She Got 3rd° Burns: How Illegal Devices End Up in Legit Spas | EP 91

Have you ever assumed a treatment was safe

just because a friend recommended it?

Sarah Kabalka is a nurse practitioner

with 13 years in medical aesthetics.

She thought she was getting a legitimate RF

microneedling treatment from someone she had known

and worked with for years.

Instead, she developed injuries she is still living

with the consequences two and a half years later.

We go deeper than the one bad treatment,

breaking down how a non FDA approved device

can end up in a treatment room that looks completely

legitimate and how trust can override critical questions

and why having a medical director

does not always mean real oversight.

Sarah also shares the exact transparency step

she now takes with every single patient

before she ever picks up a needle.

And stay till the end because the most shocking part

of her story has nothing to do with the device.

If you get aesthetic treatments or thinking about it,

you need to hear this.

Hi, I'm Dr. Kate D.

And I'm speaking today with a nurse practitioner,

Sarah Kabalka, Sarah.

Thanks for being here today.

Thank you, thank you for having me.

You know, I had worked with this person

for about seven years and I trusted her

and she said that she had gotten

our radio frequency microneedling machine

and this was two and a half years ago.

So it was relatively new technology

and I had worked with somebody who had had it done

and said it was the most painful thing

that he had ever gone through.

But it was kind of torn up the next day

but nothing like I was.

And she and a client and sort of friend

that you'd work with who is an esthetician?

She was an esthetician, she's a master esthetician.

In Washington state, there are not very many states

that have this but we do have a certification

for master estheticians that are actually allowed

to do lasers and other medical things

within their scope under a doctor.

So in Washington, that's legal.

It is and she had taken further education

at the Laser Institute in Arizona.

So I had no reason to believe

that she didn't have a medical director.

She said she was getting really good results from patients

and I had wanted to try it

because it was sort of,

we all do in this industry, the newest, whatever.

What I didn't know is that it was bought offline

probably from like Alibaba or one of those companies.

And so she didn't have an NPI or a national certification

person and advanced practice person

or an MD to back her up to buy these devices.

Basically, you have to be a medical like a doctor

to buy one of these things.

So if you're an esthetician and you don't have

a medical director, then only thing you do

is buy a cheap illegal wine often.

And that's what happened.

Yeah, because you didn't know it was at that time.

No, I didn't.

And nor did I know she was calling me her medical director.

Yeah, wait.

So she was actually using you as her medical director

and you didn't know it?

No.

Wow, okay.

Okay, sorry.

Yeah, it was a question I asked later

is if I'm your medical director,

why would you not inform me?

And how did you get it?

Because you don't have a medical license

and she said she didn't need it.

So you don't know any of this at this point.

You are your long time colleague got a new device.

He thought it was legit.

You showed up in her office presumably, right?

Right.

And then what happened?

So she numbed me because I wanted to try it.

And she used the wrong cartridge, unfortunately.

So it started out at one.

And I mean, again, the needle tip that, or what?

Yes, the depth.

So I don't know what the energy was,

but she started the depth at one.

And I didn't feel anything.

And a friend of mine again said,

it was the most painful thing he had gone through.

And so I said, what happens if we go up?

And she said, do you want to?

She said, yeah, we can,

but I didn't know she was going to go to one, to a hundred.

You know, one, two, I think it was 3.5 millimeter depth.

So we're getting into subcutaneous tissue

and the heat that was produced,

the energy that was produced by those needles at that depth

went straight into subcutaneous tissue.

So the, the dermis is where you really want to

insult this at energy.

And so you really want a depth.

And of course you need insulated needles

and you want a depth of, you know,

between one and 1.5 millimeters usually, right?

Maybe up to two if you have thick skin,

or you're in the body that has thick skin.

So she's going all the way up to 3.5.

And she gets you into the subcutaneous fat,

which is not where you want to be, but okay.

They created little white dots.

They were sticking to my skin.

And I didn't know it, but my son was in the room.

And he knew something was wrong

because the needles are supposed to just go in and out.

And they just kept pulling on my skin.

I guess she kept ripping off the tip.

And she didn't stop.

So if she had the skin was dating to the needles, basically.

It was because she was using non-insulated needles also

and the wrong tips.

So these are 10 linear needles.

They're non-insulated.

They're going way past the smears

where you really want to be for that college

and production into the subcutaneous fat.

Right.

And so, and I know we've covered RF microneedling

a couple of podcasts before,

but if people are listening or watching

and they don't know.

So the reason I've come out super duper strong

on this podcast about being against anything

with uninsulated needles,

because the damage they do is really, really huge.

And you can get a lot of complications

from that scarring and hyper and hyperpigmentation.

It's the equivalent of doing a very uncontrolled

ablative laser, it's very dangerous.

And so what you're describing is she's doing exactly that

and too deep.

It's sticking to you and she's pulling it out

and bits of your skin are basically coming with it.

I guess I was, I didn't know it was happening

because I didn't feel it.

Well, that's good now being here.

So I didn't know and then I looked in the mirror

and because she said I don't know what this is

and it was the first one.

She just sort of stopped.

I would be, I'd only have a couple.

But then I don't know because I'm not a laser tech.

And so when I used to work family practice,

I had anesthesiologist, I had family medicine,

I had internal medicine docs.

It doesn't matter at that point, they're my patient, right?

They're sitting at my table.

I'm a patient.

I am not a laser expert.

I don't know what these dots mean.

I know that I've seen it with some like radio frequency

hypercation, I've seen it with some of those machines

but I don't know what it is.

And I said, is it like frosting?

And she said, you know what?

I have seen it and it is frosting

and she just continued.

And so then after that, it continued all the way down

into here, through here, here.

And yes, into my subcutaneous tissue here, here, here.

And I was at 13 years of working in this industry

and I still had, I mean, there's no other word for it.

It's botched.

I'll never have, I can't get rid of these scars.

They're third degree.

They eventually started to split open

and then you could see straight down into the fat.

Once they started healing, they started healing wide.

And that's when I contacted a friend of mine

that I used to work with in Albuquerque.

He's a double board certified plastic surgeon and ENT doc

and I said, what do I do now?

Should I suture him shut?

And he said, you have to debris them.

And I said, okay, so they were infected.

They were, well, one was infected.

We got that infection under control.

I was on high dose steroids.

I did hyperbaric oxygen therapy.

I did PRP.

I did multi-vitamin IVs.

I did everything I could do while I was in the healing process

but they just kept breaking open.

The fluid behind them, I was so swollen.

They just kept popping open.

So you talked to your mentor who's the plastic surgeon.

You tried all these different things over the last

but two and a half years.

And so it really has left you with some permanent scarring.

It has left me with a lot of permanent scarring

and it's never going away.

I mean, it's, and because it was 10 insulated needles,

a lot of people online didn't believe it.

They said that I was doing it

because it was AI or it was self-harm,

which I took huge offense to because that's scary

because it went viral so quickly.

And so I don't want people to believe that that is a form

of self-harm and sometimes it's just the lighting

on no harm.

They're implying that you went to this person

on purpose that she would work.

They think you saw I didn't miss out home

and it wasn't an idea.

Well, we know it was another person.

We're not going to say who this person was

or where this is hard.

I think the important thing is to recognize

that there are many, many, many people

who are buying devices on the internet

that are not FDA-approved

and then they're literally practicing medicine

without a license and it's very risky, right?

Right, and so that's the thing.

How do you keep yourself safe?

How do you know that these people are legit

or how do you know that the device that they're going to use

is an FDA-approved device

and that they have adequate training.

They have a medical director behind them

and what do you do when adverse events happen?

I mean, these are all questions that people need to ask

and I didn't ask them.

Yeah, and because of trust.

Yes, and that's the thing, right?

Is for whatever reason, if you trust that person

for whatever reason and you don't ask that question, right?

I have had patients who are lawyers

who, you know, they went to a place that was illegal

and they didn't ask the question either,

but that's because their friend went there

and they just trusted them because they assumed

that it was legit.

And I think there's this assumption,

I had another guest on the show that said, like, look,

when you walk into a restaurant,

you assume they're getting inspections

and you're not asking, you know,

do you have a license to sell me the burger, right?

And so when you walk into a place that looks legit,

people are not used to asking those questions, you know,

do you have a license to do this procedure on me?

Right.

And what I think a lot of people don't realize

is that our legal system depends on this reliance

on the professional, which is just, it's the doctor,

okay, it's the doctor's license that they get

and you have to, you know, there's a whole lot of standards

that we have to comply with.

And it's our license on the line.

So if we do something dangerous,

we could lose our license and our livelihood

and we'll never be able to practice medicine again.

But so the law relies on that check, right?

But now we have in the last, especially last 10 years,

an economy where people can purchase illegal medical devices

online just delivered to their home or their spa

and just do this and there's no check,

there's no balance, nobody's looking.

And if you don't ask that question,

there's always the possibility

that this person's completely illegal

and there is no medical director, there is no doctor.

So, no, that's why I always, that's like the number one question

you should ask before you go to any provider.

Okay, is not just what's your license

but who's your medical director and look them up?

What device are you using?

Look it up.

Yes, I mean, that's the problem.

But at least if there's a medical director,

that person is responsible for making sure

that that device is legal and you're trained on it

and it's safe, the medical director is there

to make sure that it's safe.

So the idea of having a medical director

who doesn't know anything about the device

or what you're doing or aesthetics in general,

that's really not okay.

And then also the idea of having somebody

who doesn't even know that they are the medical director.

Now, you're not the first person I've talked to

who was being used as a medical director

and they didn't even know it.

I've talked to one other person in the past

where when they tried to get their own contract

with one of the, you know, talks and providers,

they couldn't because that company said,

well, you're already the medical director over here,

you already have an account

and that person had no idea.

So yeah, I had no idea until she said that

and I said, if I had been your medical director,

I would never have approved or signed off on anything

like this.

You have to talk to me before you buy anything that's invasive

or that needs, I mean, that's something

that you do training on, right?

You buy a device that is FDA approved.

That company comes in and hands on trains,

you and your staff and everybody else

including the medical director.

And so I would never have signed off on something

like this, especially because it wasn't FDA approved

but also because I wasn't told about it

or I wasn't trained on it.

So those are things because if I have a,

if she has a complication, say this was not my face

with somebody else's face that she did this to

and she calls me as her medical director,

I'm in huge trouble, right?

So I would never ever sign off on anything like this.

The Med Spa Board certifies Med Spa's

that prove they're doing things right.

Legitimate supply chains, proper licensing,

real medical oversight.

It's the difference between guessing and knowing you're safe.

If you're looking for treatments,

go to MedSpaBord.com to find certified Med Spa's near you.

And if you already have a Med Spa you love

and they're not certified, send them our link.

And if you're a Med Spa owner doing things right,

get certified and show your patients

you're not cutting corners.

Did she tell you you were her medical director

just for that moment?

Or...

No, it was after the fact.

Or literally are you on all her accounts?

I have no idea.

I've called most of what I know she has

to make sure I'm not on any of her accounts.

Okay, wow, okay.

So the crazy thing is that if you go online

there are esthetician spa, source websites,

tons and tons of them,

where estheticians can buy all kinds of devices

that they can use in their spas.

And the crazy thing is there's this giant overlap

in actual what they're allowed to do

and then all these illegal devices.

It's really remarkable actually.

I just was looking up a device the other day

because someone told me that they got treated

with a device I'd never heard of

and I had to look it up.

And actually it was taken off that company's website

because probably because of something like this.

So what I'm just curious though,

so when this was happening and your skin was sticking

to the needles and she was pulling out

and it was getting stuck,

she just kept going and doing the whole face.

So the first one again was up here.

That's when she turned the energy or the depth up

which I'm sure the machine just sort of,

I don't know if she changed the energy.

It probably changed on its own based on depth

and then she kept going.

And as soon as she kept going,

it came all from here to here.

So it's kind of like if you look at me on this side,

those are where all the scars are.

And then on this side, I got away with one or two.

Wow.

And did she recognize the damage that was done?

Did she do anything to treat it?

Did she see you back in any kind of follow up?

Or are you just too as special as to like take care of the burns?

No, she just said that she would pray for me.

Okay, that's helpful.

So was she concerned?

No, not concerned at all.

Thought I was just not concerned at all.

She kept asking me what it was.

Okay, this kind of reminds me of when the plasma pens first

came out, just been many years now.

And there's various devices

that you can just lump into that category

where it's basically, you know, a caudry in a robot

and you press down on the skin.

And if you touch the skin very lightly,

you'll just get the epidermis,

and you probably won't do too much harm.

But the more you press the farther down,

you cauterize the more and more damage you can cause.

And it's not controlled in any way.

It's literally your hand, like, you know,

putting this thing on this skin.

And the first time I saw this demo,

I'm like, this isn't safe.

Like how could this be?

This cannot be approved.

This is crazy.

And that was being offered by a statisticians all over the place.

I mean, doctors would never use that,

but it was just a totally normal, like, you know,

a statisticians thought nothing of it

because it wasn't regulated, right?

Like, it just, you could just buy it and use it

and all, it's the next best thing.

You know, I've just completely,

I still can't believe those are in use anywhere.

So if you're, if you're trying to avoid something

besides uninsulated RF micronealing,

avoid plasma pens, anything they call fiberblast,

which is a ridiculous name

because fiberblast is the name of yourself

by your dermis that make collagen.

Love fiberblast.

You're cute, they're adorable.

They make collagen, we love them.

But they call that treatment fiberblast.

I'm the first time I heard it.

I was like, what are you talking about?

But anyway, very dangerous.

So let's, let's not worry, totally agree.

Okay, well, so it's been, it's been two and a half years.

We're not, we're not naming names here,

but is there, how has this affected your practices?

Are anything that you do now that you realize

you should have been doing before?

I just, has it changed your clinical practice?

So, I mean, it's changed everything.

When I first came back to work,

because I couldn't, obviously I couldn't work for a while.

I had three patients that I had known for a really long time

and they came and, and they started crying.

I mean, they didn't even know what happened,

but they just burst into tears.

And then I explained what happened

and they were appalled.

And I, I guess I was in sort of denial.

It will, it will heal, it will heal, it will heal.

And then I flew down for my first treatment

and it, it turned out it was third degree.

So it's not going to heal.

That's the unfortunate fact between third degree

and second degree.

You get 50, 50, at second, you get 100%,

100% scarring at third, right?

Yeah.

So I've gone through five CO2s,

I've gone through all sorts of things since then.

But I have to explain it to every new patient.

I've had patients just one, just one the other day

who is saying, I was totally afraid of you

when I first met you because of the scars.

I've had patients walk out

because they don't want to look like me.

Wow.

And I can't blame them.

I mean, in the beginning, especially,

I didn't want to look like me and I still don't,

but it's, it, that doesn't mean it doesn't hurt.

Do you know what I mean?

I know, I mean myself.

Absolutely, especially, you know, in this industry,

it can be very, very harsh, right?

Yeah.

And, and also because you're offering skin treatments,

it's, it's helpful to have, you know, good skin.

You know, I mean, it's like going to a plastic surgeon

who's definitely so good.

It's like early, you know, it's like, well,

like what are you, what are you doing?

Or somebody who's totally over-injected.

There, I ran across an Instagram

real the other day and I was though,

it was a split of two, two injectors

and one of them was completely over-injected

and the other looked pretty normal, which would you choose?

And it was, I mean, everybody said the same thing.

You want somebody that looks normal.

You want somebody who looks good.

They don't want to look 52,

but what have you been doing to your skin?

And so that was the question I got all the time.

What do you do to your skin?

What do you do to your skin?

What do you do to your skin?

Yeah.

And I don't get that anymore.

Yeah.

Well, you know, just to reassure people watching.

So, I mean, RF miconadeling

is actually a fantastic treatment in the right hands.

Obviously, the right device in the right hands.

And there was recently this FDA warning about RF miconadeling

and I think that that's all about the device

and who's doing it.

I personally have had so many RF miconadeling treatments

since I turned 50, I'm 58 now.

That I don't even know how many, probably in the high teens.

But yeah, I mean, I did five that year

and then I've done one every six months since.

So it's been a long time.

And so it's not a disaster at all.

If you are very, very careful and it's done right,

it can be fantastic, but it just, it's so hard

because people are trying to cut corners on both sides, right?

This person was clearly cutting corners, big, big corners,

big legal corners.

But then also like a lot of people are like,

oh, that's so expensive.

It is because it's an expensive device.

It takes a long time to do.

It takes a really skilled person to do it.

So, you know, but you go to a place like my place

and oh gosh, that's kind of pricey

and you go find something cheaper.

And the thing is the cheaper thing

might be really super crazy dangerous.

So, I mean, price is part of it,

but there is that saying that cheap Botox isn't good

Botox isn't cheap.

You want to go to, you're not just paying for the product.

You're paying for the person that is administering

this treatment, whether or not it's seller or it's Botox

or it's RF micro-needling, you're paying that person.

So I can put on my waycode and bring in RF micro-needling

and say, I know what I'm doing and I have no idea,

but these people want that they want it

and I'm doing it at a low price so they do it.

And that was something that came up a lot

on the forum when I started posting the photos

was you did it because you're cheap.

And it wasn't that.

We trade treatments all the time in this industry.

And so it invested her.

Right, it was all about trust.

It's somebody that I trusted that I had worked with

and was friends with for seven years.

So there was no reason for me really not to trust her.

She has other FDA approved devices.

I didn't think she would be so stupid.

I'm kind of hoping she has a real medical director now though

if she really does do that.

Well, and that's a whole other topic.

I actually dropped somebody as a medical director

because they were doing things that were outside

of their scope by a long shot.

And now there are these companies where you can just

like rent a medical director.

And I don't even know if they're in the same state

but they'd never even met you.

And so how proficient are these medical directors

and how much do they know?

I mean, yes,

our of micro-needling in the right hands can be great.

For me, it's, I'm not doing it again.

I don't blame you.

I don't blame you.

But I agree with you about the medical directors.

So that's one of the things at the medspot board.

We not only confirm that the medical director

is licensed in the state,

but also we interview the medical director

to make sure they know about aesthetics,

to make sure they know who they're,

there's the make sure they are actually

doing the job of a medical director.

And then of course they have to sign an attestation saying,

yep, everything I just told you is true.

And I do think that that is so very important.

So finding a place that's legit

means having a real medical director,

not just an absentee one

and not just a rent a dock.

And there's a company that I was starting to research

and I won't name it because I don't know yet.

But there's a company that literally their whole job

is finding medical directors for people who need one.

And I think that it's really important

that we investigate that company.

And find out like who are they actually finding for this?

And do they have the skills to actually supervise the person?

And are they there?

I mean, there are laws being proposed right now

in it's like four or five different states

that require the medical director

to actually be in house a certain percentage of the time.

Right.

And a lot of these places,

the medical directors nowhere near the place.

Like they're not in forever because they're not there.

I did a previous episode about two medical directors

in California, one of whom supervised 13 or 14 spas,

all over the state and then one spot in Maine.

And I was like, there's no way you are supervising

all these places.

And he had a full time job

as a palliative care doctor in Napa.

And I was like, there's no way he's traveling around

and actually personally supervising anything, right?

No, and when you get,

so I was a medical director for a place in Seattle

and they ended up going,

it wasn't anything that happened between us.

It's just they wanted somebody there full time

and they were bringing on.

She was in an ejector

and she was a nurse practitioner.

I think she was a DNP and so it was just, it was fine.

It was, we were just flooding ways.

And she's on, of course, there was sight.

And you should always have the medical director

on the website.

But when I worked for, there was an adverse event

and he was able to contact me to tell me about it

and show me pictures and tell me what happened

in blah, blah, blah.

And I was able to tell him how to treat it and what to do

because that is extremely important.

I need to know what you're offering.

So I know how to treat what you're showing me

because those, if you want a reputable place,

that's another thing that you need to do.

As you need to go online and you need to see

who that owner is and who their medical director is.

I was never on her website as a medical director ever.

So I was really shocking to hear

that I was her medical director.

So if you've been listening to the show,

you know I've got stories for days

about what goes on in Med Spas.

I finally put them all in a book.

It's called Med Spal, Mayhem.

I wrote it because I got tired of hearing about people

getting hurt by providers who have no business

holding a syringe.

You'll read about real patients, real nightmares.

But more importantly, you'll know exactly what to look for

when you walk into any Med Spal and what questions to ask.

It's part expose, part survival, God.

And it might just save your life.

Med Spal mayhem will leave you informed, entertained,

and a little shocked at what's really going on

behind the business of the aesthetics industry.

The link is in the episode description.

Read it before you book your next appointment

because beauty should never come at the cost of your safety.

Wow, that's crazy.

Well, is there anything else about your story

that you wanted to share?

I know that this has been just a really difficult journey.

But I think it's been really, really helpful

to be able to share with our audience,

just especially to not feel bad when something happened to you.

And you just, there are so many people

who are victims of these illegal places

that are just, they're blaming themselves.

And I think you need to not ever blame yourself

because you trusted this person.

And it's that is so difficult to override that.

Even if you're feeling a little like, in the moment,

you trust that person and you don't say anything

until you have a moment to process it like to her.

So I've heard from some people anonymously now

who they're telling me their stories,

but they don't want to talk about,

they don't want to be identified

because they partly feel like it's their fault.

And I just want that message to grant everyone

that it is not your fault.

That is absolutely still part of,

and I have said it online.

I mean, there have been a lot of people that said,

it's your fault, it's your fault, it's your fault.

And I have, and there's been,

the medical community for the most part online

have been a, I mean, in my corner, they have been,

I will fly you out here and treat you.

I will send you this to try on your skin.

I will do, you know what I mean,

they're just called and they have fought back for me.

It is not her fault where I'm sitting here

typing away saying, you're right.

It is my fault because I trusted her.

I didn't ask her any questions,

which I always tell patients to do.

I didn't ask for her license.

I didn't ask where she bought the machine

if it was FDA approved.

I didn't do the things that I tell patients to

because I did the exact thing I tell them not to do.

I trusted her.

And so there is a huge part of me

that is still guilt-ridden.

Well, don't be really.

And I just, I really, really appreciate your willingness

to share your story

because I know how difficult that is.

It's hard.

I think that, you know, it is hard.

Before I got down this road,

I mean, when I first started in aesthetics,

I really, I was very trusting

and I just, I thought, well, this is medicine.

So we're gonna, I really felt like I needed to learn

as much as I possibly could

and do it really right

or I wouldn't feel comfortable.

And I just-

Well, that's everywhere.

It's integrity and ethics.

Well, and the problem is that everywhere I turned,

there was someone doing it illegally

and I was like, how are they getting away with that?

Right?

I don't know.

I knew all along there were people who had been harmed,

but it's like, it's so hard for people to speak up.

And the problem just got harder and harder and worse

and worse.

That's why I ended up writing that book

because I just needed to get it out of my system.

I thought, okay, just write about it

and people can read it or not.

And then I, at least I've said my piece.

But one thing has led to another

and it turns out, you know, oh my gosh,

it's even bigger than I ever imagined.

Even worse.

When I was first writing this, I thought,

maybe it's a third of these places illegal.

And then as we got farther along

and the book was coming out,

I'm like, it's probably at least half,

given what I'm learning.

And now with the studies recently coming out of New York

and Florida, it's like 60%.

And they're not even looking at C-POM law violations.

So I think it's probably even more than 60%.

But right now I'm saying that-

The Florida has different laws

like you can't see a physician's or something.

So and that's a whole different topic because-

For lots, it's a side.

I'm just talking about who's complying with the law.

And- Yeah, well that's true.

There's just so many people who are just not.

So- No.

So I mean, and that's another thing.

I tell people when I'm teaching them,

when they first walk into my office

and they've never met me,

but they've been referred to by somebody

because they don't advertise.

So it's like somebody's referred or Google review

or whatever.

I always, especially if I'm opening a new bottle

first of all, I never walked out of the room

unless I'm getting silly

because I don't have enough cabinet space to put everything.

But I have a refrigerator in the room.

So I always have my neural toxin in there.

And if I'm opening a new bottle of Botox or Dispored

or whatever, I don't use anything else.

So I guess I'm not opening anything else.

I show it to them.

I take it out of the box and I say, this is it.

Yeah. Can you see it?

And they're like, it's empty.

That's him left the key.

You see this little white ring?

That's it.

And that's where people will over dilute Botox, right?

And so I actually under dilute

because there seems to be a correlation

between the COVID vaccine and Botox longevity.

I don't know if it's true or not,

but it does seem to wear off faster

since COVID vaccine came out.

So I actually do 2.3.

And I'd rather have happy people,

but I never walk out of the room

when I don't trust when an injector will walk out of the room

to fill something.

I do it unless they're really needle phobic

and they cannot watch me do it.

I will do everything if I'm doing a sculpture.

I will start reconstituting sculpture right in front of them.

Yeah.

So they see every needle I pull it.

They see everything I do.

They see it step by step.

And I educate the whole time I'm going through this.

They probably might retain 10%.

But you know, the 1% that they'll retain,

they'll retain that I did it in front of them.

Right, right.

Because the next time they go someplace

and that person walks out of the room, they're going to think.

Well, so I have to say that like everyone's workflow

is different.

And we actually do it very similarly.

We do our counter and our fridge

and our sinker all in the same room.

And we do draw up in front of the patient

where the patient in the room.

But not everybody has that set up.

So I have another spot where there's four rooms in a row.

And the prep area is outside that room in a separate space.

And so all the Botox and all the supplies are in one place.

Because we also have four rooms in my place.

And now you've got to have like a separate fridge

in every room, like a separate supply.

Yeah.

Where is it going?

So it can be a very reasonable workflow

to not be in the room.

So I don't want people to go home and think red flags.

But it's true.

But the big reasoning is, yeah, is to absolutely

know that they're using real product one way or another.

And one way to prove that is they're

doing that in front of you.

But the cases last year of botulism from fake Botox,

the one nurse practitioner who actually was reported,

this was in Illinois.

She had ordered fake Botox Alpha Ali Baba.

And she thought it was real Botox or that's

what she told authorities.

And it was a spoofed box.

Like the box was obviously fake if you dealt with real Botox

in real life.

You know, we told that one up and like,

where did this come from?

That looks weird.

But she didn't know.

And a patient would not know.

You would see that.

It would look like it was a Botox violin.

It wasn't.

So that's something also that can be very difficult, right?

So I think the more important thing, rather than you,

you can validate the vial.

Because can I see the vial, please?

That's totally reasonable.

That can go get the vial.

It is very unlikely.

They've got a real vial of Botox,

but they pulled it from a fake one.

And they're giving you fake.

And they're going to show you a different, but that's,

I don't, I think that's very improbable.

I think the most important thing, though,

is to make sure that they are an actual licensed medical

provider and that there's an actual medical director there.

Those are the top two things.

Because those people do not want to lose their license.

And so they are much less likely

to be doing something illegal.

Because if they do, they'll lose their license.

And whereas these unlicensed people,

they've got no license to lose.

They do whatever they want.

And there's nobody coming after them.

And, you know, I've had, you know,

many cases reported to me where, you know,

they report this nurse,

so nurse lost their license doing illegal things.

Okay, nurse doesn't have a license anymore.

Still doing all the illegal things.

And they get report to the nursing board.

And the nursing board says, what more can we do?

We already took our license away.

And so, so, you know, the people with no license

have gotten nothing to lose.

And so you want to look that up and make sure it's valid.

I hang everything on my wall.

So there's no question.

It should be on the wall too.

Yeah, yeah.

Well, Sarah, thank you so much for sharing

your story.

I really, really appreciate it.

And I hope this has helped people feel okay.

And if anybody has a story they want to share,

you do not have to share it with your identity,

but I really do want to hear from you.

Yeah, I think it's really important

that we put this out there.

And that's, I finally got to a place where I felt like,

okay, I can put it out there.

There was a lot of lash back and that hurts.

But at the end of the day,

my priority is keeping people safe

and knowing how to keep people safe

because I don't want anybody to go through what I went through.

If you found this helpful,

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