Who Can Perform Cosmetic Injections?

Whether you’re in your early 30s to mid 60s yet you still look 10 years younger then possibly you have great genetics, or you have unlocked an effective lifestyle that the rest of us are jealous of. Enjoy that glowing, youthful look – you deserve it! For the rest of us – enter Botox and dermal fillers.

For the rest of us, trying to find that balanced aesthetic look (not too done up, but still healthy) it can be a long road to success. Some beauty services just don’t work out. We’ve tried everything. At IVONNE we’re a firm believer that when it comes to beauty – do what you want, and do it for you.  We also believe that if you are going to invest in beauty services that they should be as elegant, simple, and effective as possible. Self-care is difficult and so finding the most efficient and safest services is the best way forward.

When it comes to injectables you typically have 2 different routes; dermal fillers and Botox.

Cosmetic injector performing facial cosmetic injection.

What Is A Cosmetic Injectable?

In cosmetics an injectable is a material that is injected under the skin to help restore its shape or give volume. The ingredients may include any of the following:

  • collagen products
  • hyaluronic acid products
  • polymethylmethacrylate or PMMA
  • autologous fat

How Can Cosmetic Injectables Help?

As we age our skin changes due to exposure to sun, gravity, and other environmental factors. Micro injuries add up, and our skin begins to show signs of thinning. Wrinkles and fine lines form, and sagging takes over.

Injectables can restore the appearance of lost volume and smoothen out our skin.

How Do Injectables Work?

A small amount of toxin or dermal filler is injected into the muscles or tissue responsible for the unwanted feature. In the case of Botox the toxin disarms the muscles, allowing creases to virtually disappear. In the case of lips, dermal filler is injected strategically to specific areas of the lips to help give them plumpness and shape.

Who Can Perform Cosmetic Injections?

In the Province of Ontario injections are a Controlled Act. The Regulated Health Professions Act of Ontario says that a controlled act is “Performing a procedure on tissue below the dermis, below the surface of a mucous membrane, …”.

For a list of exemptions (including “Cosmetic Tattoo”) under the regulations check out Ontario Regulations “Controlled Acts

Can a Nurse Perform Cosmetic Injections?

We were very interested in this question, and so we did some real digging because we thought you would like to know!

We called around and finally worked our way to the Ontario College of Physicians and Surgeons. “Adam” the advisor walked us through the complete chain of relevant regulations and related policies for Ontario.

The Regulated Health Professions act mentioned earlier says that only certain regulated health professions can perform injections (physicians and nurses e.g. RNs, RPNs or an NP ). Under certain circumstances injections (a controlled act) can be delegated by a physician (to maybe an NP) to an RN, or an RPN.

When can an RN or RPN perform injections of Botox or fillers in place of a physician?

Here is the answer from both regulatory bodies in Ontario:
The College of Nurses of Ontario says that: “To administer Botox or PRP, an RN or RPN must perform the controlled act of administering a substance by injection. Therefore, RNs and RPNs who administer cosmetic injectables need to work in collaboration with a prescriber, such as a doctor or NP, and obtain the proper authorization, such as a direct order or directive.” 
The CNO also says that “having the authority to perform a procedure does not necessarily mean it is appropriate to do so”

The College of Physicians and Surgeons of Ontario says

“In every instance of delegation, the primary consideration must be the best interests of the patient. In making the decision to delegate controlled acts, the physician will con­sider how to achieve an appropriate balance of patient need, quality and access. Controlled acts must not be dele­gated solely for monetary or convenience reasons and quality patient care must not be compromised by the dele­gation.”

The CPSO asserts “that delegation cannot be done for monetary or convenience reasons. It’s (delegation) is more about expediting access to care”, says Adam.

What Do Manufacturers of Injectables Have To Say About Who Should Perform Cosmetic Injections?

Allergan is the manufacturer of Botox Cosmetic in Canada. Their product enclosure warns that “Botox Cosmetic should only be given by physicians with the appropriate qualifications and experience in the treatment and the use of required equipment.”

It is important to note that the purchase of Botox and certain fillers are only available to certain medical professionals. Most manufacturers will only guarantee or certify the authenticity and safety of their product when it is purchased through certified channels. So if your injector is buying their product from a random website then this is certainly high risk, and both the injector and the client are on their own should any issues arise.

What Are The Risks of Cosmetic Injections?

Botox Cosmetic products carry the risk that the toxin could spread to other areas of the body. The signs of “distant toxin spread”, which can be fatal, may include muscle weakness, swallowing difficulties, pneumonia, speech disorders, and breathing problems.  There are currently no known medically confirmed cases of toxin spread due to Botox or Botox Cosmetic in Canada.  There have been no serious side effects documented since their introduction in the early 1990’s.

Some bruising and swelling can occur and even drooping of the eyelid.

Patients who are pregnant, breastfeeding or who have neurological diseases should not use Botox injections.

As is the case with most products manufacturers will not guarantee the safety or authenticity of their product when it is obtained through unofficial or unapproved distribution channels. Only physicians may purchase Botox through authorized providers.  Products purchased through unauthorized reseller channels are at risk of being counterfeit with unknown ingredients, and uncertain handling conditions.

Of course, non-sterile needles, unsanitary processes or supplies are all risks associated with injections. Exposure and transmission of infectious disease is always a possibility when dealing with anything sharp, or when working in the skin.

What Are Alternatives To Cosmetic Injections?

When it comes to beauty services that are effective and efficient there are very few that will perform as well as traditional injections like Botox and dermal fillers.  The beauty industry has tried and while it has come up with some pretty great services nothing compares to the long term effectiveness of injectables.  Here are some of our recommended favourites:

If you’re looking for plumper, more defined lips then consider cosmetic tattoo. Lip tattoo can achieve a very consistent colour across your lips, and provide definition to the borders.  The effect can last several years and it looks consistently great with regular touch-ups.

In the topical skincare space G.M. Collin recently released one of our favourite HA serums that they call “Hyaluronic Filler. It’s not at all like a traditional filler that you would ever inject beneath your skin, but the engineering behind this product packs a moisturizer punch in ways that other products simply do not. So, if you’re hesitant about dropping $500-$700 on injectable fillers then consider trying this topical serum first.

What About Needle-Free Dermal Filler Devices?

In 2019 the aesthetic industry saw an explosion of interest around using needle-free dermal fillers to inject hyaluronic acid. Aestheticians jumped at the opportunity to offer what was misunderstood to be an alternative to medical injectables.  In the last part of 2019 Health Canada released a public notice that “Needle-free dermal filler devices used for cosmetic skin treatments are not authorized in Canada and may pose health risks“. Even without a needle these devices are still classified as “jet injectors” and are subject to the registration and approval with Health Canada. 

Ultimately the decision to pursue Botox Cosmetic and dermal filler injections as a cosmetic service is one to weigh carefully. We leave it to you the reader to decide for yourself who should perform your cosmetic injections.

About IVONNE: IVONNE is a Permanent Makeup and Beauty Clinic located in Ottawa, Canada. We do not offer injectable services such as Botox or dermal fillers, however we can refer you to a skilled practitioner.  If you are interested in Botox or fillers please leave your information and message in the contact form below. Doing so will be your express consent that we can provide your personal contact information to a physician to follow-up with you directly.


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