In the ever-evolving aesthetics industry, growing a successful aesthetics practice is becoming more competitive with each passing year. The ongoing responsibilities of staying up to date on the latest treatments and injecting techniques, marketing your practice, and maintaining a busy schedule of patients is a never-ending juggling act that takes time and dedication to master.

Every established injector has their own way of managing the various aspects of their career. Gail Keir, BSN, RN has been an aesthetic injector in Orange County for over 18 years, balancing a robust aesthetic practice with family life as a mother of two college-age boys. In this article, Keir opens up about her path to a fulfilling and successful career as a cosmetic injector and breaks down what it takes to become a cosmetic injector today.

Tell us your background story including your nursing education and what your career path has been as an injector.

I grew up in a family with strong female medical providers. My mom was a nurse, one of my sisters is an animal surgical nurse and vet technician, and my other sister was a psychiatric technician. I grew up with cats getting IV’s at the table and people coming by for medical checks from my mom all the time - she was the neighborhood nurse!

When I started college I was a Biology major and I wanted to go to medical school. I actually ended up graduating with a degree in English and worked for a while in publishing, but I always found myself back in the sciences. I felt like I wasn’t helping people enough, and I was still the neighborhood non-licensed nurse in a weird way, so I looked into becoming a PA or an RN.

I realized by the time I got certified as an EMT and Phlebotomist to get hours for PA school, that I could already complete my nursing bachelor’s degree since I already had a degree . I worked hard to complete my prerequisites and was accepted into Long Beach State right away. I was pregnant my last year, had my son in February, and graduated Cum Laude in June!

I went to work in the hospital and I loved it. I had a great shift with two little kids, but the hospital changed to twelve-hour shifts and that was hard for me. Shortly after that I went in for a laser appointment and found out that in California, it was required that either nurses or doctors run lasers. The RN that did my laser treatment at the time was getting married and was going to be leaving, so she recommended me as her replacement. I got trained there and started working every other Saturday and one day a week. I was moonlighting there and still maintaining my hospital hours. I loved it so much, and financially it was so good, that I ended up leaving the hospital. I didn’t have to work holidays and my hours were flexible. I did work every other Saturday for two and a half years, and that was hard. I missed out on some soccer games and things like that.

When I left my job doing lasers, I started working at a med spa and that’s when I was introduced to fillers. The fillers I started out with were bovine, or cow collagen, fillers. That was before hyaluronic acid fillers came out. You would do a little patch test on a patient, almost like a TB test, and they would come back the next day so you could make sure they didn’t have a reaction since it was cow collagen.

It would be the pharmaceutical rep who came in and taught you, and you were either good at it and you got a following, or you just weren’t. I’ve always loved it! Growing up I did my friends or my mom’s hair or their makeup... you have to have a little bit of an eye for it. I love the immediate results and making people happy. It was a positive career move for me, as it’s only become more sophisticated as the products available have expanded. I enjoy combining treatments and having long-term goals for patients.

What does your work schedule look like, and on the days that you’re working what is a typical day?

Part of what I love about this industry is the flexibility it allows me. I was able to see most of my kid’s soccer games and travel with them, but now that everybody’s out of the house I actually work Monday through Saturday. I’m available because I just love being here!

Before I got to Portrait, a typical day for me was probably seeing between 14 and 22 patients a day, it was every 15 minutes for Botox® and it was exhausting. It was turn and burn. Coming to Portrait and being able to create my own schedule and see my own patients, it’s so nice to have thirty minutes for a Botox® appointment.

I appreciate being able to spend more time per patient, and also see better financial outcomes from it. I put in my hard years creating a following by being available for people whether it was coming early, staying late, or having someone come in at my lunch. You put in the hard work early and you reap the benefits later.

What are the biggest challenges you have seen and faced within the aesthetic nursing industry?

It’s been a positive and also a negative that so many cosmetic injector training and certification programs have popped up. Aspiring injectors have to be careful to find out what spending all this money getting a certificate really means when you try to translate it into a job. I worry about people getting taken advantage of.

Hands-on experience is always the best, even if initially you might not be getting paid for it. It’s through repetition and seeing clients that you learn to assess a patient to create a treatment plan for them. As experienced nurse injectors, we need to take younger nurses or less experienced nurses under our wing to teach them and let them shadow us, and not worry that it’s going to create competition for us. It’s just going to lift the level of our industry.

How do you continue learning and what are your top resources for staying up to date?

You have to be an active participant in the industry. You have to put yourself out there and do your research.

For me, it’s been amazing to find a group of experienced nurses to exchange ideas. Being part of societies like ISPAN. Going to conferences and aesthetic shows, aligning myself with plastic surgeons and dermatologists who hold trainings.

Social media has been awesome: having YouTube videos to get ideas and hone in on whose techniques you like. When you find someone you admire, ask questions: Are they available? Would they let you shadow them? What products are they using? You have to put yourself out there because you’re the only one who's going to work for your business and success.

So what advice do you have for someone just starting out in the field?

Starting out in the field, you should expect to pay your dues. Maybe that means you start as somebody’s assistant or working part-time at a medspa. And remember that as an RN we always want to be patient advocates first and foremost and do our best for them.

Learning the ins and outs of operations, learning about the products, and having a pool of more experienced injectors to get trained by and people to practice on is also important. Know that you might not make as much money in the beginning but that experience is worth so much. It will build off of that.

What is your favorite procedure, and what is your most popular?

My favorite procedure is using Voluma® to lift the face. My goal is to have that inverted triangle of beauty - eyes to cheeks to lips. A lot of people don’t understand that we age like a triangle and we need to flip it to draw the eye up to eyes and cheeks. I love using Voluma® to restore the fullness and lifted appearance that a patient had before.

I also love to do lips! I think I’m known around Orange County for more of a natural look, my patients can wear less makeup, and have people say “You look good, what did you do?” not, “Oh, Gail did your lips”. It’s more of a restoration of what a patient had than an augmentation.

I love cheeks, lips, using a cannula. I love educating patients who are afraid to start using Botox® and fillers. The more people know the better equipped they are to make decisions.

I educate them about the variety of products and treatments available and for those who are nervous about getting something done to their face reiterate that we can start small. Generally, over time they see my work and start to trust me, and trust that I listen to them and deliver what they want safely and to the best of my ability.

What have been the highlights of your career and your experience joining Portrait? What makes you fulfilled?

Highlights have been being able to make positive life changes for someone who maybe isn’t able to have plastic surgery and is experiencing a lot of volume loss or doesn’t feel good about how they look. When I can use multiple syringes and do liquid facelifts, seeing how happy they are is rewarding.

Something that’s so positive is getting referrals or treating whole families. My whole business is based so much on referrals, friends of friends, sisters, aunts, or if somebody comes to town.

Working in the past with lasers, Botox®, and fillers, I’ve had patients with Bell’s Palsy or vascular birthmarks. It’s amazing to see patients' aesthetic treatments help them overcome some physical things that bother them or make them less confident than they should be.

I also enjoy having other nurses or PA’s shadow me, it’s fun to introduce them to this side of plastics or aesthetics.

I love the independence of Portrait, the sisterhood of nurses, having a Medical Director relationship that is so close. You feel protected and covered but you also have that independence! It feels so rewarding after establishing myself and working so hard, that I can branch out.

To connect or book an appointment with her, you can find Gail Keir BSN, RN here at her website, or on Instagram at @NurseGailKeir.

With so much experience in the medical aesthetics industry, Gail is an invaluable resource for information about injecting techniques, industry history, and all things aesthetics. Gail is now practicing out of Portrait's locations in Lake Forest, CA as our first Orange County provider.

Watch Gail’s video about her experience joining Portrait last year!

Are you an injector looking to stay up to date with the medical aesthetics industry or for opportunities to grow your practice?

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