How can I find a good injectables doc?

Here are a few shortcut questions to ask, suggests The Kit’s editor-at-large

“I am interested in getting injectables and would like advice about how to find a good place to go. My face just looks tired all the time and I would like to do something about it.” — Patricia, Toronto

Not to be glib, but I’d like to suggest “My face just looks tired all the time” as the working title for an oral history of the year we’ve had. It’s been an exhausting, bile-inducing year to say the least. So since I know you’re a smart, sensible person, I’m going to assume that you have already given some consideration to the question that naturally arises before the question you just posed, which is: How tired are you, actually? Because, yes, there is an amazingly comprehensive array of skin care science out there that can help refresh your appearance, but none of it replaces sleep or the daily machinations of caring for yourself in a basic and fundamental way.

Layering treatments on top of stress and anxiety and nights spent staring at the ceiling isn’t going to give you the results you are after.

Now, if you’re feeling good — if you’re eating real food and resting and getting outside and breathing from your belly and doing some of the important things we often forget to do — but your skin is still bothering you, then sure, you can chat with a qualified pro to see what your options are. I called Dr. William McGillivray, who founded noted dermatology clinic and medispa Project Skin MD in Vancouver, for some shortcuts to help you find the best practitioner.

“The most important thing to do is to see somebody who’s very qualified because injecting Botox or fillers is a medical procedure,” he says. That may sound obvious to some, but it doesn’t to those who have willingly gotten injections at, say, pool parties.

“Botox and fillers should only be administered in a controlled environment that is well lit, where the patient can be properly assessed, where there is time to get all their questions answered,” says McGillivray, outlining the absolute baseline concerns. Any provider should be licensed and registered with their provincial college of medicine, and that licence should be posted on the wall.

Basically, if it seems like it might be an inappropriate setting, it likely is. “A new patient of mine told me she got her lips injected in a nail salon once,” McGillivray says. “The most important question is: If a complication arises, are you somewhere that can deal with it?” (Ask these two key questions: Are there materials on hand to dissolve filler, if necessary, and is there a doctor present or on call?)

So if we are building a house of credentials, all that would form the basement. Once those concerns are satisfied, we can move onto the proverbial main floor by asking questions about the level of experience and training your provider has. How often, for instance, is the doc in question actually injecting Botox? “Some physicians may just dabble in it, so their daily experience is not much — and it’s important to note that Botox in particular has to be reconstituted, so you don’t want it sitting in the fridge for a long time before using it,” explains McGillivray. Non-permanent hyaluronic acid dermal fillers like Juvederm are gels that can be safely stored until their expiration date. Experience is particularly important because your injector must understand the anatomy of the face.

“It’s crucially important for safety for both Botox and dermal fillers because there are vascular structures that must be avoided,” says McGillivray. “Only experienced injectors should be working in the area under the eye, for example, because there are some vessels there that have a retinal branch so there can be a very bad outcome, like blindness, if the person does not know where those vessels are.” Asking lots of questions during an initial visit will allow you to gauge the doctor’s approach, since injecting is as much an art as a science. “It’s the opposite of sculpting because we add instead of take away.” But thinking of the face as a sculpture is a handy way to realize that no two can be approached in the same way.

In fact, there are different kinds of fillers that you might want to use for different areas, he explains. While the basic purpose of filler is to replenish the volume in certain areas that’s lost as we age, there are myriad details. “We can use a tiny amount to hydrate and redefine the lip line, so you have a more defined line when you put on lipstick,” McGillivray says. “Or if we correct the loss of volume in the middle of the face, we can help the area under the eyes, the folds around the mouth and also the jawline with just that one treatment.”

A little volume in the temples helps combat the look of tired eyes and lifts the brow. Jawlines can be redefined, while bumps on noses can be smoothed. (A shortcut to getting a doc who has lots of product knowledge is this: “Look for a doctor who might be involved in research. We have a research department in our clinic, so we have a big knowledge base of what’s going on out there.” And lots of pros will list what research projects they are involved in on their sites.)

The result of most fillers should last around four to 18 months, depending where on the face it’s used. The cost varies widely also. Project Skin MD charges about $500 to hydrate the lip, while a comprehensive facial rejuvenation could be as much as $4,000. And again, common sense always applies: if it’s super cheap, question why.

Importantly, expect a trustworthy professional to ask some hard questions of you, too. “The ability to talk patients out of things that might not be appropriate is essential,” McGillivray says. “I don’t have many dysmorphic patients in my practice, but it’s inevitable that you get some, and it’s our job to recognize those people and help them — not to ignore them and certainly not to enable them.”

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