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"For the physician to grow a cosmetic injectable practice, both a variety of products as well as a mastery of technique are key ingredients in the recipe for success. If one had to choose between variety and technique, I believe that it is the technique that will ultimately provide desired results and thus create many happy return visits from patients. Repeat business is the goal.

"Some injectors feel that they can attract more patients by offering a cornucopia of different products on their advertisements. This can create an illusion of competence by offering experience with many products. I do use all available products myself. This may help get patients in the door, but it is pleasing results that will encourage the patient to return. "I have been on the faculty at Duke now for 11 years and have many patients that I have injected over the duration of those years. They are loyal to me because I have provided consistently good results. Occasionally, a patient may try injections with another practice, either to shop for a discount or out of urgency because my wait time is too long, but their dissatisfaction with other results and their good results at Duke is what made them want to return to me.

"The creation of good technique requires experience from performing various types of injections, in addition to developing an artistic eye. For example, when injecting perioral rhytids, only experience from many injections helps the injector feel the difference in pressure needed to inject a needle (and ensure that it) is properly placed in the dermis, as opposed to one that is just 1 mm too deep into the subcutaneous space, where product can flow too easily.

"Courses are available that can help injectors understand facial aging and thus develop a three-dimensional artistic vision for the patient. An artistic eye for a youthful face is imperative. Big lips and weighteddown nasolabial folds are fast and easy to accomplish, but they may not make patients really look younger or better.

"Another aspect of technique is that this process is not just about the injections themselves, but also about the technique of handling complications. First, risks and benefits should be mentioned ahead of time to help the patients make informed decisions prior to injections. Also, they will not be caught off-guard if minor complications occur. Confidence in handling such complications can help reduce patient stress and create a very loyal return patient. I have had several patients that have come to me for treatment of complications from infraorbital rim injections. Expert handling of such situations will create that ultimately happy and loyal patient.

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Dr. Seiler is the Executive Director of Education, Development, Accreditation, and Research for the American Board of Laser Surgery. He is also Owner and Medical Director, Seiler Skin Cosmetic Laser & Aesthetics Center and specializes entirely in cosmetic laser and aesthetic procedures. Dr. Seiler received his Bachelor of Science from the University of Notre Dame and his MD from the University of Arkansas for Medical Sciences. He completed his residency at the Carraway Methodist Medical Center, along with fellowship laser training. ©2014

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