Why the person holding the needle should be a doctor

The question I am asked most is not about units or brands. It is some version of “does it really matter who does it?” In South Africa it does, and the law agrees.

It is a prescription medicine

Botulinum toxin, the medicine in Xeomin^®, which I use, and in Botox^®, is a Schedule 4 medicine in South Africa. That puts it in the same category as antibiotics and blood pressure tablets: it has to be prescribed, and it may only be administered by a practitioner registered with the Health Professions Council of South Africa (HPCSA) and authorised to prescribe. A beauty therapist, however skilled with skin, cannot legally buy it, prescribe it or inject it. If a salon offers it, the first question to ask is who, exactly, will be holding the syringe.

What medical training adds

The face is a map of small muscles that pull against each other. Relax the wrong one, or the right one by too much, and a brow drops, a smile goes lopsided or an eyelid feels heavy for weeks. A doctor has spent years learning that map, and learning how it varies from person to person.

Training also shows up before the needle comes out. A consultation is not a formality: blood thinners, certain antibiotics, neuromuscular conditions, pregnancy and breastfeeding all change whether and how you should be treated. And on the rare occasion that something does go wrong, a doctor knows the difference between a bruise that needs reassurance and a problem that needs treatment, and has the medication on hand to deal with it.

What a medspa is, and is not

Some spas host a visiting doctor, and that can work well. The problem is when it is not clear who is doing what. Wherever you go, including to me, these five questions are fair to ask:

• What is your HPCSA registration number? You can check it on the HPCSA’s online register. Mine is MP0967025.
• Who prescribes the medicine, and do they see me in person?
• May I see the product unopened, and will the batch number go in my file?
• What happens if I have a side effect after hours?
• What does the follow-up look like?

Why I come to you instead of opening a clinic

Standards do not depend on the building. They depend on the person and the process. Everything I would use in a treatment room comes with me: sterile single-use equipment, properly stored product, a consent form, a camera for your file, and the emergency kit I hope never to open. What you skip is the waiting room, and the walk through reception that tells everyone where you have been.

You are not paying for a room. You are paying for judgement.

Dr Philippa Volschenk, MBChB · PS Aesthetics