Clinical
How Safe Are the Top Med Spa Treatments?
By Madilyn Moeller With the rising popularity of cosmetic treatments such as Botox and dermal fillers, patients new to ...
Posted By Madilyn Moeller, Tuesday, August 20, 2024
By Madilyn Moeller, Marketing Content Coordinator, American Med Spa Association (AmSpa)
One key indicator of a safe medical spa is the training its practitioners complete, but training requirements vary state by state. With no established standard, how do you know that your medical spa practitioner has the training they need to perform treatments safely? How much training should they have for you to feel comfortable putting your safety in their hands?
Not only do aesthetic practitioners need to hold the appropriate licenses to practice aesthetic medicine, but they also need to be trained and continually evaluated for their skills to perform every treatment in the med spa.
Our legal coverage has already answered the question of how much training your state requires aesthetic injectors, laser technicians and other medical spa staff to complete before they can treat patients.
This time we reached out to experienced practitioners and asked them: what types of training do providers need, how much and how often?
Kim Burke: “AS MUCH AS POSSIBLE! The more didactic and hands-on the practitioner can get, the better! Immerse yourself in webinars, drug company sponsored trainings, private trainings, shadowing, and mentorships. Once hired, it is important that the injector go through a comprehensive orientation process as well. Our onboarding process for new providers is extensive and includes classroom training, hands-on injecting, shadowing, and completing appropriate competencies done under supervision. Once the provider and the new practitioner feel confident in their skill set, we will slowly start to open that service for booking. Everyone learns at a different pace and some new hires are only injecting part-time and still working in a hospital setting still. The providers that commit the most time to learning aesthetics, both inside and out the clinic, are the ones who typically succeed the quickest.”
Georgia Cirese: “The key lies in the provider's knowledge of anatomy and rheology. Mentorship programs play a crucial role; offering 90-day mentorship opportunities for new aesthetic providers allows them to grasp the circumferences of aesthetic medicine. This also allows them to grasp individual patient anatomy and the science behind products in each category. A basic non-biased CME course is the first training course I recommend.”
Michelle Doran: “They should have a really solid medical/nursing background first and foremost. I get so many emails and inquiries from people going to school just to get into aesthetics. I believe that you need to put your time in doing bedside nursing and know how to care for patients. This includes basic skills (vitals, assessment, med management, etc.) and more advanced skills like managing severe allergic reactions, vagal responses, codes, etc.
Dr. Gideon Kwok: “A practitioner should have gone through a good educational course with didactic and hands on experience… typically the understanding on the blood vessels, muscles (origins and insertions). There are a lot of basic courses that barely teach practitioners the why of Botox... but with a good mentor and a good foundation, a practitioner can inject pretty quickly.”
Katie Martin: “A med spa practitioner, at the bare minimum, should have a solid foundation in a relevant medical field, through formal education and licensing as a registered nurse (RN), nurse practitioner (NP), physician associate (PA), or medical doctor (MD/DO). As we know, the requirements vary from state to state. But it's not just about the degree; they need to dive deep into specialized training for aesthetics to be a competent and safe provider. This includes learning all about facial anatomy, the science behind different treatments, and getting plenty of hands-on practice with procedures like injectables and lasers.
“It's incredibly important for new practitioners to spend a substantial amount of time shadowing and having one-on-one hands-on training with experienced providers to understand technique and safety.
“In my opinion, our industry needs a governing body that creates requirements for new practitioners to complete prior to providing medical aesthetic services. Eventually, there will be a need for true certification through training facilities. Additionally, there will be requirements that may include hours of shadowing, hours of hands-on training and a set amount of treatments they must perform under direct supervision.
“Ultimately, the goal is to ensure that the practitioner not only has the necessary medical knowledge but also the hands-on skills and confidence to perform treatments safely and effectively, prioritizing patient safety and achieving optimal results.”
Burke: “At Kiss Aesthetics, we offer group and private injection training. We typically hire directly from those who have attended both our Level 1 and Level 2 trainings. Learning aesthetics is EXPENSIVE and trainings can be costly. If providers are wanting to learn to inject, it's important that they attend a reputable introductory class/training. It shows us that they are committed and serious about learning about aesthetics and have already invested in their own education. The more education that a person has invested in on their own, the more hirable they are, in my opinion.”
Cirese: “When hiring a new practitioner, specific qualifications are crucial. The most successful candidates are carefully screened for their knowledge, education and experience. However, what sets them apart is their artistic eye, skills with their hands, and ability to educate themselves and their patients effectively. Experience is valuable, but we prioritize candidates who can perform a full comprehensive consultation, execute the proper treatment plan and deliver treatment presentations seamlessly.”
Doran: “I prefer hiring a nurse/nurse practitioner with a really solid foundation and experience in other areas of health care, who now have an interest in aesthetics. For example, many of my providers come from the ER, ICU and acute care setting. They are comfortable caring for patients, performing procedures, working as a team, etc. I want someone who is really passionate about this area of medicine, not someone looking to make bank or just get out of the hospital setting.”
Kwok: “There are many possibilities depending on experience level. Of course, a practitioner who understands and has a good foundational knowledge with experience in toxins or fillers is great. Sometimes it’s a practitioner who has a good attitude who is willing to learn and spend money on their own education. Seeing a practitioner that only has experience or training from only industry trainings (like from Allergan or Galderma) … is a practitioner that lacks drive. Always nice if a practitioner has training or completion certificates and can show some before and after pictures.”
Martin: “At Holden Timeless Beauty (HTB), we require that new practitioners have an active medical license in good standing in their respective field, such as RN, NP, PA, or MD/DO.
“Although not a requirement, we prioritize candidates who have completed a formal training with an emphasis on the basics of medical aesthetic treatments – including facial anatomy, neuromodulator science and dermal filler rheology. We also take into consideration how active a candidate has been in the aesthetic community. For example, we favor candidates who have attended and participated in conferences such as the Medical Spa Show by AmSpa.
“Once hired, at HTB, we have a highly refined onboarding process for all new practitioners. Depending on skill and experience level, we have an extensive training program that ranges from two weeks to three months. Requirements for our new aesthetic providers include a set amount of hours of shadowing, a set amount of hours they are required to have hands-on in-house training and then a set amount of models for supervised treatments. These criteria will change depending on experience.
“At HTB, as Vice President of Clinical Operations, I’m also the lead clinical trainer and oversee this onboarding process from start to finish. I often lean heavily on other seasoned providers who I have vetted personally to help train the new practitioners.”
Burke: “I meet with all of our staff members individually at the end of each quarter and then my practice manager and myself do an annual review as well. During those meetings, it gives us an opportunity to set goals and revisit areas that need improvement. I would recommend doing a SWOT analysis for constructive feedback. (Strengths, Weaknesses, Opportunities for improvement, Threats). I like the provider to have this completed prior to their meeting with me, so they are prepared, and nothing comes as a surprise in the quarterly meeting.”
Cirese: “Practitioners' skills are evaluated yearly and with any new procedures or techniques. We focus on mastering beginner and intermediate levels before advancing. Through scientific knowledge and hands-on practicals, we prepare them for advanced techniques, offering CMEs to empower them in aesthetic medicine. Our aim is excellence, ensuring safe outcomes and fostering patient relationships.”
Doran: “We do a three-month orientation and ongoing mentorship for the first year, plus quarterly touch bases and education for our team. All of our staff have annual reviews and goals for education and growth. We provide an educational stipend annually and encourage conferences as well as a cadaver course and in-office continuing education.”
Kwok: “We have a standard operating procedure that requires the practitioner to have completed didactics. Then precepted on the treatment and then performed on their own. We do check back in every so often during our monthly practitioner meetings.”
Martin: “Assessment of skill is an ongoing process and happens regularly at Holden Timeless Beauty. However, we also employ a more formal evaluation process as a leadership team.
“Providers meet with their direct manager monthly for 1:1 meetings that we call PPFs (Personal, Professional and Financial Goal). In this meeting, clinic managers are able to review strengths and weaknesses of each provider. Providers are encouraged to share their preferences for upcoming clinical trainings during this meeting, particularly in areas where they want to expand their skills or enhance their current practices.
“Managers then involve me in the conversation, allowing me to arrange relevant trainings that help providers achieve their goals.”
Burke: “The role of the medical director is to be responsible for all things ‘clinical’ that are happening at each location. If the medical director is not educated on all the procedures and treatments that the clinic offers, then it can compromise the safety and aesthetic outcomes. This industry is ever changing and it's important for the medical director to be at the forefront of the changes to ensure procedures are consistent and clients are safe. It is also important for the medical director to be aware of possible complications and best practices to handle them. This includes having large quantities of hyaluronidase available at all locations. Hyaluronidase is expensive to keep on hand, so the medical director/clinic owner must be willing to invest in this.”
Cirese: “The medical director plays a pivotal role in overseeing practitioners and their procedures, making it essential for them to have a comprehensive understanding of the treatments offered. This knowledge is vital for recognizing and addressing any potential undesirable outcomes or complications that may arise. Additionally, being well-versed in all policies and procedures is key for ensuring quality care and safety standards are maintained.”
Doran: “Of course! As the medical director/clinical director, you are responsible for overseeing the care and procedures provided to the patients. In my practice, as the nurse practitioner and clinical director, I see patients 20 hours per week and provide support to my team on all of the treatments we offer. This includes our NPs, RNs and even our estheticians.”
Kwok: “Always important that the medical director is knowledgeable in all the treatments performed at the medical spa because if there are any adverse events with patients, the medical director can help manage the issue.”
Martin: “The role of a medical director can not be understated in its importance. He/she needs to know the ins and outs of all medical procedures that happen under their supervision to ensure safety and top-notch care.
“At HTB, Dr. Holden is involved from the very beginning in deciding which treatments we will offer to the very end when a complication may occur. She's always available to the team, or she assigns a temporary medical director when she's unreachable, especially for emergencies.
“As a team, we often turn to her for quick advice on how existing medical conditions might impact aesthetic treatments. She's also highly trained in managing aesthetic emergencies, like vascular occlusions. On top of that, she has built strong connections with local experts, ensuring we have reliable support if emergencies arise, all to guarantee the best care for our patients.”
Burke: “I absolutely LOVE continuing education. I probably attend 5-8 conferences each year since aesthetics is constantly evolving. My top three conferences that I attend every year are: AmSpa’s Medical Spa Show, Aesthetic Next, and International Society for Plastic and Aesthetic Nurses (ISPAN). Conferences are also a great way to network and share ideas openly. There is so much on social media that is related to aesthetics, and it's important to be able to educate your clients on what is reality and what is AI or filtered. Many clients come in with photos of celebrities or influencers and want to achieve the same look. As a provider, it's important to set the expectation of what is achievable and what is not. For injectors, I HIGHLY RECOMMEND taking a cadaver lab sooner than later. I do a cadaver lab every year, and I learn something new every time. My favorite cadaver course was Dr. Chris Surek's Academy for Injection Anatomy. GO! You won't be disappointed!”
Cirese: “Excited to highlight the importance of ongoing training in the field of medical aesthetics!
“Continuous training is key to maintaining high care standards in this dynamic industry. Private trainings by pharmaceutical companies, led by experienced professionals, play a vital role, especially with the introduction of new FDA-approved products such as dermal fillers.
“Attending national conferences and engaging in CME activities is crucial for staying updated on the latest advancements in aesthetic medicine. We typically have around 2-4 major conferences annually, including AmSpa’s Medical Spa Show, ISPAN, Learners and Legacy, Aesthetic Extenders Symposium, LA-MCA, and Modern Beauty Con. These conferences offer CME credits and provide insights from top experts in the field.”
Doran: “First and foremost, I think that any provider who is injecting neuromodulators and dermal fillers needs to have cadaver training, and this should be done every year or two. In addition, providers who are performing laser treatments, peels, microneedling, etc., should have an initial certification and annual ongoing education.”
Kwok: “Trainings that help practitioners understand the why, provide understanding on how to think outside the box. Trainings that are backed by research and experience. I personally like to go to conferences outside the US and also do private trainings with practitioners I feel are doing things differently and approaching things differently.”
Martin: “Continuous education through CME courses, workshops, hands-on training sessions, webinars and conferences are vital for maintaining high standards of care throughout our industry. Our industry is relatively young and continuously evolving and changing and we must all keep up to date.
“I make it a point to participate in training sessions several times a year, whether it's through conferences, webinars, or hands-on training with experts, to stay current with industry standards and best practices. One of the most impactful trainings I've ever attended was an aesthetic-focused cadaver course, and I strongly believe that every aesthetic practitioner should experience one.”
Burke: “Injection courses should include a combination of both didactic and hands-on. I like to have as much time as possible for the hands-on portion in our trainings. Things are VERY different when you're holding the syringe and injecting an actual person as opposed to watching it or reading about it.”
Cirese: “Science-based evidence supported by literature, reputable speakers committed to educating professionals for the future of aesthetics, and a dedication to sharing scientific knowledge derived from years of experience.”
Doran: “Pre-work/pre-assessment, training including hands-on and a plan for ongoing post training to continue to grow skills. CEUs and/or CMEs are great as well when possible.”
Kwok: “A high quality training program typically will have CME credits or bring more advanced techniques or understanding to a treatment or device. If there is research to back up the ideas in the advanced trainings, that is also good. I believe that if there is a why and explanation why there is a different technique or a deviation from the norm, then it is something to consider.”
Martin: “A top-notch training program isn’t just about sitting in a classroom or reading a textbook. It must cover all the basics like facial anatomy, history of aesthetics, skin biology, and the science behind the treatments we do every day. But that’s just the start. What really matters is getting hands-on experience, where you can practice under the watchful eye of an experienced provider. You learn the techniques, how to keep patients safe, and what to do if something doesn’t go as planned.
“Plus, it’s incredibly important to have ongoing mentorship and access to advanced training for those more advanced procedures. That way, you’re always learning, growing and staying sharp in this ever-evolving field.
“I also think a great training program should create a sense of community. It should be a space where practitioners of all levels can come together, ask questions, and learn from each other in a supportive, non-judgmental environment.”
Burke: “Every time I take a cadaver lab, I am very humbled. It's fascinating seeing how variable facial anatomy can be from person to person. Even if you know your facial anatomy backwards and forwards, it doesn't mean that it is the same for every person. Taking an annual cadaver course reminds me of this. My first day in the clinic after the cadaver course, I'm always nervous to inject, lol!”
Cirese: “Ongoing training is essential to maintain safety and continuity of the aesthetic treatment procedures. Always keep learning! There are now so many more educational opportunities in aesthetic medicine that continue to provide advanced clinical skills and techniques to improve safety and desired outcomes.”
Kwok: “Ongoing trainings are always important because there’s always new research, new techniques that are out there that can improve upon what is currently being done, so keeping an open mind and realizing that this is still a field that is constantly changing. When new research comes out or new findings come out it can help advance you and also help you become a safer practitioner, whether it’s injection or using a device.”
Martin: “Ongoing training keeps practitioners informed about the latest techniques, technologies and safety protocols. As I stated before, this industry is incredibly young and evolving. We owe it to our patients to stay up to date in new and emerging techniques and advancement. It enhances my skills by refining techniques, allowing me to stay proficient and confident in their abilities. This continuous learning process ensures that we can provide the safest and most effective treatments to our patients.”
Burke: “Like I stated earlier, it's a night a day difference WATCHING someone inject as opposed to actually INJECTING a real person. It takes time to get comfortable holding the syringe, utilizing a cannula, figuring out appropriate depth and proper extrusion force. Every filler has a different extrusion force, and the more you work with the filler, the more comfortable you feel. When it comes to learning to inject, hands-on is crucial. The more time you actually spend getting comfortable with neurotoxin, dermal filler, and biostimulators in your hands, the better you will become.”
Cirese: “The significance of hands-on training versus theoretical knowledge in enhancing a practitioner's competency cannot be overstated. Hands-on training plays a pivotal role in honing the skills required for executing procedures effectively. It provides invaluable experience in areas such as proper technique, maintaining aseptic practices, and ensuring correct anatomical placement. When theory is complemented with practical demonstration, practitioners acquire a comprehensive understanding that is essential for success in their field.”
Doran: “Hands-on training is critical to mastering a skill and growing as a safe and effective provider. I think the pre-work can be theory/watching videos, webinars, etc., but the most important thing is for providers to get their hands wet and really perfect their skill. It’s like comparing watching a golf how-to and then just going out and playing without actually putting in the work and practicing. It is essential to practice.”
Kwok: “Didactic training is always important to build a foundation of why we do things, but it still does not negate the necessity for hands-on trainings. Hands-on training is really what provides the actual results with patients and cannot be replaced by just learning through a didactic or theoretical training. As a trainer, I emphasize to practitioners that time on tissue is what is going to advance your technique and advance your results and safety for patients.”
Martin: “I can't stress enough how vital hands-on training is for aesthetic professionals. No matter what degrees or professional training you have, these highly specialized skills aren't something we learn in school. Most of us don't go through anything resembling a residency for this either. Aesthetics is all about procedures, so getting plenty of hands-on experience is absolutely key to success.”
Burke: “It's important to not only credential yourself, but for your staff to credential its providers as well. We spend a lot of time and money educating ourselves to learn aesthetics, and it's important that your clients know this. When attending trainings or continuing education, post about it! That is a great opportunity to share your knowledge with your clients.”
Cirese: “At our practice, it all starts with our dedicated staff. We emphasize our expertise through years of experience, knowledge and ongoing training. Our focus on natural outcomes is reflected in the before and after pictures of our patients. Additionally, physical credentials of our staff are prominently displayed in their treatment rooms. #Credentials”
Doran: “We share our trainings and continuing education on our social media page, including conferences we attend, in-office trainings, etc. Our bio is always updated on our website and our entire team are credentialed by the front desk team, skin care providers and RNs/NPs.”
Kwok: “We inform patients about trainings and qualifications by having certificates of completion and trainings in a binder so that a patient can see it. We can also put it on the wall and showcase all the words that come along with doing high-level work and going and speaking at different conferences. Also, just putting it on the website or social media will help a patient understand that the practitioner is constantly getting educated and getting better training so that they can bring better outcomes for the patient.”
Martin: “At Holden Timeless Beauty, we make sure our patients know about our training and qualifications through various channels—whether it's during in-person consultations, on our website, through our front desk staff, or via our marketing materials.
“At the first touch point with our front desk, patients will be reassured that they are in experienced hands. And during consultations, we share details about our certifications, years of experience, and the specific training we’ve had for the treatments we offer.
“I’m also very open on social media about the conferences I attend and speak at, as well as the trainings I’m both hosting and participating in. Being transparent about our qualifications helps build trust and confidence in the care we provide across the board.”
Burke: “First of all, do you ‘like’ the way your injector and the staff look? Are you looking for a more natural, subtle result, or are you looking for more of an augmented look? As a consumer, you need to see the before/after work of the injector to ensure that they can fulfill your aesthetic goal. Clients tend to look at before/after photos of others that are of a similar demographic. It's important to showcase your work on all ages and demographics so it's relatable to the consumer.”
Cirese: “Affirm the number of years experience in the specialty of aesthetic medicine not in general medicine. How many continuing education hours do they have? How many procedures do they perform weekly? How do they handle undesirable outcomes?”
Doran: “Book a consult and sit down with the provider to see if it is a good fit first. You really need to have a relationship that involves respect and trust as well as realistic goals and an individual treatment plan. Ask questions. Have a list of the things you want to know. Don't be afraid to ask the provider about the background, level of training, how they manage complications, etc.”
Kwok: “The advice I would give to patients who are evaluating staff is to always ask about the practitioner’s experience. They can always ask for training certificates and ask the practitioner when the last time they did any private trainings or any trainings was or when they went to any recent conferences. Having also asked questions with regard to the treatment and how it’s explained, if the patient understands this and understand why the treatment is being done, then I think that that is a great qualification for a good practitioner.”
Martin: “My best advice to patients when evaluating a practitioner’s experience is to never hesitate to ask questions! It's your right to know who will be performing your treatment. Start by checking their website and social media platforms—these are great places to get a sense of their expertise, the types of treatments they offer, and how active they are in their field. Don’t be shy about asking them directly about their experience, the degree they hold, and the kinds of continuing education they’re involved in. This could include certifications, specialized training, and whether they regularly attend industry conferences or workshops. Remember, a skilled and trustworthy practitioner will always be happy to share their qualifications and reassure you about the level of care you’ll receive.”
It depends. As a few of the practitioners referenced, there is not yet an accepted standard for training requirements nationwide. In fact, the majority of states do not officially recognize private certifications for medical aesthetic treatments.
Your health care providers are primarily governed by their state licensing board: nursing board (RN, NP), medical board (MD/DO, PA), board of cosmetology (estheticians). While a handful of state boards have provided detailed guidance for training requirements in specific aesthetic procedures such as laser hair removal, state boards often define a provider’s scope of practice more broadly, requiring providers to have "appropriate training, education and skill" in a given procedure.
Aesthetic practices have a medical director or prescribing practitioner in charge of delegating care, providing supervision, developing standard procedures, and making sure that all providers are appropriately trained and practicing safely. Ultimately, the medical spa’s medical director is responsible for the care of the practice’s patients and will determine how much training the med spa’s practitioners need, from esthetician to physician, from chemical peels to advanced noninvasive procedures.
Aesthetics is a constantly evolving profession, with new products, technologies and techniques hitting the market all the time. Practitioners stay up to date through training and continuing education.
More training is always a good thing. Medical spas proudly invest a lot of time and money into clinical continuing education every year, in a variety of mediums. Those range from didactic lectures to conference programs, hands-on technique training, cadaver courses and virtual education. They get training from the makers and manufacturers of the injectables, lasers and other energy devices used in their practice. Med spas may hire a trainer to come in for a day or a weekend to teach specific techniques. Some aesthetic practitioners have even created their own Patreon accounts to privately share clinical techniques, and webinars and virtual training options continue to grow. Each of these training programs adds value when it strengthens a provider’s knowledge and skill set, making them safer.
Seeing training certifications prominently displayed in the medical spa is sure to give patients confidence in their providers’ proficiency. But how much faith can patients place in those frames? What do they tell you about how well prepared your providers are to treat you safely or address any complications that arise?
Does a training program have to come with a certification to be valid? No. Not all aesthetic training programs provide certification, and those that do are not necessarily representative of an accepted standard by the industry or your state. Med spas are likely to choose training programs with respected aesthetic experts or those with high visibility and strong reputations.
Your provider can get a certification from a training course, but if the certification is not recognized or required by the state board and they don’t have the license to perform the procedure, they still cannot perform the procedure. They may carry a certification as a laser technician, for example, but will still need the supervision and delegation of a practitioner with the appropriate license as determined by your state.
Medical spas are medical practices. Your medical spa practitioners invest in training to grow their skills and ensure patient safety, but also do so because they are health care professionals with the obligation to acquire the education, skill and competency to safely perform a medical procedure.
Your practitioner’s license gives them the legal authorization to practice within their scope. Some states allow properly trained people to perform certain procedures under the delegation and supervision of a licensed professional, so check the rules in your state.
Consider all the elements of a safe med spa visit. Appropriate training allows your practitioner to:
For a deeper dive into the legal training requirements for aesthetic practitioners, read these previous articles from our attorneys:
As a patient, you want to walk into your favorite med spa with the confidence that your practitioner will answer all of your questions, make the procedure comfortable, and help you reach your aesthetic goals. Advanced clinical training, through lecture presentations and hands-on instruction, helps your practitioner stay up to date with the latest techniques and expand their aesthetic skills to perform your treatments safely.
How much training do they need to practice safely? Enough to meet the expectations of their medical directors, comply with the regulations of their state medical or nursing board, perform treatments with the appropriate technique and manage complications.
You can discreetly look up your service provider’s license and research the training requirements in your state, or you can strengthen the trust in your patient-provider relationship by simply asking! Trust your instincts and know that a safe med spa practice is committed to patient safety and will welcome the opportunity to credential its providers.
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