I recently had a Botox® customer come to my office whom I haven’t seen in about 5 years. The patient called to request an appointment for me to check a complication she had from a recent Botox® injection she received elsewhere. I generally do not see these patients, but request that they return to whomever injected them. However, she insisted that she had already returned and was re-injected, only to make the problem worse. Since she was a previous patient, I consented to see her. She arrived with a severe drooping eyelid- not brow, but lid. Indeed one of her eyes was partially closed. Yikes! When she returned to her injector for help, she was re-injected, which made her brow droop as well! Not a good day….
Every injector, no matter how experienced, will have an occasional adverse outcome. If an injector tells you they have never had an adverse effect- they are NOT experienced enough! The reason for this occasional disappointing result is not because the product or the technique or the injector did something different or wrong. The changing variable in this scenario is the patient. We are all unique and work differently- even facial anatomy can be quirky on some folks! Anyone can learn to inject (yes, even hair stylists), but proper injection requires extensive knowledge of anatomy, product mechanism of action and the hows and whys of the treatment. So my first rule of thumb for selecting an injector, make sure they are experienced and can handle any adverse effect that may happen.
Since we are all different (just look in the mirror) we have to be injected differently to look natural. There is no cookie cutter pattern to inject Botox®. Some people have naturally lower or straighter or higher brows; others may have a very narrow forehead or a stronger frown, on and on. As injectors we must approach every patient differently according to their natural features. This requires an artistic eye. Since “natural” is the goal, we, as injectors, must know how to achieve what is natural for each individual. In my courses I teach on facial injections, I always tell the practitioners that Botox® and filler treatments are 20 % science and 80% art! My second guideline for selecting an injector is to make sure they do not treat everyone the same. They must have an artistic eye and KNOW what “natural” looks like for you.
Lastly, no one wants to feel like they are part of a cattle herd heading to the barn! Make sure your injector is willing to spend time with you to learn what your aesthetic goal is, what your natural expressions are and that you understand how the treatment should work for you. This will take time in conversation, in animation, in repose and education. I often hear from my patients, “No one ever told me that.” Really??? Without proper education of the treatment, the expected results and follow-up, no wonder people think all Botox® treatments are the same no matter where you go. My final recommendation is to make sure your injector spends time getting to know YOU, your face and your goals! We are not all created equal when it comes to our faces. Time spent by injectors on developing facial knowledge of our patients results in better outcomes and happier patients!
So should a plastic surgeon or a dermatologist be the only ones who should inject faces? I think not! Those days are over. But should the injector have a thorough knowledge of facial anatomy and mechanics, ability to treat every possible response, as well as the time to spend with their patients to learn individual requirements and goals? A must!
