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Dr Tim Pearce
When healthcare professionals embark on a move into medical aesthetics, it is often underpinned by a commercial driver which dictates, “I must get injecting as soon as possible”. Their new career path ought to swiftly see a return on investment for their training and allow them to begin to build a profitable business. This logic is reflected in the reasons why many aesthetic training courses focus solely on foundational dermal filler and botulinum toxin injection techniques. This model of education certainly provides the practical and theoretical skills that clinicians expect to pay for, and are happy to pay for, to kickstart their cosmetic clinic journey, but it misses other core foundational education, namely better understanding of facial anatomy, that is crucial for success.
In this blog, Dr Tim Pearce explores why stepping back and getting a good grounding in 3D facial anatomy is vital for you to become a safe and successful aesthetic injector, and how a membership model for your training, with a focus on community, hands-on and joint learning can give you a more well-rounded educational experience compared to introductory courses alone.
Why do you need to master facial anatomy knowledge first?
For those of you who prefer a strategic approach to your learning, it is worth stepping back, before you even pick up a needle and syringe full of filler or botulinum toxin and considering how well you know and understand facial anatomy. Spending time absorbing all there is to know about the structures within the face will give you a significant grounding before you move on to injection techniques and aesthetic outcomes from cosmetic injectable treatments.
With hindsight, many well-established aesthetic clinicians will admit that this approach was not ‘how it was done’; they focused on learning the practical skills to deliver injectable treatments, but deeper anatomical learning came with experience and several years of clinical practice (and possibly mistakes).
The ability to name all the individual arteries, for example, draw their location on the face, and explain depth variations, was most certainly unlikely to trip off the tongue on day one of foundation injectable training. Admitting to knowing ‘enough’ to be safe is how most embarked on aesthetic injection competency as the sector began to evolve.
As we grow and reflect upon how we learn, it is time to change that way of thinking; the next cohort of trainees ought to start their learning journey towards mastering the specialty by doing things in the correct order, starting with facial anatomy knowledge.
The euphoria you will feel when you start your practical training, already knowing the ‘lay of the land’, and having the ability to ensure you inject safely will be significant with this prior understanding in place.
If you want to grow your practice, you require a stable footing, and you cannot feel stable if you are unsure where you are injecting. This will result in approaching your everyday clinical practice with a feeling of uncertainty or trepidation – despite the training certificate on the wall and the original reassurance that you had competently mastered the technique.
If you feel like you are injecting blind because you lack anatomy knowledge, this is precisely the reason why this must come first in your training pathway. This uncertain feeling will ultimately cause you to step back and avoid clinical practice because your inner self understands your anxiety and will dissuade you from implementing the injection techniques you apparently learnt in training. Doubts will inevitably creep in – you know a little bit and perhaps enough to probably get away with it and deliver the treatment, but you do not REALLY know what you are doing to be absolutely safe and successful. No one likes to feel like that, so master your anatomy knowledge, it will help with both clinical applications and complications management.
Can mastering an injection technique trump mastering anatomical understanding?
There are those who may dispute this of course, feeling that if you master the techniques taught, replicating what you were trained and educated to do with reassurance that you can go away and do it again and again with success, either as apart of one-to-one training with an experienced trainer or by watching a KOL on stage at a conference event, then wider understanding can become a moot point.
And that may be true – and may also coincide with the Dunning-Kruger effect – but eventually the technique that works on 99% of patients will fail and cause a significant complication in the 1% who do not have the expected anatomy, which you will be ill-equipped to spot before delivering the treatment. You cannot rely on thinking replication is easy, when anatomy varies, and injection depth is critical. Most practitioner realise this as they begin to treat more and more patients using the techniques they were told were child’s play.
Read up on How to become a confident injector: The Dunning-Kruger effect.
A ground-up approach is frankly the best and only option for becoming a safe and competent aesthetic injector. One where you learn the anatomy first, then the injection techniques and their nuances, and the safety steps to perform to mitigate being in the wrong place to narrow the complication risk as much as possible
Ask yourself, how could this go wrong, where are the arteries, and at what depth are they located, what angle should I be approaching treatment to avoid them. Only then can you inject in a way that makes more sense and feels more comfortable to deliver, physically and mentally, than just a ‘see one, do one’ approach.
Mastery anatomy will occupy your mind as you inject
With heightened awareness of the anatomy comes building a mental picture as you inject, the closest you can get to x-ray vision as you evaluate the structures that you could encounter beneath the skin.
Without this, and when you are simply replicating a technique, you can find that your mind can wander because you are not having to think much about what you are doing; the practice becomes wholly automatic.
As soon as you focus on the anatomy, you build a mental picture of the tissue layers, the proximity of structures, and the vasculature, injecting more precisely, mindful of depth and needle angles, and taking necessary safety measures like aspirating before injecting. This is when you will find that your mind is completely occupied and not thinking about anything else, even though the injection technique is the same.
How to learn facial anatomy by building a 3D sculpture
We all learn in different ways and embedding and retaining learning is often the difficult part.
Looking at a textbook of 2D anatomical images might not cut it for many, because chances are you will recall very little, compared with getting hands-on with 3D anatomy where you build a face, layer by layer. We can do this with a model or sculpture, starting from the skull and bones, adding muscles, fat and vasculature, finding and placing the origin and insertion points for muscles, laying out anastomoses, and weaving the structures through in three dimensions. This brings the anatomy to life, helping you store a mental picture with increased recall ability.
The experience of building the anatomy from scratch with modelling clays – much like breaking down and rebuilding a bicycle or car engine with all its constituent parts – will provide a much-enhanced level of knowledge and understanding of how everything works and interacts, and you will have a future reference tool that many go on to treasure.
This type of hands-on, 3D anatomy creation may be better than doing a cadaver-based anatomy course because it allows you to start from a base and build the structural layers. Whereas, you must have prerequisite anatomy knowledge to undertake a cadaveric course where you are attempting to locate known, relevant anatomy by recognition. Similarly, cadaveric samples vary in quality and structure; often ageing has altered the anatomy compared to the real-life morphology of your patient cohort making it more difficult to build that mental picture.
Your 3D sculpture will not only have an immediate impact on your injection skills, but it will also help future understanding when training in advanced or additional injection techniques.
If you have any clinical or anatomical questions, ideas for future podcasts or community discussions, you can also find Dr Tim Pearce on Instagram.
Podcast
Listen in full
Podcast 5: Why Knowing Anatomy Is KEY If You Want To Become A Successful, Safe Injector
Foundation eLearning Courses
If you want to increase your confidence in anti-ageing injections, Dr Tim Pearce offers two comprehensive courses that are highly rated by our delegates:
Both give CPD and certificates on completion.
In addition, browse our FREE downloadable resources on complications.
Dr Tim Pearce eLearning
Dr Tim Pearce MBChB BSc (Hons) MRCGP founded his eLearning concept in 2016 in order to provide readily accessible BOTOX® and dermal filler online courses for fellow Medical Aesthetics practitioners. His objective was to raise standards within the industry – a principle which remains just as relevant today.
Our exclusive video-led courses are designed to build confidence, knowledge and technique at every stage, working from foundation level to advanced treatments and management of complications.
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