What Makes a Competent Injector? Research on Skill Levels

A 2024 study asked several hundred people who perform aesthetic injections how long, and how many treatments, it takes to move from beginner to competent to highly skilled. Their answers suggest that skill builds over years, and that some facial areas carry more risk and need more experience than others. For patients, it offers a useful framework for asking about training without needing to judge credentials yourself.

Why this was studied

In many countries, a wide range of professionals can perform injectable treatments, and training pathways differ. There is no widely agreed international definition of what "competent" means in this field. The authors, a group of injectors and educators, wanted to start building one by asking practitioners what they believe.

What the researchers did

The team circulated an anonymous online questionnaire through social media in 2023. It asked about background and experience, how many years and injections people thought it takes to reach each skill level, and how difficult and risky they considered different facial areas for fillers and for neuromodulators.

They adapted a well-known model of how people learn complex skills into three levels: novice, competent and expert. Each level was described by knowledge of anatomy and products, ability to assess patients, awareness of complications, and sensitivity to each person's background and goals.

In total, 386 people from 61 countries responded. The largest group were nurses and physician assistants, followed by other non-surgical physicians, dentists, aesthetic practitioners, dermatologists and surgeons. Their own experience ranged from under two years to more than ten.

What they found

On average, respondents felt it took a little under four years of practice, along with several hundred filler and neuromodulator treatments, to move from novice to competent. Reaching the highest level was estimated at around six years and well over a thousand of each type of treatment. Estimates varied enormously between individuals, and plastic surgeons tended to suggest longer timelines than some other groups.

For filler, the nose was rated the most difficult area, and the nose, frown area, forehead, temples and smile lines were among those rated highest risk. For neuromodulators, the area around the mouth was rated both hardest and riskiest. Based on this, the authors proposed matching facial areas to skill levels, with beginners focusing on lower-risk areas first.

How strong is this evidence?

This is an opinion survey, not a measurement of actual skill or patient outcomes. The authors themselves describe the numbers as preliminary and in need of validation. Important limits include:

• respondents were reached through social media, with a very low response rate, so they may not represent injectors as a whole;
• estimates of injection numbers ranged from one to tens of thousands, so averages hide huge disagreement;
• "difficult" and "risky" were based on perception, not complication data;
• the lead author runs an anatomy education company, which was disclosed.

So the figures should not be read as a pass mark. A person with fewer years may be careful and well trained, and years alone do not prove good judgment.

What it means for you

The study's most useful message for patients is not a number. It is the idea that competence includes several things working together: understanding facial anatomy, assessing whether treatment is right for you, recognizing and managing complications, and respecting your goals and background.

It also supports a common-sense point: higher-risk areas, such as the nose, frown lines and temples for filler, deserve extra caution and appropriate experience. If someone is quick to recommend treatment in these areas, it is reasonable to ask about their training and their plan if something goes wrong. Our article on vascular occlusion safety explains why these areas need care.

Another point the framework raises is that competence is not only about technique. The authors include patient assessment and sensitivity to each person's background as core skills. In practice, that means a competent injector spends time understanding why you are seeking treatment, whether your expectations are realistic, and whether treatment is appropriate at all. Sometimes the most skilled decision is to suggest waiting, a smaller amount, or a non-injectable option such as skincare.

It is also worth remembering that you do not need to evaluate someone's skill by yourself. Clear answers, a willingness to discuss risks openly, and a well-documented consent process are all signs of a careful practice.

Questions to ask at your consultation

• What is your professional background, and who oversees treatments here?
• How did you train in this treatment, and do you keep up with ongoing education?
• How often do you treat this particular area?
• What complications can happen, how would you recognize them, and what is your emergency plan?
• Would you ever advise against treatment, or suggest something simpler?

A good injector should welcome these questions. At HealthPark, treatments are physician-led, and consultations include time for questions like these. Our article on physician-led aesthetics explains what that model involves, and your first injectables consultation covers what to expect.

Frequently asked questions

Should I only see someone with a certain number of years' experience?

This study cannot tell you that. It reflects opinions, not proven thresholds. It is more useful to ask about training, supervision, how often they treat your area, and how complications are handled.

Does the type of professional matter?

Regulations about who can inject, and under what supervision, vary by province. In Nova Scotia, prescription injectables require a prescriber's involvement. Asking who is responsible for your care is reasonable.

Are some areas "safe" for beginners?

No area is completely without risk. The study suggests some areas are lower risk than others, which is why training often starts there.

If you are considering injectable treatment, a consultation is the place to ask about training, experience and safety in plain terms, and to decide whether treatment is right for you at all.

Source

Cotofana S, Mehta T, Davidovic K, Swift A, Rohrich RJ, Biesman BS, Gold M, Nikolis A, Dayan S, Alfertshofer M. Identifying levels of competency in aesthetic medicine: a questionnaire-based study. Aesthetic Surgery Journal, 2024. Read the study