S ince botulinum toxin type A (Botox Cosmetic) was approved by the FDA in 2002, it’s no secret that its use has skyrocketed by trained and untrained providers alike. Many non-dermatologists and even dermatologists who aren’t primarily cosmetic dermatologists are now injecting Botox simply because there’s such a great deal of direct-to-consumer marketing behind this product that patients are demanding it. In addition, the number of non-dermatologists and even non-physicians who are injecting are also causing many general dermatologists to include Botox in their practices for fear of losing their patients altogether and the ability to provide them with overall skin care. I know of internists, anesthesiologists, pathologists and other non-dermatologists in my area who are now skincare “experts.” And you may be experiencing the same type of “phenomenon” in the geographic area in which you practice. Many cosmetic dermatologists who have included Botox in their practices for years are now injecting areas that previously would have been overlooked. This has occurred because the early adopters of Botox now have a comfort level with respect to safety and efficacy. Yet despite those who have a higher level of expertise, I still thought it would be appropriate to discuss some basic pointers as a refresher for seasoned users and impart something to newer injectors. Most Important Pointer The most important facet of injecting Botox is knowledge of technique and anatomy. No matter how many times I inject, I still benefit from viewing other practitioners give hands-on courses. I also try to review my favorite anatomy book and some of the groundbreaking articles a few times a year. Additionally, the Carruthers’ videotape is worth viewing annually. Updating Patient Care Information Patient care handouts can benefit from frequent updating to inform patients of the latest information. In addition, every year I update my consent forms and care sheets. Last year, I added the information from the Botox package insert to alert patients about possible side effects they may experience following the procedure such as headache, flu-like syndromes and a few other relevant precautions. On the flip side, I also mention to my patients that people who participated in studies with Botox and were in the placebo groups also experienced similar side effects as those who were injected with Botox. Other paperwork that would be considered basic but still important are the patient care sheets that I hand out to each patient following the procedure. These educational forms spell out what patients should and shouldn’t do. For copies of my consent form and a post-treatment care sheet for patients undergoing Botox injections, please visit my Web site (www.palmbeachcosmetic.com) and click on “Patient Forms.” Applying an Anesthetic Patient comfort may be enhanced by applying a topical anesthetic, such as ELA-Max, to the areas in which you’ll inject. You might be surprised at how much easier the procedure goes once the patient is comfortable. In my practice, we have made adding a topical anesthetic our standard policy, unless the patient prefers not to use it. This has made the procedure more comfortable and I think is a worthwhile addition to the experience. I have also purchased gel packs that we keep in the freezer. We use these before and after injections as another method of increasing patient comfort and decreasing bruising. The gel packs have our practice name and phone number on them, and patients may reuse them if they wish. In addition, if a patient has a question, then our number is always close at hand. Since some bruising is inevitable, I try to let my patients know that this may occur (one would not want this risk before a significant social event) and this possibility is spelled out in the consent form. In addition, I’ve purchased small packages of bruise concealer from Physicians Formula, and when I see the first signs of a bruise developing, we give patients this concealer so they can use the product immediately and won’t have to search for it to purchase. Bruising is certainly mitigated by applying pressure for 3 minutes to 6 minutes in the event that one inadvertently injures a vessel with the injection. Keeping the Eye Drops Handy The final bit of basic information that’s worth imparting is to have iopidine eye drops in the office. They’re readily available (for example, you can purchase them at Wilson Ophthalmic [www.hilco.com]), but these drops are difficult to get in a local pharmacy. In the event that one injects and the patient develops a partial ptosis, it’s helpful to have something to offer your patients. Clearly, it’s better to have a great injecting technique and avoid these issues. But when one injects all day, droop happens. One Step Ahead As we dermatologists face increasing pressure and competition from “outsiders” who portend to be skincare experts but who lack the years of training we dermatologists have, we need to be at the top of our game when it comes to honing and refreshing our skills and better communicating with our patients. By providing my patients with additional knowledge of the procedure and creating a comfortable environment for them while they undergo Botox injections, I have not only retained my patients and had them return for repeat procedures, but I’ve seen my word-of-mouth referrals grow.
Botox — Revisiting the Basics
S ince botulinum toxin type A (Botox Cosmetic) was approved by the FDA in 2002, it’s no secret that its use has skyrocketed by trained and untrained providers alike. Many non-dermatologists and even dermatologists who aren’t primarily cosmetic dermatologists are now injecting Botox simply because there’s such a great deal of direct-to-consumer marketing behind this product that patients are demanding it. In addition, the number of non-dermatologists and even non-physicians who are injecting are also causing many general dermatologists to include Botox in their practices for fear of losing their patients altogether and the ability to provide them with overall skin care. I know of internists, anesthesiologists, pathologists and other non-dermatologists in my area who are now skincare “experts.” And you may be experiencing the same type of “phenomenon” in the geographic area in which you practice. Many cosmetic dermatologists who have included Botox in their practices for years are now injecting areas that previously would have been overlooked. This has occurred because the early adopters of Botox now have a comfort level with respect to safety and efficacy. Yet despite those who have a higher level of expertise, I still thought it would be appropriate to discuss some basic pointers as a refresher for seasoned users and impart something to newer injectors. Most Important Pointer The most important facet of injecting Botox is knowledge of technique and anatomy. No matter how many times I inject, I still benefit from viewing other practitioners give hands-on courses. I also try to review my favorite anatomy book and some of the groundbreaking articles a few times a year. Additionally, the Carruthers’ videotape is worth viewing annually. Updating Patient Care Information Patient care handouts can benefit from frequent updating to inform patients of the latest information. In addition, every year I update my consent forms and care sheets. Last year, I added the information from the Botox package insert to alert patients about possible side effects they may experience following the procedure such as headache, flu-like syndromes and a few other relevant precautions. On the flip side, I also mention to my patients that people who participated in studies with Botox and were in the placebo groups also experienced similar side effects as those who were injected with Botox. Other paperwork that would be considered basic but still important are the patient care sheets that I hand out to each patient following the procedure. These educational forms spell out what patients should and shouldn’t do. For copies of my consent form and a post-treatment care sheet for patients undergoing Botox injections, please visit my Web site (www.palmbeachcosmetic.com) and click on “Patient Forms.” Applying an Anesthetic Patient comfort may be enhanced by applying a topical anesthetic, such as ELA-Max, to the areas in which you’ll inject. You might be surprised at how much easier the procedure goes once the patient is comfortable. In my practice, we have made adding a topical anesthetic our standard policy, unless the patient prefers not to use it. This has made the procedure more comfortable and I think is a worthwhile addition to the experience. I have also purchased gel packs that we keep in the freezer. We use these before and after injections as another method of increasing patient comfort and decreasing bruising. The gel packs have our practice name and phone number on them, and patients may reuse them if they wish. In addition, if a patient has a question, then our number is always close at hand. Since some bruising is inevitable, I try to let my patients know that this may occur (one would not want this risk before a significant social event) and this possibility is spelled out in the consent form. In addition, I’ve purchased small packages of bruise concealer from Physicians Formula, and when I see the first signs of a bruise developing, we give patients this concealer so they can use the product immediately and won’t have to search for it to purchase. Bruising is certainly mitigated by applying pressure for 3 minutes to 6 minutes in the event that one inadvertently injures a vessel with the injection. Keeping the Eye Drops Handy The final bit of basic information that’s worth imparting is to have iopidine eye drops in the office. They’re readily available (for example, you can purchase them at Wilson Ophthalmic [www.hilco.com]), but these drops are difficult to get in a local pharmacy. In the event that one injects and the patient develops a partial ptosis, it’s helpful to have something to offer your patients. Clearly, it’s better to have a great injecting technique and avoid these issues. But when one injects all day, droop happens. One Step Ahead As we dermatologists face increasing pressure and competition from “outsiders” who portend to be skincare experts but who lack the years of training we dermatologists have, we need to be at the top of our game when it comes to honing and refreshing our skills and better communicating with our patients. By providing my patients with additional knowledge of the procedure and creating a comfortable environment for them while they undergo Botox injections, I have not only retained my patients and had them return for repeat procedures, but I’ve seen my word-of-mouth referrals grow.
S ince botulinum toxin type A (Botox Cosmetic) was approved by the FDA in 2002, it’s no secret that its use has skyrocketed by trained and untrained providers alike. Many non-dermatologists and even dermatologists who aren’t primarily cosmetic dermatologists are now injecting Botox simply because there’s such a great deal of direct-to-consumer marketing behind this product that patients are demanding it. In addition, the number of non-dermatologists and even non-physicians who are injecting are also causing many general dermatologists to include Botox in their practices for fear of losing their patients altogether and the ability to provide them with overall skin care. I know of internists, anesthesiologists, pathologists and other non-dermatologists in my area who are now skincare “experts.” And you may be experiencing the same type of “phenomenon” in the geographic area in which you practice. Many cosmetic dermatologists who have included Botox in their practices for years are now injecting areas that previously would have been overlooked. This has occurred because the early adopters of Botox now have a comfort level with respect to safety and efficacy. Yet despite those who have a higher level of expertise, I still thought it would be appropriate to discuss some basic pointers as a refresher for seasoned users and impart something to newer injectors. Most Important Pointer The most important facet of injecting Botox is knowledge of technique and anatomy. No matter how many times I inject, I still benefit from viewing other practitioners give hands-on courses. I also try to review my favorite anatomy book and some of the groundbreaking articles a few times a year. Additionally, the Carruthers’ videotape is worth viewing annually. Updating Patient Care Information Patient care handouts can benefit from frequent updating to inform patients of the latest information. In addition, every year I update my consent forms and care sheets. Last year, I added the information from the Botox package insert to alert patients about possible side effects they may experience following the procedure such as headache, flu-like syndromes and a few other relevant precautions. On the flip side, I also mention to my patients that people who participated in studies with Botox and were in the placebo groups also experienced similar side effects as those who were injected with Botox. Other paperwork that would be considered basic but still important are the patient care sheets that I hand out to each patient following the procedure. These educational forms spell out what patients should and shouldn’t do. For copies of my consent form and a post-treatment care sheet for patients undergoing Botox injections, please visit my Web site (www.palmbeachcosmetic.com) and click on “Patient Forms.” Applying an Anesthetic Patient comfort may be enhanced by applying a topical anesthetic, such as ELA-Max, to the areas in which you’ll inject. You might be surprised at how much easier the procedure goes once the patient is comfortable. In my practice, we have made adding a topical anesthetic our standard policy, unless the patient prefers not to use it. This has made the procedure more comfortable and I think is a worthwhile addition to the experience. I have also purchased gel packs that we keep in the freezer. We use these before and after injections as another method of increasing patient comfort and decreasing bruising. The gel packs have our practice name and phone number on them, and patients may reuse them if they wish. In addition, if a patient has a question, then our number is always close at hand. Since some bruising is inevitable, I try to let my patients know that this may occur (one would not want this risk before a significant social event) and this possibility is spelled out in the consent form. In addition, I’ve purchased small packages of bruise concealer from Physicians Formula, and when I see the first signs of a bruise developing, we give patients this concealer so they can use the product immediately and won’t have to search for it to purchase. Bruising is certainly mitigated by applying pressure for 3 minutes to 6 minutes in the event that one inadvertently injures a vessel with the injection. Keeping the Eye Drops Handy The final bit of basic information that’s worth imparting is to have iopidine eye drops in the office. They’re readily available (for example, you can purchase them at Wilson Ophthalmic [www.hilco.com]), but these drops are difficult to get in a local pharmacy. In the event that one injects and the patient develops a partial ptosis, it’s helpful to have something to offer your patients. Clearly, it’s better to have a great injecting technique and avoid these issues. But when one injects all day, droop happens. One Step Ahead As we dermatologists face increasing pressure and competition from “outsiders” who portend to be skincare experts but who lack the years of training we dermatologists have, we need to be at the top of our game when it comes to honing and refreshing our skills and better communicating with our patients. By providing my patients with additional knowledge of the procedure and creating a comfortable environment for them while they undergo Botox injections, I have not only retained my patients and had them return for repeat procedures, but I’ve seen my word-of-mouth referrals grow.
