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Aesthetics Practice Today

Who Can and Should Be Allowed to Inject?

Published January 17, 2012 7:51 AM by Cindy Cobb

Who should be allowed to inject botulinum toxins and dermal fillers? I live and own a clinic in Louisiana, and the state's Board of Nursing recently issued a statement about this. The board stated that certain nurse practitioner specialties are allowed to inject both botulinum toxins and dermal fillers, if they have been trained to do so and if they are practicing collaboratively with a physician who provides aesthetic services. However, RNs are allowed to inject only toxins -- if they have received training and only if a physician or nurse practitioner is present in office. The board's opinion excludes RNs from injecting dermal fillers.

Interestingly, the board that regulates licensed practical nursing in Louisiana allows LPNs to inject toxins under the same circumstances as RNs, with the exception that a physician must be present. Their statement was released in 2010.

The Board of Nursing statement raises a couple of issues. What about RNs who began injecting fillers prior to the publication of this opinion? What about RNs who have been injecting without a physician or nurse practitioner present but who operate under written protocol or standing orders? The statement additionally limits nurse practitioner practice owners who have RN employees, now requiring their presence at all times.

What about estheticians injecting botulinum toxin? This occurs in my medical community. To my knowledge, the Board of Cosmetology in Louisiana has not issued a statement deeming it to be within the scope of practice for estheticians to perform injections. One of the first questions estheticians ask when I hire them is, "When are you going to teach me how to inject Botox?" My response, "As far I can determine, it is not within your scope according to your board."

I'd like to hear your thoughts on who you think should be allowed to inject and under what circumstances.



Honestly, I must disagree. It’s not an art of injecting, and it’s not only training. It must be done by a certified doctor, ant the reason why is because, in 7 years of medical studies, we know more than anyone, on what’s going on a patient, and on Aesthetic medicine, if the patient has an illness issue, we know how to solve it. If a nurse, or anyone who is not a doctor, just trained to inject does it without knowing the illness of a patient, it could have great trouble to send the patient to a certified doctor to solve that issue, when doctors knows when its appropriate, and when not, to treat a patient. Aesthetic medicine is not only injections, its more than that, its endocrinology, anatomy, physiology and more, all what we have learned in 7 years of studies plus the other 5 years of career and 1 - 2 years of aesthetic medicine. So until there is a big problem on patients health because of a Nurse practitioner doing only "injectable" the law will change, and nurses only can be allowed to do topic treatments, and some should be with the presence of a doctor. As always, Nurses always has to be the hands of a doctor, and guided by doctors, never acting by themselves, because of their limited knowledge.

Nestor Luglio, General Medicine - Doctor , MD Aesthetic Medicine April 26, 2018 5:24 AM

Honestly... I think anyone with a medical license, LPN, RN, PA or MD can inject fillers with additional training. Why should it matter ? As long as an MD or RN is with an LPN?LVN why couldnt they inject ? Titles do not determine expertise in artistry.... Also, LPNs have a license to administer medications much more intense than botox. I do not see any ligitimate concern here...

Debora Briggs, Disability - RN December 17, 2013 8:41 AM
Hanover PA

I'm here in CA. The only practitioners allowed to inject are licensed: MD's, PA's, NP's and RN's. Not LVN's. They've closed facilities down where they've found non-licenced personel injecting. It's a medical treatment and needs to be done by a medical provider. I once had a patient tell me that he got his Botox and fillers from another country and injected himself at home. I asked what he would do if he encountered a problem. And he said, "I won't have a problem". My response was, "And therein lies the problem". It's not just injecting, but knowing what problems might arise and how to fix them.

Gigi, Aesthetics - FMP May 27, 2012 4:27 PM

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    Occupation: Physician Assistant/Nurse Practitioner
    Setting: Miami & Upland, Calif.
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