Five questions to ask before getting Botox or Fillers

Who is undertaking your Botox or Dermal Filler injections and are they appropriately qualified to do so? Botox must first be prescribed by a qualified doctor. It may be administered by a doctor, dentists and in some jurisdictions by a nurse. Beware of flashy websites - these don't necessarily reflect the necessary skills or qualifications. Some states may only allow physicians to inject medications such as Botox or Dysport, as it's a medical procedure and not the same as giving a medication (like a flu shot). Other states require the physicians to be present, while a nurse or physician-assistant perform the actual injection. Some states allow non-physicians to practice this form of cosmetic medicine without physician oversight. Also, some of these cosmetic injections are performed by such physicians as obstetricians, anesthesiologists, and primary care physicians. In the UK some prescribing nurses are allowed to inject Botox. In Ireland they are not. Beauticians are not allowed to inject Botox.

There are some nurses that have focused so much on injecting fillers, under the supervision of a doctor, that they develop better technique than the supervising doctor. There is an art and science to injecting fillers, and the technique improves with experience. Some injectors have a forceful hand and bruising and pain increase. Others are very gentle and give slow injections which can make it less painful and there might be less bruising as a result. These techniques can be learned by a nurse as readily as a doctor. Dentists have recently become involved in aesthetic injection. Beauticians are not allowed to inject dermal fillers.   

Where - Where are you having your Botox? It must be an accredited day surgery. It must also be a safe and clean environment. There also needs to be resuscitation equipment on site in case of an emergency. The doctor will usually carry some adrenaline and sterois if required. Any doctor injecting dermal fillers must carry hyalase for emergency treatment

What - What happens after the injections? Find out who will take care of any complications that may arise post-procedure. BOTOX injections take about 15 minutes to administer and don't require any downtime. If your job doesn't involve physically strenuous activities, you can return to work immediately. You should take it easy in the first 2 or 3 hours after getting the injections and avoid rubbing the treatment area. You may also wish to skip your daily workout for the same reason, and avoid consuming any blood-thinning products, such as aspirin or alcohol, for a couple of days before and after the procedure. Botox results typically take about 3 to 4 days to appear and usually last about 4 months. 

All dermal fillers have the potential to cause complications. Most are related to volume and technique, though some are associated with the material itself. Different injectable products have widely varying properties, associated risks, and injection requirements. The majority of adverse reactions are mild and transient, such as bruising and trauma-related edema. Serious adverse events are rare, and most are avoidable with proper planning and technique. Vascular compromise following filler injection is a major, immediate complication that is almost always the result of intravascular injection into an artery, causing an embolism that impedes blood flow. Always use a reversible filler where possible and make sure that your injector has the ability to reverse a problem. 

Hyaluronic fillers work in part by drawing your own fluid to their injection site. So the day of the injection, swelling may occur, especially the lip may look a bit full, giving a duck like projection that is unnatural. It also tends to hang over the lower lip the first day, if the lower lip is not simultaneously injected. So I always tell patients to wait a day for an important social event, in order to let the normal details and contour of the upper lip return.

Why - Why are you having it? What are you expectations of the results and what benefits do you anticipate? It's important to have a realistic understanding of the likely results and to be aware of the limitations of surgery.

How - How much will it cost? Beware of cut-price offers or packages. If it sounds too good to be true, it probably is. If you are getting a bargain price procedure, ask if the savings being made affects the level of care, the experience of the person conducting the procedure or the standard of the facilities.

Dr. Patrick Treacy is Chairman of Royal Society of Medicine Aesthetics Conference Organising Committee. Chairman of the Irish Association of Cosmetic Doctors and Irish Regional Representative of the British Association of Cosmetic Medicine. Fellow of the Royal Society of Medicine and the Royal Society of Arts. (London). Chairman of the Ailesbury Humanitarian Foundation. Honorary Ambassador to the Michael Jackson Legacy Foundation. Editorial boards of five international aesthetic and dermatology journals. Pioneered facial endoprosthesis techniques for HIV facial lipodystrophy and radiosurgery thermocoagulation.

Faculty: IMCAS Paris 2016, AMWC Monaco 2016, EAMWC Moscow 2016, AM Live London 2016, FACE London 2016, AMEC Paris 2016, and RSM ICG London 2016, Kolkhida, Tbilisi 2016, AIDA, Abu Dhabi 2016,IIAFA London 2016, CCR London 2016,  Cuernavaca, Mexico 2016  .

Awards: 'Best Professional Journalist Ireland' (2003). 'Best Medical Clinic in Ireland' (2005). Highly Commended 'Best Aesthetic Clinic Ireland & UK (2008) (2009). Winner of the MyFaceMyBody 'Best Innovative Technique' facial aesthetics and hair transplant (2012) (2013). Winner AMEC Paris 'Best Medical Case Facial Rejuvenation (2014). Best Aesthetic Doctor UK & Ireland (2016) -Runner Up 

Featured on the Today Show, Ireland AM, CNN, Dr. Drew, RTE, TV3, Sky News, BBC and Newsweek.

(Source: Adapted from the Australian Society of Plastic Surgeons)