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“Botoxonomics” – The Economics of the Total Facial Aesthetic Practice Louis Malcmacher, DDS, MAGD

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With the rise of Botox and dermal filler therapy in dentistry, and the introduction of an entirely new category of total facial aesthetics, I wanted 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 percent of North American dentists are performing Botox and dermal filler therapy, whether for therapeutic and for cosmetic reasons. This area of dentistry is becoming increasingly popular.

Let's tackle the practice management benefits of adding Botox and dermal fillers to your practice. Botox is the number-one cosmetic procedure done in the world. As important and fashionable as bleaching and veneers have become to patients, these don't come close to wanting the total package of a beautiful smile and face. We have become too "teeth-centric."

A beautiful smile consists of the hard tissue (teeth and bone) and the soft tissue in the mouth, as well as the extra-oral soft tissue, including lip, cheeks, nasal labial folds, marionette lines, chin and jowls. All of these together make a beautiful smile – not just the teeth. There is nothing in dentistry that is as recognizable to patients as Botox, Juvederm and Restylane. The reason can be found in any People Magazine that you pick up – every once in a while a big movie star gets a smile makeover, in nearly every issue of People Magazine, the stars are getting Botox. Many of the beautiful women celebrities 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 add one question to their medical history form, "Have you ever had Botox and dermal fillers in the past?" You will be amazed at the number of patients who answer affirmatively. Although treatment priorities are different for each patient, it is not unusual for a patient to forgo a procedure to repair a broken tooth, but to consider Botox to be an essential procedure.

What are the economics for facial injectable therapy with Botox and dermal fillers in a dental practice? And why is it the fastest growing area of dentistry? One major reason that dentists are interested in facial injectable therapy is because there is no big-ticket capital equipment to buy and no monthly lease payment. The accessory items needed to deliver these products literally cost pennies, and the more product they deliver, the more 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 the office because the providing companies can ship these products overnight.

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, in addition to learning about Botox, we spend time teaching the anatomy, physiology and psychology, as well as how to prevent and treat adverse reactions. The participants are amazed that the entire Botox procedure on the patient only takes about five minutes. The dermal fillers procedure may take 10 to 15 minutes to accomplish. In terms of time involvement, once you are well trained and have completed a few cases, it is 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 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. You can set fees according to how much of the 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 aesthetic case, including a smile makeover. Packaging of facial aesthetic 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 of cosmetic procedures.

If you were to break down the Botox and dermal filler fees alone, generally speaking, there is easily a patient fee of $600 to $3,000 just for the Botox and dermal filler therapy. You take the time involvement (five to 20 minutes), and the product cost ($50 to $500) and you can quickly see how profitable these procedures are.

Now with nearly every state allowing dentists to use Botox and dermal fillers for therapeutic uses (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 many other health care professionals have had in the past, as well as the financial rewards that go with performing total facial aesthetic therapy.

The dentist is the only health-care professional that can practice total facial aesthetics. 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 used, the anatomy you are applying these products to and how they will affect the aesthetics of the face.

With so many other health-care professionals such as nurses, medical aestheticians, chiropractors and all types of physicians performing these procedures on patients, it is time we realize we are equally if not better skilled in the facial areas than any other professional. Ultimately, it is our patients that benefit from more comprehensive treatment done by dentists they trust. Dentists doing Botox? The time has come to add this to your practice.
Author’s Bio
Dr. Louis Malcmacher is a practicing general dentist and an internationally known lecturer, author and dental consultant known for his comprehensive and entertaining style. Dr. Malcmacher is the president of the American Academy of Facial Esthetics www.facialesthetics.org. You can contact him at 440-892-1810, e-mail dryowza@mail.com, or visit www.commonsensedentistry.com.
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September 2025
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