to arrange a personal consultation.