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Botulinum Toxin Appointment: 10 Tips You Want Your Nurse to Know

Increasing numbers of nurses perform injections in aesthetic practices and medical spas. These tips can improve the patient experience and outcomes.
By: Scott Alten


Scott Alten

Scott Alten is Managing Partner at RxPhoto, which enables HIPAA Compliant Photo Management. RxPhoto.com


1. Emphasize expertise

Never underestimate your patients. Gen-Xers and Millennials have a wealth of information at their fingertips and most likely, a sophisticated awareness of Botox (or other neuromodulators) and its benefits and limitations, thanks to the accessibility of information available on the Net. Patients want to feel reassured that they are in competent hands, and that your nurse injectors have sufficient expertise to ensure they get a beautiful outcome.

Train your staff to showcase their professional knowledge. Clients appreciate when staff take time to examine and explain the particulars of their facial anatomy, how this impacts on where the injections are made and the improvements they can expect to see, while also priming them to have realistic expectations of what Botox can achieve. Patients relax when they know they are in the hands of a confident, consummate professional whom they can trust.

2. Point out existing asymmetries

Faces are very rarely completely symmetrical. Many individuals exhibit uneven wrinkles or frown lines, which warrant asymmetric dosing. Often, patients are unaware of their facial asymmetry. For this reason, it is critical to point out any existing asymmetries before injecting, so the patient knows that they were already there pre-treatment. Your clinic’s injectors can also explain how the distribution of more units of Botox on one side of the face may help to balance out these asymmetries.

3. Take before and after photos

The camera never lies. Before and after photos are an invaluable tool for accurately documenting the patient’s facial landscape pre- and post-treatment. RxPhoto offers a convenient and highly effective app for professional-quality photos that allow patients to visually appreciate the effects of neuromodulators. Furthermore, it stores the photos in a HIPAA-compliant secure cloud to ensure patient privacy. Ensure your staff take images of the patient at rest and also activating the muscles that will be injected prior to treatment. Your injectors should photograph their patients at every follow-up so that they can see their improvement over time. When a patient loves their before and after photos, they are much more likely to become a loyal client and return to your clinic in three months for their next dose.

4. Explain that there are different types of wrinkles

Many patients are unaware that wrinkles fall into two categories: active and passive. Neuromodulators offers an excellent technique of treating active wrinkles by preventing muscular contraction. However, it is not always so effective in eradicating passive lines (though in many cases it does soften them). Patients enjoy their results more when they have realistic expectations, so it is important that your staff point out the limitations of neuromodulators. They can, however, add that neuromodulators can be used preventatively to inhibit the formation of future passive lines.

Encourage your injectors to show their patients other clients’ before and after photos (with their consent) who have been injected preventatively. These images can emphasize the benefit of adding a conservative dose of neuromodulators in areas where passive lines may form in the future (such as the crow’s feet area).

5. Map out Injections

Staff who are new to administering neuromodulators or other injectables benefit from mapping out their injections. A white eyeliner pencil can be used to mark out injection spots while asking the patient to make different facial expressions. The eyeliner can be removed easily, and patients feel reassured when staff show this level of care and detail. Encourage new nurse injectors to focus on the areas where the patient will see the most benefits, and utilize services to photograph and document the markings for future consultations.

6. Have ice on hand

Ice is an incredibly economic and effective method to reduce the risk of bruising. Remind your staff to place an ice pack on the area to be injected as it will temporarily constrict the blood vessels. It also has the added bonus of rendering the injections more comfortable for the patient.

7. Ensure the reconstitution is consistent and documented each and every time

Over-diluting Botox is not good practice. When injectors add saline to Botox in the hope that it will spread further on wider areas such as the forehead, the likelihood of a complication occurring (such as eyelid ptosis) increases. Allergan recommends that 2.5mL of saline is added per 100 unit vial. Your staff should abide by this recommendation. The reputation of your clinic and future business will be compromised if patients perceive that you are diluting Botox and spread the word on social media. Make sure you document the reconstitution on every chart, for every patient, every time.

8. Repeat post-injection instructions

Make sure nurse injectors adopt the habit of reiterating post-treatment guidelines to all patients, even the “frequent flyers.” Staff should remind their patients to refrain from lying flat for four hours following treatment, to avoid rubbing their eyes for 24 hours, and to not exercise for the remainder of the day. These simple instructions are essential to ensuring an optimal outcome.

9. Develop good relationships with patients

Nurse injectors who adopt a professional yet friendly relationship with the patients they inject see those patients return again and again. When bonds of trust have been established and your clients believe in the competence and ability of your staff, business and profits flourish. Good relationships can be developed in simple ways such as this: encourage your nurses to go over the pre-treatment photos with patients and ask them to identify what bothers them. By doing this, your nurses and patients can develop a mutual treatment plan that also empowers the patient.

10. Be scrupulous in documentation

Thorough documentation of each injection site with the number of units injected is best practice and provides a solid reference point for future consultations. The documentation annotated by your staff should be specific and anatomically concise enough that if another staff member were to administer the injections, they would have a clear blueprint of any previous work.

Programs (such as RxPhoto) offer an injection tracker feature and can generate reports that facilitate easy electronic documentation. Furthermore, these reports can be printed with your practice’s logo as the letterhead. Documentation reports help to consolidate your brand, and they double as a marketing tool when the client passes it on to friends or contacts.

Bottom Line

Educating the patient, while setting the stage with realistic expectations, reaffirms that the nurse injector is educated, experienced, and confident.