Is Your Botox Real? How to Know for Sure

You sit in the chair, ready for your usual Botox appointment. The injector is friendly. The room looks clean.

But here's the question nobody asks: where did that vial actually come from?

I sat down with Dr. Kristen Jacobs on the Med Spa Confidential podcast to talk about something most patients never think about, product sourcing. It sounds boring until you realize that counterfeit and illegally sourced injectables are everywhere.

And if your medspa isn't buying from verified, legal suppliers, you could be getting injected with something that was never meant for your face. As a physician who's seen what can go wrong, I'm breaking down why this matters and how to protect yourself.

The "Gray Market" is Mayhem

"If a medspa is buying products outside the legal supply chain, they're putting every patient at risk and most patients have no idea." — Dr. Kate Dee, Med Spa Confidential

Botox, Dysport, and fillers are prescription medications. They're supposed to come directly from the manufacturer or an authorized distributor. But there's a thriving gray market where medspas buy these products from unauthorized sources, sometimes because it's cheaper, sometimes because they don't know better.

Even if the box says “Juvederm,” it might be fake, expired, or mishandled. And you won't know the difference by looking at it. The packaging can look identical. The box might have the right logo. But what's inside could be diluted, contaminated, or completely fake.

For medspa owners, this is about patient safety and your license. If something goes wrong and the state investigates, proving you sourced your products legally is the difference between defending yourself and losing everything.

What Patients Should Ask

"You have every right to ask where your Botox came from. If they won't answer, that's your red flag." — Dr. Kristen Jacobs, Med Spa Confidential

Most people don't think to ask about product sourcing because they assume it's regulated. It's not. There's no inspector walking into every medspa checking invoices. That means it's on you to ask the right questions.

Before your next treatment, ask: "Where do you source your injectables?"

A legitimate medspa should be able to tell you they buy directly from the manufacturer or an authorized distributor like Allergan Direct or Galderma. If they hesitate, change the subject, or say "we get a great deal from a supplier," that's a problem.

You can also ask to see the product before it's opened. The packaging should be intact, the lot number visible, and the expiration date current. If your injector seems annoyed by these questions, find someone who isn't.

Why This Matters for Medspa Owners

"Certification isn't about making your life harder. It's about proving you're already doing what's right." — Dr. Kate Dee, Med Spa Confidential

If you're running a medspa and sourcing your products legally, the MedSpa Board certification process is straightforward. You document your suppliers. You show your invoices. You prove the chain of custody from manufacturer to patient.

But if you're buying from someone who "has a great deal" or ordering from an online supplier you can't verify, you won't pass.And honestly, you shouldn't. Because when a patient has a complication and it turns out your product wasn't legitimate, you're not just facing a lawsuit, you're facing criminal charges.

Legal sourcing protects your patients, your practice, and your license. It's not optional.

Before Your Next Appointment

If this story made you rethink where you're booking treatments, good. That's exactly the point. You deserve to know what's going into your body and where it came from. And medspa owners deserve to understand why shortcuts in sourcing can destroy everything they've built.

Listen to the full episode of Med Spa Confidential to hear how Dr. Jacobs ensures every product in her practice is traceable, legal, safe and what questions you should be asking before anyone picks up a syringe.

Transcript

[00:00:00] Dr. Kate Dee: Hi, this is Dr. Kate d and I'm excited to talk to Kristen Jacobs today. She is another physician who's been in the medical aesthetic space for many, many years now, and she's been on the podcast before. And we're gonna go over exactly how to get certified by the Med Spa Board and what those requirements are.

Dr. Kate Dee: And I'm gonna introduce her, all the requirements, and we're gonna go over what it is for. Our practices to qualify. So, are you ready, Kristen?

Dr. Kristen Jacobs: I am ready. I'm excited for you. First of all, congratulations on this and I'm so excited to hear what all you have to say.

Dr. Kate Dee: Yeah. Well, cool. So I have in front of me, the list of requirements and I just thought we would just kind of go over them and talk about how, how we comply and what we're trying to get at here to make sure that everyone complies with this and, and why it's so important and so. For, for other doctors or, you know, med spa owners who might be [00:01:00] listening to realize just kind of how simple it is to get certified if you're already legally compliant.

Dr. Kate Dee: But then also for consumers, anybody listening at home who is wondering, you know, what the heck and, and why this is a big deal to understand what we are requiring and why it's so crazy to go to a place that's not actually complying with this stuff. Right. So. Let's just launch right into it. Okay? So the very first thing on the list is licensure.

Dr. Kate Dee: Okay. So everyone in the spa has to have an active license to do the thing they're doing okay, and actually has to have a license at all. So can you tell me a little bit about like your staff and what the license situation is,

Dr. Kristen Jacobs: Right. So that sounds like the easiest thing in the world, right? Like and why would, why would you have anything that you know, or why would you have somebody doing something that's not licensed? But every single state is different on the requirements of what, Each person can do in the office. [00:02:00] So our, the only other, I'm a, an MD and so obviously I have my license, but the only other truly licensed provider that I have currently is a physician's assistant

Dr. Kristen Jacobs: So I don't have any RNs or nps or anything like that. I also don't have any estheticians. the state of Illinois, which is where I am, is a little bit, iffy on what aestheticians can do. And so it just makes us really. Stay in that compliance. You know, I don't wanna go outside of the lines. I wanna make sure that I'm sticking with what I'm supposed to be doing.

Dr. Kristen Jacobs: Yeah.

Dr. Kate Dee: Right. And so in my place there's uh, actually three MDs, two nurse practitioners. uh, pa uh, four Master Estheticians, which we have here in Washington. That's an unusual license. That's, I think only about eight states. That has a master aesthetician, uh, license. And so the, so the key thing is when you do apply or a med spa that applies, they'll have to list their [00:03:00] staff members and their license numbers, and that'll include the estate license and then also their NPI number.

Dr. Kate Dee: And for anyone who doesn't know the, the, the National Provider Index is a list of every medical provider that's actually licensed in the country. So, and we're gonna, as the med spa board is just gonna verify that all the people who are working there actually have an active license. And they're, they're qualified to do the things they do.

Dr. Kate Dee: So that seems pretty straightforward, right? Like, you know, you would think this wouldn't be that complicated except that, you know, many places have providers doing these treatments, whether it's injectables or laser that do not have a license of any kind. And you'd think, well, how's that possible? Well, 'cause nobody's watching, nobody's requiring anybody to, to be legally compliant.

Dr. Kate Dee: This and the med spa board, we are voluntary. Nobody has to get certified. Right. [00:04:00] But, there are many places, and, and if you look at the headlines, and I know we've talked about the lady who died in Texas, but you know, the person who killed her had no license of any kind. Okay. And so. Obviously a place like that would not be able to get certified.

Dr. Kristen Jacobs: Right, right,

Dr. Kate Dee: Okay. Alright. So that's like the simplest thing here. Okay, let's move on. Let's move on to the medical director because this is really a big topic. Okay. So I'm just gonna read to you from our requirement. So the medical de director has to have an active MD or do license, or if it's one of the states that allows this.

Dr. Kate Dee: A nurse practitioner, can be the medical director. There are very few that allow a, a pa to be the medical director there. There are, I think, maybe five states that allow that. They have to be qualified and active. That means that the medical director, this is their practice. Every single [00:05:00] patient who comes through that practice is their patient, so they have to understand.

Dr. Kate Dee: Aesthetics. They have to have the appropriate education, training, and experience and competence to administer and delegate and supervise each aesthetic medical treatment at the spa. They have to ensure appropriate supervision of each medical aesthetic treatment. They have to accept ultimate responsibility for the safety of the patients in that spa.

Dr. Kate Dee: They have to ensure that the medical spa's providers are trained and qualified to provide the procedures. That they've been tasked to provide. They have to ensure the medical spa is equipped with all the necessary equipment, supplies, and pro processes to address medical complications and emergencies.

Dr. Kate Dee: And they have to develop and sign written protocols for aesthetic medical treatment to be performed at the Med Spa. Okay. So obviously you're the medical director of your spa, and you've been doing this for how many years [00:06:00] now?

Dr. Kristen Jacobs: Well since 2008, so I think

Dr. Kate Dee: 2008. So a really long time. So, uh, you know, can you talk a little bit about those things that you're doing, but then also, you know, why this is important?

Dr. Kate Dee: What compared to like these other places that have medical directors who don't actually do any of these things?

Dr. Kristen Jacobs: And that's, unfortunately that is a lot of the medical spas that are out there, the medical director is not involved at all. They just put their license on, uh, on record. And to me that's extremely scary. Like you, you as the medical doctor, let's say, a nurse practitioner, some of the states, like you should know what's going on and you should understand what the laser procedure could do.

Dr. Kristen Jacobs: And it is just a really scary thing in my opinion. So with, in, in our clinic, because there's a couple different things going on that you had said too because you mentioned supervising. So in the state of Illinois, you have to have a, an MD and NP or a PA for certain supervising, roles, meaning certain, [00:07:00] treatments that can be done.

Dr. Kristen Jacobs: So it's not just about being that medical director, it's making sure that you're following compliance as far as who's supposed to be on site when certain procedures are being done. This again, is why I don't necessarily, it's not that I don't want an aesthetician or don't want an rn, it's just that right now it's not really in the cards for us.

Dr. Kristen Jacobs: So when MD has to be on site or an NP or pa, the other thing is we're one of those states, Illinois is one of those states that MPS can technically own their own practice. But what really bothers me is that they have to have 4,000 hours. Well, they're not getting 4,000 hours of aesthetics. Then going out and opening up their own practice.

Dr. Kristen Jacobs: They're just saying, well, I have 4,000 hours as an np. It could be an ICU, it could be just in the, on the med floor, you know, and then they're able to open up a practice in aesthetics when they have no background or no training. So you can tell I feel very [00:08:00] passionate about this part of it. And, and I, I really am passionate about the medical director being.

Dr. Kristen Jacobs: A hundred percent involved. And I am, you know, not with every single treatment, but there's, I'm a phone call away if I'm not on site or I am usually, I feel like I'm on site all the time. So.

Dr. Kate Dee: Right, and, and the thing is that the reason this is a big deal is that traditionally in the prac practice of medicine, you go to medical school, you go through residency. You learn, you know, your, your specialty, whatever that is. And then you, you practice, it's your practice. And if you hire people under you, then you can supervise them.

Dr. Kate Dee: But what's happening in aesthetics in this country is that the lowest level provider is going to a weekend course. Learning a basic skill of like how to do an injection, literally spending a couple hours doing [00:09:00] that. and then they are busy trying to find a medical director who is willing to put their name on it, right?

Dr. Kate Dee: So for whatever price, you know, how much do I have to pay someone a month to have someone loan me their license so that I can go off and do this thing I just learned over a weekend. And that is unfortunately the norm now. And, and so the medical directors, you know, they're finding whoever they can find, so. You know, unlike the doctor who went out and forged, you know, a practice and, and learned aesthetics. 'cause there's no residency in aesthetics. Uh, you have to get training, but you have to have a medical background. So you have to be able to know anatomy and treat emergencies. And there are so many different interactions, complications that you can have if you have certain diseases, if you, you know, and, and we've learned about those 'cause we went to med school, so someone who went to a weekend course doesn't know about any of those things.

Dr. Kate Dee: Right. So what happens is [00:10:00] there's a market for, medical directors out there, and that price has gone lower and lower since, since you and I have been in doing this business. 'cause it, for me, it's been not quite 11 years now. And for you even longer, right? It, it used to be a little less common when we started and the price was higher, right?

Dr. Kate Dee: Because why would any doctor loan you their license? Take all that liability on for not much money. I mean, that sounds really scary to me. I'd never in a million years sponsor somewhere that I didn't know. But now there are so many people doing it that and especially there are so many nurse practitioners willing to be the medical director 'cause I don't think they realize the kind of liability they have.

Dr. Kate Dee: But, but either way, the price has gone from several thousand dollars. A month to about $500 a month, and most people are out there trying to find a cheapo medical director who's not related, doesn't show up, [00:11:00] may not even be in that state, doesn't even do aesthetics, has no oversight whatsoever, and probably doesn't even realize they're taking on the malpractice liability.

Dr. Kate Dee: Like anything goes wrong, it's their butt on the line, not this untrained, you know, person who doesn't have. Even insurance, right? So, so it's very, very common, and this is how all these illegal places pop up where they actually do technically on paper have a medical director that's somewhere, right? And that's how they're buying their Botox or whatever neurotoxin or other products they're getting.

Dr. Kate Dee: Which you can only buy these things if you are a doctor, if you have a medical director. But these non-medical people or you know, nurses or lower people who are, who can't practice medicine on their own. They're basically renting out someone else's license. So what we're doing is we're, interviewing the medical director and asking them these questions and [00:12:00] finding out what their, what their knowledge is, how, how often they show up at the spa, how do they know?

Dr. Kate Dee: Staff, are they, do they, are they really well aware of their training? Are they monitoring it? Do they respond to emergencies? Are they involved in any way? And they have to sign an attestation saying, yep, that's what I'm doing. And so my, my guess okay is I don't know a lot of doctors who would say they were doing this when they weren't and then sign an attestation that they were doing it when they weren't.

Dr. Kristen Jacobs: I would hope not. Right. Yeah.

Dr. Kate Dee: so I think a lot of these kind of. You know, fake, I call them fake medical directors, but like, you know, absent medical directors, I think a lot of them would just be like, no, I'm, you know, I'm not signing that. You know, I'll take the 500 bucks a month, but I'm not putting, you know, this in writing,

Dr. Kristen Jacobs: right, right, right.

Dr. Kate Dee: So, so that is the big, that is the big step that we're doing with that.

Dr. Kristen Jacobs: think that's huge. I mean, quite [00:13:00] honestly, it terrifies me having my license out in my own clinic and knowing that my pe the people under me, you

Dr. Kate Dee: Absolutely. Like I have to know my people Absolutely. Inside and out and, and I need, if ever there's somebody who's like, not, you know, I mean, I can't, I can't function, I

Dr. Kristen Jacobs: No, no. Right. Exactly.

Dr. Kate Dee: if you are an actual doctor who knows medicine and you know the person under you like isn't. The best or isn't knowledgeable enough, you won't, you won't be able to tolerate it because it's like we, this is in our DNA, right?

Dr. Kate Dee: Like we, we care about humans, we care about health, and we don't first do no harm. We absolutely don't wanna harm anyone, and there's nothing more harmful than doing something elective that has a bad outcome. So we just don't want that,

Dr. Kristen Jacobs: No, and it's not just, you know, it's not about the money to us, like it

Dr. Kate Dee: oh, no.

Dr. Kristen Jacobs: and like you said, the humans and the, and the, the, the way that we can help people. And I think that [00:14:00] this is so important and the unfortunate thing of all these, you know, doctors or a lot of nurse practitioners that are lending out their license, it is about the money and it's so sad and

Dr. Kate Dee: Well, and, and the thing is, we're in a capitalist society and people need to make money. You have to have a business. But, but you know, as a physician, like I can just tell you that like, yeah, we wanna make a living, but we would never in a million years wanna make a living off of harming anybody or giving someone something they didn't need medically.

Dr. Kate Dee: Like we don't, that's not. Who we are. I mean, I'm sure there's a, a subset of doctors who are unscrupulous and awful people, but I mean, there, there's always a, a subset of, of, of bad actors out there. Right. and I, and we can't prevent those people from existing or, or doing whatever. But as a consumer, your goal is to find someone like you, Dr. Kristen Jacobs, or me, who really cares about you, like doesn't wanna just sell you a bunch of stuff.

Dr. Kate Dee: Right. And I think that, that having a medical director. Involved is the key to [00:15:00] that. Not that people, you know, lower down on the, on the hierarchy, don't care. They absolutely

Dr. Kristen Jacobs: Of course. Of

Dr. Kate Dee: the people who are busy cutting corners, they just want the money.

Dr. Kristen Jacobs: Right,

Dr. Kate Dee: They want the

Dr. Kristen Jacobs: right,

Dr. Kate Dee: they don't care. Right. and they also don't know the possible negative outcomes.

Dr. Kate Dee: Like all these people who are non-medical setting up IV bars, they don't know that actually that is like super crazy dangerous. They don't even realize that. They're like, oh, this is a great business idea. And that's, that's what they know. Right? So, okay. So the next topic is doing a good faith exam.

Dr. Kate Dee: Which obviously in your place, so, well, let's, let's just, let's just define what that is for people. So, and we've talked about this also on the podcast before, but a good faith exam is when you're a new patient and you establish a new doctor patient relationship with a new place, a new, [00:16:00] new doctor, and, uh, only a doctor or a nurse practitioner or a PA working under a doctor.

Dr. Kate Dee: Can do that. Okay? A nurse cannot, estheticians, cannot. And so you have to have the right personnel performing that initial assessment and plan. They're supposed to do a whole full, you know, history, physical, you know, figure out what a treatment plan is, and, and, and prescribe a treatment. Okay? That's what a good faith exam is.

Dr. Kate Dee: So can you talk a little bit about like, what you guys do and, and also, you know, why, why this is such a big deal in our industry?

Dr. Kristen Jacobs: Right. So, we also do this annually, so it's not just a new patient, so this has to be done, every single year, which, you know, really is a, a, a time suck when you have everybody at the same time needs their good faith. But basically what we do is re we review everybody's medical history, so what medications they're on.

Dr. Kristen Jacobs: What kind of surgeries they've [00:17:00] had. Do they have any metal implants? Because that's gonna determine what treatments we could do a pacemaker. You know, you can't do radio frequency if you have a pacemaker. So we have to ask all of these questions so that we can create that treatment plan and or say, oh, absolutely not.

Dr. Kristen Jacobs: This patient can't do this or can't do that. Something as simple as a milk allergy and how you can't use Dysport. Um, there, you know, there's all these little. Simple things that we need to know. So a, a very thorough, medical exam is, absolutely, imperative when they, when they come in. But like I said, we, we do it every single year as well.

Dr. Kristen Jacobs: So we, we have in our system. It will say, good faith is due, you know, on whatever date and then it pops up automatically, thankfully. So that's probably the one good thing about our electronic medical, uh, record system, is that it does keep us on track for that. And then the, the ma will actually go through all of that, just like if you were going to a regular [00:18:00] doctor's office.

Dr. Kristen Jacobs: And then when I come in the room, I go through it again, and then we have a sheet that's just for. The doctor or the RPA to sign off on. So we're making sure that we've got everything updated and then I go through and check all the boxes. The patient has to sign it. Then I have to say, patient is cleared for all treatments or they're not cleared and these are what they cannot do.

Dr. Kristen Jacobs: And then I sign it and then that gets tucked away for a year. So it's, but we do ask every time they come in anyway. Like, I mean, this is a medical. Place. This is a doctor's office, so every time you go to have your blood pressure checked, the nurse is going to ask you, or the MA's going to ask you, are you on any new medications?

Dr. Kristen Jacobs: Are you, you know, has anything changed with your medical history? So that's how we treat it for every visit, and then we'll update as we go. But the good faith is annually that we do.

Dr. Kate Dee: Right. And it's required in every state. It's [00:19:00] illegal to practice without that. Okay. we also have a, we have a form that basically lasts for one year, so. It will no longer, it will also pop up as not, you know, needs to be redone so that we get triggered to always, you know, refill that out. And one of the big things that people just seem to not understand, both consumers and also providers who don't do a good faith exam, is that.

Dr. Kate Dee: It actually matters if you have any medical thing, even just allergies, even just minor things you don't think about as being all that important. It actually can matter having Botox or laser or any of the other treatments that we do. And so God forbid you have a complication because you just didn't know that was a problem.

Dr. Kate Dee: Right? And so. A good faith exam has to be done by somebody qualified. So it can't be done by an RN or an esthetician. It has to be done by a doctor [00:20:00] or a pa or a nurse practitioner. And, and that is also, it's skipped in a, a lot of med spas. So as part of this, we actually have to, you know, we, we make sure that.

Dr. Kate Dee: Both the owner and the medical director, you know, have that plan in place. And then of course, both of their attestations say, yes, we, we performed this good faith

Dr. Kristen Jacobs: Right. Right. That's great.

Dr. Kate Dee: And it's, and you'd be amazed at how many places just don't ever do that.

Dr. Kristen Jacobs: Right.

Dr. Kate Dee: so if you go into a place and you never see any of those level providers, if you see a nurse or an aesthetician, you have anything medical done to you?

Dr. Kate Dee: Totally not legal, right?

Dr. Kristen Jacobs: Exactly. Exactly. And like you said, it's very scary 'cause there are a lot of 'em out there or, and it is legal for them to do a Zoom call or a well, telemedicine or however you, I guess zoom's probably not, but telemedicine and quite honestly, I feel like. That's a little iffy, but it is legal, um, [00:21:00] for

Dr. Kate Dee: Yeah. And that, so that, that to me is in a gray area. And honestly, I'm actually open to suggestions if anyone out there listening feels strongly about this, because it is legal to do a, telemedicine, good faith exam. So let's say you have a place that's entirely staffed. RNs and they are not legally allowed to see a new patient or anything.

Dr. Kate Dee: A lot of these places will outsource, their good faith exam and their prescription. So whoever's gonna prescribe the treatment to a company that provides good, good faith exams, it's usually a five minute consult with a nurse practitioner, usually in a different state. And they're not really making an assessment of your skin or anything.

Dr. Kate Dee: What they're really doing is clearing you for stuff. So, you know, making sure that you don't have certain diseases and conditions and stuff. And it's really interesting 'cause for [00:22:00] me it's a very in between thing. Like it's better than nothing because if you really do have a major contraindication to Botox, they will.

Dr. Kate Dee: They will, you know, they'll, they'll figure that they should anyway, figure that out. Right? But they're not really making the assessment. It really is. Like, they're just, you know, screening for a bunch of stuff. They're not really assessing your skin and prescribing stuff. So it's kind of like, it's like a dotting of the eye that's better than nothing, but it's not necessarily.

Dr. Kristen Jacobs: Right. So

Dr. Kate Dee: necessarily kosher by me, but, so we do everything in person. I assume Of course you do everything in person.

Dr. Kristen Jacobs: We

Dr. Kate Dee: Um,

Dr. Kristen Jacobs: But

Dr. Kate Dee: yeah. And really hard to assess Someone's on a video call, really hard

Dr. Kristen Jacobs: Last year I didn't have another provider. And so, if, uh, even if a patient wanted to come in, let's say for LAIs or, you know, for, for anything where I was not on site, I shouldn't say I didn't have a provider. I didn't have a PA or an mp. [00:23:00] And so we did try a telemedicine because I was a little bit on the desperate side.

Dr. Kristen Jacobs: And so the interesting thing was with the company I used. They would only clear the patient for whatever service was that day, so that was great. Right? So if they had, uh, just the diamond glow, then that's all they would talk about. And they really did do a, a great job with that. They did not clear, patients more than they did, which was also very interesting.

Dr. Kristen Jacobs: And to me, I was like, well, this isn't working out. I'm paying for, you know, a company. And they, they did charge. Per patient and per treatment. So it was, like I said, it was interesting. So I do think that they were a better level company. I honestly, I don't even remember what the name of the company was, but thankfully I didn't have to use them for very long, and I bet we only used them four or five times.

Dr. Kristen Jacobs: And then I finally had somebody else who, you know, I could bring on to help. But it was, it was interesting. So I think there's, high quality companies out there. And then I also [00:24:00] think it's the same as what we're talking about. I think there's some more, a little bit shadier companies out

Dr. Kate Dee: Yeah, and I honestly think that that's gonna be really hard to assess.

Dr. Kristen Jacobs: Right,

Dr. Kate Dee: so I think that that will be part of our work will be, figuring that out for, if people apply for certification and they're using one of those services, then the service itself has to be evaluated. And, it's possible that over time some of those companies will, they'll get vetted and they'll be like, okay, you guys do an adequate job.

Dr. Kate Dee: And then maybe other ones. Don't, I don't know. It's gonna be, it's gonna be interesting 'cause they probably can't control, if they've got 20 nurse practitioners in 20 different states, they probably can't control each one and the quality of each visit, they're probably not monitoring every single thing.

Dr. Kate Dee: Right.

Dr. Kristen Jacobs: Right, right, right.

Dr. Kate Dee: You know, if you're getting paid piecemeal as a nurse practitioner sitting at home to do a five minute piece of work. How much effort are you putting into that? So hopefully they're putting the proper amount of effort into that. But like I, you [00:25:00] know,

Dr. Kristen Jacobs: Yeah. So

Dr. Kate Dee: I could see problems with that model, but, you know, obviously every company is, is different in trying to to, to, you know, provide quality services, you know, in, in that.

Dr. Kate Dee: So I find that, I think that's gonna be a tough area for, for, evaluating. okay, let's, let's move on to the next topic. And that is delegation. So, I'll just read it to you. All. Medical services provided by licensed practitioners permitted to provide that service. One pro. Uh, once a proper initial examination, diagnosis are made and the treatment plan is developed.

Dr. Kate Dee: Treatment may be performed by or delegated to a qualified provider. Under the following minimum provi requirements, the provider is trained and qualified to perform the specific treatment. The provider is properly supervised and proper protocols have been developed by the qualified supervising physician or medical director to address [00:26:00] complications in adverse events.

Dr. Kate Dee: So, basically the place is. Delegating the treatments to the proper people and those people are safe and those people know what they're doing. Yeah. And you know, as we've talked about, unfortunately, many, many, many med spas across the country have people providing services who have no qualifications to do that.

Dr. Kristen Jacobs: Right. So in Illinois it's the same. It's the same thing. So I mean, here, here's technically what the guidelines state is that I could delegate anybody to do anything without any kind of a license. We call them medical assistants. And estheticians can't inject a neuromodulator, but I could delegate a medical assistant to if I really wanted to.

Dr. Kristen Jacobs: I mean, it, I, I have reread and read and, and, you know, the, the delegation, requirements and it, it, it still blows my mind. I mean, I [00:27:00] truly could teach somebody who isn't licensed to do some of the things. So obviously

Dr. Kate Dee: that very common in Illinois?

Dr. Kristen Jacobs: I would say. Well, I don't know the answer. It's more of, in my opinion, the, clinics opening up illegally with the nurses owning it or somebody else.

Dr. Kristen Jacobs: But truly, if they are, you know, thinking they're, they're, they're legal, then their medical director should be delegating. But how can they delegate because they're not on site. So it's this, in my opinion, it's such a vicious cycle, right? So. I think, I mean I don't, I don't think, but I don't know the answer 'cause I'm in my little bubble down in southern Illinois.

Dr. Kristen Jacobs: I don't think people that are just quote unquote medical assistants are injecting neuromodulator. But as the law states, I mean they could. So let's hope and pray that they're not, and there are actually, you know, delegate in correctly.

Dr. Kate Dee: Yeah, there are a number of states that have that that's unusual, so most states would, that would be [00:28:00] illegal. But the big one that we've seen is Texas that allows, you know, if basically if a doctor in Texas decides, you know, this person can inject, it's my butcher, but I taught them how to inject Botox. that's actually legal as long as that physician.

Dr. Kate Dee: Takes full responsibility for that person. And they don't even have to call 'em a medical assistant. So a lot of people probably listening to this do not realize that the word medical assistant has no meaning. There's no license, there's no training, there's no school, there's no nothing. Medical assistant, anyone could walk in off the street, get a job with a doctor's office and get trained to, you know, wipe down counters and hand a doctor things.

Dr. Kate Dee: The doctor can call them a medical assistant. There is no school, no nothing that, that me that has no meaning basically. Right. And so, these places, you know, a lot of places will take an esthetician that's already working [00:29:00] there, and then train them to do something. Doesn't matter what it is, call them a medical assistant.

Dr. Kate Dee: May, I mean, I, you know, the one thing that. Makes sense to me is drawing blood. So it doesn't, you don't need any kind of degree or licensure to be a phlebotomist. You can go get a go, get trained, go get a job with LabCorp or one of those big, you know, and start drawing blood for a living that you don't need a license for that. Right. which is interesting, right? It's a little, it's like a, a very unusual little piece of medicine that we need so much of that they're willing to like. Farm it out to just about

Dr. Kate Dee: anybody. Right.

Dr. Kate Dee: but obviously somebody does that for a living. Like they get really good at it. Right? 'cause that's all they do all day.

Dr. Kate Dee: Okay. but you're not really supposed to train a medical assistant to do medical things and let them do that. That's not legal In the vast majority of states. There's a couple states. So Illinois, Oklahoman, and Texas for sure are all, are all in that. Where if a doctor deems it appropriate, they give that doctor the leeway to practice [00:30:00] medicine the way they want.

Dr. Kate Dee: Right? And those laws exist because they are relying very heavily on a doctor's judgment. And so, you know, that's what happens when you, you, you, you have a licensure to do something that other people can't do. You, you defer to their judgment. Unfortunately with medical aesthetics, what's happening right?

Dr. Kate Dee: Is Joe Schmo. The butcher goes to a weekend course, takes a, a Botox, injecting, uh, you know, lesson over the weekend. And then they again hire out, you know, find a medical director for 500 bucks a month, and then they put up a shingle and before you know it, they're practicing medicine without a license, which is a felony.

Dr. Kristen Jacobs: right.

Dr. Kate Dee: So, okay, so let's move on to products. So, the, the other requirement is that the pa, the spa must use, uh, legal, uh, FDA approved products. So yeah. so can you tell us like where, where you [00:31:00] get all your products and, and where you see people kind of cutting those corners?

Dr. Kristen Jacobs: Yes. So we get 'em directly from the company that makes them, I mean, I, you know, I know you can get. Stuff on Amazon. You can get stuff from Canada, Mexico, any other, you know, country. But

Dr. Kate Dee: And that's all illegal.

Dr. Kristen Jacobs: that's all illegal. Yes, yes. Staying.

Dr. Kristen Jacobs: Yes, all that part is illegal. But we get ours directly from the company that makes them, I mean, I, I refuse to get it from anywhere else.

Dr. Kristen Jacobs: And we there, you know, I, I don't know if you're gonna get into this, but there's a, you know, there are off-label uses, there's on-label uses. And so we go with the, I mean, obviously we're gonna do a little off label, but we're with the standard of care. And so I feel like that's, probably a whole nother topic.

Dr. Kristen Jacobs: Getting the products from the company is an absolute must. We must stay within the, uh, expiration dates. You know, there's just so many things that we look at. I mean, if, you know, God forbid something expires, well, we don't use it. We throw [00:32:00] it away. So we make sure that we're using it. So obviously staying within the, those, uh, those I think very important guidelines.

Dr. Kate Dee: it's super important. So yeah. So of course you need a contract with the makers of. Botox and Dysport and all the things, and you actually have to buy it in America. So it's not legal to import, uh, these products from other countries. And that's, that is, it's kind of interesting. There's two issues with that.

Dr. Kate Dee: One is, you illegally import it, uh, that the, customs and border control, they get upset. The FDA gets upset. You're messing with taxes and you're trying to avoid taxes and tariffs now. And so that's like a, a more of a financial, you know, illegal thing. But then also when you're importing it from other places, then the supply chain is not what it's supposed to be, and you don't know where it's been stored and you don't know what the.

Dr. Kate Dee: Expiration dates are, if you're illegally importing it from Asia or [00:33:00] Europe, the expiration dates are, you know, so first of all, they have different versions of things that are not FDA approved here, but also, you know, you just don't know where it was stored. Was it on a hot boat floating here from China over a month?

Dr. Kate Dee: I mean, so, there's problems with quality. Even if the label says Juvederm, it doesn't, it's not necessarily something that is okay to inject once it lands in your office and you somehow got it for cheap 'cause you did that. and then there's tons of people ordering stuff of all Alibaba. It's fake.

Dr. Kate Dee: It's fake, it's filled with other stuff. It's super dangerous. It can be contaminated with bacteria. So, we, uh, right now, and this, this may change, but right now we're just requiring the owner to sign an attestation saying that they, have, uh, contracts with, you know, Allergan and Galderma, the other companies.

Dr. Kate Dee: we, we don't have a plan to ask for a copy of the contract. I think it's really interesting 'cause you can't prevent even somebody who has. A contract with Allergan, they're getting actual Botox and they're [00:34:00] paying full price for it. You can't control that. They don't, you know, on one day run short and like go on online and try to order something illegally, but we're gonna make them sign an attestation saying that they don't do that.

Dr. Kate Dee: So, you know, again, some of this is, they could lie. Right. But then they would be, you know, lying and, and, and signing their name on the bottom line saying, we never do this, and then they're doing it anyway. So, because part of, part of what we're trying to do is make this simple and straightforward. We don't have an army of inspectors to go out and look in every cabinet and make sure they don't have any fake product there.

Dr. Kate Dee: I, I, you know, maybe, maybe someday we'll have the kind of. Ability to do that, but right now we don't have that,

Dr. Kristen Jacobs: You know, I think maybe at some point doing random checks if you are starting to hear rumblings or something like that. But, you know, we, and, and it sounds like you're a lot like I am, like we work on the honor system and [00:35:00] I feel like everybody's gonna tell you the truth and why wouldn't they tell you the truth?

Dr. Kristen Jacobs: But unfortunately there's always like somebody that ruins it for, you

Dr. Kate Dee: there will be some, there will be somebody. Yeah. And, and, and we are, we do plan to recertify every year. So we are gonna ask them, you know, and if they have, we're requiring them to let us know if they change medical directors and we have to. Interview the new medical director for them to stay compliant, or each year we will, we will do that.

Dr. Kate Dee: So that, so that hopefully, you know, I mean, the thing is that. It's better than what we have now, which is a free for all.

Dr. Kristen Jacobs: That's right. That's

Dr. Kate Dee: There's just, there's just nothing. So, and then the other, the other thing that there's not much to talk about, just that the owner has to comply with state laws. They have, we will verify their ownership and that they're, we're we corporate entities, legal 'cause that is also separately, won't necessarily endanger patients.

Dr. Kate Dee: It could. But, but there are [00:36:00] laws that says who can own a medical practice and we're gonna make sure that it's legally owned. And then the last thing is about emergency preparedness. So can you talk a little bit about like what, what you do for that and you know, why that's important?

Dr. Kristen Jacobs: So with all of our. Let's say laser treatments first, because, you know, worst case they get a blister or they get, you know, something. I mean, in my opinion, like all that stuff, yes, it would be terrible if it happens, but it's a little bit easier to fix versus like a vascular occlusion. But we have protocols on, you know, burns, on rashes, on, you know, anything that can go wrong.

Dr. Kristen Jacobs: We have a protocol. The the biggest thing is the front desk saying to the patient. Come in, let us see you. I wanna lay eyes on the person. I don't care what time of day it is. I don't care what day it is. You know, we want to lay eyes on 'em. So I think in that sense, those are just our, they're, they're easier protocols to create and they're [00:37:00] standard and they're just in our little book.

Dr. Kristen Jacobs: But it's more about training with the front desk. And then of course our staff members. Also communicating with the patient. If you see this or you may see this, then you need to give us a call. But getting into vascular occlusions, we have the emergency protocol in an emergency protocol box plus.

Dr. Kristen Jacobs: Everybody that is involved in that treatment has to go through this and talk and walk and talk it out. You know, I'm, I'm glad you mentioned that 'cause actually we need to do that again. 'cause we try to do that annually. And I have a, I have a brand new team, so it's time to do that again. I'm training my PA on injectables, so I did make sure that all the printouts are there and I went through it all and I went through it with her.

Dr. Kristen Jacobs: But I need to talk to the other people who are setting the room up or whatever, where, you know, where, where is everything located so that we know exactly, how to get it, where to get it, and, and, you know, making sure that our, is not expired. And you know, it's, it is just, there's so much that it

Dr. Kate Dee: and having [00:38:00] enough of it.

Dr. Kristen Jacobs: and having enough of it.

Dr. Kate Dee: the, the most important thing here, right, is that, I mean, so we both agree. So having a vascular occlusion, which is when you clog a blood vessel an artery. Filler and hopefully in, in your hands. It's extremely rare. I think the last time we talked, we each had seen one in our, in all our combined 30 plus years of

Dr. Kristen Jacobs: Right. Knock on wood. Where's my

Dr. Kate Dee: knock on wood. I know. It's like, oh my God. It's the one thing, like, if you know anything about medicine, it will, it will keep you up at

Dr. Kristen Jacobs: Yes,

Dr. Kate Dee: So there was actually a, a recent TikTok, my staff showed me of an injector. Who, got a vascular occlusion herself, right? I think it was her own face, and she completely freaked out.

Dr. Kate Dee: So she was a injector herself. She had one, she was in tears. She, they didn't know how to treat it. They'd never heard about it. They, they, they went on TikTok toe, make sure other people knew [00:39:00] about this thing, right? And she was an injector

Dr. Kristen Jacobs: Right. Isn't that scary?

Dr. Kate Dee: And, and this is the, the problem is that like you think, oh, of course people know how to, you know, no, they don't, they don't even know that it exists, right?

Dr. Kate Dee: So they're willy-nilly throwing filler in people. And, and this is how you can be scarred for life. You can have, I interviewed one lady on, on the podcast last year. Who had, uh, a very severe vascular occlusion and she lost half of her nose. Okay? So she's scarred all up and down her face and literally has to wear a nasal prosthesis, uh, because the person who is treating her.

Dr. Kate Dee: Didn't know how to treat it. And so it's really important to know that people have those protocols in place because generally if you recognize it and you treat it right away, it's gonna be fine. but you have to treat it right away. And if you let it go, I mean, the longer you let it go, the worse it is.

Dr. Kate Dee: But if you let [00:40:00] it go for three days untreated, it's, you're not

Dr. Kristen Jacobs: in trouble. Right. What area did that lady have injected? Because I

Dr. Kate Dee: she had her nasal labial fold injected with radius.

Dr. Kristen Jacobs: Okay.

Dr. Kate Dee: which you and I would probably both agree, should never be injected unless it's hyper dilute, maybe. I don't, I don't use hyper dilute radius, but, so we've talked about this, but you know, any filler that's not dissolvable.

Dr. Kate Dee: In my opinion, should not be injected. So that includes Radius and that includes Bela Hill. I personally don't think either of those should even be on the market, but whatever. They're on the market, but they are not treatable.

Dr. Kristen Jacobs: right.

Dr. Kate Dee: So anybody who understands what vascular occlusion is would just never wanna use it because you just don't wanna take that risk that you're one in a, you know, a gazillion is, is gonna be, you know that and then you can't do anything about it. So we're gonna make sure that they have, they acknowledge they have at least 16 vials of Linx in the fridge and that they practice, a, a, a drill. We call it a code [00:41:00] blanche in my

Dr. Kristen Jacobs: cold blanche. I like it.

Dr. Kate Dee: once a year, and make sure they have up to gate date protocols and that they're aware and that the medical director is aware that they need to be at least available.

Dr. Kate Dee: To respond, to that we have ultrasound in my office. Not everybody has ultrasound, but you know, as a recovering radiologist, why wouldn't I have

Dr. Kristen Jacobs: See? A hundred percent. Yes. I wish I was a recovering radiologist for that purpose.

Dr. Kate Dee: you really don't. I, you really don't. But yeah, I mean, I don't think that ultrasound is mandatory. It's very helpful though, especially if you know how to use it.

Dr. Kristen Jacobs: That's the

Dr. Kate Dee: But, but, and there they have to sign off that yes, we, we, we practice for this.

Dr. Kristen Jacobs: So would you ever get into asking how many vascular occlusions have been in the clinic and

Dr. Kate Dee: yeah.

Dr. Kristen Jacobs: you know, and get into a little bit more detail about that? 'cause I

Dr. Kate Dee: Well I think that's part of, that's part of the medical director, interview. Like, have you, have you seen one? Have you managed one? I mean, I have, [00:42:00] we've had. Two in my clinic that we've treated, but one was caused by someone else and they walked in and we recognized it. And we just treated it. ' cause that's, and then the other, the one, the one that we, we had, we treated immediately and it was fine.

Dr. Kate Dee: And you know, if they've never seen one and. You know, never treated one. I guess that's great that they haven't seen one, but they need to know what to do. Like,

Dr. Kristen Jacobs: they do.

Dr. Kate Dee: that they know what to do. Now if they've had one a month,

Dr. Kristen Jacobs: That might be a then that's a really

Dr. Kate Dee: big problem. I, once I, I interviewed a nurse practitioner for a job once who told me that her previous employer would have one a month.

Dr. Kristen Jacobs: my gosh,

Dr. Kate Dee: And that just freaked me out. I was like, how is that even possible? And that was a big, big, big Beyl injector. Now she's outta business now, so, I, I don't have to worry about her existence anymore, but it really freaked me out.

Dr. Kristen Jacobs: Yeah. Another question and know, you probably already have this, but another question is, what area, are you treating? Because if [00:43:00] you're a medical spa, in my opinion, you don't need to be doing noses. You definitely don't need to be doing glabella. In fact, I rarely ever do nasal labial folds. And so I think that's extremely, important.

Dr. Kristen Jacobs: But one more

Dr. Kate Dee: We don't do

Dr. Kate Dee: forehead either,

Dr. Kristen Jacobs: no

Dr. Kate Dee: We'll do

Dr. Kate Dee: sculpture for temples, but not so, yes. And so those are, those are really important questions that we'll ask the medical director. I mean, obviously a rogue RN can do whatever they want and you won't necessarily even know unless there's a complication.

Dr. Kate Dee: But you know, these are, the reason we're talking about this is that these are areas that are very high risk for bad complications, and so we just don't go there. So there are areas of the face where the likelihood of occlusion is higher and the likelihood of bad outcomes from an occlusion like going blind or higher.

Dr. Kate Dee: So we. Do not touch those areas. So we don't touch noses either. We do not touch glabella, we do not touch forehead or, or temples. [00:44:00] We will do nasal labial folds, but we don't come anywhere near, um, where the vessels come up close to the skin. And, and then of course you have to know your anatomy in order to know to avoid those places.

Dr. Kate Dee: And I think that's the biggest thing is, is having providers who really know what they're doing so they know what's dangerous and they just will never do that.

Dr. Kristen Jacobs: Right, right. You have to have a little bit of fear, you know? You really do. And one of the things I was thinking as you were talking to somebody who hasn't had one, maybe offering resources, and I don't know if you wanna get into that 'cause that maybe is legally kind of setting you up, but there's so many resources out there that if they hadn't, 'cause I mean, I was in practice.

Dr. Kristen Jacobs: 15 years, 16 years before I saw my first one. I went, I've, I've, I've, I've heard about it. I've watched it on, you know, on, like you said, TikTok being treated or whatever it is. But until you are in that situation, it's, you know, you just don't, you don't really know, you know. I mean, the bottom line is we know what to do, but if you've [00:45:00] not done it, it is a little bit scary.

Dr. Kristen Jacobs: So just thinking

Dr. Kate Dee: No, I, I think that that's, so that's very much high on my agenda, like once we get launched. What I'm hoping, assuming you know, if we do succeed in all of this, we're educating both the public and providers on, you know, on safety and best practices and. Hopefully we provide a network, uh, so people have each other to help each other out.

Dr. Kate Dee: But, but also we are, we're really, thinking down the line of having educational resources for both consumers and providers on, on the website that they can access that will help them. Figure stuff out. You know, we are not right now. It literally is, it's very scrappy. It's like me and seven other people just kind of pulling the website together and getting launched.

Dr. Kate Dee: But if, if this works out, then, you know, hopefully we'll be promoting not just transparency, but, but safety across the industry [00:46:00] and, and yeah, I mean, I, I wanna be able to do as much as that, uh, of that as possible. As long as a lawyer doesn't say, Hey, that's too much liability. You don't have insurance for that.

Dr. Kate Dee: I, I don't, you know, we can't guarantee, uh, any safety of any individual. Spa or service provider. But what we're trying to do is, is guarantee that they are abiding by the law. And right now that seems like a really low bar, like, you know, illegal versus not. But there's so many illegal spas outta control.

Dr. Kate Dee: It's so crazy. And so, you know, right now that's my goal. And, and hopefully as we mature as an organization, we'll be able to provide more and more resources like

Dr. Kristen Jacobs: I think it's incredible. I think it's incredible.

Dr. Kate Dee: So stay tuned. I think by the time this airs, we will be just about launching right then, hopefully, uh, within the next couple weeks.

Dr. Kate Dee: It's really, really exciting. We have a new logo I'll have to show [00:47:00] with you, show it to you. Yeah, we just, we just, I'm literally expecting the final to be delivered to me today. It's really exciting.

Dr. Kristen Jacobs: I mean, like I said, congratulations and this is so exciting. A much needed service. And it's not an, if you will, do well, you will. It's a win.

Dr. Kate Dee: Let's hope.

Dr. Kristen Jacobs: You will, and it's a win. You know, and the good thing is that I, I know you are gonna have so many people like myself who are going to support you. 100%. Get certified, get our names out there so that we can get your name out there and say, Hey, I mean, for a consumer, like why wouldn't you want to go someplace that is certified?

Dr. Kristen Jacobs: Um, I just, I don't understand it, which is why we're having this conversation, which is why you started this new, endeavor. I don't understand it, but

Dr. Kate Dee: Well, I, I I truly believe that most people don't really understand just how many places are operating illegally and just what those risks are. You know, I just think [00:48:00] that people don't know. And so if we reach enough people, especially if the movie gets made, uh, we'll see. Don't know still working on that, but, But my, you know, Hollywood producer colleague, he thinks it's totally gonna get made. So that's exciting. So if we reach enough people, then you know, it will really become a co common knowledge and that's, that's my hope.

Dr. Kristen Jacobs: And that's so important.

Dr. Kate Dee: Yeah. So Chris, thanks so much for talking with me today. It's always fantastic to, to speak with you and for everybody listening at home, I'll have all of Dr. Kristen Jacobs's links.

Dr. Kate Dee: so if you are in the, Illinois area, 'cause it's. Carbondale, did I get

Dr. Kristen Jacobs: No, we're actually right outside of St. Louis. Um, it's Glen Carbon. You

Dr. Kristen Jacobs: were close

Dr. Kristen Jacobs: Carbon.

Dr. Kristen Jacobs: Yes. Yes.

Dr. Kristen Jacobs: Yeah. So we're 20 minutes from downtown St. Louis. Five hours south of

Dr. Kate Dee: The Midwest. Yeah, so, so outside St. Louis in, in the, in Illinois. So we'll have all those links in the show notes. So thanks so much and we'll talk again soon.

Dr. Kristen Jacobs: Thank you for having me.

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