Only MDs in the United States are allowed to purchase Botox from its manufacturer, Allergan. There are illegal arrangements where nurses, estheticians or those with even less training obtain Botox from an absentee physician and then perform unsupervised injections. This practice is unsafe, unethical and unfortunate. This is, however, increasing in frequency as poorly trained "practitioners" or "injectors" swarm the field of cosmetic medicine and, in some tragic cases, plastic surgery.
Like many ethical issues, these practices result from financial pressure. An ethical physician would never put his or her patients at risk to make a profit. However, there are those physicians and other providers who have decided that offering cut rate injectable treatments (Botox, Dysport, Juvederm, Restylane, Perlane) is the path to a tidy sum. For very good reasons, legitimate FDA-approved drugs are not cheap (hence the higher cost of being treated by a reputable Plastic Surgeon or Dermatologist).
When the $8 per unit Botox provider realizes that they lose money on every unit injected, there is tremendous pressure to reduce costs. This can sometimes involve overly diluting the medication such that patients receive fewer units of Botox than they paid for. Alternatively, medications can be purchased from foreign companies in India, China and Canada, to name a few. In some cases, there is no active medication in the purchased product. In other, more dangerous cases, there is excessive or non-medical grade product masquerading as an FDA-approved, safe medication.
I am reminded of a case in which research grade Botulinum toxin was reconstituted and injected by a chiropractor. He injected himself, his (soon to be ex-) girlfriend and another couple. All four survived but wound up in the hospital for prolonged periods due to a ludicrous overdose of the drug. This type of complication is a "never event" and does not occur when Botox is purchased from its manufacturer in the US.
The take home message is that there is an increasing number of unscrupulous providers entering the practice of cosmetic medicine. There will always be those that look to make a quick buck rather than building relationships and providing exceptional, long-term care to their patients. Warning signs include:
- non-core physicians (those other than Facial Plastic Surgeons, Plastic Surgeons and Dermatologists) offering cosmetic services. Many among us have seen ads for injectable treatments at their internal medicine or OB-GYN office. A patient of mine was actually offered Botox by his gastroenterologist!
- non-physician "injectors" with no physician affiliation are suspect. To reiterate, they cannot legally buy the product they're offering to inject at bargain basement prices. Thus, you must ask where the product came from.
- prices that are too good to be true. In fact, they are.
It is important to note, that fixing bad Botox is much more expensive than having it done right the first time. There is no substitute for exceptional training and experience.
If you would like to discuss Botox or other injectable treatments with a board-certified Facial Plastic Surgeon in the Denver area, schedule a consultation.
Stephen Weber, M.D., F.A.C.S.
Lone Tree, Colorado
