Before You Book Anything, Read This

I want to start Part Two with what most aesthetics books skip over.

The procedure conversation is exciting. It's the part most readers flipped to first. Botox, fillers, threads, lasers. The things that can make visible changes in a way skincare alone can't. I get the appeal. I do these procedures for a living and I find them genuinely transformative when they're done well.

But before we talk about any specific procedure, I want to talk about something more important than the procedure itself. Where you go to get it done, and who does it to you.

This is the conversation I wish every patient had with themselves before walking into their first injectables appointment. Most don't. They book based on a Groupon, an Instagram ad, or a friend's recommendation. They walk in trusting the office because the office looks nice. They sit down in front of someone they've never met and let that person inject something into their face.

I'm not trying to scare you. I'm trying to give you the framework I'd give a family member who came to me asking where to start. The injectables industry has exploded in the last decade, and quality has not kept pace with demand. There are excellent providers everywhere. There are also a lot of people doing procedures they don't have the training for, in settings without proper oversight, on patients who don't know what they don't know.

Let's fix that.

Who's Allowed to Inject You?

The rules vary by state, which is part of the confusion. In most US states, injectable procedures (Botox, fillers, and similar) must be performed by or under the supervision of a physician. The specific delegation rules vary.

The providers you might encounter, from most to least training:

Physicians. Plastic surgeons and dermatologists are the highest-trained providers in this space, though their actual injectable expertise varies widely. A plastic surgeon who hasn't done a Botox treatment in a year is not necessarily better than an experienced injector with a different background. Other physicians (family medicine, OB/GYN, ER, etc.) sometimes train and offer aesthetics. Their skill depends entirely on what training and continuing education they've sought out.

Nurse Practitioners and Physician Assistants. Mid-level providers with prescriptive authority, like me. We're trained in medicine, anatomy, and the procedures themselves. The quality of NP and PA injectors varies enormously based on training, experience, and the mentorship they've had. A well-trained NP who has done thousands of injectables can be just as skilled as a physician. A poorly trained one can do real damage.

Registered Nurses. RNs can inject in most states under physician supervision, but they cannot independently assess, diagnose, or write a treatment plan. The quality of supervision matters a lot. An RN injector at a clinic where the supervising physician is on-site, hands-on, and reviews complications is in a different category than an RN injector at a clinic where the physician signs off remotely and isn't actually involved in care.

Other licensed professionals. Depending on the state, this can include dentists (who often have excellent facial anatomy knowledge and increasingly add aesthetics), and sometimes others. Same rule: training and experience trump credential alone.

Aestheticians and others without medical licensing. In most states, these professionals cannot legally inject. If you're being injected by someone who isn't a licensed medical professional, you're in an unsafe situation, period.

The credential alone doesn't tell you whether someone is a great injector. But it does set the floor for what's legal and what isn't.

Red Flags Before You Book

Things that should make you pause:

Suspiciously low prices. Real Botox costs the office money per unit. Real filler costs the office money per syringe. When you see "Botox for $5 a unit" or "filler for $300 a syringe," ask yourself how that math works. Often the answer is diluted product, counterfeit product, or a provider so inexperienced they're using prices to attract patients. Sometimes it's a legitimate office running a controlled promotion. But cheap pricing is a flag that deserves a second look.

Office that doesn't feel medical. Real aesthetic clinics have appropriate medical setup, including emergency response protocols and proper sterile technique. If the place feels like a salon with a treatment room added on, that's worth noticing. A spa atmosphere is fine. A spa atmosphere with no medical infrastructure underneath is not.

Pressure to book during the consultation. A good provider gives you information and lets you decide. A bad one creates urgency. "This deal expires today," or "I have a cancellation in an hour, we should do it now," is selling, not medicine. You should never feel rushed into a procedure.

Pressure to do more than you came in for. You ask about a small amount of filler in your lips. The provider suggests filler in your cheeks, your chin, your jawline, plus Botox in three areas, and threads in two. Up-selling exists everywhere, but in aesthetics it can become aggressive enough to cause real harm. A good provider will sometimes recommend more than you asked about, but with clear reasoning and no pressure.

Refusal to show you results. Ask to see before-and-after photos of the provider's actual work. Photos of their own patients, not stock images from product training. A good injector has a portfolio they're proud to show. Resistance to showing you work is a flag.

No discussion of risks. Every procedure has potential complications. If a provider tells you there are no risks, they're either lying or undertrained. A consultation should include an honest discussion of what can go wrong, how often it happens, and what they'd do if it did.

No follow-up plan. Good providers want to see how their work settled. They schedule follow-ups, especially for new patients or first procedures with them. If a clinic does the procedure and you never hear from them again, that's a sign of volume-driven, low-touch care.

Product they won't name. This is the big one. Every legitimate injectable has a specific brand and product. Botox, Dysport, Xeomin, Daxxify, Jeuveau for neurotoxins. Juvéderm, Restylane, RHA, Belotero, and similar for fillers. If the provider can't or won't tell you exactly what they're injecting, walk out. This is how counterfeit or dangerously off-label products end up in faces.

Green Flags Before You Book

What I look for when I'd send a friend somewhere:

Provider with substantial dedicated injectables experience. Years specifically doing injectables, not years of general practice with injectables as a side interest. Continuing education in the specific procedures they offer. Membership in professional organizations.

Comprehensive consultation. A first visit should include a real conversation about your goals, your medical history, what you've had done before, and a thorough exam. Not a five-minute chat before they pick up the needle.

Honest assessments, including saying no. Good providers turn people away. They tell patients they're not a good candidate for what they're asking for. They redirect to better options. They say "I don't think this will give you what you're hoping for." A provider who says yes to everything is selling, not advising.

Specific recommendations. "I'd use one syringe of Restylane Lyft for your cheek area, with two units of Botox in your masseter, and we'd revisit in eight weeks" is a treatment plan. "Let's start with whatever you want" is not. Specificity reflects expertise.

Transparent pricing. Real costs for real products, in writing if you ask. No bait pricing. No "we'll figure it out when we're in there."

Clear emergency and complication protocols. What happens if you have a vascular event, an allergic reaction, swelling that's concerning? A good clinic has the answer ready, including access to reversal agents (hyaluronidase for HA fillers), emergency drugs, and contact protocols.

Photos of their actual work. Both glamour shots and honest, varied results. The patient who looks naturally refreshed, not the celebrity-cosplay overdone result.

How to Find a Good Provider

A few practical paths:

Referrals from people whose results you trust. If someone has aesthetics work you admire (subtle, natural, age-appropriate), ask who their injector is. This is more reliable than online reviews.

Professional organization directories. The American Society for Dermatologic Surgery, the American Society of Plastic Surgeons, and similar organizations have directories of members. Membership isn't a guarantee, but it filters out the most undertrained.

The provider's own work, not the office. Sometimes clinics market themselves heavily but the providers vary in skill. Find out who specifically will be doing your procedure. Look at that person's work, not the clinic's branding.

Consultations with more than one provider. If you're new to this, see two or three providers before deciding. You'll quickly learn what feels right versus rushed. The conversation will tell you a lot.

Avoid groupon-style aggregators for first procedures. Once you trust a provider, deal pricing is fine. As your introduction to injectables, the steepest discount in town is rarely the place to start.

The Cost Conversation

Aesthetics isn't cheap. The most common reason people end up at sketchy providers is price. Let's be honest about it.

A few rough national averages, which vary by region and provider:

Botox typically runs $10 to $20 per unit, with most facial treatments using 20 to 60 units. So a Botox appointment might run $200 to $1,200 depending on areas treated.

Hyaluronic acid fillers typically run $600 to $1,200 per syringe. Most areas use one to two syringes per treatment.

Threads vary widely depending on type and number, often $500 to $3,000.

Sclera-based collagen builders (Sculptra, Radiesse) often run $700 to $1,500 per syringe, typically requiring two to three syringes in a treatment series.

Lasers vary enormously, from $200 for a single IPL session to $3,000 to $5,000 for ablative laser resurfacing.

When you see significantly cheaper than these ranges, there's a reason. Usually one of these: counterfeit product, diluted product, inexperienced provider learning on you, volume-driven clinic with corner-cutting, or an introductory promotion (which can be legitimate but warrants the same scrutiny otherwise).

When you see significantly more expensive, that's also worth understanding. Sometimes high prices reflect genuinely exceptional skill, premium products, or expensive overhead. Sometimes they reflect a brand premium without corresponding quality. Pay for skill and quality, not just for the prestige of the address.

Here's the framework I give people who can't comfortably afford what they're being quoted: do less, less often, with someone excellent. Two units of Botox in one area from a great injector is a better investment than a full face of Botox from someone unqualified. One small touch of filler done well will look better than three syringes done badly. The procedures we're about to discuss are not all-or-nothing. Quality over quantity, every time.

Questions to Ask in Your Consultation

A starter list you can take with you:

How many of this specific procedure have you done?

What's your training background and continuing education in this area?

What specific product will you use, and why?

What are the most common side effects, and how often do you see them?

What are the rare but serious complications, and what's your plan if they happen?

Do you carry the reversal agent for hyaluronic acid fillers (hyaluronidase)?

Can I see before-and-after photos of patients similar to me?

What's the realistic expectation for my specific concern? What can this procedure do, and what can't it do?

What's the follow-up plan, and what do I do if something seems wrong after I leave?

A good provider welcomes these questions. A defensive or impatient provider is telling you something important.

A Word on the Emotional Stuff

Choosing to do aesthetic procedures often comes with emotion. Excitement. Nervousness. Hope. Sometimes shame about wanting them in the first place. Sometimes pressure from a partner or a parent or social media.

Before you book, take a quiet moment with yourself. Why do you want this? What are you hoping it changes, not just on your face but in how you feel? Are your expectations realistic? Are you doing this for you or for someone else?

I ask my patients these questions during consultations. The answers tell me a lot about whether we should proceed and how to set expectations. Patients who can clearly articulate what they want often have great outcomes. Patients who can't, or whose motivations are tangled in difficult emotions, often don't, even if the technical result is perfect.

You're allowed to want aesthetic procedures. You're allowed to want to look different than you do. None of this is about whether your desires are valid. It's about whether you're going into the decision with clear eyes.

The next chapter is the first close look at a specific procedure. Botox and the other neurotoxins. The most common aesthetic injectable in the world, the most misunderstood, and the easiest one to do badly. Let's get into it.