How to Vet a Doctor Before a Botox or Filler Appointment
A decade or so ago, Botox and filler were considered taboo cosmetic procedures explored only by a certain type of clientele. Nowadays, they're common in-office treatments that can quickly and effectively address everything from fine lines and wrinkles to sunken under-eye areas and thin upper lips. With demand for neurotoxin and filler on the rise, more and more practitioners are joining the industry. The problem with that? Not everyone is extensively schooled on the subject. Luckily, there's a foolproof way to avoid a botched cosmetic procedure: Know what to look for in a practitioner before making an appointment for injections.
Related: Four Questions to Ask a New Dermatologist During Your First Visit
Qualifications to Look For
New York City-based double board-certified plastic surgeon Dr. Adam Kolker says that patients should seek a board-certified physician who provides care in a safe, sterile, in-office environment. "Plastic surgeons certified by the American Board of Plastic Surgeons (ABPS) are experts in facial anatomy and have undergone years of rigorous training and education in order to help patients achieve their aesthetic goals," he explains, noting that this education plays a vital role in an appealing outcome.
The same goes for dermatologists: "This stamp ensures that your doctor has passed the certifying examination that demonstrates a mastery of the specialty and a basic foundation of clinical knowledge in the subject matter," explains board-certified dermatologist, Dr. Corey L. Hartman, who is the founder of Skin Wellness Dermatology in Birmingham, Alabama. Beyond scouring out a board certification, Dr. Hartman says you should also try to find a dermatologist who has a specific interest in cosmetic procedures and performs them every day. "This is not the time to seek the help of a casual participant," he says. "There are matters of anatomy, injection technique, cultural competence, product selection, and aesthetic eye that can only be honed by performing the procedures on a regular basis." With this in mind, Dr. Hartman says to fully vet a dermatologist's website and social media to ensure that their aesthetic matches your cosmetic goals. "If you see a bunch of scary-looking faces, then perhaps it's not the practice for you," he adds. "If the look matches your goals for yourself, however, that's a reassuring sign."
While it's ideal to book with a board-certified plastic surgeon or dermatologist, Dr. Kolker admits that, given the popularity of Botox and fillers—and the fact that they are usually the first treatment offered by providers of all types looking to enter the aesthetic space—booking based off of word-of-mouth recommendations and patient testimonials can be a reliable method, as well. Dr. Hartman agrees: "Chances are if your most trusted friends and family have found success with a particular board-certified dermatologist, then so will you," he assures. But, again: You'll want to fully scan the practice and its past patients to determine if it's the right fit for you.
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Questions to Ask
After you find a candidate, it's important to prepare for your appointment. When you book a consultation, be ready to chat: Your medical professional should be able to thoroughly explain how these types of cosmetic procedures work. "Botox treatments work well to soften lines of dynamic expression (those that are visible during muscle contraction): the frown lines between the brows, transverse forehead wrinkles, and fine lines at the corners of the eyes," Dr. Kolker explains. "The muscles of facial expression have soft tissue attachments to the overlying skin through the superficial muscular aponeurotic system (SMAS). When these muscles contract, the overlying skin moves, forming dynamic wrinkles that become more etched with time and repetition. Providers need to take the time to evaluate patients' dynamic muscle action through a series of expressive exercises, ideally performed in a mirror so that provider and patient are seeing the same thing as they work together to develop a treatment plan."
As for the next step? Have several questions to ask your dermatologist, plastic surgeon, nurse practitioner, or esthetician (yes, they can administer injectables, as well!) at the ready. According to Dr. Kolker, important queries to ask are: What can realistically be achieved? What are the alternatives? How is this treatment being tailored to my unique goals and anatomy? "Patient satisfaction is enhanced when expectations are properly managed, so providers should be able to articulate exactly what Botox injections can and cannot achieve," he adds. In Dr. Hartman's eyes, the more questions you ask, the better. After all, by gathering all the information possible surrounding your cosmetic treatment, you'll be able to set realistic expectations and determine if those are personally worth the treatment in your eyes. With that in mind, Hartman says to arrive with the below questions top of mind (or at the top of your iPhone notes for easy reference):
Are you qualified to administer this procedure?
How many of these procedures do you perform in a week?
What are the risks and benefits?
Is there any downtime associated with these injections?
Am I a good candidate for injectables?
What should I do before and after the procedure?
What's the difference between Botox and fillers?
Can you show me before and after photos?
How long will the filler and Botox last?
Are there any alternative treatments that provide similar results?
Once you've come to terms with a practice's before and afters and determined that you'd like to book an official appointment, board-certified dermatologist Dr. Bruce Katz of JUVA Skin and Laser Center in New York City says to specifically ask the dermatologist what they'd recommend for you. "Tell them about your goals, and let them outline a treatment plan," he says. "Ask about the plan, including the number of appointments you need to achieve your goals and what specific injectables they would use."
Red Flags to Avoid
As with any cosmetic treatment, there are a handful of red flags that should be reason enough to turn away from a practice. If it seems too good to be true, trust your gut. "There could be a good reason for this, like counterfeit, expired, or illegal product," Dr. Hartman warns, noting to avoid bargain deals for this type of cosmetic work. If a Botox or filler practitioner offers zero before and after photos, Dr. Hartman says to seek help elsewhere. "The doctor should be proud to show off their work and offer clinical photos for you to review," he says. Dr. Kolker notes that patients should be wary of one-size-fits-all treatments—your practitioner should work with you to determine what's best for your complexion. "I favor natural results and prefer to work with my patients to titrate their Botox dose, sometimes over a series of a few visits, rather than risk a frozen or unnatural result by being too heavy-handed with the initial treatment," he says. "The idea is to relax muscle action and soften expression, not to eliminate it entirely. Achieving these results requires meticulous attention to detail and a collaborative approach between provider and patient."
Dr. Hartman says that doctors that have too much product themselves (read: heavy work) can be a red flag. "There needs to be a critical eye to ensure that the work looks natural," he says. And though it arguably goes without saying, when working with needles and your face, you want as clean and orderly of an environment as possible. "Not only is there an expectation to treat you with sterile technique to avoid infection and complication, but an organized office also ensures that the procedure will be administered properly," Dr. Hartman explains.
