Best Aesthetic Medicine Course for botox and filler for physicians/NP/PA

EMME

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Hello, hopefully someone can help me. A friend of mine is attempting to start an business and had questions I couldn't answer. Does anyone know what course is best for non-dermatologists, primarily for injecting botox and fillers?
 

asmallchild

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What field is your friend in?

It doesn't take a rocket scientist to inject botox or filler.

That being said, my PA is having a tough week with cosmetic complications and is learning that complications will rapidly take away all the joy and profitability of doing cosmetic procedures.
 
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MOHS_01

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It's no longer a part of my practice as it proved to be neither for me
Word. Not to mention the psych component...and let's be honest -- there's no polite way to tell a 60-something who looks 90 (but thinks they're 40) that botox and filler won't accomplish what they want to accomplish.
 
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EMME

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Jan 29, 2013
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What field is your friend in?

It doesn't take a rocket scientist to inject botox or filler.

That being said, my PA is having a tough week with cosmetic complications and is learning that complications will rapidly take away all the joy and profitability of doing cosmetic procedures.
They are in emergency medicine, I guess getting burned out... came up with the idea due to multiple non-dermatologists/plastic with successful businesses in random little towns in TX. I don't know any other details, but was just tying to get him some basic info on education and pitfalls of these cosmetic procedures.

I will gladly relay the message back to him in regards to low profitability...but based on what these family med and internal docs are doing, I'm unlikely to convince him otherwise.
 

Skindoc83

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They are in emergency medicine, I guess getting burned out... came up with the idea due to multiple non-dermatologists/plastic with successful businesses in random little towns in TX. I don't know any other details, but was just tying to get him some basic info on education and pitfalls of these cosmetic procedures.

I will gladly relay the message back to him in regards to low profitability...but based on what these family med and internal docs are doing, I'm unlikely to convince him otherwise.
then at least tell him to steer clear of devices. Nothing will bankrupt him faster than a few six figure lasers that he doesn’t know how to use and the market can’t support. Those firms are predatory
 

Slack3r

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Why do people think cosmetics is so easy and so lucrative?
Because it’s easy to see someone charging $6-800 per syringe of filler and see $$$, but not realize the overhead, the time to build a panel of cosmetic patients, and the need to compete with every Tom Dick and Harry that wants in on the gravy train.
 

username456789

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They are in emergency medicine, I guess getting burned out... came up with the idea due to multiple non-dermatologists/plastic with successful businesses in random little towns in TX. I don't know any other details, but was just tying to get him some basic info on education and pitfalls of these cosmetic procedures.

I will gladly relay the message back to him in regards to low profitability...but based on what these family med and internal docs are doing, I'm unlikely to convince him otherwise.
Tell him in the most kind and respectful way you can to go f*ck himself.

Or, he can do a second residency.
 

zanzizic

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Oh man. I’m so sick of this ****.

I remember when I matched into Derm and some of my med school friends and acquaintances were giving me grief about it. They were going into Emergency Medicine and Surgery to be *Real Doctors*!!!

Now the ER guy is bailing out and going to Big Rock Candy Mountain, huh?
 
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Oh man. I’m so sick of this ****.

I remember when I matched into Derm and some of my med school friends and acquaintances were giving me grief about it. They were going into Emergency Medicine and Surgery to be *Real Doctors*!!!

Now the ER guy is bailing out and going to Big Rock Candy Mountain, huh?
As an ER doc, I so wish I did derm.

Totally had the scores and grades.

Man, what a mistake.
 

MOHS_01

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As an ER doc, I so wish I did derm.

Totally had the scores and grades.

Man, what a mistake.
Seriously, it's a grass is greener scenario. The entire house of medicine has gone to ****, it's just that you're more acutely aware of the variant you're stuck in.
 
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MedicineZ0Z

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What field is your friend in?

It doesn't take a rocket scientist to inject botox or filler.

That being said, my PA is having a tough week with cosmetic complications and is learning that complications will rapidly take away all the joy and profitability of doing cosmetic procedures.
What specific complications?
 

asmallchild

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What specific complications?
1. Unexplained rash and alopecia s/p Botox in an immunocompromised patient. Pt now demands hair transplant
2. Swelling s/p filler (which is completely normal and it not a complication). Pt states she has had numerous fillers before without a hint of swelling and now wants a refund

The point is, it’s not difficult to do these procedures. Dealing with complications (real or imagined, expected or unexpected), pt expectations (reasonable or unreasonable), and difficult patients in general is the hard part. It’s never easy to deal with the latter but you are better equipped if you have appropriate cosmetic training.
 
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asmallchild

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But how common is this? ACE inhibitors can cause life threatening angioedema, yet we still Rx them.
All of our routinely prescribed meds carry very rare side effects too.

FYI, derms/plastics have RNs do their cosmetic injections.
I don’t know what your last line is supposed to mean.

Derms have RNs do their cosmetic injections for them? Or to them?

N=1 but that’s a no on both accounts for me.
 
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1. Unexplained rash and alopecia s/p Botox in an immunocompromised patient. Pt now demands hair transplant
2. Swelling s/p filler (which is completely normal and it not a complication). Pt states she has had numerous fillers before without a hint of swelling and now wants a refund

The point is, it’s not difficult to do these procedures. Dealing with complications (real or imagined, expected or unexpected), pt expectations (reasonable or unreasonable), and difficult patients in general is the hard part. It’s never easy to deal with the latter but you are better equipped if you have appropriate cosmetic training.
Lol @ "pt now demands hair transplant." I'm sorry but that is one of the funniest posts in a while.
 
Jan 3, 2019
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I don’t know what your last line is supposed to mean.

Derms have RNs do their cosmetic injections for them? Or to them?

N=1 but that’s a no on both accounts for me.
LOTS of practices have their NPs/PA/RNs do cosmetics - whether it be Botox, fillers, PRP, etc. Maybe that's why complications have increased. I went for a consult for a thread lift on my face - I got this defensive, angry male nurse who essentially quizzed me about what I knew about thread lifts, told me I needed fillers, and when I told him I have n interest in fillers I'm interested in thread lifts as stated below, and told me "We are done, I can't work with her" Lol. Couldn't really explain basic facial anatomy, couldn't explain the procedure, etc. Medspa was owned by a physician.
 

MedicineZ0Z

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I don’t know what your last line is supposed to mean.

Derms have RNs do their cosmetic injections for them? Or to them?

N=1 but that’s a no on both accounts for me.
I'd honestly be surprised if even a sizeable minority of plastics/derm practices had the physician do cosmetic injections. If anything, I'd be surprised if it's even a midlevel. It's almost always an RN nowadays. Family doctors who do a lot of cosmetics take advantage of this in some places by marketing as "physician only" and they can charge more than what the derm charges when their RN does it.
 
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sore eye asses

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I'd honestly be surprised if even a sizeable minority of plastics/derm practices had the physician do cosmetic injections. If anything, I'd be surprised if it's even a midlevel. It's almost always an RN nowadays. Family doctors who do a lot of cosmetics take advantage of this in some places by marketing as "physician only" and they can charge more than what the derm charges when their RN does it.
In my practice all injections are performed by a highly trained house cat. He has taken all the relevant courses and has a rudimentary knowledge of facial anatomy. His demands for kibble have increased recently so we’re looking to the reptilian realm or perhaps feral pig workforce so we can keep our robust aesthetics practice cranking while disentangling ourselves from the feline tyranny. But damn it if that cat isn’t the best botoxer in the county. We’ll likely have to meet his demands. I’ll keep the board updated...
 
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Jan 3, 2019
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In my practice all injections are performed by a highly trained house cat. He has taken all the relevant courses and has a rudimentary knowledge of facial anatomy. His demands for kibble have increased recently so we’re looking to the reptilian realm or perhaps feral pig workforce so we can keep our robust aesthetics practice cranking while disentangling ourselves from the feline tyranny. But damn it if that cat isn’t the best botoxer in the county. We’ll likely have to meet his demands. I’ll keep the board updated...
Ah I remember you, you are the funny derm :)
 

dermie1985

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1. Unexplained rash and alopecia s/p Botox in an immunocompromised patient. Pt now demands hair transplant
2. Swelling s/p filler (which is completely normal and it not a complication). Pt states she has had numerous fillers before without a hint of swelling and now wants a refund

The point is, it’s not difficult to do these procedures. Dealing with complications (real or imagined, expected or unexpected), pt expectations (reasonable or unreasonable), and difficult patients in general is the hard part. It’s never easy to deal with the latter but you are better equipped if you have appropriate cosmetic training.
^ Agreed. I think people have misconceptions about the challenges of cosmetics. (1) more demanding patients that can *drain* you (2) dealing with complications on something the patient paid for, rather than insurance paid for (3) feeling more like a "provider" than a "physician" - e.g. you're just there to do what the patient wants. There's also lots of other issues, like volume / competition / setting prices / etc. Lasers are a whole other issue (they're expensive, how often will you use them?, should you rent one? buy one from the company? what's the maintenance contract cost?).

Personally, my practice has a number of dermatologists who are more heavy on cosmetics. I don't have any cosmetic slots for new patients, but I occasionally will do some (botox, filler, PDL, few other lasers) for select patients I see in clinic for other things and happen to mention cosmetic concerns at their visit. This way, I can screen out the high-maintenance, crazy patients (just send them to my "cosmetic" colleagues) and keep the normal ones that I think would be reasonable to do cosmetic procedures on.
 
Jan 3, 2019
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^ Agreed. I think people have misconceptions about the challenges of cosmetics. (1) more demanding patients that can *drain* you (2) dealing with complications on something the patient paid for, rather than insurance paid for (3) feeling more like a "provider" than a "physician" - e.g. you're just there to do what the patient wants. There's also lots of other issues, like volume / competition / setting prices / etc. Lasers are a whole other issue (they're expensive, how often will you use them?, should you rent one? buy one from the company? what's the maintenance contract cost?).

Personally, my practice has a number of dermatologists who are more heavy on cosmetics. I don't have any cosmetic slots for new patients, but I occasionally will do some (botox, filler, PDL, few other lasers) for select patients I see in clinic for other things and happen to mention cosmetic concerns at their visit. This way, I can screen out the high-maintenance, crazy patients (just send them to my "cosmetic" colleagues) and keep the normal ones that I think would be reasonable to do cosmetic procedures on.
Like there are challenges to cosmetics, it would be unrealistic to suggest that cosmetics is not profitable. There is a reason why many derms and other physicians go into cosmetics. Even if you are not making obscene amounts of money, cosmetics generally brings in a reasonable amount of cash particularly for the time invested. Many many patients are looking for cosmetic solutions to a multiplicity of problems - so while challenging sure beats dealing with insurance and peer to peers with people who have no clue.
 

Skindoc83

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Like there are challenges to cosmetics, it would be unrealistic to suggest that cosmetics is not profitable. There is a reason why many derms and other physicians go into cosmetics. Even if you are not making obscene amounts of money, cosmetics generally brings in a reasonable amount of cash particularly for the time invested. Many many patients are looking for cosmetic solutions to a multiplicity of problems - so while challenging sure beats dealing with insurance and peer to peers with people who have no clue.
false. It is this kind of thinking that causes family med docs to buy a bunch of lasers and open up a medi spa only to go under in a few months. one laser often costs over 100k not including the maintenance plan (a few grand a year) or the consumables (200 bucks a treatment). Fillers are several hundred dollars a syringe and expire. Each cosmetic appointment is a longer time slot, requiring more handholding, and is never a guarantee that the patient will buy a service, or even show up. Furthermore you are unlikely to be the only game in town. Not to mention the fact that most fillers and many lasers only provide subtle results, that many patients won’t appreciate. It is often more profitable to see more General derm patients than bother with cosmetics.
 
Jan 3, 2019
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false. It is this kind of thinking that causes family med docs to buy a bunch of lasers and open up a medi spa only to go under in a few months. one laser often costs over 100k not including the maintenance plan (a few grand a year) or the consumables (200 bucks a treatment). Fillers are several hundred dollars a syringe and expire. Each cosmetic appointment is a longer time slot, requiring more handholding, and is never a guarantee that the patient will buy a service, or even show up. Furthermore you are unlikely to be the only game in town. Not to mention the fact that most fillers and many lasers only provide subtle results, that many patients won’t appreciate. It is often more profitable to see more General derm patients than bother with cosmetics.
Lasers are a gamble I would agree, but to suggest that again cosmetics is not profitable is flawed in my opinion. Are we suggesting that all these people go into cosmetics because they love charity? Don't think so.
 

username456789

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Lasers are a gamble I would agree, but to suggest that again cosmetics is not profitable is flawed in my opinion. Are we suggesting that all these people go into cosmetics because they love charity? Don't think so.
Many of them go into it because, like you, they mistakenly think it’s more profitable than it is.
 

dermie1985

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Lasers are a gamble I would agree, but to suggest that again cosmetics is not profitable is flawed in my opinion. Are we suggesting that all these people go into cosmetics because they love charity? Don't think so.
It can profitable -- but it also takes an incredible amount of legwork, networking, business-savvy to make it profitable. Though, I'm sure in certain metro areas (LA, NYC) you can charge ridiculous premiums and cover the overhead. Where I work - you'd make way more $$$ seeing tons of follow-up skin checks (Level IV returns + cryotherapy / biopsy procedures) than doing all cosmetics.
 
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TheLesPaul

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But how common is this? ACE inhibitors can cause life threatening angioedema, yet we still Rx them.
All of our routinely prescribed meds carry very rare side effects too.

FYI, derms/plastics have RNs do their cosmetic injections.
Common enough that I see these complications several times a year in my (cosmetic) practice.
 

MOHS_01

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Shouldn't this be a question for the ER docs? Physician side gigs? :lame:
 
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