As demand for medical aesthetic treatments continues to rise, Botox and similar treatments have become increasingly popular due to their convenience, ease of administration, and effective results. With steady growth in popularity across the United States, Botox and similar treatments are now some of the most sought-after medical aesthetic treatments available.
A study by the American Society of Plastic Surgery found that Botox (and other neuromodulators) was the most popular non-invasive aesthetic medical procedure in 2020. The US Botox market size was valued at $5.91 billion in 2021 and rose to $6.27 billion this year—and is projected to grow to $8.59 billion in 2029.
Why the rapid growth? One contributing factor is the recent prevalence of virtual meetings. With more attention on the face, individuals are seeking treatments to help improve their on-camera appearance. There has also been a trend towards “preventative botox,” with younger people treating the face before lines appear in an effort to slow or prevent the development of future wrinkles.
But what exactly are these treatments, and who can administer them? With this article, we aim to provide readers with the information they need to decide whether neuromodulators are the best option for their med spa. We’ll discuss what Botox is, what alternatives are out there, and who can become a Botox injector.
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What are neuromodulators?
The American Society for Dermatologic Surgery (ASDS) defines neuromodulators as “wrinkle-relaxing injections” containing botulinum toxin type A (BoNT-A).
The treatment involves injecting a small amount of neurotoxin directly into the muscle underlying the stubborn lines. The toxin then blocks nerve impulses from reaching the muscles, causing them to release and relax.
In turn, the lack of muscle contraction causes the wrinkles and deep furrows caused by facial expressions like smiling and frowning to soften or disappear gradually. The result is smoother skin for about three months.
What is Botox?
Botox is the trade name for a brand of neuromodulator containing BoNT-A, developed by Allergan. Botox became a household name because it was the first neurotoxin injectable approved by the US Food and Drugs Administration (FDA) to temporarily improve moderate and severe frown lines in April 2002.
Like “Kleenex” is used to describe any facial tissue, many people refer to all neuromodulators as Botox; however, there are multiple brands of neuromodulators on the market today.
How do different brands of neuromodulators compare?
Botox is one of many FDA-approved BoNT-A injections available on the market. There are currently four commercially available and offered in med spas: Xeomin (Merz), Botox (Allergan), Jeuveau (Evolus), and Dysport (Galderma).
All these treatments have the same main active ingredient (BoNT-A) and have comparable effects. However, their formulations differ, affecting how much they spread once injected and how quickly they take effect. For instance, Botox, Dysport, and Jeuveau all have BoNT-A encased in proteins, while Xeomin contains pure BoNT-A.
Dosages can also differ among brands. Botox and Xeomin use the same dosing. Meanwhile, one Botox unit is equivalent to three Dysport units. Although Dysport is not as strong as Botox, it spreads more quickly to larger areas and works faster. However, the effect does not last as long as with Botox.
As mentioned above, Xeomin is the only neuromodulator that does not come with additives, and this lessens the risk of a person’s body developing resistance against it. With Xeomin, you may need fewer units to get the desired results compared to other neuromodulators.
Compared to the rest, Jeuveau is the most affordable. One thing to consider with the product is that Evolus decided not to have Jeuveau approved for medical indications beyond glabellar lines to keep its cost low. This means your clients may not have insurance coverage for off-label uses in other areas of the face.
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What can you treat with Botox?
You may use Botox and other neuromodulators for therapeutic and cosmetic purposes.
Cosmetically, the areas most commonly injected with Botox include:
- glabellar lines, aka frown lines and 11s
- wrinkles around the eyes, aka crow’s feet
- forehead creases
- nasolabial folds or smile lines
- cobblestone chin
Doctors also use these products off-label, which means administering a drug in a way that is different from what they are expressly approved for by the FDA.
Here are several off-label Botox uses:
- bunny lines
- lowered nasal tip
- gummy smiles
- vertical lines on the upper and lower lip
- vertical cords in the neck (platysmal bands)
There are numerous uses for Botox across a wide range of non-aesthetic medical conditions, including:
- chronic migraine
- cervical dystonia
- excessive underarm sweating (hyperhidrosis)
- crossed eyes (strabismus)
- involuntary eyelid movements (blepharospasm)
Who can inject Botox?
The injection of BoNT-A is a medical procedure. Only licensed physicians, surgeons, or other licensed medical professionals (like registered nurses, physician assistants, and nurse practitioners) working closely under physician supervision can perform them.
Neuromodulators are controlled substances, meaning only licensed medical professionals cleared by regulatory authorities can store and purchase them for commercial use.
Estheticians are not allowed to inject Botox because they are not licensed medical professionals. However, they can assist clinicians during treatment.
In what states can nurses inject Botox?
Generally speaking, you need to be a Registered Nurse (RN) or higher to administer Botox. Injecting nurses cannot practice independently, and most require the supervision of a medical doctor.
Below is a list of various states and their associated requirements for who can legally administer cosmetic injections:
- California: Only licensed physicians may inject without supervision. PAs, NPs, and RNs need the supervision of a physician. Link.
- Texas: According to Texas Medical Board, a physician’s assistant (PA) and advanced practice registered nurse (APRNs) “can inject with a written order.” They may also delegate to a trained professional who is well-versed in the procedure as long as they are on-site or available for emergency consultation. Link.
- Florida: The Florida Board of Nursing states that aesthetic injections do not fall within a nurse’s scope of practice” and therefore RNs cannot inject Botox. Link.
- New York: State laws allow “licensed medical professionals,” including RNs, to inject Botox as long as they are under the supervision of a licensed physician, PA, dentist, or NP. Link.
- Pennsylvania: Physicians, PAs, NPs, APRNs, and RNs can perform cosmetic medical procedures. However, they must be actively practicing in Pennsylvania and have the necessary education or training to perform cosmetic procedures. Link.
- Illinois: State laws allow “licensed medical professionals” to inject Botox but explicitly prohibit aestheticians from administering Botox.
- Ohio: Licensed nurses can execute aesthetic injectable medication under a validly authorized provider, an individual authorized to practice in Ohio acting within their scope of practice. Link.
- Georgia: Nurses can administer injections in Georgia as long as they do so in a medical office and under the supervision of a physician. Link.
- North Carolina: Registered nurses (RNs) do not require a physician, PA, or NPs to be on site. On the other hand, licensed practical nurses require an on-site presence or supervision of a licensed medical professional. Link.
- Michigan: Anyone who qualifies as a “health practitioner” can perform cosmetic injections. However, they can only do so under the supervision and direction of a physician. Link.
- Arizona: The Arizona State Board of Nursing allows RNs and APRNs to perform medical aesthetic procedures.
What training is required to inject Botox (and other neuromodulators)?
To be able to administer Botox and other neuromodulator injections, you should first be a licensed medical professional.
The minimum degree requirement for this is a bachelor’s degree in nursing or a related medical field. You should also complete additional requirements like training and licensure exams as your state licensing board requires.
Some states may require licensed medical professionals to complete specific training hours, hands-on experience, or Botox certification requirements before they allow you to offer Botox treatments in a med spa or clinic.
There are several aesthetic schools and institutions where you can get your Botox training or Botox certification course. Some of them include the following:
- American Academy of Facial Aesthetics (AAFA)
- International Association for Physicians in Aesthetic Medicine (IAPAM)
- National Laser Institute
- Empire Medical Training
It is best to contact your state’s medical licensing board or your state professional association to determine the specific requirements for administering Botox and other neuromodulators in your state.
Neuromodulators can help reduce wrinkles and other signs of aging. Patients love the results, and are increasingly looking for these treatments in an age where we are constantly looking into cameras and having our faces displayed on screens.
Note that facial injections like Botox are not like facials and peels. While they are non-surgical treatments, they are considered medical procedures requiring medical knowledge and training for proper and safe administration—the exact type of procedure that fits a med spa’s menu of treatment offerings.
When considering offering neuromodulator treatments like Botox, the most important thing to consider is that only appropriately licensed medical professionals may administer them. It is best to check with your state’s medical licensing board or professional association to learn whether you can legally administer Botox or other neuromodulators.
Whether you’re just exploring med spas or ready to take the next step toward opening your medical aesthetics business—the Moxie team can help you get started. Learn More About Moxie and How We Work >
*This article is intended to provide a general guide on what professional licenses and conditions are needed to operate a practice or perform certain treatments. This information alone does not authorize, certify, or confer the ability of anyone to perform these treatments, practice outside their scope, or violate the corporate practice of medicine.
While based on currently available information, the rules and policies on scope of practice issues and ownership can, and do, change frequently. Specific training, education, supervision, protocol and regulatory requirements will differ depending on each person's situation in their state. Therefore, each person must examine their own professional situation, skill level, regulating board guidance, and scope of practice before proceeding.
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