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An obstetrician, for example, might take a weekend certification course on Botox or Juvederm before offering the treatments to clients. Many plastic surgeons and dermatologists question this kind of crossover, warning that even a top-notch doctor may lack the experience and knowledge for damage control if complications occur. “The injector should have a comprehensive understanding of facial muscles, their function and the effect of specific doses of Botox on muscle activity and facial expression,” says Dr. Patrick Sullivan, a plastic surgeon in Providence and associate professor at Brown.

The risks aren’t always medical. “What training do you get in facial artistry if you’re a gynecologist?” Sullivan asks. Botox injected in the wrong places can cause eyebrows to become abnormally elevated, giving the patient a look of perpetual surprise. There may be eyelid drooping if an improper injection freezes the muscle that controls the eyelid. And with fillers that draw in water over time, it takes a couple of days to see results. “The person doing the filling has to be able to anticipate these changes to give the patient the best result,” says Sullivan.

It takes only one look at a procedure gone wrong to see why cosmetic medicine is no time for budget shopping.

“If somebody low-balls the price, there is a reason they’re doing it,” says Dr. Richard Zienowicz, a plastic surgeon in Providence who is also an associate professor at Brown. He recalls treating a patient who came to him with third-degree burns and permanent scars caused by a laser treatment from a nonspecialist who took a weekend course in the technique. On another occasion, a patient sought his help for permanent scarring that occurred after a board-certified surgeon trained in facial plastic surgery performed a tummy tuck. These stories are common. “Seek the advice of nurses and doctors who work with the individual, as well as satisfied clients,” says Zienowicz.

With a more youthful face just a lunch hour away, it’s easy to get caught up.  “We want to believe,” says Goldstein. “One patient said to me, ‘Don’t tell me about the medicine. Tell me about the magic.’” — Denise Dowling

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