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By admin July 10, 2014



With the rise of Botox and dermal filler therapy in dentistry and the introduction of an entirely new category of total facial estheticstm into the dental practice, I waned to write an article about the practice management aspects of this important and exciting addition to the dental practice. It is now estimated that close to 20% of North American dentists are performing Botox and dermal filler therapy, whether it is for therapeutic and for cosmetic use as well. This area of dentistry is rising faster than just about any other area. You will shortly see the reasons why this is so.

Let’s tackle the practice management benefits of adding Botox and dermal fillers to your practice first. Botox is the number one cosmetic procedure done in the world. As important and as fashionable that we think bleaching and veneers have become, to patients, these don’t even come close to wanting the total package of a beautiful smile and face. Interestingly, what we have done in dentistry is we have become” teeth centric”. Many general dentists have pretty much ripped the teeth out of the skull and tell patients all the time that if they get ten veneers instead of six veneers, they will have a beautiful smile as opposed to just beautiful individual teeth.

Nothing could be further from the truth. A beautiful smile consists of the hard tissue (teeth and bone) and the soft tissue in the mouth as well as all of the extra-oral soft tissue, including lip, cheeks, nasal labial folds, marionette lines, chin, and jowls. All of that together makes a beautiful smile – it’s not just the teeth. There is nothing in dentistry that is as recognizable to patients as Botox, Juvederm and Restylane. The reason can simply be found in any People Magazine that you pick up – while every once in a while some big movie star is getting a smile makeover, in nearly every issue of People Magazine, the stars are all getting Botox. Most of the beautiful women actresses have had some lip plumping procedures done with dermal fillers.

It is fascinating to watch patients’ reactions when you introduce Botox into your dental office. I routinely tell dentists to go ahead and add this one question to their medical history form – ask the patients, “Have you ever had Botox and dermal fillers in the past?” You will be amazed at the number of patients who say yes to that question. You may also get a little aggravated as well. The reason this may upset you is because this patient has completely ignored your treatment presentation for needed treatment and has been walking around with a broken tooth for the last few years, never spending any money to get it fixed. This same patient is the one who has gone ahead and paid for minimally invasive facial esthetic procedures like Botox and dermal fillers. It’s not unusual for patients to have their priorities in what we may consider the wrong places, but what they consider essential to their overall beauty and well being.

What are the economics for a dental practice of facial injectable therapy with Botox and dermal fillers and why is it the fastest growing area of dentistry? First of all, in a survey of dentists who have take The American Academy of Facial Esthetics training courses, of which I am privileged to serve as the president, many male dentists simply do the mathematics and figure out that if they start providing Botox, even if it is only to their wives and family members, they will financially come out way ahead rather than paying another professional to perform these services. Another major reason that dentists are interested in facial injectable therapy is because there is no big piece of capital equipment to buy, no monthly lease payment, the accessory items needed to deliver these products cost literally pennies, and the more product they deliver, the profitable the office is. Certainly, the biggest cost is the actual Botox and dermal filler product. There is absolutely no reason to have a large inventory of these products in your office because the companies that provide the products literally ship these products overnight.

I have been teaching overhead control in dentistry for approximately 25 years. Being an evaluator for Clinicians’ Reports for many, many years, my good friend, Dr. Gordon Christensen, taught me years ago about “faster, easier and better” dentistry. This is the secret to overhead control. In our office, we will invest in anything that will increase the quality of the procedure while reducing the time it takes to perform it. This is especially true when it comes to Botox and dermal filler therapy. In our training courses, we spend most of the time teaching about the anatomy, physiology, psychology, preventing adverse reactions, treating adverse reactions, and the entire gamut on how to use Botox. The participants are then amazed that the entire Botox procedure on the patient only physically takes about 5 minutes or less. And that is with a dentist who is injecting for the first time! The dermal fillers procedure may take about 10 to 15 minutes to accomplish. In terms of time involvement, once you are well trained and have completed just a few cases, it is just incredible how many procedures you can then perform during the course of a week. I always ask dentists this question – do you think you can squeeze in a patient for a highly profitable five minute procedure during your busy day? I would suspect that most of you reading this would say yes and it would be multiple times during any given day.

Now let’s get to the patient fees for these procedures. There are a number of ways that are commonly used to set up patients’ fees for Botox and dermal filler therapy. You can set fees according to how much of the actual products are used, you can set fees according to different areas of the face that you are treating, or you could give an overall treatment fee that would involve a total facial esthetic case, including a smile makeover. Packaging of facial esthetic services with dental services is unique to the dental office and is highly successful. It is not unusual for patients to go ahead with bleaching and Botox, veneers and Botox, crowns and dermal fillers, or any combination thereof.

If you were to break out the Botox and dermal filler fees alone, very generally speaking depending upon how much materials are being used, how many areas are being treated and if any kind of soft tissue augmentation is being accomplished, there is easily a patient fee of $600 to $3,000 just for the Botox and dermal filler therapy in addition to any other dental treatment that we are performing. We take the time involvement of being anywhere from 5 to 20 minutes, and the product cost for that kind of treatment may be anywhere from $50 to $500. You can quickly see how profitable these procedures are especially with the small time involvement.

Will patients pay for that? You have to be kidding me – if you are a man, just ask the women in your life. If you are a woman, then you already “get it”.
With now every state allowing dentists to use Botox and dermal fillers for therapeutic uses such as TMJ, bruxism, clenching, angular chelitis, soft tissue functional challenges, and facial pain patients, and with over 30 states allowing dentists to use these products for cosmetic uses in the oral and maxillofacial region, it is about time that dentists see the clinical benefits that many other healthcare professionals have had in the past as well as the financial rewards that go with performing total facial esthetic therapy.

By the way, the dentist is the only healthcare professional that can practice total facial esthetics because you are the only one that in addition to being able to perform Botox and dermal fillers, you are the only one who can actually treat the teeth. The only way to get started is to get trained today. You wouldn’t just watch a DVD to start performing implants or sinus lifts. Botox and dermal filler therapy is no different. It requires live patient, hands on instruction and a thorough understanding of the products being used, the anatomy you are placing these products into and how they will affect the esthetics of the face.

With so many other healthcare professionals such as nurses, medical estheticians, chiropractors and all types of physicians performing these procedures on our patients in the same area that we work in every day, it is about time that we realize that we are t equally or better skilled in the facial areas than just about any other professional. Ultimately, it is our patients that benefit with more comprehensive treatment done by dentists they trust. Dentists doing Botox? The time has come and it is here to stay. It is time to add this to your practice.

Dr. Louis Malcmacher is a practicing general dentist and an internationally known lecturer, author, and dental consultant known for his comprehensive and entertaining style. An evaluator for Clinicians Reports, Dr. Malcmacher is the president of the American Academy of Facial Esthetics . You can contact him at 440 892-1810 or email His website is where you can find information about his lecture schedule, botox and dermal filler hands-on live patient training, audio cd’s, download his resource list, and and sign up for a free monthly e-newsletter.

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