It is natural to experience nervousness when injecting for the first time. It is important to familiarise yourself with the basic injection patterns and understand the anatomy. However, it’s crucial to remember that this is just an intramuscular injection. Synthetic model heads can be helpful for practice, as they can help you gain confidence
When discussing neurotoxin treatment during consultations, obtaining full consent is essential. Patients should have ample time to ask questions, and it’s equally important to encourage them to ask questions.
A brief review of their understanding is beneficial. Asking them a standardised short list of basic questions, such as the expected duration for the product to take effect or potential side effects like heaviness and swelling, is helpful. Enquiring what they wish to achieve and discussing realistic expectations sets the foundations for a realistic outcome.
It is crucial to make them aware that neurotoxin treatments are not free and “top-ups” involve costs. Using leading questions can guide the discussion and enhance their understanding, ensuring they feel more comfortable with the procedure.
A thorough explanation of costs, longevity of the product and suitability of treatment based on the patient’s presenting anatomy will provide a clear and concise picture to the patient.
You must reinforce that every batch of neurotoxin is different and every time they have a treatment, complications are possible (like every time we drive, we can have an accident). As we age our responses can also change.
It is crucial to communicate that every individual’s musculature is unique, and muscles can vary significantly among different people.
It’s important to be aware that different neurotoxins have distinct characteristics. For example,
- Some neurotoxins can be more potent in certain areas.
- Some neurotoxins can sometimes spread further.
- Some neurotoxins can be generally considered a gentler, softer product.
Further information on specific brands will be provided during your practical training.
In older patients and patients who present with an anatomically lower frontalis, it’s essential to inform them that injecting the full forehead can lead to a “feeling” of heaviness, and it may even cause brow drooping. To address this, you can consider initially treating the crows’ feet and frown muscles, which are depressor muscles as they pull down, a couple of weeks before then upon review assessing the forehead activity and perhaps titrating the forehead dose. Let them decide!
This is an example of using the Socratic open-ended question method with patients, offering them choices and thoroughly documenting their preferences and their decisions. This documentation is vital for ensuring clarity and medicolegal protection.
Some patients may also experience pseudo-brow heaviness, which could be due to a feeling of heaviness (as mentioned ) or due to puffiness caused by insufficient forehead lymphatic drainage. For these latter patients encouraging patients to maintain an upright sleeping position, use an extra pillow, apply ice in the evening and morning, and perform forehead exercises can help alleviate this concern.
An alternative low-risk approach to achieving maximum brow lift with neurotoxin is by treating the crows’ feet and the area just beyond the outer brow endpoint. Also, focus on injecting the procerus muscle just below the eyebrows. By relaxing these muscles, you may achieve some lift, although this effect may not occur in all patients.
There are various techniques for injecting neurotoxin, but the fundamentals involve injecting the muscle at a superficial to mid-depth while avoiding accessory structures like tear glands and nearby muscles.
One technique is the direct stab-type technique, and another is the skewer technique. Personally, I prefer the skewer technique because it allows the toxin to spread along a line of the muscle, reducing the likelihood of it spreading beyond the muscle’s edges and causing complications. The stab technique is more commonly used but tends to create a circular spread of the toxin, which can lead to unintended spread. Your training nurses will demonstrate these techniques to you.
Gaining experience and learning from experienced staff is invaluable. Focus on the basics first and if unsure always get a second opinion.
When administering neurotoxin, use an insulin needle to ensure no product is wasted. Follow strict aseptic techniques and provide aftercare instructions.
Treatment with neurotoxin involves.
- Washing hands
- Cleansing the area
- Preparing the product using aseptic techniques
When using neurotoxin, ensure that you expel the air bubble from the syringe and leave a small bubble behind the last drop of toxin. This practice can save significant amounts of product and reduce waste. Encouraging patients to have their own ice packs ready at home helps with reducing swelling and bruising. Maintaining strict aseptic technique is necessary, but you can do so in an economical manner.
Providing aftercare instructions, including a scripted message for concerns and information about aftercare resources on the website, is crucial. Some patients may claim they didn’t receive aftercare, but using a consistent script ensures that you haven’t overlooked this step. The script should include instructions for contacting the clinic for any concerns and an urgent after-hours contact number. A complimentary phone call the next day to check on the patient’s progress is often wise, and for more anxious patients, offering a complementary check-up is recommended.
These steps can help you avoid or manage complications effectively.
Understanding complications and their diagnosis is crucial in your practice. In the early stages of your career, it’s advisable to refer any concerns to your supervising doctor. Inform patients that if they encounter anything that sounds urgent, they should send a photograph or video to the doctor’s phone immediately, along with a text message explaining the situation. Email is not recommended for urgent matters, as it can be less reliable.
Prioritise focusing on the fundamentals first and rehearse them thoroughly. Then, gradually add additional details to your practice.
