How to get into Aesthetic Nursing

By: Ali Wagstaff, NP

One of the most frequent questions I get asked by friends, colleagues and random people on the internet is how to become an aesthetic injector.

This path is different depending on your medical title: RN, PA, NP or Physician and I have other articles that answer general med spa questions, like who can inject and even how to open a medical spa.

This article will focus specifically on nursing, for Registered Nurses (RNs) and Nurse Practitioners (NPs) that want to get into aesthetics.

Becoming a RN Injector

First off, know your state guidelines because in certain states, such as Florida, RNs cannot inject at all. Only providers (NP, PA and Physicians can).

In other states, such as here in Colorado, RNs can inject with a Physician Medical Director overseeing them or in some cases a Nurse Practitioner Medical Director. 

In general it’s very competitive to get a job in this field. I get at least one email or DM every few days from nurses looking for a job or asking how to get into aesthetics. 

I usually ask what experience they have and 9/10 times they have none and have done nothing to try to get any. Maybe they have applied for a few jobs but that is it. 

I usually tell them to take some classes so they have something to put on their resume. Show that they’re interested and willing to put in the work. 

It’s a huge investment training a nurse in this specialty and half the people want training so they can go start their own thing. As a business owner why would I spend my time and money to train someone that is already planning on leaving before they even start? If I am going to invest in someone they need to show they are willing to invest in themselves first and want to be part of a great team. 

How/why I hired my nurse Molly:

Molly had 3 years of nursing experience in Women’s Health and had graduated cosmetology school many years before. She decided she wanted to get into aesthetics and took an injection course BEFORE she started applying to jobs. I had a posting out for a medical assistant and Molly applied. I let her know that I would love to have a RN at some point but that this position was just for an assistant.

She said she would be my assistant first if I might be willing to take her under my wing and train her later. She said, “I’ll be your assistant, answer the phones, clean up; whatever you need me to do if you’ll give me a chance and train me as an injector in the future”. She even said she would be an assistant for a full year and would sign a 2-year contract to stay post training if needed.

Needless to say, I hired Molly. Molly was my assistant for 3-months and we treated it like an apprenticeship for her to shadow and learn how I do things while assisting. Then we started doing some hands on training with her. Now she is injecting one day a week and building her clientele while being my assistant the other days and continuing to learn. 

THAT is how you get a job and get training as a Nurse Injector. 

Becoming a NP injector

If you’re a NP looking for a job as an injector then I would follow all of the same advice above. Take some initiative and get some training. Not only do you want to do trainings to make sure you like this specialty but also to have something on your resume when you apply.

If you are a NP and want to open your own practice, still get the experience. The laws are vague for NPs in independent practice and you have to be able to prove you had adequate education and training in whatever specialty you are going into.

You also have to have prescriptive authority in your focus area in order to be independent. So in CO you must have 3 years of work experience as a RN or NP and then complete the 1000 (may be 750 hrs now) of supervised prescribing before you can apply for prescriptive authority. 

So for perspective I am a dual certified NP with prescriptive authority for AG-ACNP and FNP and I’m a fellow in aesthetic medicine. My fellowship was an additional 160 hours of aesthetic specific training on top of the hundreds of hours of experience and training I already had.

People often ask me if they can practice independently if they are a CRNA, acute care only NP, or other specialty. I don’t know as I am not a lawyer and I’m not on the state board of nursing. Unfortunately if you call the CO state board 1/2 will tell you you can’t practice and the other half say you can with adequate training and experience and must call yourself a “Nurse Medical Director”. Apparently the Nurse Practice Act was written to be vague in order to not limit our scope of practice but some people use it to try to limit our scope. 

But if you’re a FNP or AGNP and in any position to advocate for NP independent practice in aesthetics for your state, here are just a few arguments for it:

  •  NPs are holistic practitioners and aesthetics is part of caring for a whole person and falls under the primary care focus. It’s just another system like cardiac, pulmonary, or mental health. Anti-aging medicine is hugely important for holistic care and quality of life for many patients. 
  • There is no aesthetics training for Physicians in residency. So NPs sit in the same classes as Physicians to learn aesthetic injectables and laser. My fellowship was about 75% Physicians in fact. So why should they supervise us if we do the same training?
  • If NPs have independent practice in the state but the state does not allow independent practice only in aesthetics then there could be legal ramifications against the state. They cannot support/endorse Physician owned practices in this one specialty of medicine only (per lawyers, not my language)
  • Lastly, many of us have prescribed and supervised much more dangerous drugs. For instance I worked in ICU and often prescribed opioids, sedatives, vasoactive drugs, and other dangerous meds. Botox and fillers are not even controlled substances and the prescription and administration of them fall under our prescriptive authority. If they didn’t, then pharmaceutical companies would not allow us to order them. 
With all of that being said, don’t try to go out on your own in any specialty without getting adequate education and training. And if you have a great physician mentor or colleague there’s nothing wrong with teaming up! This is simply to say that it doesn’t make any sense (in my opinion) to be required to have a physician medical director just to have a physician on staff. Especially when most physicians have less training than the aesthetic NP they would be supervising. 

Getting off my soap box… but long story short, you need to research your specific situation and scope, get lots of education and training and consider legal consults before practicing independently in aesthetics.

A Simple Guide to Skincare (by age)

Table of Contents

Introduction

With how many products are available over the counter and at your provider’s office it can be overwhelming trying to decide what to buy. This is a quick guide on what products and ingredients are most important and we’ve broken it down by age. Now keep in mind that skincare, even by age, is not one size fits all. So it’s still good to have a trusted skincare expert you can go to to get recommendations based on your unique skin. If you’re near Denver, CO click below to book a consult with one of our experts!

A quick note on diagnosing skin conditions

Keep in mind that some skin conditions do really need to be diagnosed and treated by a medical professional. The only providers that can legally diagnose and treat are Physicians, Nurse Practitioners (NPs), and Physician Associates (PAs). Often what looks like acne could actually be a staph infection, a complex dermatitis or even rare types of herpes outbreaks. So if you’re ever unsure, please see a pro. A good aesthetician will also know when to refer to a medical provider. As usual, nothing in this article is meant as medical advice or to diagnose and treat. We can’t do that without seeing you in person so talk to your prescribing provider before trying anything new :-). 

What is the best skincare routine in your teen's?

  • For teens, it’s recommended to use a gentle, non-medicated cleanser most days, with an option to incorporate a salicylic acid based cleanser a few times a week to prevent acne. The salicylic acid could be increased to daily use for moderate acne (more on acne in next section). 
  • DO NOT use a toner or exfoliating pads (or at the very least use extreme caution). Many toners and pads, especially those tailored towards teens and acne-prone skin, are loaded with drying alcohols (SD alcohol, alcohol denat.) that strip the skin of oil, which may seem good in the short term, but this can lead to increased oil production, damage to the skin’s microbiome, and worsening acne. Consider witch hazel as an alternative to harsh toners.
  • Moisturizing is important, even for oily skin. They make moisturizers for all skin types for a reason, so just because someone has oily skin doesn’t mean their skin doesn’t need hydration—in fact it can help balance oil production and keep the skin from feeling and looking tight and shiny.
  • Always wear sunscreen every day. Usually hybrid organic/inorganic (“chemical” and mineral) filters are best for oilier skin types (ie. octinoxate and zinc oxide) because they tend to be less oily. Sunscreen not only protects from the sun but can prevent scarring from acne and is also anti-aging. 
  • Keep the routine simple, and if you’re struggling, consider seeing an aesthetician for an initial evaluation or going straight to a dermatologist for more complex skin issues. 

Teen skincare summary:

– Cleanse nightly with a gentle cleanser

– Optional salicylic cleanser for acne prone skin

– Avoid alcohol based toners and exfoliating pads

– Moisturize and use sunscreen daily

– See an aesthetician or get referral to dermatology for complex issues

What is the best routine for acne prone skin?

  • The best acne routine depends on the type of acne.
  • Superficial and mild acne typically responds well to salicylic acid cleansers and light hydration. Salicylic acids can penetrate deep into the pores to break up oil and kill bacteria.
  • For moderate acne, a combination of a benzoyl peroxide face wash a few days a week to kill bacteria (and a gentle cleanser other days) and a topical retinoid serum/cream like retinol, retinaldehyde or adapalene gel can help unclog pores and speed up cell turnover. Remember to never use benzoyl peroxide with hydroquinone (a skin “lightening” agent) as dark staining of the skin may occur. 
  • For severe and hormonal acne, seek out help from a specialist like a dermatologist, who may work with an esthetician as well to come up with a series of specific treatments such as chemical peels or laser, and at home care.
  • Also consider working with a nutritionist to determine if you have an imbalance in your gut or food sensitivities that could be contributing to acne. 
  • In general, monthly chemical peels in a series of 3-6 are a great option for those suffering from mild to moderate acne.
  • Avoid products containing high amounts of drying alcohol.
  • Always wear sunscreen and keep skin hydrated to prevent scarring.
  •  Blue LED light or IPL can also be very beneficial for acne. 

Acne Prone Skin Summary:

– Mild acne salicylic acid cleansers or pads

– Moderate acne add in benzoyl peroxide and retinoid products

– Severe acne or hormonal acne seek help from dermatologist or skincare expert

– Consider working with a nutritionist to see if a gut imbalance or food intolerance is contributing

– Do regular facials and peels

– Always wear sunscreen

– Blue light therapy may be helpful

What is the best skincare routine in your 20’s?

  • This is a great age to start coming in for regular monthly facials. Regular facials are very helpful to have your skin looked at monthly and they can also speed up cell turnover.
  • Weekly exfoliating cleansers or leave on exfoliants such as salicylic acid or glycolic acid can be started or continued.
  • Consider introducing a topical vitamin c serum. Vitamin C is an anti-oxidant that helps protect your skin from damage. It also acts a light exfoliant. Look for ascorbic acid, ascorbyl glucoside and/or tetrahexyldecyl ascorbate.
  • Consider changing to a more hydrating moisturizer as skin typically changes from puberty, and ends up producing less oil. Look for ceramides and fatty alcohols.
  • Consider starting a retinoid. Look for retinol or retinal/retinaldehyde as they tend to be more gentle. Start slowly and always reduce use if there is irritation.
  • Continue to wear sunscreen daily.
  • In the mid to late 20’s consider starting preventative Botox. 
  • Microneedling can also be great for those with acne scars or those that want to do something to prevent lines and wrinkles. 

Skincare in 20's Summary:

– Start monthly facials and peels

– Use at home exfoliants

– Start retinoids

– Always wear sunscreen

– Consider preventative Botox and microneedling

What is the best skincare routine in your 30’s?

  • Consider switching to glycolic or lactic based exfoliants instead of salicylic acid for non-acne prone skin.
  • Start to consider quarterly Botox and even yearly preventative fillers. We all lose about 1 syringe of filler per side of volume after age 25-30. 
  • Consider microneedling and IPL to help tighten skin, rebuild collagen, address any scarring or hyperpigmentation caused from past acne or sun exposure.
  • See an esthetician for monthly facials/peels.
  • Continue using a retinol in the evening (or every other evening) and vitamin c in the morning (if able to tolerate both), and wear sunscreen daily. Don’t forget to reapply sunscreen every 1.5-2 hours when in direct sunlight! There are great powder SPF sunscreens available that can be used over make-up

Skincare in 30's Summary:

– Use lactic acid or glycolic acid exfoliates if having less break-outs

– Consider quarterly Botox and yearly preventative fillers

– Consider microneedling and IPL

– Monthly facials and peels

– Continue retinoids, vitamin C and sunscreen

What is the best skincare routine in your 40’s?

  • Skin is usually dryer, so using a lactic acid or enzyme-based exfoliant can be helpful.
  • Consider deeper, more nourishing creams that contain things like ceramides, plant sterols, and amino acids/peptides.
  • Quarterly Botox, yearly fillers and IPL are usually more essential now to make up for volume loss and to smooth out expression lines.
  • See an esthetician for monthly facials/peels.
  • Continue using retinol and vitamin c serums, and of course wearing sunscreen every single day. 
  • See a dermatologist for annual skin cancer checkups if you haven’t already (can start at any age, the sooner the better).
  • Consider resurfacing lasers for deeper lines and wrinkles. 

Skincare in 40's Summary:

– Use lactic acid or enzyme based exfoliants.

– Use nourishing creams that contain ceramides, plant sterols and amino acids/peptides.

– Quarterly Botox, yearly fillers and IPL are more essential now.

– Continue monthly facials and peels.

– See a dermatologist yearly for skin checks.

– Continue retinoids, vitamin C and sunscreen. 

– Consider resurfacing lasers.

What is the best skincare routine in your 50’s and 60's?

  • Use enzyme and lactic based exfoliants as they are gentler and less drying on mature skin.
  • Use hydrating, cream-based cleansers that can nourish the skin and keep it more hydrated.
  • Use thick cream moisturizers with fatty alcohols, oils, plant sterols, and amino acids/peptides. Maybe even consider adding a facial oil to the evening routine for extra moisture. 
  • Quarterly Botox, yearly fillers and IPL treatments are essential. You may even want to consider laser.
  • See an esthetician for monthly facials/peels.
  • Continue using retinol and vitamin c serums, and wearing sunscreen daily.
  • See the dermatologist for annual skin cancer checkups.

Skincare in 50's and 60's Summary:

– Use lactic acid or enzyme based exfoliants

– Use nourishing creams that contain ceramides, plant sterols and amino acids/peptides

– Quarterly Botox, yearly fillers and IPL are essential

– Continue monthly facials and peels

– See a dermatologist yearly for skin checks

– Continue retinoids, vitamin C and sunscreen

– Consider resurfacing lasers

Were do I start with skincare?

If you’re reading this and you’re feeling way behind because you haven’t started anything, that’s ok! It’s never too late to start good skincare. At any age here are the absolute essentials with each additional add on:

What are skincare essentials?

– Wash your face every night with a gentle cleanser. It’s important to wash off make-up, dirt, oil, grease and whatever else from the day, every day.

– Wear sunscreen EVERYDAY! and we don’t just mean your tinted foundation or lotion. Wear a broad spectrum SPF 30+ every day under your make-up. Then re-apply every 2 hours if by a window, driving, or in direct sunlight. You can use a sunscreen powder over make-up to make this easier. 

– Consider adding in a retinoid. Retinoids help speed up turnover of skin cells reducing lines and wrinkles, decreasing discoloration and they can actually reverse DNA damage from the sun. 

– Consider adding in a Vitamin C serum, if you can tolerate this with a retinol. If you can’t, prioritize the retinoids. 

– Consider Botox, Fillers and IPL. We never thing we need them until we start to age and see the years catching up with lines, wrinkles, lost volume and discoloration. Many many people that you think are just aging well are doing all of these things. It looks very natural with the right provider. 

– Consider monthly facials and peels for regular skin assessments and also to get a much better, and much more relaxing, treatment than can be done at home.

What is medical grade skincare?

Medical grade skincare requires more rigorous testing and has to be proven to be 99% pure. Cosmetic grade, or what you can get over the counter, only has to be 70% pure. So many over the counter products are great but if you have any skin conditions or want to be able to guarantee the quality of your products you want medical grade.

 

Now there are many different brands of cosmetic and medical grade products. Do your research or talk to your skincare expert to decide what is best for you. 

What should I avoid to prevent aging??

It’s important to do all of the above for a great skincare routine but what about what should be avoided? 

– Avoid tanning beds unless it’s just for the red light therapy. You may look good tan in your 20’s and 30’s but as you age you will look older and older because of damage from tanning beds. Also, there is spray tan so you can be tan without severely damaging your skin. Many people will say things like, “well fat looks better tan”, but tanning damages skin making it thinner- this causes more cellulite to show and skin to appear thin and wrinkly.

– Quit smoking tobacco. This is tough because it’s a very hard habit to break. However, if you care about anti-aging you have to quit smoking. After sunlight and tanning beds smoking is the next biggest contributor to premature aging. 

Need help with your skincare routine?

Book a free consult below. You can book a skincare consult with a licensed aesthetician or book with one of our medical providers to talk about more invasive procedures. 

Book Now

All about under-eye filler

EMA client before and after Under Eye Filler

Table of Contents

All about under-eye filler

Have you gotten tired of trying under-eye creams hoping that they would help you get rid of the dark sunken look under your eyes? For many clients this area is extremely frustrating, but the good news is that there is a low maintenance solution. Under-eye (tear trough) filler can give the area under your eyes increased volume and reduce the appearance of dark spots. In this article we’ll dive into what types of fillers are used, what the procedure is like, and what under-eye fillers cost.

What is under-eye filler?

Tear trough filler is a treatment where hyaluronic acid (HA) dermal fillers are injected using a needle or cannula into and around the dark hollows under the eyes. It can be done alone or in conjunction with cheek filler. It’s important to address the whole face when treating this area for a natural and balanced look. Oftentimes under eye hollows can be from loss of volume in the cheek so it’s important to determine the underlying cause of the deficit before treating. 

It’s also important to go to an experienced provider as this area can not only be dangerous to inject but also difficult to inject in the correct plane (the correct level).

What types of filler can be used in the under-eye region?

Most of the softer HA (hyaluronic acid) fillers can be used in the under-eye area. Sometimes firmer HA’s can be used in severe cases or when they are diluted. It is not advised to use non-HA fillers in this thin sensitive area. 

The most commonly used hyaluronic acid fillers for under-eyes are:

Other fillers such as collagen, Sculptra and Radiesse are NOT recommended in this area due to risk of overfilling, pain, reaction and nodules. This is a high movement area that needs a soft and gentle HA filler for best results.  

For more information on fillers, check out our filler guide.

What does tear trough filler treat?

Our bodies can naturally lose volume in our tear trough as we age due to volume loss.  We also have separation of the fat pads under the eyes and the cheeks. This leaves an indentation or dark hollowing under the eye which can be softened with dermal fillers. 

Who is a good candidate for under-eye filler?

A good candidate for under eye filler is someone who:

  • Has always had dark under eye hollows genetically
  • Developed dark under eye hollows with aging
  • Has good skin quality and good cheek support

 

  • A poor candidate for under eye filler is someone:
  • Who has large under-eye bags rather than hollows 
  • Has extremely thin or fragile skin that appears “see-through”
  • Has full-face hollowing and requires full-face intervention prior to under-eye filler

Are tear trough fillers safe?

All medical and aesthetics procedures come with risks. Under-eye fillers done by experienced medical providers can be done safely. It’s important to consult with your injecting provider to discuss the risks and benefits of any procedure. Some of the risks involved in tear trough filler include:

  • A poor result, usually over-filling with a puffy appearance
  • Prolonged swelling from poor product selection or placement
  • A blue tinge under the eyes (tyndall effect) from too much filler, filler placed too superficially or filler placed on a poor candidate
  • A vascular occlusion where dermal filler gets into the artery (angular artery) which can lead to severe complications
Vascular system for under eye fillers
Image Courtesy of Plastic and Aesthetic Research

What are the benefits of tear trough filler?

  • Tear trough filler can add volume to lessen the “hollowness” under the eyes
  • It can give you a more rested and youthful appearance 
  • Filler will diminish under-eye bags (in certain cases) 
  • It will eliminate or lessen dark circles under the eyes

How much does under-eye filler cost?

Under-eye filler varies in cost based on the type that you receive, where you have the procedure done, and who is performing the procedure. Below is a breakdown of the cost  on average.

  • Hyaluronic Acid Fillers like Juvederm, Belotero, and Restylane generally cost between $600-$1200 per treatment. This does not including any other filler that may be recommended. When combined with other facial fillers the cost for the under-eye portion may be lower. 

How do you prepare for under-eye filler?

Talk to your injecting provider for a complete list of instructions but in general, it will likely be recommended to:

  • Avoid over the counter medications that may thin your blood like aspirin, ibuprofen, fish oil  (unless prescribed).
  • Not consume alcohol 24-48 hours before your procedure
  • Come to your appointment with a clean face and no make-up if possible. 

You can also consider icing under your eyes for 10-20 min prior to your procedure to decrease the risk of swelling or bruising. You can also consider taking arnica tablets to prevent bruising and swelling. As with any medication or supplement, talk to your provider about any medications or supplements you decide to take.

What is an under-eye filler treatment like?

Under-eye filler appointments are generally about 30-60 minutes. The actual procedure itself may only take about 5-minutes per side, but the preparation and discussions prior to the appointment will take up extra time. Your injector may also recommend injecting other areas first, such as the cheeks and midface, to support the tear trough area and for a better result which takes additional time.

What is under-eye filler aftercare like?

Every injector will have their own specific aftercare instructions. Below are some of the general recommendations for under eye filler aftercare:

  • Try to avoid using concealer or other eye makeup for the first 24 hours.
  • Do not rub the treated area for at least 24-48 hours after your injections. 
  • Avoid intense physical activity for 24-48 hours, if possible, as exercise may increase swelling to the area treated
  • Consider avoiding alcohol for 48 hours after your treatment. Drinking could increase the swelling and bruising.
  • Use an ice pack to ice the area for 5-10 minutes off and on for the first 48 hours. This will help you reduce  swelling quicker. It’s also a great reason to sit on the couch and relax.

When will I see results from tear trough filler?

Immediately after the procedure, you will be able to see your results. For many people, there will also be some swelling immediately post-procedure. The swelling will start to go down in about 48 hours. You will be able to see the final results in 7 to 14 days in most cases but in rare cases, it may take longer, especially during allergy season.

How long do under-eye fillers last?

Over the years we have discovered that filler tends to last much longer in this area than in other high movement areas. Lasting even longer than the lips. The same filler brand that may only last 6-8 months in the lips may last 1-2 years under the eyes.  More cross-linked fillers, such as the Juvederm family, can last 2-3 years, but this does come with an increased risk of reactions and late-onset nodules. Talk to your injecting provider about what dermal filler is best for you.

What is the best under-eye filler?

Hyaluronic acid fillers are the best fillers for under-eye treatments and we have tried almost all of the available brands on the U.S. market. Our favorites have been Belotero Balance and Restylane-L for most cases. 

We also use other, firmer HA fillers or Radiesse in the cheeks prior to doing under-eye fillers to support the area and also give a more natural look.

Under eye filler before and after

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