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: