Budgeting for Botox AGD Impact Sept 15

Budgeting for Botox

The Costs of Making It Work in Your Practice

Dentists often ask me questions regarding integrating Botox® and dermal fillers into their practices. One question that often gets asked by dentists doing their proper due diligence is: What costs are involved? I have covered this and the return on investment (ROI) of Botox and dermal filler treatment in past AGD Impact columns, most recently in the July 2015 issue (“The Right Stuff”). The summary of that article is this: The typical cost of proper and comprehensive training using Botox and dermal fillers for both therapeutic and esthetic uses is approximately $4,900. The training completely pays for itself in less than 10 treatments, or if financed, one patient per month will more than pay for the monthly financing. This is a skill set you will use for the rest of your career. The ROI on this type of skills-based training is enormous. Now, let’s get to the most common follow-up question: What else is needed to make Botox and dermal filler treatment work in my office? What makes these products so remarkable and almost unparalleled in dentistry is that, after training, the additional costs are limited to the cost of product, the cost of consumables used in treatment, and the costs associated with updating your medical emergency kit. Let’s take a look at each of these areas individually.

Cost of medications

The name Botox has become synonymous with botulinum toxin. Botox is the most well-known of the botulinum toxins and it certainly comes with the highest cost at approximately $5.65 per unit; a 100-unit vial costs the practitioner $565. Dysport® has a different unit structure but is similarly priced. Both of these botulinum toxin products are equally effective for all of their uses. Generally, for either of these products, this will translate to a patient fee of $10 to $20 per unit, with a basic botulinum toxin case easily using 40 to 60 units, which can be delivered in 5 minutes by a well-trained clinician. The primary alternative to botulinum toxin is Xeomin®. The per-unit cost is approximately $4.35, with a 100-unit vial costing $435, which is a significant savings over competing products. The most well-known of the dermal filler products are Juvéderm® Ultra XC, Voluma®, Restylane®, Radiesse®, and Belotero Balance®. Except for Radiesse, which is a calcium hydroxyapatite-based material, the other dermal fillers are hyaluronic acid-based fillers. The general cost of these dermal filler products ranges from $295 to $400 per syringe, with each syringe containing approximately 1 mL of dermal filler material. Typically, the patient fee for these fillers ranges from two to three times the cost of the filler used. The fillers can be delivered in approximately 10 to 15 minutes. (Of course, all these prices are subject to change by manufacturers.)

Cost of consumables

You already have most of these items, including gloves and gauze. Dermal fillers come prepackaged with the filled syringe and the appropriate needles to deliver the pharmaceuticals to the patient. The main consumable that is needed for the delivery of the botulinum toxin is a specific syringe. I have found that the ideal disposable syringe for botulinum toxin delivery into facial muscles is the Comfortox™ syringe, which comes in either 0.3 mL or 0.5 mL sizes with a sterile, individually packaged, specially designed multi-beveled 31-gauge needle. The 31-gauge needle is ultra-fine and also is designed, when necessary, to be used as a microscalpel for delivery of dermal filler to add volume to deficient interdental papilla to correct black triangles. The cost of these syringes is low, with each syringe costing approximately 24 cents each. Therefore, the total consumables cost per procedure ranges from $1 to $3.50.

Cost of updating your medical emergency kit

There are three simple upgrades that you will need to make to your emergency medical kit before you begin using botulinum toxin and dermal fillers in your office. Even though complications due to use of these treatments are rare, preparation is the key to treating any complication. As you might expect, the most common complication of any injection is bruising and swelling as a result of treatment. Arnica ointment should be added to your medical emergency kit and can be used at the time of treatment. Arnica is a homeopathic anti-bruising agent that works very well in reducing or eliminating bruising from these injections. Another addition to the kit is a nitroglycerin topical cream or ointment that can be used in cases of intravascular injection of dermal fillers, which is incredibly rare. The third agent needed is hyaluronidase, which is used to break down hyaluronic acid-based dermal fillers if too much was placed, an error that is completely avoidable with excellent training. When you are ready to add Botox and dermal fillers to your practice, be sure that your kit contains the basic American Dental Association-recommended emergency medical medications and the above-mentioned additions. Sign up for automatic refills so your kit never contains expired medications and be sure you are trained in the use of every product in the kit. Skills-based dental training will always have the highest ROI of any investment you make in your office. Learning how to properly deliver Botox and dermal fillers for esthetic and therapeutic treatment is a great investment, and one that will help you treat patients better than ever for the rest of your career.