Dr. Furnas (00:01):
Search for scary videos of filler injections and other non-surgical cosmetic treatments and plenty of hits come up. Some have been injected by doctors, some by nurses, and some by physician assistants. So how can you find whom to trust holding that needle? Welcome to Skintuition. I'm Heather Furnas.

Dr. Korman (00:25):
And I'm Josh Korman. As two plastic surgeons, we lay aside our scalpels and explore the nonsurgical world to bring you what's new, what's safe, and what to look for. When you're ready to hit refresh.

Dr. Furnas (00:39):
It's a true pleasure to introduce Kirstie Anderson, a registered nurse and a certified aesthetic nurse specialist. She has been injecting Botox and other neurotoxins fillers as well as treating patients with energy devices like lasers and microneedling RF and other devices. Full disclosure, she works at my med spa.

Kirstie Anderson (01:04):
Hello.

Dr. Furnas (01:05):
Thanks so much for joining us, Kirstie.

Kirstie Anderson (01:07):
Yes.

Dr. Korman (01:09):
So Kirstie, what, that's a lot of words, what is a certified aesthetic nurse specialist and how do you become one?

Kirstie Anderson (01:18):
Well, a certified aesthetic nurse specialist is basically someone who has specific training in the field. So I could be any nurse and be injecting and nobody would know the difference, right? So becoming a certified aesthetic nurse specialist just means that I have a minimum of two years of experience in the field of aesthetics, including injectables, lasers, skincare, body contouring, and I work under a board certified plastic surgeon. You also can work under a board certified dermatologist, ophthalmologist or ENT, and then you need to be endorsed by that plastic surgeon and apply to test and pass the test.

Dr. Furnas (02:03):
So you became a certified aesthetic nurse specialist without prompting for me or the other doctors, the practice. Why did you pursue the certification?

Kirstie Anderson (02:14):
Mostly kind of because, like I just touched on is that people don't know who they can trust. They don't know what people know and don't know. There's so many med spas and not even just med spas, there's mobile injectors these days. So I wanted my patients to understand that I am committed to educating myself in the field. Being a nurse, you do need to do some continuing education and there's absolutely no requirement for you to do it under the field that you work in. I can do my education in ER nursing, I could pick whatever I want and I can educate myself that way. But when I'm a CANS nurse or a certified aesthetic nurse specialist, I am obligated to do continuing education in that particular field. So it's not that easy to find as a nurse. You can find lots of platforms to get educated on in any other area of nursing, and that's kind of, I think what a lot of people do.

(03:13):
They just find the easiest way to do it and get it done. So the education out there currently in aesthetic nursing is actually, I think better. It's better than any of the other areas. Yes, you can go to conferences and other areas, but there's very involved conferences for aesthetic nurses, which is really nice or is in the field in general for not just nurses, but so over the next three years, I have to do so much education in that, and I just think it's important for me to stay up to date. There's a lot of things changing in the field. It's evolved a lot since I started 11 years ago. It's continuing to evolve every year, and I think it's important to understand what the latest and greatest things are and know the safest techniques.

Dr. Korman (03:59):
So I always tell patients that the most important thing about the filler is the filler, and that's not the stuff, but the person who's doing it. So is it better to go to a plastic surgeon or a dermatologist or a nurse working under those two versions of physicians for filler Botox and a laser treatment?

Kirstie Anderson (04:25):
Yeah, just like you said, I mean, what's most important is the person behind the syringe or behind the laser, the one educating you. Hopefully they are educated because anybody can pick up a syringe and do someone's lips, for example, and then they can start putting it everywhere else, and maybe they're not really fully trained on it. With that being said, nurse or a mid-level do have to practice underneath a supervising physicians.

Dr. Furnas (04:54):
Yeah, it's interesting you mentioned that in at least the state of California, you need to have an overseeing physician, but that physician could be an ER doc or cardiologist or a family practitioner who knows really nothing about aesthetics, which is one reason the Certified Aesthetic Nurse certificate that you have specifies what we call the core aesthetic specialty. So plastic surgery, dermatology, facial plastics, which is a subset of ear, nose, and throat as you mentioned, and then oculoplastics, which is a subset of ophthalmology because it's the doctor's expertise, which is also important when they oversee the nurse.

Kirstie Anderson (05:39):
Yeah, I think that those are things going forward for patients or future patients or people looking for a practitioner to maybe start thinking about. I think we put a lot of trust in somebody who just opens up a med spa and says they can do this and that. And a lot of people don't know. They just don't know what they should know or what they don't know.

Dr. Furnas (06:07):
So how did you learn the treatments that you perform?

Kirstie Anderson (06:10):
A lot of trainings. Many, many, many trainings and lots of practice. I've had lots of trainings by really well-known industry leaders, so I'm very fortunate for that. Like I said, I've been doing it for 11 years, so a lot of it is trying stuff and seeing what I think of it and staying up to date. Not only do I do the trainings through work, but I go places for training. So it's just getting yourself out there. You can't just stick with one thing and you got to continually evolve cautiously with the industry.

Dr. Korman (06:50):
So what would you say to a nurse who is interested in aesthetics about how they should go about learning what they need to be an efficient and skilled aesthetic nurse in a core physician's office when they're starting with maybe a lot of experience in telemetry that's in the ICU or in the cardiology branch of the hospital, but no experience in aesthetics?

Kirstie Anderson (07:22):
Yeah, it's difficult. I mean, I started out, I took a course, I invested in myself and I took some courses and I didn't know anything. Then I hadn't even had Botox myself honestly, so I was very new to it, but interested and it's definitely a different type of nursing. It's not your hospital nursing, and some people prefer it and some people try it and they don't prefer it. So a different type of patient for sure. But I would say definitely you need to seek out some education on your own and look for opportunities to learn things, ask to shadow places if you can get your foot in the door that way. I also worked in the PACU in plastic surgery, so I got to see more things and it just sort of organically happened to shift into straight med spas. There's a lot of med spas out there with nurses, and there are definitely some new ones, and it's great if you have an artistic eye, but that's not just all it's about. So seeking out training is the only way that you're going to learn some things.

Dr. Furnas (08:35):
Yeah, I think you made a good point. You invested in yourself. I think a lot of nurses that we get a lot of inquiries just as Josh, you just mentioned a lot of inquiries. Oftentimes I just graduated from nursing school. I'm really interested in aesthetic nursing, and they bring enthusiasm, but they've not shown any commitment or investment in themselves. And so it tells the med spa owner, the physician, that someone's truly committed and truly passionate and is much more likely to be committed to self-education and be passionate about education if they have invested in themselves. And you had said that you like to try things, and I just want to add, when we try different things, we have sort of a staff alert, and so if

Kirstie Anderson (09:31):
You want to Yes, I don't just try on someone who comes in the door for the first time. Yeah, we willingly practice on each other.

Dr. Korman (09:43):
So how do you first evaluate a patient?

Kirstie Anderson (09:46):
So a patient, if it's their very first time coming in, it took a lot for them to get there and they're nervous. They have no idea what to expect beyond what they've seen on social media potentially. So I just kind of let them talk to begin with, what brings you in? What would you like to address? What's most important to you? Some people just want one thing and that's all they want, and other people can give you a long laundry list of things that they're interested in. So I just think it's really important to listen to them and hear them out. And I am never trying to push anyone into anything. I really just want the best for them. I want them to be happy with their treatment, and I think that's what's most important. So if they just want to come in and they've got one line between their brows and they want to address that, that's okay.

(10:32):
I hand them a mirror, we go over things together. I talk about the aging face and maybe some things that they've noticed in themselves. I don't try to point out things on people that I see that are flaws because everybody has their own natural beauty, and I'm not the judgment of that. I'm just wanting them to feel good about themselves. So I think really asking them, what's your priority? And we start from there. I create a care plan for them. So we talk about different options and different ways to achieve their results, and we start with step one.

Dr. Furnas (11:08):
So let's say that you evaluate, somebody comes back for a second or third or fourth treatment and they like what's happened. Maybe they want a little bit more, maybe their Botox or Daxxify or Dysport is wearing off. How do you evaluate them then? They're established and they're looking at, I like what you've done.

Kirstie Anderson (11:29):
And I think that once they have that trust and they see that getting a little Botox here or there isn't so scary anymore, then they may be more open to having conversations about other things. Maybe they're not ready, maybe they are, maybe they're just a little interested. So I think just having conversations about, well, you could do this, you could do that if want, no big deal. I just think that stuff comes sort of as the trust is built. And I think that once they know that I'm not trying to make them look funny or push them into anything, then they are sort of more willing to ask. And I'm definitely here to help. We've got lots of options. And so when I just suggested, and they may decide to go for it or they may have to think about it another time.

Dr. Korman (12:19):
On the flip side of that, what are some of the issues you see with patients that come in with problems or they've had treatments sent elsewhere, and that can range from everybody who said it didn't work, whatever it is, it didn't work to, oh, it was more expensive there and everything in between in terms of, oh, I don't like how it made me look or how it made me feel. Obviously their back or their back in a new location. So what kind of issues do you see?

Kirstie Anderson (12:53):
I think sometimes there's just a lack of communication or education on the process, and that seems to be a common problem. So I never like to talk bad about another provider because you never really know the true situation. If someone came to me and they said, I didn't like that they did this or that, I make a mental note, well, they don't like this, so I will be sure not to do that if they didn't like it because their brows peaked up high afterwards. And then I think a little education is you could have gone back to that provider and they could have probably easily fixed it, but I understand your brows tend to peak. You really don't like that. So I'm going to try my best to not do that, but I'm also going to see you back in two weeks if we're going to make sure that doesn't happen this time. So sometimes there is poor placement or filler has migrated, and that's not necessarily the fault of the provider either. So I've reversed a lot of old filler, migrated filler, overfilled filler, and patients need to know that those things can happen with anyone. But I think just listening to them and hearing them out and making a plan together so that they feel comfortable and not pushing 'em into anything is the most important thing to do.

Dr. Furnas (14:18):
And I think we see the same thing with surgery. And if something really was poorly done, I think it doesn't help the patient to bash the person who delivered bad care, all it does is create anger. Why did I go? And I think that it doesn't help the patient. I just want to move on and make something that may not look great and improve it. So let's say someone comes in wanting the injection of a neurotoxin like Botox or Daxxify or something for a bunch of areas, crow's feet and the glabella in between the eyebrows, maybe forehead, but they say, I can only afford a certain amount of money that will allow for an under number of, say 30 instead of 60 units or whatever you're recommend. How would you handle that?

Kirstie Anderson (15:11):
Well, I always start by giving 'em my recommendation. So I am recommending this many units if you want to treat these three areas, for example, or you need this many syringes if you want to achieve this result. And if they have a budget, I need to respect that, that's important to them. So I'm not going to push them. I will let them know we do have options. So if they are interested in financing options, we have that. We have a membership, which is great, makes things very budget friendly, also gives them a little bit of a discount on treatments. But I usually say, well, if you have this much, let's start with the area that's most bothersome to you, and then we'll go from there. I never want to undertreat them because then they will essentially be throwing money out the door, so they'll be putting all this money in and seeing very, very little or no results, so that wouldn't be worth it to them. So starting with one area so that they really love it, and then maybe they come back the next month and we treat the other area. But I definitely work with people if they have a budget, that's not a problem, and.

Dr. Korman (16:20):
Yeah, I think probably even the wealthiest person on the planet has a budget. It's what people have decided what it is they think something is worth. I also think that most people really would like to find someone that they can trust, and once they trust somebody, it's like a match made in heaven. So what advice would you give to patients who are looking for a practitioner they can trust?

Kirstie Anderson (16:52):
Well, number one, you can to start with read reviews, look at their website, look at before and afters, look at their social media, anything that will give you some information that makes you interested. But I think the biggest thing is just schedule a consult because you do need that trust. You need that relationship. You need to feel comfortable. And the only way you're going to truly know is to meet with that person and see what they recommend and see if they are listening and if they care, ask 'em about their training and experience. But really it's about the connection. So you just have to schedule a consult. And if you need to schedule more than one consult, do so, but at least start there and see how it feels.

Dr. Furnas (17:35):
You mentioned some great tools, before and after photos on social media and reviews. How do you evaluate your own work?

Kirstie Anderson (17:44):
Well, number one, patient feedback. I mean, I've definitely changed the way I say things or my approach with things based off of feedback from people. And I review my own before and after. So if I just saw a patient and whether or not we reviewed it or whatnot, I am always looking at my before and afters because it really tells me a lot. I could see things happen, but I want to see it from someone else's eyes and see, was that good enough? Should I change my technique? Should I change my placement? So I do that a lot. I also talk to my coworkers, the other injectors in my office or laser specialists, and we ask each other a lot of questions. We're always communicating about patients and what the things that we did that worked really well or maybe what didn't work as well. And then we do meetings with the doctors and we do some case scenarios, so that's always helpful too, because we kind of get a team approach, look at it.

Dr. Korman (18:50):
So obviously you work under plastic surgeons who are, I'm biased also, they're fabulous and friendly.

Kirstie Anderson (19:03):
They are.

Dr. Korman (19:04):
They are. So I get it, but not everybody can work for them and not everybody.

Dr. Furnas (19:10):
Poor you, Josh?

Dr. Korman (19:14):
So I guess the question is do you think it's an advantage, or obviously that's a loaded question because what do you think are the advantages of working under the umbrella of a plastic surgery practice? And specifically not just with a face, with body contouring, just in general, because one of the things that I personally think is that, and obviously I'm biased obviously, is that when all you have is certain things in the toolbox, then obviously everything you're going to use is in the toolbox. If your toolbox is bigger, then you have more tools in the box. So with that, and with all the disclaimers I just said, do you think it's an advantage to work under the umbrella of a plastic surgery practice?

Kirstie Anderson (20:08):
Absolutely. It's very, very much an advantage. I am very fortunate to work at a plastic surgery office, but not only that, to work with very good plastic surgeons. So I'm just going to say that to start.

Dr. Furnas (20:23):
Thanks, Kirstie.

Kirstie Anderson (20:26):
They're not just anybody, but there's so many advantages. I mean, beyond that, they stay up to date with everything. They keep our office up to date with products and technology and all of that. But also, just like you mentioned, I have an array of tools at not only my but their fingertips. And if someone came in and they had under eye bags and all I had to offer was Botox and filler, well, there's not really a lot that I can do. Of course, if that's all I have, that's what I'm going to try to use. But they might not be very happy with it in the long run. So I can truly offer multiple options. I have lasers, which might be a little bit more than just Botox and filler, but I also can recommend that they speak with one of our plastic surgeons, and I think they would be much happier with that than me just taking their money for something that's going to have very little impact. So definitely having all the tools is just really nice.

Dr. Furnas (21:30):
And it goes both ways as Kirstie knows, I see plenty of, particularly the face cases, eyes, laser, facelift, rejuvenation, where surgery can only do so much. And so a lot of times we'll see patients together and discuss a plan of what to do after surgery so that it's a handoff. I can do what I can do in surgery. And I know Josh is going to do the same thing, cuz he's got the med spa right there with his surgical practice. Because people will come in saying, I want surger cuzI want it to be permanent, and I don't want to have to repeat doing anything. And we have to break the news to them that surgery can only do so much. And so that's why we, I'll grab Kirstie and we've developed a plan that will be effective for the holistic approach.

Dr. Korman (22:29):
So is there anything else you'd like to add that we've left out or something that if you were the patient, what you would like to know or you would like to ask?

Kirstie Anderson (22:39):
I think being a patient, especially for the first time, is scary. You don't know who to trust. You don't know what you're going to look like. A lot of times they do a consult and then they come back for their treatment and they're like, I'm so nervous. I'm like, what's making you so nervous? It's like, is it the pain or is it after? What are you nervous about? And sometimes it's just like, I just don't know what to expect. And I try to tell them, I am not going to make you look funny. So I think that there's so much bad filler and plastic surgery results that you see, and sometimes on celebrities. And so people after Madonna debuted her face at whatever show or whatever it was at, I heard a lot of that, oh, I'm not going to look, I suggest three syringes, for example, now they think they're going to look like Madonna did.

(23:34):
But that's not the reality, right? So I think that as an injector and a plastic surgeon, I think it's important for us to steer the patients in the right direction and not just take their money because they want filler or because some people will push for that overfilled look. But my philosophy is just to appreciate their natural beauty and to keep them looking natural and just have them age a little bit slower. So not necessarily gracefully, I guess, but a little slower. And I just want patients to know that they can trust that process.

Dr. Furnas (24:20):
Thank you so much, Kirstie. Really appreciate your coming on Skintuition. Join us every two weeks as we tackle topics from hair loss to hormones and pimples to wrinkles, discovering new ways to feel better about ourselves.

Dr. Korman (24:36):
If you enjoyed this podcast, please rate us, review us and share. Have an idea for a topic? We'd love to hear from you. The music by Diego Canales, production and engineering by The Axis. See you next time.