Today is a discussion that has needed to happen for quite sometime and it is solely focused on the current state of aesthetic medicine. As a patient, it is critical that you understand aesthetic medicine as a whole and that it is just that– medicine. As a provider, I think it’s time we band together to start calling out the bologna and elevate the specialty to the realm it deserves. There’s going to a be a lot of hot takes in this blog, so buckle your seatbelts!

First Off, Aesthetics IS Medicine

Let’s start the scene. When you see a provider for a medical issue, you are prescribed a treatment plan or given a solution by someone who is either a Nurse Practitioner, Physician Associate, or Physician (MD or DO). While it is not incredibly rare that a patient comes to a provider nowadays with their treatment plan already somewhat figured out thanks to WebMD and the like, it is fairly rare that a patient would insist on a specific treatment or argue with their provider about what medication they are to prescribe, as the provider is seen as the professional.

In the aesthetics industry, however, it is a bit of a different story. More often than not, patients show up to initial consultations with an idea of what they “need” based on what they’ve seen on social media. Sometimes the patient is exactly right and, sometimes, they arrive and their proposed treatment plan couldn’t be farther from what I actually propose as the treatment plan.

As most of you know, I’ve been in the aesthetics industry for quite sometime (I like that verbiage better than using the year number since I try to pretend I’m far younger than I actually am) and during that time, I’ve very gratefully had my hands on pretty much any and every FDA-approved injectable on the market at one point or another. This means I’ve had the opportunity to see what works (or doesn’t), what does or doesn’t hold up over time, and what has the best safety profile. As a provider, I then use that information to make the best decision about what medication is the best treatment option for you based on your concerns and medical history. That is the role of the provider and it is a similar situation to primary care or any other specialty of medicine, as the provider is seeing through their expertise what is typically the best fit for each patient they’re seeing. It is all individualized care.

The issue lies in that while most patients wouldn’t argue with their provider and tell them that they don’t think they should be prescribed an ACE inhibitor for their hypertension, but instead are probably better suited for a calcium channel blocker, patients do typically tend to specifically request a specific brand of FDA-approved medications for aesthetic use such as Botox or Juvederm-brand fillers. But why is that? Why are other specialists seen as just that, yet aesthetic providers are sometimes treated as if we are just injectors and nothing more?

More Stickiness of Aesthetics

The issue with aesthetics gets deeper. Aesthetic medicine is a field that is solely based on cosmetic use. That means that for good or bad, there’s a lot that goes on that is far different from other areas of medicine. You no longer see an aesthetic injector in just a plastic surgeon or dermatologist’s office. For instance, there are technically MAs, aestheticians, CNAs, LPNs, and RNs seeing you in MedSpas, mobile vans, and even in your own home prescribing medication for you.

Any credential below a provider (NP, PA, MD, or DO) legally cannot assess and prescribe for patients, so that means that if we are getting down to the nitty gritty, all other providers are practicing outside of their scope or are practicing illegally if they do not have a provider assessing their patients or providing a Good Faith Examination. To my knowledge, no other area of medicine does this occur in and it is a huge problem that honestly makes me sick, but that’s a topic for another day.

In addition to the laxity in regulation of who is injecting, there’s a lot of laxity in that patients feel more empowered to steer their treatment thanks to the amount of emphasis on aesthetic medicine on social media. While this has been a great thing in decreasing the stigma surrounding aesthetic procedures and in empowering patients with (hopefully accurate) knowledge, it also makes them familiar with treatments that they might not be a candidate for.

While in other fields you would have a specialist that is credentialed building a treatment plan, some patients are being seen by uncredentialed providers or by those that are solely money-focused, meaning that when you are the provider that refuses to administer treatments if the the risk outweighs the benefit or if the patient is not a candidate, you are left living in the world I currently reside in and it is an at times quite bitter one.

While I try to focus solely on prioritizing my patient and their safety, being an honest and ethical provider, and helping patients achieve their best and most confident version of themself, I watch as some of those around me hold the same job as I do without actually taking the legal road of being a provider, profit off of taking advantage of patients, coerce patients into unnecessary treatments that aren’t based on any evidence whatsoever, put patient’s safety at risk, and seemingly are coming out ahead.

But Wait… There’s More!

If all the above wasn’t bad enough, let’s go ahead and add in that patients are also being swayed into treatments by aesthetic manufacturers, which are pharmaceutical companies. For instance, Allergan (the maker behind the brands you know such as Botox and Juvederm) has now rolled out Alle Pay, tying patients directly to their products alone, aka forcing providers to prescribe their medications (after all, that’s what they are). This isn’t totally new, as we have had both Botox Days and Juvederm Day in the past, allowing patients to prepurchase amounts to be used toward Botox and Juvederm dermal fillers with the added bonus of incentivized pricing, and there have been promotions of getting free syringes of filler with purchases of Allergan implants.

This is all fine and well, but again, we don’t see Zoloft days or Synthroid days, now do we? Have you ever heard of getting a free year of Prilosec if you have a double, triple, or quadruple bypass? NO! Instead, patients and providers work together to find the treatment plan that works best based on their expertise.

Add Lack of Standardized Education As A Sprinkle on Top

Lastly, maybe the largest issue of all is that there’s no standardized education in aesthetics. This is a topic I could write an entire blog on alone, and maybe I will in the future, but today I’ll just keep it as concise as possible. While I am so, so thankful for the years working alongside both dermatologists and plastic surgeons to obtain the firm foundation I use to safely and effectively treat my patients, that isn’t a requirement. In fact, there’s really no required education for it, so you as the patient are left being the investigator in finding the experience, training, and credentials of the person treating you.

Ending My Rant

In conclusion, whether you’re a patient, a provider thinking of getting into aesthetics, or a fellow aesthetics provider, I think we can all agree that aesthetics has a very dark underbelly and it continues to progressively get darker the longer I’m in it.

I do want to emphasize that even with all of the nonsense that takes place, I wouldn’t trade my career for the world. That said though, it is time to call it for what it is and it’s time for change. Everyone deserves better.

While I am thankful I had the opportunity to open my own clinic so I would know with assurance that all things were being done honestly, ethically, and to the highest degree, unfortunately the solid truth is that I can only control me. However, there is power in numbers.

What can you do?
As a patient: Research your injector and only allow legally credentialed individuals to inject you (this is state dependent as to who can legally inject). Trust the expertise of your provider and allow them to build your treatment plan, as they are the expert after all. Don’t fall prey to marketing gimmicks from aesthetic companies that try to force you into being affiliated with their brand only, as your provider should be making that decision for you based on your personalized health history and physical examination. Don’t enable bad practices such as Botox parties, allowing an injector to treat you in a mobile van (I can’t believe I’m typing that, but it is a real thing), or in your home. Treat aesthetics as you would any other specialty of medicine, as you deserve only the best.

As a provider: Let’s be better! Join me in prioritizing patients over profit, which means: saying no to things such as Botox parties, injecting patients in salons, pushing for ineffective treatments that aren’t backed in science, giving patients unnecessary or trending treatments they don’t need, selling gimmicky skincare treatments that have zero research behind them, not performing treatments you do not know how to safely perform/do not know how to safely manage complications of, allowing patients to tell you what they need instead of being the expert that builds a treatment plan, investing in continuing education constantly… even if you’ve been injecting for years, assessing your patient, and practicing within your legal scope of practice.

I love my job and this specialty, but something’s gotta give.
Let’s make aesthetics SAFE again.

Until next time,

Blakelee Paige Smith, MSN, APRN, AGPCNP-BC, NP-C
Dual Board-Certified Nurse Practitioner + Owner
Skin + Aesthetics

[As a reminder, all blogs are sole property of Blakelee Paige Smith, NP and Skin & Aesthetics TN LLC. Blogs are not to be copied or distributed, neither partially or in entirety. All rights reserved.]