I have seen some family practitioners get some kind of board certification in cosmetic medicine and have their names posted on the allergan site for being certified in botox injections .Any one know what kind of board certification this is

I do not believe that it is board certification. I believe that it is certification from Allergan. If you contact Allergan, they will tell you where you may be certified by them. Then, if you purchase a certain amount of product and obtain CME credits in cosmetic education, then they will put you on their web site as reccommended.

I believe you need to have ordered 12 vials from them.

actually it is 10 vials

When I graduated from med school, only me and another guy got into a derm residency - and he had a PhD in Immunology before getting into med school. The OB's and FP's were at the bottom of the class. Now they want to get into cosmetic dermatology for the money - but they are NOT TRAINED to do anything with skin. Derm is a 3 year residency - these people know so little they don't have a clue how little they know. Studies have shown that when primary care physicians get minimal (like 4-6 weeks) of Derm training, they begin to see that it's an incredibly complex field of which they know not, and the number of referrals to derms INCREASES - the more training they receive, the more they refer.

The Cosmetic companies and laser companies are all in it for the money so they don't care WHO they sell to. This is all going to change - the policy makers are already working on it so these FP's etc who are going into it better have their own practice of sore throats and earaches to fall back on since the balloon is about to bust.

Sounds as though LS has a chip on his shoulder. I think you need to take a look at some of your assumptions. One is that you are smarter than everyone else (there is always someone smarter) FP's are in the bottom of their class (I was in the top 10% as are many FP's) and that dermatology residency gives you some super powers when it comes to procedures involving the skin (I have seen some poor results from derm docs I have had to correct).

I would also like to see the research where it shows that FP's refer more as they have more training (some just get lazy). I actually refer less and believe it or not I even prescribe Accutane. I remove skin cancers including from the face and also do flaps with very nice results. Yes, I believe we need derm doc's and yes derm is a complex field and deserve my respect. I do not think they have the corner on the cosmetic market as in most cases derms have only done a few of the procedures in their residency, if any at all. I do more of the cosmetic procedures in my community, of 150,000 people, than all or most of the derms. As our derms are extremely busy doing derm that they only dabble in cosmetic procedures.

So the question comes down to who you want to do the procedure? The derm doc that does a lip augmentation once a month or the FP that does a couple a week? When commenting on a forum you may want to look at your audience. Many of the individuals on this site are the dopey FP's and OB's you seem to look down upon. Remember, if you are a good doc and good at what you do the patients will come. I hope that you are an excellent dermatologist and so busy you do not need to worry about us dopes out here.

I would also like to know what you think of all the plastic surgeons and derms that have nurses or midlevels do most of their cosmetic minimally invasive procedures. I would have to assume this makes your blood boil as they weren't even smart enough to get into medical school (to all of the nurses and midlevels on here please forgive this last comment as I know many of you that do a better job than some of the derms).

This web site is for ALL of the providers to learn from each other. If you are truely worried about the dopey people doing these procedures and patient safety, then you should be the one at the front of the line teaching these dopes how to do the procedures correctly. But my guess is that you will be the one at the front of the line trying to legislate others out of business mainly because you are afraid of the competition.

Well said LH. I am boarded in FP. I did 3 years of General Surgery and three years of FP. Granted FP was never a tough residency to get into, but the reason for that is not because it is a less demanding specialty, but because insurance and medicare compensation is biased towards procedural specialties (although this is rapidly changing). None the less, some of the top students in my class went into FP. So when I read someone writing that FP and Ob's are at the "bottom of the class" I get a little hot under the collar. It is commonly beleived that all we FP's do are treat "sore throats and ear aches". With 6 years of residency under my belt, not three, and having spent the past 10 years practicing ER, I'm comfortable with all areas of medicine, not just the skin. I've treated septic shock, Acute myocardial infarct, severe trauma, I've intubated more patient's than I can remember,
i've treated 1st, 2nd AND 3rd degree burns,severe scalp and facial lacerations, I've even sewn on a few ears (with excellent cosmesis by the way) and yes, I've treated several dermatologists along the way. I think one had a Otitis Media or an "earache" as you call it.
So let me asks you something LS...The argument I've heard is that you have to be a dermatologist to treat complications to a laser or other cosmetic procedure. If a patient has an anaphylactic reaction to lidocaine, for example, What are you going to do? The best you can do is call an ambulance and let a real doctor handle it.

I am an oculoplastic surgeon who has been doing cosmetic surgery for 10 years. You must have a good background and many hours of honest cme including cadavar lab, dissection, in OR training and preceptorships before performing procedures that are not traditionally in your area of training.

That being said you must also delineate what is simply "barrier to entry" into a procedure". I am boarded in neurology as well as ophthalmology and have been using botox in facial muscles for over 20 years. I find it comical and troubling to hear practitioners - often plastic surgeons adn derms who had not even heard of botox 5 years ago state that only they have the right to perform the procedure!

This is but one example of many.

Thank you for your comments Oculoplastics. I couldn't agree more. Until recently (as you stated, 5 years) most PS and Derms learned these procedures by attending post-residency CME. And even now, the technology is advancing so rapidly, that it would be impossible to get trained on all the new technology while still in residency. Sculptra, for example, has only been FDA approved within the past year. Fraxel, three years ago, was not even on the market.
As you stated, "you must have a good background and many hours of honest CME...before performing procedures that are not traditionally in your area of training". I couldn't agree more. One can expand on your argument, however, to include dermatologists. Because cosmetic medicine has not "traditionally" been a part of dermatology training either. The word "tradition" by my definition implies a greater time span than only a few years. And it has only been a very short time since dermatolgy has incorporated lasers, fillers, and Botox into their curriculum. When I completed my residency which wasn't more than 10 years ago, none of laser or filler technology that we are using today had been invented, or were so early in developement that they were impractical for widespread clinical use. The question in my mind remains as to why a non Derm/PS board certified MD/DO can't perform these procedures as well as a derm or PS given adequate training. I think the answer is that they (we) can.

The problem is that medicine has never moved beyond the medieval apprentice/journeyman/ master guild mentality. I know a plastic surgeon who trained in detroit and did not perform a single cosmetic breast enlargement during his training.

We need to get away from the guild mentality, do away with traditional residency training which is falling by the wayside in any case and consider a more scientific and reproducible method of training.

This should include a core training in surgical technique for example followed by carefully delineated(number of procedures seen, number assisted, number of patients evaluated under supervision etc.) and certify physicians in each individual procedure that they perform.

if desired a certain number of core competencies would allow one to call oneself a specialist whether in cardiology or cosmetic surgery etc,

Oculoplastics:

I agree with you 100%. I also believe that the traditional residency program is archaic. Of ccourse it works well for the hospitals who have residents work 110hrs a week for minimum wage. (I'd love to have some work for me for those kind of wages!!!) But, for surgoens who are doing "simple" cosmetic procedures, it certainly doesn't take 9 years of residency to become proficient in a breast aug. for example. Be that as it may, if you look at the posts on Medical Spa MD's: What is you're problem...you will find some interest in developing an unique specialty of cosmetic medicine open to surgeon's and non-surgeons. My vision is similar to yours in that there would be a mechanism to certify each physician not only in the general field, but in each procedure. For example those who have had some surgical training like myself would be able to get "certified" to do liposuction for example once proficiency has been established by CME and/or a proctorship. The same for IPL, botox, fillers etc. Each candidate would be able to obtain certification and credentialing for any procedure he/she is interested in. I see no reason why a physician has to spend 9 years of residency to learn how to do a breast augmentation for example. Please let me know if you are willing to commit some time and perhaps some funds to this project. This is strictly a not-for profit venture. thank you.

I firmly believe that dermatologists are not the only specialist that may perform “Cosmetic Medicine " procedures. I have had the pleasure of meeting some of the best Ocluoplastic surgeons, FP, OB-Gyn and varied other medical specialists that can and do learn lip augmentation and laser procedures effectively within a short period of training. Derms and Plastics have never had the ability to care for NICA needs as a single specialty or composed of the two. The doctors desiring to implement cosmesis programs need something that derms and plastics have never had within their programs…. namely, ingenuity beyond standardization or traditional medicine practice. Every medical specialist (from ER Medicine-Psychiatry) can implement a comprehensive facial aesthetics management program that addresses the woman’s quest to have a “physician” present a multi-layered level of aesthetic procedures. These programs would work on the 5 principles developed and implemented for all doctors, nurses and aestheticians to continue to work within the medical paradigm and still offer clinical services that were not so traditionally accepted. With the ever-changing dynamics of our society, I believe the “patient/client and customer “will turn eventually to a Medical Aesthetics Program rather than seeking a medication from the derm (8 minute time frame) or scalpel from plastics. The doctor/surgeon desiring to stay competive, financially sound and address the “patients” needs, will find implementing a Medical Aesthetics Practice can facilitate his/her concerns. I would like to tell all dermatologists that there just is no need to put down other medical specialists for getting into the skin/cosmetic work. Dermatologists by training were never recognized more than doctors that just did not take aesthetics seriously as compared to their “Medical Mentality” until Cosmetic Dermatology was finally accepted. These traditional dermatologists realized they were missing a financial link when they saw nurses/aestheticians performing laser procedures and doing financially well. My final opinion is that our aging society will demand more than a medication or scalpel to address their aesthetic concerns. There really is room for varied medical specialists to prepare their practice for a bold future by integrating competive and safe therapeutic procedures that requires the physician, nurse and aesthetician to work as a team. Let us work together. Stop the Turf Interspeciality War of Words.

Good one LH,

As a fellow dumb GP I cant help remembering the patient with erythroderma from ACE (HTN also Type 2 DM etc) where the Derm stopped everything and treated with high dose prednisone, followed by the IM chap who did not feel he had to deal with the subsequent hypertension or the GS who agreed he had abdo pain but gave no suggestions. (Fore gut necrosis). We are not all made the same we all need help and advice.
I was lucky and eventually asked the right person for help.

I work in the UK and its interesting to note that some of the biggest injectable clinics here are run by ex-nurse phlebs and anesthetists..as well as dentists? Actually, one dentist is has the biggest name in facial cosmetics who is famous world-wide...dr.bob khanna as he is on many international societies.... As far as ive seen, dermatologists and plastic surgeons were too busy making money from other procedures before realizing that Botox,lasers..etc. was lucrative and then entered this field later on and are now lagging behind the competition....the nurse phleb here in U.K. usually has more experience as that is all she/he does.
Anyway, the problem with our profession is that we pull each others leg to succeed rather than support each other....

I agree with UK Doc we do pull each others leg in order to succeed than to support each other-which is a shame, but credit where it s due to those who are doing well in our prof. Talking of dentists, I find it incredible that more and more are getting trained in this however, I have heard about dentist Bob Khanna but incredibly awful things about him and his treatments. You will probably only find dentists partaking with him as unfortunately they don't know any better. I don't think for one bit that he is internationally known! It is a shame that someone in a profession can bring others down either by pulling their leg or by doing a rubbish job. Praise for those who do well and are known for their art, including the nurses. I agree that these things take time to perfect and it is a shame that we have amateurs attempting to teach our younger generation about aesthetic medicine for the sake of making a business.

Interesting thread. I am a FP with over 100 training hours in esthtics, have read everything from Goldman in sight and do very nice IPL and Erbium peels with a Sciton. I went to the local Derms asking if we could partner and bring my laser into their office after showing them some nice before-after pix. They were all terrified at the discussion of laser in their office. One gentleman explained to me that the senior partner sends his patients to a friend and hour away, but it is too far. Then he sends them to another derm around the block, but everyone hates her due to attitude. When I called back to see what the senior partner said, he was flustered shooting be down and said, "WE don't even feel comfortable doing laser." I guess his osmotic understanding of laser was clearly more than my tangible training. In some areas there is no choice for a patient, but a lowly FP like me. I am looking into board certification with the ABLS, which has been rejected by the "college" but is some showing of qualification.

I have a friend who is a pharmacist, and her husband is a dentist. She wants to practice laser hair removal, and botox injection and so on. She will go for training. Can she do that? I thought that only doctors can perform, and purchase equipment, and medications.

Pharmacists can not practice medicine. She needs to talk to a lawyer before she wastes her time. She will likely make more money as a pharmacist than she will doing LHR.

Thank you for all of your posting. I learn a lot just from reading all of your comments. I feel really good reading some of comments especially from MG and LH. I am a family practice physician, and interested in doing botox, mesotherapy but don't know where to start. If anyone knows where I can go for training, please let me know.
Thank you again for all of your comments.

YNL,

Where are you located? You may be able to come spend some time at my clinic. I have always learned more from other physicians than I have at most conferences.

Hi, LH
I am so happy that I get your response. I just found this website accidentally and don't know if anyone would write back.
I am in Springfield, VA.
Thank you for the invitation. I would love to come to your clinic but I am don't have much to offer when it comes to these anti-aging procedures. I am looking for a good hand on training for Botox, and dermal filler. I am a female, and looks young myself. I have so many female patients asking me if I can give Botox or dermal filler. I always think about it, but don't know where to start.
Do you offer any training in your office. If you do, please let me know. I would like to be trained by one of the physician. I just love your comments, and feel that you are a very humble and kind person. There are so many training/certification classes out there but I don't know if I am going to get a good training. So, please let me know if you can help.
Thank you again LH.

Dear YNL: I have some other options you might want to consider. Can you provide your e-mail address?

RON

YNL,

You can contact me by e-mail at lornell@lazaderm.com

LH

Hi, Mr. Ronald
Thank you for asking. My email address is nle3@yahoo.com.
I am very glad that I found this site with so many nice people who are willing to help each other.

Hi, Mr. Ronald
Thank you for asking. My email address is nle3@yahoo.com.
I am very glad that I found this site with so many nice people who are willing to help each other.

Hi Ron,
I am getting into my 3rd year FP residency, would love to get some info where i could get some hands training and certifications on some of the procedures discussed above. I am in VA. my email address is ihsansani@hotmail.com

Thanks!

Hi Ron,
I am getting into my 3rd year FP residency, would love to get some info where i could get some hands training and certifications on some of the procedures discussed above. I am in VA. my email address is ihsansani@hotmail.com

Thanks!

is it legal for a doctor in USA to order botox and fillers through medicaspaRX because these products are from europe

thanks

Why would you need a botox certification?
As long as you are a licensed physician, you can then inject botox.
For botox, I dont think there is ever a certification program, except direct training and
certification by botox allergan. Please enlighten me if I am on the wrong spectrum of the wavelength here.

LS, LS, LS-come on!
I am almost certain that your Derm attendings never took you aside and showed you how to inject botox/fillers.
I am a plastic surgeon and I was never hand held in these procedures- I actually learned them from watching videos and belive it or not a Dentist for the dental blocks. Anyhow, the number one injector in my practice is not even a doc-it is a nurse (as seen in many other practices)-she is awesome and has a large client base. So, my advise to you would be to concentrate on building your practice and using this forum as a way to enhance your knowledge-you can learn from everyone-nurses, aestheticians, PA's, and even FP's!!!!!!

Anyway I also think about who you want giving you your flu shot every year. Your over worked GP/FP doc or his or her nurse. Unless it was an ER doc or someone who handle syringes a lot I would personally go running, screaming into the night if a doc came at me with a needle. LOL My personal GP hasn't touched a syringe in years

That might be the case with your GP/FP, but no need to perpetuate and extend this typical nurse vs doctor stereotype to all GP/FP.

Just because you as a nurse think nurses inject more and better than all GP/FP doctors it does not mean it's true, and your comment surely needs to be corrected.

MH

I just found this blog and I am excited to see the exchange in the posts...I am a FNP working in rural medicine and am wanting to teach other providers to perform botox, restylane and teach them how to market these services to improve revenue in their practices. Do you know if there are any legal restrictions to teaching others if I have been trained in aesthetics cme classes and hands on with a physician?

You should have a lot of experience before you start teaching. It sounds like you do not have much experience with these injectables.

I'm waiting for my license to come from Sacramento and would really love to work with some of you and learn some procedures. If anybody is in the L.A. area and would like to teach to a newbie, please let me know! Thanks.

Hi,
I am in 3rd year FP residency, would like to get more hands on training and certifications on some of the procedures - botox, fillers, laser etc. I am in Ewing, NJ my email address is skhokher11@yahoo.ca

Thanks.

I am a newly grad FP,who has never seen herself being at the botom of medical or any other classes....
I dont really feel I need to show off my credentials to convience anybody that with proper trainning I can do a good job in Cosmetic medicine.I dont understand this need from certain specialties to prove themself by putting FP down.
Dear 3 y derm residency and all other specialists ,we all provide healthcare to people , I need your knowledge and I hope you now that you need mine.

Don and LH,

I am an RN and a dentist, along side with my husband, a physician, would like to learn doing Botox and injectable fillers. Please direct us to a reputable course or practitioner willing to train newbies. Thank you so much.

By the way, my husband's medical class was Pass/Fail... Nobody knew their ranking.. He went on to do general surgery and later switched to radiology, and finished a 2 year fellowship at Harvard. So for LS to make assumptions that Derm are better/smarter than other docs, that will come back to haunt him/her.

@Amy, There are a couple of courses that I'd recommend. First, I'd start with Botox Training MD which is a pretty comprehensive online course and costs less than $500. (It's an entire course on video that's the same course that is in a two day seminar but having the videos to refer to is a real bonus.

If you want some hands on training I'd suggest that you search this site a little since some of the more common providers have a less than stellar reputation with those who have gone through them. Best of luck.

there is no harm in using botox injection but the thing is that it is done under proper instruction or by professional. see how nicely they done in this Botox Injection Training Video

Botox injections are very effective if used under experts or if one should have full training about these drugs. for online video training must watch
Botox injection online training