In 2015, nearly 7 million Americans received Botox or similar neuromodulator treatments. Approximately 2.5 million dermal filler treatments were done in the same year. With the overwhelming success of cosmetic injectable treatments, they have become broadly accepted by the American public. However, with this rise in popularity has come the unfortunate emergence of non-core specialty practitioners trying their hand at injectables. When I say “non-core” I am referring to all doctors who are not Board Certified plastic surgeons or dermatologists. Only these specialties include specific didactic and practical training in the use of cosmetic injectables as a part of their board certification process. That is not to say that other doctors cannot get trained later at a training course; however, when your pediatrician or ER doctor offers you Botox, or your hair salon suddenly starts offering Juvederm injections, you should understand that this was not part of their medical training, and you may be putting yourself at risk for more than just an undesirable cosmetic result. Imagine if one day I started offering to color my patients’ hair- the results would be disastrous. Many an unsuspecting person has fallen victim to bargain basement prices on such treatments, but the old adage applies here more than ever, you get what you pay for.

As a Board Certified plastic surgeon I feel it is my obligation not only to provide the highest level of treatment, but also to educate the public on what may or may not be correct for them. Often a patient will come to me asking for Botox for their forehead lines, but the problem is actually a heavy brow or excess skin of their upper eyelids. After explanation of the dynamics of facial aging and anatomy, I make the appropriate recommendation, which often is not an injectable at all. Routinely I see an unhappy patient come to my office complaining how their doctor did Botox in their forehead and now they look unhappy and mad all the time, and ask me if I can fix it. Botox and fillers can provide an amazing non-surgical result when used correctly, but knowing when and how takes correct training and years of experience. This is as much an art as it is a science. It has taken me more than a decade and tens of thousands of injections to master the art of injectables. I have compiled a list of questions that you should routinely ask when you go to a new provider for injectable treatments. My savvy new patients sometimes ask me these questions, and I am more than happy to answer to put their minds at ease.

Always ask your doctor about their experience with injectables: How and when were they trained, how many years of experience they have with each individual injectable as they are all different in their required technique.

Ask if your doctor has reversal agents for hyaluronic acid fillers (such as Juvederm or Restylane) in the event of less than desirable outcome or adverse event.

Ask your doctor if they are able and willing to help you in the event you are not satisfied with your results. I always ask my patients to call me in a week or stop back if things don’t look the way they expect. Often, if there is any issue, it is an easy fix that I don’t charge for.

Always ask to see the actual bottle of Botox or syringe of filler being used. Ask your doctor if they buy the products directly from the manufacturer or if it is obtained from the grey – or worse, black – market where quality control is suspect. Look for the holographic seal on the Botox bottle ensuring it comes directly from Allergan the manufacturer.

Ask how many units of Botox or Dysport are being administered. Dilutions may vary, but units are consistent.

Ask your doctor when the bottle of Botox was opened. Did you know that once opened and reconstituted, Allergan recommends the Botox be used within 4 hours to ensure potency? In a busy injectables practice like mine, that is no problem as we go through multiple bottles daily, but in a slower practice, beware.

Ask to see your doctor’s before and after pictures, especially of his or her injectable filler patients. Nothing gives a prospective patient a better idea of how they will look than seeing the doctor’s actual work!

The most important thing is to seek out a well qualified doctor you trust who has the full compendium of knowledge and tools to help you achieve the best possible result. Most of the time, injectable fillers give a beautiful, near immediate result. But even in the best of hands, aesthetic medicine can have less than perfect results, and those are the times you need your doctor and their office to be at the top of their game.

For more information about cosmetic injectable treatments call our Dr. Guy Cappuccino at 301-829-4110 or visit

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