Not just anybody can go around shooting you up with toxins anymore.

Botoxsafe

As of July 1, a new law in Nevada is in effect that limits who can administer injectables like Botox. The law prohibits aestheticians, medical assistants, and dental hygienists from administering botulinum toxins (Botox, Dysport and Xeomin) and other dermal fillers like Juvaderm. Specifically, Nevada now limits who can administer the popular cosmetic procedure to, "...a physician, physician assistant, dentist, registered nurse, advanced practice registered nurse or podiatric physician..."

And it makes sense from a safety perspective. Clostridium botulinums (the fancy Latin name for the active ingredient in Botox) is a potent toxin that causes paralysis. It is a pathogenic bacterium found naturally or created synthetically. The pharmaceutical is injected into facial muscles which temporarily paralyzes the muscles under the skin. When the muscles relax the skin on top of the muscle smooths out and eliminates wrinkles. Dermal fillers are similar in that they are injected into the patient's face and provide temporary results. However, dermal fillers do not affect facial muscles. Instead, they re-hydrate and "fill" skin that has lost natural moisture and volume due to aging.

Botox-like injectables and dermal fillers make up the most common cosmetic procedures in the world. In 2013, 6.3 million procedures were performed in the United States alone. And with millennial use on the rise as the generation navigates their 30s, current forecasts expect Botox products to reach $2.9 billion globally by 2018.

In Nevada, the strongest pushback for the new law came from dental hygienists. While Botox is not typically used in dentistry for cosmetic reasons, it is a common treatment for temporomandibular joint disorders (TMJ) and temporomandibular disorders (TMD). For those suffering from TMJ and/or TMD, Botox provides relief by paralyzing the muscles and relieving jaw tension and pain. Under the new law, dentists are required to undergo training to administer Botox. However, there is no avenue for hygienists to be able to perform the procedure.

As licensed medical professionals, many dental hygienists believe they should be afforded the same training requirement so they can continue administering Botox to their TMJ and TMD patients. As written, the law allows dental hygienists to administer local anesthesia or nitrous oxide but not Botox. The argument for allowing dental hygienists to administer injectables is that if dental hygienists receive adequate training to obtain their license to administer local anesthesia, hygienists should also be able to administer Botox.

Unfortunately for dental hygienists, Nevada legislatures determined the new law better protects consumers from potentially unqualified persons administering injectables without including exceptions for hygienists treating TMJ and TMD patients. Moreover, hygienists found violating the law will face suspension or revocation of their professional licenses. It is notable that with the passing of the new law, no state will allow dental hygienists to administer Botox. Nevada was the first state to allow dentists and dental hygienists alike to administer facial injectables, and after the new law takes effect, will be the first state to revoke that ability from hygienists.

While dental offices commonly perform botulinum toxin procedures on TMJ and TMD patients to relieve them of pain, the vast majority of injectable providers are health and med spas for cosmetic purposes. There, a doctor, physician assistant, advanced nurse practitioner, nurse, medical assistant, or aesthetician usually administers the injections. Now medical assistants and aestheticians are prohibited from administering these facial injectables. While consumers will be guaranteed the safety of a highly trained and educated professional providing this service, a consumer who previously received this service from a medical assistant or aesthetician may experience an increase in pricing. With the new law requiring a highly paid professional to administer injectables, these costs will likely be passed down to consumers.

Are the costs worth the regulatory safety to consumers of a toxin? Well, for a bacteria strain that was originally an epidemic, and later studied for chemical warfare, only allowing the most highly trained professionals to administer the drug seems to win a cost/benefit analysis for consumers. While the new law may hinder some professions, it is at the priceless gain of protection to consumers.