1. CME Accreditation for MD, DO, NP, PA, RN’s (Score: 6/10)

The word “certification” is used prominently by this training program, yet it has no formal legal meaning.  It just means receipt of a piece of paper.  The standard for post-graduate education is CME or CEU-accredited training that is peer reviewed and backed by an organization called a “joint sponsor” who is authorized to award AMA Category 1 Credits which are the only credits accepted for physicians, NP’s, PA’s and nurses. AAFE has CME credits through Pace for dentists which cannot be used by doctors and nurses.  AAFE states that another organization backs their CME for doctors and nurses called “Medical Education Resources” however in three attempts to contact them to verify credit, they have not responded.  If you choose to attend AAFE, please check with Medical Education Resources regarding the validity of their CME credits for each class or “level” of training you plan to take.  Also ask if any online portion has independent accreditation as an enduring material.

2. Faculty Qualifications and Transparency (Score: 2/10)

While difficult to ascertain for any private company, AAFE appears to be controlled by a 68 year-old Dentist in Ohio named Louis Malcmacher.  It is unknown who any other owners might be, or what percentage of ownership is non-medical.  In aesthetic circles he goes by “Dr. Malcmacher” which while factually correct, is misleading to make one believe he is an MD instead of a Dentist.  Dentists cannot legally perform cosmetic Botox and Filler in many US states since it is not considered germane to dental practice, yet he often introduces himself as a world-renowned expert in facial esthetics.  He definitely knows more than most dentists, but it is still very misleading when they market heavily to MD’s, PA’s, NP’s and RN’s as well.  In no jurisdiction do dentists teach and supervise nurses in any procedure.  How many dentists were on your nursing or medical school faculty?

It is impossible to know who is teaching any one given AAFE course offering as they never list the faculty for a given date and location.  Therefore you will not know the qualifications of your instructor.  However, scanning social media and other reviews, it is apparent that a small group of nurses and NP’s do the hands-on training that is not marketed with dental indications.  This can be problematic for hands-on, because in most states, RN injectors require other higher-licensed providers to perform the patient evaluation exam.  Some states also require supervision for NP’s as well.  Also, anyone teaching a hands-on class must be licensed in the state of the class.  Many traveling aesthetic faculty are not licensed where they teach so faculty transparency is crucial for potential attendees.  This can be quite problematic for NP’s and MD’s taking the class as they may be considered responsible for the RN and any bad outcomes that may arise from hands-on.  It appears that this group of instructors are not from diverse experience backgrounds, but many also work for what appears to be an AAFE-operated medspa found in Ohio and in several other states.  They have other “AAFE” branded medspas around the country with a single nurse or NP provider.  It appears that the vast majority of the faculty trained at AAFE and have worked much or all of their careers with AAFE.  Moreover, those who work in AAFE-branded medspas most likely trained with AAFP, and likely have no experience starting a business, hiring a medical director, and marketing as this was likely done for them in exchange for teaching revenue that flows back to Malcmacher. Therefore, it appears all Level 1 Botox and Filler courses are taught by these RN’s and NP’s with limited experience, until proven otherwise.  From watching some of their YouTube videos, it appears that the courses specifically highlighting dental indications may also be taught by dentists.

There has been a prior suit against AAFE and Malcmacher for hiring unqualified faculty who later got cited by the California Dental Board for performing treatments outside his scope of practice while teaching AAFE courses.

Another more recent suit is by a PDO Thread manufacturer accusing Malcmacher of misrepresentation and defamation while teaching for AAFE.

AAFE’s faculty page is littered with people who do not actively teach, with 98% of those identified as “Dr.” are really dentists.  For a company that aggressively markets to medical providers, not just dentists, this is quite misleading.

If you plan on registering for a AAFE class, please contact them first and ask for the name and degree of the instructor.  Then go to the state nursing board website where the class is held and be certain that nurse has an active medical license in that state.  Then if she does, do your due diligence on her experience level and history in the industry beyond involvement with AAFE.

A nurse with a multistate compact license can only function as an RN in other states.  If she is an NP in her home state, that does not carry over to other states.  There is no NP muti-state licensure.

3. Completeness of the First Level Course (Score: 3/10)

It is difficult enough to calculate the cost of training when factoring in your time commitment and travel.  However, when training is incomplete, or you have to purchase the product for hands-on (See Point 4 below), that makes it even harder.

The standard here is to teach everything that is FDA-cleared and off-label indications that work in the level 1 course.  This includes using the most concentrated dilution for Botox.  Most people learn a 1cc dilution for a vial of toxin, yet AAFE considers this “advanced”. Looking at the limited information taught in Level 1, and the important basic information reserved for Level 2, it is apparent that their business model is to sell high-priced memberships and force people to take multiple courses (but at a “discount”) instead of being a one stop destination for great comprehensive training on the first contact date.  For more information please check out this video.

4. Transparency Regarding Hands-On Product Provided in Tuition Cost (Score: 4/5)

UPDATED:  After A-T.com called out this organization for not providing toxin and filler for hands-on at the live events, they now supply a reasonable amount of toxin and filler to inject at live events.  However, this comes at a steep price now putting their Level 1 (basic and incomplete) training in Botox and Fillers at a total cost of $3,594 which is the most expensive in the country by more than $600.  And for this, you still have no idea who will be teaching each class.  And you will still need to pay fpr an additional class just to learn 1cc toxin dilution and lip fillers which is taught in later levels of the class.

5. Maximum Hands-On Class Size (Score: 0/5)

Looking here it appears that the class can be as large as they want it to be with a single faculty instructor.  Everywhere are photos of rooms with 10 or more providers in a class, some photos have 20-30.  This is too large for a 1-day training.  They have no published cap for hands-on class size.

The standard for a training course should be a cap of around 5-6 providers per instructor for the best hands-on treatment experience.  If an organization has more demand, they should open more dates, not cram in additional attendees and dilute your experience for the same tuition cost.

6. Location Transparency (Score: 2/3)

It takes some digging to find the location for each training city.  Some have incomplete addresses without suite numbers, some have no address at all. 

7. No Fake Boards, Fake Society, or Membership Upsells (Score: 0/5)

This is where AAFE is one of the most over-marketed and misleading training sites out there.  First, a “membership” has zero value.  Training does not need to be renewed.  Period.  Training is not licensure.  Furthermore, despite Malchmacher’s claims on YouTube and elsewhere that the “AAFE” name is well known by medical and dental board members and that training and ongoing membership will somehow protect you, this is also marketing fluff.  We cannot stress enough, this organization is Malcmacher, not an actual society of diverse providers of record that has earned the respect of peers and dictates standards and policy in any jurisdiction anywhere in the world.  

Furthermore, there is no Board or true Academy here.  That would be made up of diverse individuals who are paid by AAFE but have no interest in AAFE and have trained elsewhere, who guide AAFE’s leadership independently with their talents.  That is simply not the case.  AAFE’s instructors and leadership all seem to be local to them, and therefore, this is not an “academy”.  They are simply imitating the nomenclature for naming real authorities in medical fields without actually being an authority.

Moreover, memberships, renewals and such are not required for any kind of training status over the long-term.  Training is training.  Aesthetics is not a medical specialty.  AAFE is not an authority for an industry.  And a Dentist is certainly not an authority for MD’s and NP’s.  They are a for-profit training center, and an extensive lobbying organization to convince state dental boards to allow them to sell their training courses to dentists.

AAFE actually has the nerve to sell fake statuses that they call “accreditation” but are only open to people who paid to train with AAFE and completely run by AAFE.  This is a worthless piece of paper and should be stopped immediately.

8. Offers a Blended Online plus Live Learning Environment (Score 2 out of 5)

It appears that their Botox and Filler courses which are purchased separately but held on the same date have an online component and some online courses when purchased separately are CME approved.

There does not appear to be any independent CME certification of the online components as a standalone and therefore, the credits for the live date will lack the time spent on the online materials.

However, based on the class sizes seen in pictures, it would not be possible for that many people to have a proper review of the online material, Q&A, patient evaluations, and perform one-on-one treatments in under 4 hours for a Botox class and 4 hours for dermal filler class..

9. No Risk of Paid Models at the Live Training (Score:  2 of 2)

UPDATED:  After this risk was exposed by A-T.com, AAFE has shifted to a “bring your own model” plan, at least publicly, instead of recruiting patients from the community.

When you treat someone who in hands-on, you establish a provider-patient relationship with them.  You could get sued.  And patients who pay for a treatment (not volunteer) or are unknown to you have less tolerance for bad outcomes.  Moreover, if your instructor is an RN and you are higher level, you could be responsible for that outcome.  Don’t take these risks.

One gray area is when you attend one of the AAFE branded clinics for training that are run by a local nurse who was trained by AAFE in the past.  It is entirely possible that paying patients from these practices could be used or offered to attendees.  The same risks remain.  If you offer to bring a friend or relative to receive your treatment, AAFE should allow this.

10. General Truthfulness and Accessibility  (Score: 1 of 5)

When you enter into a teaching relationship, it should be collegial and not adversarial.  The tone and language of the terms and conditions can give you a good idea.

Using their customers as potential marks for additional profit from extra levels of courses, buying memberships and renewals that are not required.

Please use your own judgment when reading their reviews.  Most tend to have a very similar format with names like “Dr. K.” and they often compliment the instructor by his/her first name.  Buyer Beware here.  

Malcmacher in this video touts the benefits of accredited training and states why AAFE has to retrain so many providers who did not have adequate training.  But while acting like an authority or expert makes bold claims, but virtually everything he says is misleading…

• AAFE is him, not an independent accreditation board and does not even supply it’s own CME.  They need a third party like everyone else.  it is not an academy.  it is him.  This is a Dental course that he has had to market to non-dentists to grow and remain relevant, but their backbone is still dentistry applications.
• Why do they not properly identify dentists as DDS or DMD instead of the misleading term of “Dr.”?
• They tout that only they offer post-course support to their members.  Of course, memberships have to be paid for to get that support.  Plenty of other courses answer questions from attendees for free.  The tuition is high enough.  You don’t need to pay to ask questions later on.

Final Score:  22 out of a possible 50 

Final Recommendation… If you are a dentist and these procedures are in scope of practice in your state, then take an AAFE Botox course.  Otherwise, you may have better options.