Study Investigates Who Treats Patients with Injectables

The Dermatologic Surgery journal published a study on who performs cosmetic injections at dermatology and plastic surgery practices.

The Dermatologic Surgery, a peer-reviewed journal of the American Society for Dermatologic Surgery (ASDS), published a study on procedures at 492 dermatology and plastic surgery practices, and found that cosmetic injections to relax wrinkles and add volume are predominantly performed by physicians.1

During the study, the practices were asked who performs injectable treatments and it was reported 18.35% of dermatology and 25.4% of plastic surgery practices had nurse practitioners and physician assistants give injectable treatment. This percentage includes both with and without oversight of the supervising physician. 

There has been a growing demand of minimally invasive cosmetic procedures and a larger number of non-physicians who can legally perform these procedures combined with practices offering more cost-effective care. A physician has a rigor and length of training that non-physicians do not have. 

The ASDS believes that providers need dermatologic expertise to perform injectable treatments, because only physicians have extensive medical education, training, and aesthetic expertise to deal with complicated facial anatomy and possible complications.

“The role of non-physician practitioners in dermatology and plastic surgery practices is controversial and highly debated,” said Naomi Lawrence, MD, co-author of the article, Marlton, New Jersey. “However, studies have shown that non-physician providers are being increasingly used in the delivery of dermatological care. We were surprised to see that a significant number of practices that use non-physician injectors could not verify on-site supervision at all times.”

The advocacy group American Society for Dermatologic Surgery (ASDSA) promotes patient safety, and more than 6,400 board-certified dermatologists are members. They support the position requiring on-site physicians to supervise all non-physician providers to ensure patient safety. ASDSA also opposes decision-making based on financial gain to ensure the best quality of care and patient outcomes, as stated in its position on Physician Oversight in Medical Spas.

“[Patients need to understand] there are risks of temporary and permanent side effects from improper techniques, and different injectables have a wide range of properties and associated adverse events,” said Ashley Decker, MD, a co-author of the study, Marlton, New Jersey. “The injector needs to be sufficiently experienced with the products being used, maintain a detailed understanding of facial anatomy and be prepared to provide appropriate treatment in the case of adverse events. The ultimate responsibility for each patient’s outcome rests on solely on the supervising physician.”

The ASDSA has a new model legislation, called Medical Spa Safety Act, to keep medical procedures under the supervision of physicians in medical spas. The model would require on-site supervision of any non-physician treatment providers, along with requiring medical directors to have training on all procedures being performed. The bill also mentions additional education requirements; notification if a physician is not on-site; and options for mandatory adverse event reporting.


1. New study confirms physicians perform the majority of cosmetic injections. PRWeb. Accessed July 13, 2021.