Make sure you know who is doing your Botox and if it is Legal!

With all the craze of botox and fillers, medical spas are popping up on every corner. Having a “botox party” is not only normal, but becoming a regular phrase used among millennials.  Laws vary from state to state, but almost all including Oklahoma, require a doctor to evaluate, examine, diagnose, and provide a treatment plan.  This does not mean that a doctor has to be the one who injects, although that is an added bonus if you can find a cosmetic surgeon to be your injector.  There is no doubt that the extra years in training give an unmatched precision in anatomy and surgical skill, but nurses and physician assistants can be excellent injectors.  What is important to know is that it is ILLEGAL for a nurse to inject you with anything without having an order from a doctor. 

I will be the first to say that when I was a surgical resident student on call in the middle of the night, one of the first people I would turn to for advice was a seasoned nurse.  I would humbly ask for reassurance that the medication and dosage I just looked up and was wanting to administer was one that other doctors normally prescribe.  These nurses at academic institutions, may have taught me more than some of my own medical professors.  On countless occasions, even if they already knew what medication and dosage was needed to treat a patient, they always called me and asked for a doctor’s order.  Of note, prior to giving an order, the doctor must evaluate the patient and obtain a history and physical exam.  If I or one of my co-residents has not evaluate the patient, I had to go see the patient even if it was at 2:00 AM! I also learned a lot about black coffee and scavenging for saltine crackers in the lounge when I was stuck at the hospital for what seemed to be never-ending hours. 

So back to botox and facial fillers - this may all sound silly and over the top.  Why does this matter? Although neurotoxins (the fancy doctor name for Botox, Dysport, Newtox, Xiamen, etc) and facial fillers, are generally safe, things can go wrong, very wrong.  There actually is a reason, that we spend all of those years in medical school and residency.  Although this message is a warning for patients safety, it is also very important that nurses do not feel pressured by a business to act illegally.  Many medical spas are owned by doctors who have no training in cosmetics, and are not present for the initial evaluation.  This is illegal! Both the doctor and especially the nurse can lose their license, as in these situations, the nurse is impersonating a doctor.  If a doctor is lying and signing off that they evaluated the patient, this is also illegal for obvious reasons.  It is only a matter of time, until a serious injury occurs, and the law starts to crack down on these businesses.