Cosmetic injectables are increasingly popular, with patients seeking them out for a raft of reasons. But what are they? What’s actually being injected, what does it do, and should you be doing it?
In this post, we’ll share how injectables work, what they’re used for, and why patients want them, as well as who can deliver them and why adding them to your scope of practice is a good idea.
If you find it useful, keep an eye out for the next parts of this three-part series, where we’ll talk in more detail about the two main types of injectables. For now, we’ll start by asking, what are cosmetic injectables?
What are cosmetic injectables?
Cosmetic injectables are substances that can be injected into the face and body to change their appearance. This can include reshaping body areas as well as reducing the appearance of facial wrinkles and damage or aging to the tissues of the face. They can be used to alter body and facial proportions, or to add volume, structure and framework to the face in areas like the cheeks and lips.
Why are injectables used?
As we age, or as our general health declines, we lose collagen. Collagen is a substance the body uses to build connective tissue: it’s what tendons, muscle fascia, bones, ligaments and skin are all made of. When you have plenty of collagen and it’s in good condition, your tissues have good volume and elasticity, but as you age they can become thinner and less elastic.
When this happens to connective tissues and bones it translates to an increased risk of fractures. When it happens to your skin it means wrinkles, sagging and a thinning of the face in areas like the cheeks, temples and around the eyes.
People use injectables to:
- Add volume to skin
- Make facial features more symmetrical
- Plump up lips and cheeks
- Smooth wrinkles and creases
Injectables can be used to partially paralyze (and thus relax) the underlying muscles of the face, making skin smoother and younger-looking. They can also be used to reduce excessive sweating — and unexpected as it sounds, botox can be used to stimulate hair growth, relaxing scalp muscles to improve blood flow to the follicles.
Why do patients seek injectables?
Sometimes patients want injections to combat the normal aging process; sometimes it’s purely cosmetic. It’s difficult to draw a precise line between this and other uses for injectables: for instance, some people living with HIV and AIDs are prescribed medications that cause thinness in the face. Smoking or excessive sun exposure can damage skin collagen, leading patients to seek injectables to repair their appearance. In addition, some people recovering from surgeries or accidents may seek treatment with injectables.
They’re not just used for the face — sometimes they’re used in the hands or other parts of the body. In general, we can think of injectables as between surgical and nonsurgical options, focused around volume and skin appearance. We should also remember that we’re not talking here about silicone injections, which are quite different and typically used where a lot of volume is desired.
Which patients are using injectables? Which patients should be?
We’ve seen that patients seeking injectables are a mixed bag. In addition to having varied needs, they might have quite varied conditions and expectations. This is important: the ideal candidate for injectables is:
- Otherwise healthy, or at least has clearly defined and understood health problems, such as the HIV patients we discussed earlier
- Committed to maintaining good skin health — not just good skin appearance
- Someone who doesn't smoke or have excessive sun exposure. Smoking in particular is a risk factor for infection as well as for further skin and tissue damage
- Combines a positive outlook with a generally realistic view of what injectables can achieve
Carefully applied, injectables can make a big difference to someone’s appearance but they’re not miracles. Patients need to understand what their likely outcomes will be, based on their selected treatment and their needs and circumstances. Some patients actually need plastic surgery to get the results they want, while others don’t even need a procedure as invasive as an injection. We need to be in a position to offer guidance.
What are we actually injecting?
Injectables come in two main categories: toxins and fillers.
Toxins are used to prevent muscles from contracting. By far the most popular is purified botulinum toxin (botox), which is often used to prevent the appearance of wrinkles around the eyes, forehead and lips by paralyzing the muscles that lie under these areas with a neurotoxin.
Fillers are used to provide shape and volume. One of the most-used is hyaluronic acid, technically a long-chain sugar used in the body to preserve skin flexibility and promote healing. It’s often found in moisturizers and skin products for this reason, and because it’s naturally present in the body it’s very safe to use in injectables.
Other substances are used in both categories — there’s an expanding market of fillers and toxins as injectables become mainstream and more patients and professionals see their benefits.
Who is doing the injecting?
Physicians can administer injectables. So can the following roles:
Physician Assistants (PA)
Physician Assistants must work under a medical director to perform injectables, but they can practice independently without a physician being on site with them. Supervising medical directors may not be required to be on site either, giving PAs greater freedom in the locations they deliver injectables.
Nurse Practitioners (NPs)
Nurse Practitioners can administer injectables, but many states require that they have a collaborating physician named on the account with the pharmaceutical company.
Dentists can perform injections in some states but not others. In some states, a dentist can perform botox injections, but not fillers. In others, they can only perform injections as part of a dental treatment plan. In some, a dentist can perform any filler or toxin injection.
Registered Nurses must work with a physician to deliver injectables. The physician is responsible for supervision, and may have to be on site or within a certain distance, depending on state law. The physician has to be named on the account with the pharmaceutical company to obtain the injectable.
Note that there is significant variance in state laws, so you should check the laws in your state for clarity.
Why adding injectables to your scope of practice is smart
Many private medical practices face struggles for revenue, especially with long payment cycles from insurers. Injectables and other aesthetic procedures can be another revenue source for these practices, letting them keep their heads above water and build a more flexible revenue base. As cosmetic procedures become more normal, they’re becoming a part of what patients expect from their doctor’s office.
At the same time, it’s a great option for individual NPs and PAs. It can be the tool that lets NPs launch a nurse-led practice of their own (depending on state laws). Even if running your own practice isn’t on your radar, getting trained to deliver injectables can help with career advancement if you’re already working outside the hospital system, making you a more in-demand hire and expanding your work options.
General side effects of injectables
Injectables are usually safe and well-tolerated. That’s not to say there aren’t side effects. Toxin injections can have side effects including:
- Drooping eyelids
- Face pain
- Redness, bruising, and swelling around the injection site
- Skin tightness
- Muscle weakness
- Numbness or pins and needles
- Blurred vision
Fillers can have side effects including:
- Bleeding, bruising, swelling and redness at the injection site
- Skin discoloration
- Bacterial and viral infections at the injection site
- Ulceration at the injection site
- Lumps or nodules forming under the skin
- Allergic reactions
- Hematoma (internal bleeding)
- Weakness in the muscles of the face, neck, and head, with effects on swallowing, vocal cord function, and eye movement
In addition, there is a much smaller risk of:
- Permanent disfigurement or scarring
- Vascular occlusion, in which filler blocks a blood vessel; this leads to pain and blanching of the skin. If not treated within 24 hours it can lead to necrosis.
- Inflammatory reactions, especially associated with unregistered dermal fillers administered by unqualified personnel and which may require surgical removal
These are much more likely if a patient seeks injectables from someone unqualified. They’re also rare, but it’s important to be aware of them.
If you’re new to considering injectables and this article has been helpful, it’s done its job. If your interest has been piqued, stay tuned, because it’s the first of three. The other two will each focus on one type of injectable, fillers and toxins, giving you in-depth information about how they work, what you can expect, and what you should tell your patients.