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Administering Botulinum Toxin Injections – Who is Qualified?

botulinum injections

If you are getting botulinum injections done as a patient, or as a doctor you wish to refer patients to specialists for botulinum injections, it is good to know who exactly can and cannot inject patients with the toxin.

General rule

Botulinum toxin is a drug and as such should be treated as one when being prescribed and administered. Physicians possessing an MD or DO, and who are trained to administer botulinum toxin injection are clearly allowed to do so. Special training is offered to people who can both prescribe and administer the injections, such as Physicians Assistants (PAs) or Nurse Practitioners (NPs), as a good knowledge of anatomy is required and simply knowing where to inject and injecting the toxin is not sufficient. Qualified registered nurses who have been through the training can also offer injection treatments, under the supervision of a supervising physician.

In the United States, a number of different trained professionals can administer the injections. These include board-certified plastic surgeons and dermatologists who are trained in this area. Whatever the training they have received may be, it is still essential to look at their experience they possess i.e. the number of years they have been performing the procedure for. Eye plastic surgeons can also inject botulinum toxin, especially around the eyes. While most states require a doctor to prescribe and inject botulinum toxin, states like Texas and Florida allow for other health care professionals to inject as well, such as NPs and Pas.

However, in most cases where non-MDs are injecting botulinum toxin, it is recommended by the Physicians Coalition for Injectable Safety (PCIS) that the injections be performed in the presence of a trained doctor. This would include registered nurses. The rules can vary between different states in the US, and if in doubt, the medical board can always be contacted to confirm the physician’s credentials to see if they can inject botulinum toxin. As far as most state regulations go, medical aestheticians or medical assistants (MAs) are not licensed to prescribe or inject botulinum toxin.

In Canada, the rules are similar. In most cases, botulinum toxin can only be prescribed and injected by a certified physician (MD, DO, or ND):

In a nutshell –

  • Board certified physicians and licensed physicians, physicians assistants and nurse practitioners can prescribe and inject botulinum toxin.
  • Registered nurses cannot prescribe botulinum toxin but can inject it under supervision of a trained certified physician.
  • Medical aestheticians cannot prescribe or inject botulinum toxin.

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