Cosmetic Botox injections have been shown to be safe and effective and MCI clinics wish to offer this service. The MCI Quality Committee makes the following recommendations to ensure patient safety and satisfaction.

1. Training
   • All practitioners who provide Cosmetic Botox Services must demonstrate adequate training in its use.
   • Training should include: anatomy, injection locations, dosages, assessing response to treatment, potential re-treatment intervals, contra-indications, and techniques to minimize side effects and maximize efficacy.
   • The adequacy of training will be decided on a case by case basis when approval to provide the service is sought from the EGC. Acceptable training will include residency training, short courses, and preceptoring.
2. Re-constitution and Handling of Botox
   • The package insert gives the following instructions:
     • Use 0.9% sterile saline without a preservative
     • Store no more than 4 hours at 20 – 80 C.
   • An acceptable alternative is (from reference below):
     • Use preserved 0.9% sterile saline
     • May store up to 6 weeks at 40 C.
   • No special handling precautions are required beyond those for any injectable.
3. Setting & supervision
   • All Botox services should be provided only in a physician office setting.
   • Botox injections given by non-physician practitioners must be supervised by a physician on the premises at the time of the procedure.
4. Patient Assessment & Counseling
   • Each patient should undergo a basic history and exam
     • The history should review allergies, medications, and problems pertinent to Botox (pregnancy, neuromuscular disorders)
     • The Physical should include physical and anatomical findings pertinent to use of Botox.
   • Overall aesthetic goals and a treatment plan should be developed for each patient to establish realistic expectations for the outcome.
   • Signed informed consent should be obtained (practitioners should develop a form for use in their office – a sample is supplied)

Reference:

Consensus Recommendations on the use of Botulinum Toxin Type A in Facial Aesthetics, Plastic & Reconstructive Surgery. 114(6) Supplement: 1S-22S November 2004.

Variation from this guideline is always acceptable, if in the opinion of the attending physician, individual circumstances require it