Cosmetic Procedures: Who-Where-When-How?

By Don J. Fontana, MD, PA

There has been a recent increase in awareness of cosmetic surgery and procedures whether due to the transformation of Caitlin or the TV program Botched. Cosmetic procedures have become so popular that dentists, physicians of all types, and nurses are offering certain cosmetic treatments including Botox, fillers, liposuction, laser treatment of spider veins, and tattoo removal.

In our free market society, the competition among different service vendors is a good thing, except when a patient’s well-being and health is involved. Deciding who is best qualified to administer a treatment is a personal decision, however the qualifications of the professional providing the service should always be checked.

Most cosmetic injectable procedures are routinely performed in a physician’s office under antiseptic conditions. These same procedures are offered and done in hair salons, medispas, fitness centers and residential homes under the label of “Botox/filler parties.” According to the State of Maryland law, injectables can be administered by non-physicians (registered nurses) only under the direct supervision of a physician present at the particular facility.

When should a prospective patient consider having one of these procedures done? The answer is only when it is appropriate. The person administering the treatment should always review the patient’s medical history and determine whether it is medically appropriate and when there are aesthetic indications for treatment.

Once the patient is counseled, a patient-physician relationship is established giving the patient the right to pursue any legal claim against the treating individual.

The standards of care are the same whether the treatment is given by a plastic surgeon, dermatologist or nurse. All of the injectable treatments are very technique dependent. How the injection is done can make the difference between an excellent result and a disaster that could last six months.

Knowledge of facial anatomy, facial balance and volume, and the dynamics of facial animation all contribute to an excellent end result.

Injecting Botox incorrectly can result in a sagging eyebrow, lip or drooping eyelid. There is no corrective treatment other than allowing the Botox to dissipate over the next 3-4 months.

Facial filler not placed within the correct layer of skin or subcutaneous tissue, can result in distortion and lumpiness of the treated area and may require months to be absorbed.

The good news about facial fillers and agents like Botox is that when they are administered by a qualified physician, the results can be fantastic. Creases and wrinkles are often diminished or completely removed, albeit temporary. The results of properly injected facial fillers are immediate and the folds about the nose and mouth are markedly improved or eliminated.

Before considering either of these cosmetic treatments, check the qualification of the health professional providing this service.