BACKGROUND Botulinum toxin and dermal filler injections are the most commonly performed minimally invasive cosmetic procedures in the United States. These injectables require extensive medical training, experience, and oversight to be administered safely due to risk of significant complications. However, rules and regulations governing their administration differ widely across states. OBJECTIVE To summarize the legal statutes, regulations, codes, and professional guidelines governing administration of botulinum toxin and dermal filler injections in the United States using sources from legal databases, scholarly search engines, state government websites, and the American Society for Dermatologic Surgery Association (ASDSA). METHODS WestLaw, LexisNexis, PubMed, Google Scholar, and state government websites were searched using key terms. ASDSA Patient Safety Resources and referenced source materials were examined for each state and the District of Columbia. Relevant material from January 1, 2000 to December 31, 2024 published in English was recorded. RESULTS Substantial variability exists among states in scope of practice restrictions, medical supervision, and oversight requirements for cosmetic injectables. Several states have no specific regulations in this area. CONCLUSION Inconsistent or absent state regulations may jeopardize patient safety. The technical skill and potential risks associated with cosmetic injectables warrants consistent national standards surrounding their administration. Significant state-to-state variation in provider scope of practice supervision requirements highlights the need for clear, consistent legislation that clarifies provider roles, establishes minimum competency standards, and prioritizes patient safety.
OBJECTIVE To explore factors affecting women undergoing menopause transition, focusing on lifestyle, facial-skin changes, and current aesthetic treatment interests for this. METHODS Quantitative research (online questionnaire) was undertaken by women aged 45 to 60 years from 9 countries to understand their menopause experiences, determine their level of knowledge and perceptions of menopause, and to gain further insights into their current skin care, as well as understand menopause-related skin changes and skin concerns. RESULTS Across 4,303 respondents, perimenopause and menopause affected facial wrinkles/fine lines (59%), loss of firmness/elasticity (58%), increased dryness (56%), and duller skin tone (40%), which negatively impacted perceived attractiveness (60% agreed/strongly agreed), creating anxiety or low mood (57% agreed/strongly agreed) and impacting self-confidence (55%). The most common treatments to reduce effects of perimenopause and menopause were food supplements (51%), everyday skincare (47%), and dietary changes (46%). Only 15% of the women used specialist aesthetic treatments for menopause, but 88% of them were satisfied/very satisfied with these treatments reducing the effects of menopause. The main triggers that encouraged the respondents to seek aesthetic treatments were health care professionals’ (HCPs) recommendation (46%), cost-related affordability (40%), and information/education (40%). CONCLUSION This international survey demonstrated that changes to facial skin during perimenopause and menopause negatively affect perceived facial attractiveness, creating anxiety and reducing self-confidence. Specialist aesthetic treatments might play a key role in reducing the effects of menopause on the skin, with health care professionals aiding understanding.
