- Botox and filler injections have grown in popularity over the years.
- Not everyone offering them is qualified or following safety protocols.
- A cosmetic physician and a dermatologist shared the red flags to watch out for.
Botox and filler injections have been growing in popularity for years, at least partially because they're less invasive than plastic surgery. Still, they're not without risk.
In April, the CDC released a warning about counterfeit Botox after 19 women became ill. On a smaller scale, botched Botox or overdone filler can lead to unpleasant side effects that last for months, from a frozen facial expression to a puffy "pillow face."
Dr. Morgan Robach, a dermatologist, and Dr. Vivian Chin, a cosmetic physician, both administer Botox and filler treatments. They shared some of the biggest red flags to look for when booking your first appointment, from "deals" to unsanitary working conditions.
Your injector doesn't have the right credentials
Treatments from unlicensed or unqualified injectors are always dangerous, whether you're getting Botox or "vampire facials," because they can neglect basic safety protocols.
Chin said that your injector should be an MD, registered nurse, nurse practitioner, physician assistant, or a doctor of osteopathic medicine.
"Botox is a medical procedure, so an esthetician or a medical assistant cannot inject Botox," she told BI, even though she hears of clients being injected by estheticians all the time. "They should not have done that."
You found a 'deal' on the treatment
One of the biggest red flags is a "very, very cheap price," Rabach said, because neuromodulators like Botox are expensive for injectors to buy.
The average cost of Botox in the US hovers around $500 per session, so if you're eyeing a coupon for $150, you're either sacrificing experience or safety, such as an injector using an illegal or expired product, Rabach said.
Flat fees are not necessarily red flags but can be a waste of money. For example, if you go to a pop-up clinic that offers Botox for $450, you're getting a set amount that isn't necessarily enough for you to see results, Rabach said. "It incentivizes the place to use less because then their margin is more."
Chin said that she's had clients come to her for extra Botox injections after going to flat-rate clinics because the injectors wanted to "scrimp and save." She recommended getting a consultation and personalized quote from an injector to save time and money.
Your injector is inexperienced
When it comes to injections, you get what you pay for — including experience.
"Even the same units put in by an experienced provider can look different," Rabach said, adding that a medical doctor with a knowledge of facial anatomy is "going to be a different expertise level than someone who trains in a weekend course and starts injecting."
The space isn't clean and comfortable
The office should always be clean and well-lit. Other safety protocols include the injector wearing gloves and cleaning your face before injecting, Rabach and Chin said.
A good office should also be prepared for emergencies. If you're getting filler, the office should be stocked with hyaluronidase, an enzyme that breaks down filler, in case you get a filler occlusion.
To help prepare for possible fainting at a Botox appointment, Rabach said reputable offices usually have squeezy balls, juice boxes, or smelling salts for when clients seem nervous or pale.
You're skeptical of the high dosage
Even if you're new to Botox or filler, it's good to know roughly how many units work for you. As a rule of thumb, Rabach said the average amount per area is 20 units, but that can vary by age. A person in their 20s getting preventive Botox might need 10 units or less on their forehead.
It could be a red flag "if you feel like you're getting oversold or pushed into more units" — a sign that the injector just wants to ramp up the cost, Rabach said.
The place doesn't take 'before' photos
Rabach and Chin said you should always get photos taken before you get injected. Beyond helping you see your progression, it's also a sign that the place follows best practices.
"My malpractice insurance requires before photos of every patient," Chin said.
You don't like your injector's style
If your injector's own Botox and filler looks too dramatic to you, it's worth being cautious, according to Rabach. Everyone has a different injecting style — Los Angeles is very different from New York City, for example — and an injector's personal look reflects what they think looks good.
You can get an idea of this ahead of time by reading reviews. "I tend to be a conservative injector," Chin said. "All my reviews say that."
Arguably, the best way to find a solid injector is through a referral, she said. That way, you know the place is legitimate and that the results will align with your goals.