Facial Injector Training: Safety First With Nicola Lowrey

Nicola Lowrey, PA-C, shares her career journey from emergency medicine to aesthetic injector, why she thinks anatomy is so important to patient safety, and how an alternative career to traditional medicine became her passion. Nicola juggled working in the emergency room and at a med spa for nearly 15 years before striking out on her own.

A career alternative to traditional healthcare.

Nicola’s career continued its trajectory into emergency medicine as she originally intended, but she never forgot about her experience discussing neurotoxins while she was a graduate student at the University of Southern California to become a physician assistant. So, when an opportunity arose to take a weekend certification course in aesthetic injectables, she jumped.

After earning her certification, she landed a job at a med spa. “Back then, you learned from your mistakes,” Nicola says. “But we’ve definitely come a long way.”

For 15 years, Nicola maintained roles in emergency rooms and at a med spa, before finally deciding to transition into Medical Aesthetics full time.

Personal experience made patient safety a top priority.

Somewhat early on in Nicola’s career, a patient she treated had a complication. Here, she shares that experience.

“Years ago, I injected a young woman’s lips. I had a tiny bit of product left over in my syringe. The feeling was that I can’t just throw this ‘liquid gold’ away—I intended to provide my patient with the best treatment experience possible. So I placed the product in each nasolabial fold. It looked fine at the time, but late that evening, we received some messages and images. She had changes in her skin all the way up into her forehead. It was a pretty big deal,” Nicola says.

“But what was most concerning to me was that I had no idea why no one had ever told me this could happen,” she continues, “and if I didn’t understand why it was happening, or how to take care of her, I realized I had no business doing what I was doing.”

Luckily for Nicola and her patient, she had help and support from her supervising physician, some of her mentors, and even the pharmaceutical company. That particular patient completely recovered and is fine today. “She actually ended up becoming a dermatologist!” Nicola says.

But the experience left its mark on Nicola’s approach to Medical Aesthetics. “It was a big eye-opener,” she explains. “I was either going to quit, or I was going to dig deep and figure out how to be better—without having access to the type of education that exists now.”

Anatomy held the key to success and safety.

“I searched the educational resources out. I called, shadowed, attended with, and spoke with as many people as I possibly could, and I still do. In the past 10 years, I would say that I developed my own little PhD program, where I was able to learn everything that I felt I could learn to make my practice better and safer,” Nicola says.

“The one thing I’ve learned over and over again in the past 10 years is that anatomy tells us everything,” she continues. “It’s how we keep our patients safe, and it’s how we deliver desired outcomes.”

While studying anatomy, Nicola noticed that the majority of educational resources spoke more to surgeons, and there weren’t specifics for what she needed to know. So, quite literally, Nicola wrote a book on anatomy focused on aesthetic injections. For an introduction to facial anatomy, download Spark’s anatomy tool.

“It’s very intentionally targeted for aesthetic injectors. We talk about the tissue planes, the variable vascular anatomy, the why behind specific techniques,” she explains. “At the end of the day, to be a great injector, you have to have a good eye and be able to see. You also have to be very attuned to the minutiae of the face.”

“Anatomy helps us as injectors because it teaches us the pathophysiology of the aging face,” she says. “Having anatomical knowledge also helps us understand that every face is going to be completely different from the next, and how to deliver safe and natural outcomes for each different patient.”

In addition to relying on her expertise in facial anatomy, Nicola stays up to date on emerging technologies in the Medical Aesthetics field to help keep her patients safer.

Innovating Medical Aesthetics treatments with ultrasound.

Nicola uses ultrasound technology to help deliver more precise treatments to her patients, which can be safer as well. “Pretty much every specialty of medicine uses some sort of imaging to help solidify a diagnosis or better correctly treat their patients,” Nicola says. “In Medical Aesthetics, we have not had that.”

Although still in its infancy in the field of Medical Aesthetics, ultrasound is proving to be a useful tool for the precise work of aesthetic injections. Nicola uses it in specific instances. “What I often do in areas of high risk is take my ultrasound and do some pre-mapping to provide a deeper understanding of that particular patient’s facial anatomy. Then I know that I’m giving the patient the safest potential treatment that they can expect.”

Nicola looks forward to seeing ultrasound imaging grow and expand throughout the Medical Aesthetics industry. “This gives us a responsible way to be able to manage our treatments and procedures in a way that takes the best care of the patient.”

What Nicola’s looking forward to.

Nicola’s background in emergency medicine gave her a strong commitment to the importance of evidence-based practice. “I’ve tried to bring that commitment into my Medical Aesthetics practice, but it hasn’t always been easy, just with the lack of true evidence-based support that has traditionally been available.”

But, according to Nicola, that’s starting to change for the better. “Now, there’s more and more available every month, from medical journals to peer-reviewed studies. Evidence-based medicine is giving us the best source of how we should continue to evolve and move forward in Medical Aesthetics.”

At Spark, we think you can never learn too much about safety.

Check out our other Facial Injector Training series articles:

• Julie Bass Kaplan’s, FNP-BC, NP-C, MSN, CANS, CPSN, HCMT, PHN, advice about making patient safety a whole mindset
• Leslie Fletcher’s, MSN, RN, AGNP-BC, unique take on the role mental health screenings play in patient safety