Steps to be a successful injector- For New Aesthetic Clinicans

How to be a proficient injector and steps to make for success

By Marisa Amechi RN CANS

What does it mean to be a proficient injector, and why is it so hard for patients to find a good injector? The issue is with injecting, and with anything aesthetics related, there really are no standards in place. There are no accrediting bodies for the aesthetic industry that certify, test, and recertify aesthetic clinicians. As a result, anyone can start injecting the next day without formal training. Dr. Chris Surek, a world-renowned injector, educator, and facial plastic surgeon, once said there are certifications and requirements needed to work in the hospital. Still, no requirements are required to become an aesthetic clinician.

The best advice I can give a newer injector is to not only invest in your education by going to courses but also take the initiative and educate yourself by reading injection textbooks, reading clinical studies, taking advantage of all of the free information provided by the injectable companies: Galderma, Allergan, Revance, Merz. Use your free time to watch videos and watch them again. You will be nervous about your first few patients, which will be completely normal. What helped me gain my confidence was seeing patients come back that were satisfied with their results and getting good feedback. It is essential not to be overconfident; you will not know everything initially. Start conservatively with smaller amounts and have your patients return for follow-ups as needed for touchups.

It is better to underdose than overdose for neurotoxin because the patients will likely be stuck with a heavy forehead, droopy eyelids, or frozen muscles for 3 to 6 months or more. When I say overdose, I don't mean enough to cause adverse reactions, but I mean using more units than the muscles need, causing frozen-feeling muscles. You will have patients writing bad reviews, not returning, and telling their friends, colleagues, and family they do not recommend you. For filler, there is definitely more of a learning curve and more room for error, but again, start with smaller amounts. The injectable companies invest a lot in their customer's education, so don’t be shy about asking them for free products to train on; ask them for on-site, hands-on training sponsored by their company. Companies have a budget every quarter. Also, ask your reps for any classes that might be coming up in your area. If you keep connected and communicate with your representatives, they will reach out to you if they host free small group classes with one of their clinical trainers. Most of the training I received was free, in clinic, and hands-on, provided by the companies. These trainings will only show you on-label, FDA-approved areas. If you want to learn off-label, you can hire a private injection trainer like myself. In a survey completed in an aesthetic Facebook group of more than 18,000 members, the average amount spent on training, conferences, and education was $15,000/year. Most of us do not have the luxury of working for an office that pays or reimburses us for training. If you can find an office that pays for training, that is similar to winning the lottery! Suppose you are a solo injector with no injectable experience. In that case, I recommend finding a mentor or joining a subscription-based mentorship where you can ask more experienced injectors questions and guide you along the way. If you jump right in without knowing what you’re doing, you will start with a bad reputation. Practice practice, practice on friends and family, your hairstylist, your mother-in-law, etc. Use their photos and get consent to post them on your social media; those photos can help you gain future clients.

You must attend a beginner or level I training course to gain knowledge. After attending these courses, start practicing on models right away. Practice what you have learned. There are advantages to bringing in a private trainer vs. going to an injection course. When you hire a private 1:1 trainer, you have more control over the models you will be injecting on, and it will be 1 to 1 versus a group training where you may only be able to inject on two or three models or less. When seeking a course, ask how many models you will inject, how many attendees there will be, and models (Large groups of 5 or more may mean you will get little hands-on) and inquire if complications will be covered.

If you have unhappy patients or you’re getting negative feedback, do not get discouraged. It will take approximately two years with full-time injecting to feel 100% confident. However, there may not be a time when you’re at 100% because the industry is ever-evolving, and new products are coming out that keep us on our toes. There have been days when I felt like quitting aesthetics when I had an unhappy patient. But I kept going, I kept educating myself, and I kept asking for more training. Eventually, I became a more confident injector with loyal patients who refer to their friends and family. These days, I take what I have learned and educate, mentor, and consult other aspiring aesthetic clinicians.

If I could tell myself one thing when I was a new injector, it would be to under-promise and over-deliver with my patients. I struggled with setting expectations with patients because I wanted to please everybody, and I was desperate for their business. Educating yourself on which patients are good candidates and who is not is essential. It is necessary to dose them appropriately. I would underdose patients, and they would come back unhappy because I told them they only needed a set number of units. I also would tell patients with deep static lines that they would go away when they required multiple treatments and years of toxin to smooth their static lines out. There are times where static lines will not smooth out because they are so deep, and they have been using those muscles for decades. Deep static lines are similar to deep scars tethered to the skin's underlying structures. Tell patients you are going to start conservatively and if they need more to come back around the two-week mark for neurotoxin. Take your time; step out of the room if needed before injecting to plan your treatment.

Take photos of EVERY PATIENT. Good lighting, same position, hair pulled back, and no large jewelry. These photos will be your insurance. A handful of times, I had patients come in upset, stating they didn’t notice a difference or I had made something worse. They changed their mind when I compared and showed them their before and after photos. Some would apologize for blaming me for making something worse when they had the imperfections before injecting. One patient I remember told me her eyelid and eyes were smaller on one side after neurotoxin. When I showed her before and afters, we both agreed that she had those before injecting neurotoxin.

As the years go on, you will become a more confident injector with a returning clientele that will refer you. Remember always to continue educating yourself, attending conferences, buying new textbooks, staying humble, and not letting your ego get in the way of continuing to learn.

Marisa Amechi RN CANS