The Consultation Checklist: What to Ask, and Which Answers Should End the Appointment

Evidence reviewed to Aug 2026

This page is a set of questions to bring to a consultation for an injectable (botulinum toxin or dermal filler) or an energy device (laser, intense pulsed light, or radiofrequency microneedling). It is built to be printed or screenshotted. It does not tell you which treatment to have, whether you are a candidate, or which provider to choose — those are decisions for you and a licensed clinician, and this site recommends no provider and no city. What it does is name the questions that separate a supervised medical practice from an improvised one, and state flatly which answers should end the appointment.

What should a real consultation include?

Before any questions of yours, a legitimate consultation asks questions of you. The American Society of Plastic Surgeons (ASPS), in its patient guidance on injectables, describes a consultation that covers your medical history, current medications and supplements, allergies, prior treatments, and your goals — before anyone proposes a product or a dose.^[1] The United Kingdom's National Health Service (NHS), in its consumer guidance on cosmetic procedures, adds the step most sales conversations skip: checking the practitioner's qualifications and experience yourself, and taking time to decide rather than booking on the spot.^[2]

A consultation that is actually a consultation will also discuss alternatives — including the alternative of doing nothing. Botulinum toxin's effect is temporary by design: the FDA BOTOX Cosmetic prescribing information gives a duration of approximately 3–4 months, and reports that the severity of glabellar (frown) lines was reduced for up to 120 days in the pivotal trials.^[3] A provider who cannot calmly discuss "wait and decide later" as an option is running a sales process, not a medical one.

The checklist

Five groups: who treats you, what goes in you, what the plan is, what happens if something goes wrong, and what it costs. Print this section.

1. Credentials — who is treating me?

• What is your name, and what license do you hold? RN, NP, PA, MD, and DO are different licenses with different scopes. Every US license is publicly checkable through your state licensing board, and physician board certification can be verified through the American Board of Medical Specialties' consumer lookup^[4] — the exact registries, and how to read what you find, are covered in our guide to looking up a license.
• Who is the medical director, and have they examined me? Injecting botulinum toxin and fillers, and operating lasers and IPL, is the practice of medicine in most states, requiring a licensed prescriber and — in many states — physician supervision.^[5]
• Who do I see if there is a complication — and is that person a prescriber? Managing a complication can require prescription drugs. An answer that names a person and a pathway is a good sign; "that never happens here" is not.
• How often do you personally perform this exact procedure?

The rules vary sharply by state, which is why "is this legal?" has no national answer. Three examples from the compliance literature: in California, botulinum toxin, laser, and IPL procedures may be performed only by a physician, or by a physician assistant or registered nurse under physician supervision — never by medical assistants, cosmetologists, or estheticians.^[6] In Arizona, nurse practitioners have full independent practice authority, so physician supervision of a med spa is not required. In Minnesota, a med spa must have a medical director who is an MD, DO, PA, NP, or APRN.^[5] State medical boards — Texas, California, New York, Georgia, and Arizona among them — have pursued med spas for improper supervision, absentee "ghost" medical directors, and unlicensed practice of medicine.^[7] The practical takeaway: ask the questions above, then check the answers against your own state's board, not against this page. Who may legally hold the syringe in the first place — and what a "medical director" actually does — is the subject of its own article here.

2. The product — what exactly is going in?

• Which brand and product, specifically? "Botox" is one brand of botulinum toxin type A among six FDA-approved products; fillers differ by material, and the differences matter — hyaluronic acid fillers can be dissolved with an enzyme called hyaluronidase, while calcium hydroxylapatite and poly-L-lactic acid fillers cannot.^[8]
• Where do you purchase it? The correct answer is the manufacturer or an authorized distributor. Botulinum toxin products are prescription drugs regulated by the FDA,^[3] and federal law — the Drug Supply Chain Security Act — exists to keep counterfeit and diverted drugs out of patients. In April 2026 the FDA issued a warning letter to a Texas med spa after an inspection found discrepancies between the Botox units it had purchased from authorized sources and the units it documented administering.^[9]
• May I see the vial, the packaging, and the lot number before injection? A provider using legitimate product has no reason to refuse.
• Is this product FDA-approved or FDA-cleared for this use — and if not, will you say so plainly? "Medical-grade" is marketing language, not a regulatory category.

The reason to care is not hypothetical. In 2024, the CDC investigated harmful reactions to counterfeit or mishandled botulinum toxin: as of April 15, 2024, 19 people in 9 states had been reported, with injections given by unlicensed or untrained individuals and/or in non-healthcare settings such as homes or spas. Nine were hospitalized and four were treated with botulism antitoxin; symptoms included blurred or double vision, drooping eyelids, difficulty swallowing, slurred speech, difficulty breathing, and generalized weakness.^[10] A home, a hotel room, or a "Botox party" is a setting question with a one-word answer: no. The setting itself appears in the CDC's case descriptions. What that 2024 cluster revealed about prices that cannot cover legitimate product is examined in our article on cheap Botox.

3. The plan — what are we actually doing?

• What dose range are you planning, and why that range for my anatomy? You are not asking to set the dose — dosing is the clinician's judgment. You are checking that a plan exists and can be explained.
• Is this reversible? What specifically happens if I hate the result? For hyaluronic acid fillers the honest answer involves hyaluronidase; for other filler materials the honest answer is that reversal is not available and time is the remedy.^[8] For botulinum toxin, the effect wears off — the FDA label gives a duration of approximately 3–4 months.^[3]
• What result would you consider a failure, and what would we do then?
• What are my alternatives, including doing nothing?
• For an energy device: which settings, and what is your experience on my skin type? The FDA's October 2025 safety communication on radiofrequency microneedling reported serious complications — burns, scarring, fat loss, disfigurement, and nerve damage, some requiring surgical repair — tied largely to device misuse, operator inexperience, and aggressive settings.^[11] Operator experience is not a courtesy question; per the FDA's own framing, it is the variable.

4. Complications — what is the 2 a.m. plan?

• What complications do you counsel every patient about for this procedure? An answer that only mentions bruising is incomplete. For dermal fillers, the FDA identifies unintentional injection into a blood vessel as the most serious risk, with reported complications including tissue necrosis (tissue death), vision abnormalities including blindness, and stroke.^[8]
• If you inject filler: what is your vascular-occlusion protocol? A prepared injector can describe recognizing the signs, stopping, and treating — including having hyaluronidase physically on site for hyaluronic acid fillers. "We've never had one" is not a protocol.
• Who do I call at 2 a.m., and what number do I use? You want a named clinical pathway, not a front desk that opens at nine.
• Will I get written aftercare instructions and warning signs to watch for?

5. Money — what is the real price?

• May I have the price in writing, itemized, before anything is scheduled?
• For toxin: is pricing per unit or per area, and how many units do you estimate for me? A per-area price without a unit count cannot be compared to anything.
• For filler: price per syringe, and how many syringes does the plan call for?
• What would follow-up, touch-up, or — for filler — dissolving cost if I need it?

For scale, not for shopping: the ASPS publishes national average physician fees of $435 for a botulinum toxin injection, $715 for a hyaluronic acid filler, and $901 for a non-hyaluronic-acid filler.^[13] Those are physician-fee averages that understate the all-in price a consumer pays, and local pricing varies. Their use here is as an anchor: a price dramatically below what legitimate product plus a licensed injector's time could plausibly cost is not a bargain signal, it is a supply-chain question — the one the CDC's 2024 counterfeit investigation answered in the worst way.^[10]

Which answers should end the appointment?

Stated flatly. Any one of these is sufficient on its own:

• Refusal to name who holds the license, or to say who the medical director is. Every legitimate answer to this question is public record anyway.
• Refusal to show the vial, packaging, or lot number, or vagueness about where the product was purchased. The CDC's 2024 case series is what the downside of this answer looks like.^[10]
• The injection is happening in a home, hotel, or event setting. Non-healthcare settings appear by name in the CDC's descriptions of the counterfeit-toxin cases.^[10]
• "Complications don't happen here" — or no answer to the 2 a.m. question. The FDA lists blindness and stroke among reported filler complications; a provider who will not discuss them is not safer, only quieter.^[8]
• No hyaluronidase plan for a hyaluronic acid filler injection.
• Pressure to decide today — expiring discounts, prepaid packages pushed before you have asked your questions.
• Anyone offering to inject filler with a needle-free device such as a "hyaluron pen." The FDA warns consumers and providers not to use these devices at all; it has received reports of serious injuries and, in some cases, permanent harm to skin, lips, and eyes, and no such device is FDA-approved for filler injection.^[14]

Walking out of a consultation costs you a consultation fee at most. None of these red flags requires you to be right about what is behind it; the refusal to answer is itself the information.

How should I read reviews and before-and-after photos?

Skeptically, and with one piece of regulatory literacy. Since October 2024, a Federal Trade Commission rule — 16 CFR Part 465 — has prohibited fake consumer reviews and testimonials, including reviews by people who do not exist, reviews by people with no actual experience of the service, and buying positive reviews; the FTC's Endorsement Guides separately require that material connections between an endorser and a business be disclosed.^[15] The rule exists because the incentive to fabricate is real and the fabrication is cheap. So treat a wall of five-star reviews as marketing until proven otherwise, and weigh specific, detailed accounts over volume. Before-and-after photos add their own problems: lighting, angle, expression, and makeup can manufacture a result, photos are unverifiable to you, and the best case on a wall tells you nothing about the typical case or about you. This publication sidesteps the question by publishing no before-and-after imagery of any kind — and, for the same reason, you should treat any single image as an advertisement, not as evidence.

What this page cannot do

It cannot pick the provider, and it cannot make the medical decision. Whether a treatment is appropriate for you, at what dose, in which anatomy, and how a complication should be managed are judgments for a licensed clinician who has examined you — not for a website, this one included. The checklist's job is to make that consultation better: to get the license named, the product shown, the plan explained, the emergency pathway written down, and the price itemized, so that whatever you decide, you decide it with the facts on the table.

What we don't know

As of August 2026: there is no national registry of med-spa adverse events, so nobody can tell you a true complication rate for the average storefront — the CDC and FDA actions cited here are investigations and warnings, not denominators. Scope-of-practice law shifts state by state and year by year; the California, Arizona, and Minnesota examples above describe the compliance literature's account as of this page's review date, not a permanent map, and your own state's licensing board is the current authority. And no study we can cite measures the thing this page is really about — whether asking these questions changes outcomes. We think the logic is sound; we cannot prove the effect size, and we say so.

References

1. American Society of Plastic Surgeons. Patient guidance and cost pages for injectables. plasticsurgery.org/cosmetic-procedures/botulinum-toxin
2. National Health Service (UK). Cosmetic procedures: advice on checking practitioners. nhs.uk/conditions/cosmetic-procedures
3. FDA. BOTOX Cosmetic (onabotulinumtoxinA) prescribing information. accessdata.fda.gov (label PDF)
4. American Board of Medical Specialties. Board-certification consumer lookup. certificationmatters.org; Federation of State Medical Boards physician lookup. docinfo.org
5. Quarles & Brady LLP. Med Spa Compliance Series: scope of practice and supervising-physician compliance. quarles.com; American Med Spa Association state guidance. americanmedspa.org
6. Medical Board of California guidance on who may perform Botox, laser, and IPL procedures (physician, or PA/RN under physician supervision; unlicensed personnel may not). Via mbc.ca.gov
7. Holt Law. Legal actions against medical spas for lack of medical oversight (state medical board enforcement survey). djholtlaw.com
8. FDA. Dermal Fillers (Soft Tissue Fillers): risks and FDA-approved products. fda.gov/medical-devices/aesthetic-cosmetic-devices/dermal-fillers-soft-tissue-fillers
9. American Med Spa Association. FDA warning letter to a Texas medical spa (April 1, 2026) over purchased-vs-administered Botox unit discrepancies under the Drug Supply Chain Security Act. americanmedspa.org
10. CDC. Harmful reactions linked to counterfeit "Botox" or mishandled botulinum toxin injections (investigation as of April 15, 2024: 19 people, 9 states, 9 hospitalized, 4 treated with botulism antitoxin). cdc.gov/media/releases/2024/s0416-Counterfeit-Botox.html
11. FDA safety communication on radiofrequency microneedling devices (October 15, 2025): reported burns, scarring, fat loss, disfigurement, and nerve damage tied to misuse, operator inexperience, and aggressive settings. fda.gov (RF microneedling safety communication)
12. Annals of Emergency Medicine (2023). Filler-induced vascular occlusion presenting to emergency departments. sciencedirect.com (S0196-0644(23)00578-4)
13. American Society of Plastic Surgeons. National average physician fees: botulinum toxin $435; hyaluronic acid filler $715; non-HA filler $901. plasticsurgery.org cost pages
14. FDA safety communication: Do not use needle-free devices (such as "hyaluron pens") for injection of dermal fillers. fda.gov safety communication; FDA consumer update, Dermal Filler Do's and Don'ts. fda.gov/consumers
15. Federal Trade Commission. Final Rule Banning Fake Reviews and Testimonials, 16 CFR Part 465 (announced August 14, 2024; effective October 21, 2024). ftc.gov; FTC Endorsement Guides. ftc.gov endorsement guides

Update log

• 2026-08-05 — First published. Sources reviewed to August 2026.
• 2026-08-05 — Editorial fact-check: corrected the botulinum toxin duration to match the FDA label's wording (approximately 3–4 months; glabellar-line severity reduced for up to 120 days), corrected the RF-microneedling safety-communication date to October 2025, and repaired the CDC, FDA, and FTC source links.