“My biggest concern is not only the training, but also the experience in handling adverse events and complications,” says Naomi Lawrence, M.D., professor of Medicine and director of Dermatologic Surgery at Cooper Medical School, Rowan University. “Since there is no standardized residency or fellowship for non-physicians, the training really varies and is left up to the individual.” While this doesn’t mean the technician injecting you will do something wrong, depending on the practitioner and their expertise, it could mean they might not have the necessary scope of knowledge required to deal with potential side effects. For Botox, these can include temporary drooping or infection at the injection site. Improper application of fillers can lead to tissue necrosis or blindness in extreme cases—if products are accidentally injected into a blood vessel.

“These risks are always there, but an M.D. practitioner has superior knowledge of facial anatomy, skin physiology, fluid dynamics, and other topics taught in premedical studies and medical school that help them minimize these risks and effectively manage complications when they do occur,” says Murad Alam, M.D., vice chair of the Department of Dermatology at Feinberg School of Medicine, Northwestern University. Much like Lawrence, he rates the training levels for non-M.D. practitioners on a sliding scale, “from none at all to pretty good.” His main worry is that no matter how good, it will inevitably be less than that of a board-certified derm. “You would want even the most skilled technician to be supervised by an on-site, board-certified physician who is an expert in injectable procedures,” he recommends. Customers should also take note of M.D. practitioners who are injecting outside their scope of practice and lack specific training.

Part of the problem is that doctors and aesthetics bars seem to prioritize different guidelines when it comes to defining a “safe” experience. Garritano, Levy, Bland, and Ricketts primarily emphasize how much experience their technicians have with performing a single, specific kind of service. Ject’s Garritano, a board-certified, New York-licensed physician assistant, cites her lengthy experience working alongside plastic surgeons. “All Ject providers are physicians, physician assistants (PAs), or nurse practitioners (NPs), and are licensed and certified to practice medicine in New York,” she says. “They are experts in injectables, as this is their sole practice.” She adds that her employees are trained on how to manage any complication that could potentially occur. Clients, for their part, are happy with that info. Siegel says she researched Garritano’s qualifications online before going and also looked at their social media for reviews and photos. After this process, she was confident it was a good decision.

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