Figure 1: Botox, fillers, and PDO threads rejuvenated this patient’s lip lines and smile lines for much improved facial esthetics.

Learn something new: Incorporating Botox and dermal fillers into your practice

Aug. 19, 2022
Dr. Louis Malcmacher explains how incorporating something new, such as esthetic injectable therapy, into your clinical procedure mix can add to your practice’s bottom line and even help prevent burnout.

Dentists are at a real crossroads today. The ongoing challenges of the last two years coupled with the changes in the dental practice industry have dentists questioning what their future should and will look like. This is true for all dentists, whether you want to have an independent practice or have joined a dental service organization (DSO). How will you be successful in your dental career? Will you have fun doing dentistry, or will you be burned out in the next one to five years?

Here is the only advice I ever received that has worked for my 40-plus years in dentistry: Learn something new.

What services are you offering?

Dentists tell me all the time that they are just not busy enough. They want to blame it on the pandemic, inflation, and assorted outside factors. They have the capacity to see a lot more patients, but they just can’t seem to get their treatment chairs filled. So many dentists complain they are bored with dentistry, and the pandemic has advanced burnout more than ever before.

The first thing I ask these dentists is: What services are you offering to patients? The answer I typically get is “everything.”


Here’s where it gets interesting. I question dentists about the services they actually provide in their offices. Do you do crown and bridge and restorative dentistry? “Of course.” Do you do endodontics? “No, I never really liked endo.” Do you do orthodontics? “No, I couldn’t figure out the wire bending or aligners.” How about cosmetic dentistry? “Sure, I do that; I do a couple of veneer cases a year.” Do you place implants? “No, implants scare me, but I restore them sometimes.” What about Botox and dermal fillers? Do you offer those? “I know my patients want Botox and my team is making me crazy to learn, but I just haven’t gotten around to it yet.”

The procedures patients want

It is no wonder these dentists are having trouble filling their postpandemic schedules; they aren’t offering procedures their patients want! Boredom and burnout are going to be very high when you have barely learned anything new since dental school. According to the May 2022 economic outlook survey from the American Dental Association (ADA) Health Policy Institute (HPI), “Dentists’ confidence in economic recovery continues to drop. In May, only one in five dentists had high hopes for US economic recovery in the coming months.”1

Learn something new

If you are looking for something that will have the most immediate impact on your practice production, profitability, and schedule, it is time for you to add injectable therapy, Botox, dermal fillers, and PDO threads to your practice right now. While most dental practices were down 38% in patient volume and revenue by the end of 2021,2 dentist members of the American Academy of Facial Esthetics (AAFE) who perform injectable therapy have had production increases on average of 33% in 2021, and this has continued into 2022.

The reason for this is that even with inflationary pressures, consumer spending has maintained and even increased in elective esthetic procedures. There is now a Botox boom because people are going back to the office and want to look their best. Patients are investing in themselves, especially when it comes to their own facial esthetics.3

Economics of dentistry

Compare this with the traditional dental procedures in your practice, especially if you are involved with PPO plans that are now reducing reimbursement rates to dental practices. If you take the time to do a cost analysis of the dental services you provide, based on the time and cost of goods involved, there may be certain procedures you do right now that only break even or have a small return on investment (ROI). This is especially true when compared to injectable Botox and filler procedures.

Look at the comparison chart in Table 1. It has some notes to explain the profitability of injectables versus one of the most common dental procedures, a single crown.

The injectable examples are based on average treatments and fees. Injectables are recurring revenue procedures, with Botox treatment recurring every three to four months, dermal fillers every six months, smooth PDO threads three times a year, and lifting PDO threads one-and-a-half times a year. These recurring revenue esthetic treatments are the most popular in the world with high patient satisfaction. A single crown is a one-and-done procedure. Among the cost of goods for a single crown are appointment-related costs including, but not limited to, impression material, temporary material, cutting instruments, etc. The single-crown fee in this example was calculated with a private-pay fee, a low lab fee, and 90 minutes total whether it was one or two appointments. This profitability will be significantly reduced with PPO/HMO fees and any changes to the single-crown numbers.

How Botox and dermal fillers affect production

With most of the dentistry performed today being elective, if you want to fill those holes in your schedule, you should be offering the most popular types of services patients want and yet are getting elsewhere. If you’re still providing the same services that you’ve always provided and can’t fill up your schedule, then you must do something different: you must learn new skills to provide the elective treatment patients want.

The AAFE has trained approximately 20,000 dentists in Botox and dermal fillers, which is more than the number of practicing dermatologists and plastic surgeons combined.4 AAFE dentists have rapidly expanded their dental practices by incorporating Botox and dermal fillers with everyday dental treatment plans. Member practices that are giving patients what they want average an additional $32,500 of monthly production with these esthetic procedures.5 What would your practice look like with that added production?

Therapeutic and esthetic uses

Botox and dermal fillers have many therapeutic and esthetic uses in dentistry, including the treatment of temporomandibular joint (TMJ)/orofacial pain, restorative dentistry, establishing lip lines/smile lines, endodontics, treatment of gummy smile, orthodontic relapse, denture retention, eliminating black triangles, and a myriad of other uses (figure 1). Across the nation, dentists are allowed to use Botox and dermal fillers for dental esthetic and therapeutic uses in the oral and maxillofacial areas, which are the same areas you treat daily and that are well within the scope of dental practice. To deliver the best esthetic outcomes for your patients (figure 2), all you have to do is learn the new skill of providing Botox and dermal filler services.

Learn something new! Expand your services by adding Botox, dermal fillers, and solid-filler PDO threads to the menu of services you offer your patients. If your patients are not ordering what is on your current dental service menu and you have empty holes in your schedule, you need to change the services you are providing and give people what they want (and what they’re paying for at other offices). Stop complaining and being bored: get trained, fill those treatment chairs, and have fun doing dentistry!  

Editor's note: This article appeared in the August 2022 print edition of Dental Economics magazine. Dentists in North America are eligible for a complimentary print subscription. Sign up here.


  1. Economic outlook and emerging issues in dentistry. American Dental Association Health Policy Institute. May 2022.
  2. COVID-19: Economic impact on dental practices. American Dental Association. Health Policy Institute. December 13, 2021.
  3. Glodowski A. A Botox boom for back-to-work. Crain’s New York Business. April 28, 2022.
  4. Physician specialty data report. American Medical Association. Association of American Medical Colleges. December 2019.
  5. American Academy of Facial Esthetics (AAFE) member study. January 2022.

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