Many dentists and primary care physicians now offer Botox to their patients. However, it's important to realize that not all Botox providers are created equal.
In fact, it might be convenient or less expensive to get Botox from a doctor that you frequent, but it doesn't always mean that it's a good idea and that they know what they are doing.
When choosing a Botox provider, to avoid getting a botched job, it's helpful to find out if they are board certified by the American Board of Plastic Surgeons. Or, at the very least, have received thorough training in aesthetic procedures.
Chances are, the primary care doctor or OB/GYN who claim to be certified by The Aesthetic Society, have probably just taken a weekend course on injectables.
What are some qualifications patients should look for when getting Botox? What type of questions should patients ask their Botox provider?
Greg Wiener MD, FACS, shares why you shouldn't get Botox at the dentist and what you need to ask before getting a Botox procedure.
RadioMD Presents: Melanie Cole's Health Radio | Original Air Date: June 9, 2015
Host: Melanie Cole, MS
Guest: Greg Wiener, MD, FACS
It’s time for Health Radio with Melanie Cole.
MELANIE: Many dentists and primary care physicians now offer Botox to their patients. However, it’s important to realize that not all Botox providers are created equal. In fact, it may be convenient or less expensive to get Botox from a doctor that you frequent but it doesn’t always mean that it’s a good idea and that they really, truly know what they are doing.
My guest is Dr. Greg Weiner. He’s a Board Certified Plastic and Reconstructive Surgeon who’s been practicing at Resurrection Hospital for the past nine years.
Dr. Weiner, welcome to the show. So, Botox. It sounds like we are going to be seeing this over the counter soon. How come is it being offered at your dentist’s and physicians?
DR. WEINER: Hi, Melanie. Thanks for having me. It’s unbelievable. One of the issues is that anybody, any licensed practitioner can get Botox whether its primary care, whether it’s a dentist, is with a prescription they can get Botox directly from the company.
MELANIE: Wow. So are they charging more or less? Is there no difference for us in the charge factor?
DR. WEINER: It’s all across the board. In most cases those practitioners, dentists, primary care, at worst, salons and things like that, are probably charging lower than what you are going to see in a plastic surgeons office, in a board certified dermatologist’s office, facial plastic surgeon. They are a wide range of doctors that should be doing this. And you’re right, they will be charging a little bit more.
MELANIE: Okay. So they will be charging a little bit more. How do we know who’s doing it knows what they’re doing? You’re a plastic surgeon, you’re a reconstructive surgeon. Do they have to know, I mean, is there room for a margin of error, Dr. Weiner, in these little shots, the little tiny needles? How do we know that they know what they are doing?
DR. WEINER: In my mind, there’s a subset of doctors who should be doing this. That’s your general plastic surgeons, number one; your board certified plastic surgeons, your facial plastic surgeons who are usually ear, nose and throat trained. They’ve got a lot of training. They’ve got really good residency programs and they’re doing aesthetic and cosmetic surgery on the head and neck area. And then, your dermatologists. Most dermatologists--not all dermatologists, but a majority of them--have training on some kind of surgical level. They do minor surgeries on the face and, in some cases, they will do major surgeries on the face as well. So, those three – your facial plastic surgeon, your plastic surgeons and your dermatologists-- especially your surgical dermatologists – they’ve got the training, they know the anatomy. What’s more is, they are doing cosmetic procedures; they’re doing aesthetic procedures so they have an artistic vision as well. It’s not that you might suffer some kind of catastrophic problem. It’s still possible if you go to somebody who’s not qualified but more than likely, you are just going to get a sub-standard result.
MELANIE: So, that’s for sure. Our dermatologists may or may not be pretty well qualified. Certainly plastic surgeons. You guys are the ones that started this.
DR. WEINER: I do think that most dermatologists probably are, too.
MELANIE: So, you and maybe our dermatologists are the ones who brought it to the forefront. You know what to do if something goes wrong. You’re right there. So people are trying this as all kinds of….Now, they are looking at Botox for so many different things. Are there any of those other things we should worry about now?
DR. WEINER: What I’m concerned with is mainly the cosmetic issues. There are a lot of other applications for Botox. Even neurologists will use Botox for migraine headaches and its FDA approved for that as well. Remember, Botox has been around for 30 years plus. It really wasn’t approved for the cosmetic uses until the last 15 years or so. It’s been used to treat muscle spasms and things like that for a long time, so there are other practitioners who are qualified to use it as far as the cosmetic applications go. Really try to limit it to your plastic surgeons and your facial plastic surgeons and your dermatologist. The big issue is that number one, anyone can get his, anybody with a medical license. It could be a primary care, it could be a dentist, and it could be all manner of doctors. They can take a couple of weekend courses and feel that they are comfortable to do this. You have a lot of people with a lot of different backgrounds; what you are going to see as far as downside is usually pretty limited. Even if somebody does make a major mistake, it’s usually a sub-par cosmetic result not necessarily something…
MELANIE: That’s what I was going to ask you. What’s the complication factor? What’s the problem if somebody does mess it up a little bit?
DR. WEINER: If somebody messes it up a little bit it, it could be anything from a sub-standard result, which is what you are usually going to see. That means maybe the wrinkles aren’t adequately corrected, maybe there’s some asymmetry but then you start getting into major things like if somebody has a droopy eyebrow or, even worse, a droopy eyelid for three months. Then you’ve got some major issues. You’ve also, as far as complications go, you’ve got the practitioners that are on the fringe as far as maybe some of the salons or maybe some of these people who give the Botox parties and where are they getting their Botox? Are they getting an online Botox equivalent of some type that may not be pure? It may not be Botox. Or even worse, there was a case in Florida a couple of years ago where they got research grade Botox by mistake via an online company of some kind and it put several people in the hospital. Basically, the Botox was so powerful that even with small injections, the medication spreads through the body and paralyzed muscles completely. People were unable to breathe, they were placed on ventilators. It was just terrible.
MELANIE: So, those complications notwithstanding, give us your best advice for Botox itself. Where do you think it’s going in the future? I have these little lines around my eyes, Dr. Weiner, that I look at and I’ve tried a lot of creams and things. I’m nervous for someone to shoot a needle by my eye.
DR. WEINER: Sure. It’s definitely here to stay. It’s a great treatment. It’s easy to do. You come in two or three times a year and it’s going to work if it’s done by somebody who’s qualified to do it. In reality, it’s really safe. The medication, if it’s used correctly has a very, very low chance of causing a problem or paralyzing a muscle that it shouldn’t paralyze. Again, it’s not a substitute for a facelift. You’re just kind of freshening yourself up. It should be done in a fashion that doesn’t freeze that whole top of your face. People tend to do that, too, sometimes. It should be done in a careful, thoughtful manner. That’s another thing that you’re getting, by the way, with a facial plastic surgeon or a plastic surgeon or a cosmetic dermatologist is, you’re getting an evaluation and some really thoughtful treatment on how you’re going to look better without looking frozen, without looking unusual.
MELANIE: See and I think that’s the secret, right there. We are out of time but you are such a great, fantastic guest. It’s Dr. Greg Weiner. He’s a Plastic and Reconstructive Surgeon at Resurrection Hospital in Illinois. You can visit him because this is the kind of person who knows what they are doing. So, be careful of those Botox injectors out there. Get it from somebody who is board certified and knows what they are doing and can help you with the situation.
This is Melanie Cole. You’re listening to Health Radio right here on Radio M.D. Stay well.