Ethics · 5 min read
Who Should Be Injecting Your Face? Credentials, Regulation and What to Ask
Botox is a prescription drug and filler is a medical device. The rules that follow from that are not always followed.
In Ontario, neuromodulators such as Botox are prescription medications, and dermal fillers are regulated medical devices. Injecting either is a controlled act under the Regulated Health Professions Act. That framework exists because these are medical procedures with medical complications. In practice, the way it is applied varies enormously between clinics, and most patients have no way of knowing which kind they have walked into.
Who is legally permitted to inject
Physicians and nurse practitioners can assess, prescribe and inject independently. Registered nurses can inject under a physician's or nurse practitioner's order, which requires that a prescriber has actually assessed you and authorised the treatment. Some clinics operate exactly this way, with a physician on site who examines each patient. Others operate with a "medical director" whose name appears on the paperwork and who has never met you. Aestheticians, unregulated technicians and anyone without a nursing or medical licence are not permitted to inject prescription drugs, and yet advertisements from them are not hard to find.
Why it matters beyond the paperwork
Filler can, uncommonly, enter or compress a blood vessel. Left untreated for hours, that can cause skin loss and, in the rarest cases, blindness. The treatment is prompt injection of hyaluronidase by someone who recognises the signs, has the drug on hand, and can manage what follows. Neuromodulators can cause a drooping eyelid or brow if placed incorrectly. Infections, allergic reactions and nodules occur. None of these are common, but every one of them is a medical problem that requires medical training to prevent, recognise and treat.
Beyond emergencies, assessment is medical too. Whether your under-eye darkness is a hollow or a pocket of fat, whether your pigmentation is sun damage or melasma, whether the medication you take affects bleeding, whether your thyroid condition affects the plan: these are diagnostic questions, and the answer changes the treatment.
Questions worth asking any clinic
- Who will assess me, and who will inject me? Are they the same person?
- Is the injector a physician, a nurse practitioner, or a registered nurse? Can I verify their registration?
- If a physician is the medical director, will I meet them? Have they examined me before I am treated?
- Do you stock hyaluronidase on site? Who administers it and how quickly?
- What is the emergency contact after hours, and who answers it?
- Which products do you use, and are they Health Canada approved?
A reputable clinic answers all of these without hesitation. Evasiveness about any of them is itself an answer.
How to verify a licence
Every physician in Ontario is listed in the public register of the College of Physicians and Surgeons of Ontario, which shows their qualifications, specialty and any disciplinary history. Nurses and nurse practitioners are listed in the College of Nurses of Ontario register. Both are searchable online by name in under a minute, and I would encourage every patient to do it, including for me.
Price as a signal
Prices in aesthetic medicine vary for legitimate reasons, but a price dramatically below the market for the same product should prompt a question about where the product came from, how much is actually being injected, and who is doing it. The most expensive treatment is the one that has to be corrected.
Common questions
Who is allowed to inject Botox in Ontario?
Physicians and nurse practitioners can assess, prescribe and inject independently. Registered nurses can inject under a prescriber's order following a proper assessment. Aestheticians and unlicensed individuals are not permitted to inject prescription medications.
What is a medical director at a medspa?
A physician or nurse practitioner who authorises treatments performed by nurses at a clinic. In some clinics the medical director assesses every patient; in others they are rarely present. Ask whether you will be examined by the prescriber before treatment.
How do I check if my injector is licensed?
Search the public register of the College of Physicians and Surgeons of Ontario for physicians, or the College of Nurses of Ontario for nurses and nurse practitioners. Both show qualifications and any disciplinary history.
Is it safer to get Botox from a doctor?
A physician can assess, diagnose, prescribe and manage complications personally. Skilled nurse injectors working under genuine physician oversight also provide safe care. The essential elements are a proper medical assessment, an injector trained to recognise and treat complications, and hyaluronidase available on site.
What questions should I ask before getting filler?
Who will assess and inject you, their registration, whether the prescriber has examined you, whether hyaluronidase is on site, what the after-hours emergency contact is, and which Health Canada approved products are used.
Dr. Mazzuca is a licensed physician practising medical aesthetics in Markham, Ontario, with additional training in cosmetic medicine, facial anatomy, women's health, and longevity medicine. Every treatment at the clinic is performed by her personally. Her registration can be verified through the College of Physicians and Surgeons of Ontario.
Written and medically reviewed by Dr. Monique Mazzuca, MD, CCFP. Published September 11, 2026.
This article is general information, not medical advice, and it is not a substitute for an in-person assessment. Results vary between patients, and every treatment carries risks that are reviewed with you before you consent. Suitability is determined by Dr. Mazzuca at your consultation.
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