Should You Add Facial Injectables to Your Practice?

09 Jan 2017 Dr. Gigi Meinecke
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Dr. Gigi Meinecke demonstrates facial injectable techniques during one of her continuing education courses. Dr. Gigi Meinecke demonstrates facial injectable techniques during one of her continuing education courses.

For many practitioners, adding aesthetic services to an existing dental practice seems very enticing. Moving from “the patient requires” to “the patient desires” presents a refreshing change of pace, and certainly the thought of adding to the bottom line is equally compelling. But before you commit to the training and expenses that go along with developing a facial injectable practice, a bit of self-reflection and careful consideration is justified.

In the field of injectables, one- or 2-day courses can give the practitioner basic skills and a foundation on which to build. True technical and treatment plan competency is sometimes harder to reach and can vary greatly by practitioner. It’s one thing to feel competent to inject, but it’s another to fully appreciate the fine and often variable anatomy that guides the “why” of how specific products and their precise delivery sites are chosen.

Successful treatment and patient satisfaction are directly related to this mastery. A “one and done” attitude about training courses dooms an injectable practice to ultimate extinction. This evolving field requires frequent skill-honing and information updates. I personally go to at least 2 meetings a year to remain current.

Over the last 7 years of teaching facial injectables, I’ve watched doctors get trained and then never fully integrate these services in their practices—and in some cases never implement them at all! They’ll take several courses from multiple CE providers, spend lots of time and money, and for whatever reason they just never commit. I imagine this same scenario repeats itself with other areas like implant placement, Invisalign, and sleep medicine.

But my involvement in and passion for this field leads me to wonder specifically about why it happens with facial injectables. Imagine people who buy a plane ticket for an exciting destination. On the day of departure, they show up at the airport, go through security, sit at the gate, and then never board the plane. And some do this multiple times!

So, what are these self-imposed barriers that keep practitioners on the injectable sidelines? I’ve wracked my brain trying to understand this. Is it fear? Lack of interest or confidence? Lack of staff buy-in, or inertia? As an educator, I’d really like to know how to identify the causative factor for these individuals so that I could solve it for them. But the reality is that practitioners can solve this for themselves before they ever enroll in a course!

Like any other specialty treatment, facial injectable procedures aren’t a perfect fit for every practitioner. In my opinion, practitioners should first ask themselves if they are even interested in facial injectables. If the answer is no, then that should really be the end of the story. You should only add elective market services to your existing menu that you enjoy doing and that satisfy you personally and professionally. If you’re constantly banging your head against the wall, the money isn’t worth it.

Next, take an objective look at your existing practice and its demographics. This is the population that you’re most likely and least expensively able to market your new services to. According to the American Society for Plastic Surgeons, most Botox and dermal filler treatments are performed on patients between the ages of 40 and 54. If the median age of your patient population falls below or above this range, I’m not going to say it’s impossible, but you’ll need to market outside your practice to grow this segment. Do you already have patients asking about these procedures? If you do, that’s a great indication you may already have untapped interest. (My own injectable practice started with only 2 women!)

Now, think about the physical interior of your practice. In other words, what is your brand? Would you classify your office as more Best Western or more Four Seasons? I’m not suggesting an extreme makeover, but if you want to be part of the aesthetic business your office needs to reflect that experience. At a minimum, your reception area has to look less clinical and more salon. Your willingness to modify office decor can give great insight into your personal commitment to being part of the injectable market. If your response to this is that you’ll deal with it later, that pretty much says you’re not “all-in.”

Think about this from the consumer’s perspective. If injectables don’t seem like a natural extension of your existing practice, patients may question why your office is adding these procedures. Moreover, if the general appearance of your office is that of “we do root canals or tooth maintenance,” the takeaway message is that you only dabble in Botox and dermal fillers and, therefore, probably have limited experience.

If your office is located in the same building as a medspa or established dermatology or plastics office you may encounter strong headwinds, but this alone shouldn’t be a deal-breaker if the market interests you. As a practitioner of dentistry, you’re at an advantage since injectables aren’t your only income source. Moreover, the practice of dentistry is predicated on a prevention and wellness model, which is complementary to aesthetics. People don’t just want to feel good, they want to look good. Building this segment of your practice slowly is definitely an option.

I’ve watched a number of practitioners attempt to grow their aesthetic practice through Groupon and other social coupons (which, by the way, is fee-splitting and illegal for dentists and medical doctors in most states). In my opinion, this is a race to the bottom and is no way to develop an injectable practice. When you appeal to the “price shopper,” all you do is fill your schedule with unloyal individuals who remain at-the-ready to move on to the next advertised sale. This demographic has no interest in quality or consistent results. Instead of converting “believers,” you wind up giving it away to bargain-hunting drifters. Remember, price is only an issue when the practitioner fails to demonstrate a difference in value.

I really believe that staff buy-in has a profound effect on success. Enthusiastic staff are able to answer patient questions (often when you’re out of the room!) and increase interest. Moreover, if your staff receives injectable treatment from you, they become excellent ambassadors and serve to reassure prospective patients with their visible results.

The best way to ensure staff buy-in is to have them attend training courses with you. This gives them a solid background from which they can draw to intelligently answer questions and allows them to educate patients on the indications of Botox and dermal fillers. Think about this: procedures you regularly perform in the office are easy for your staff to discuss and explain. Patients inherently know this. If your staff can’t fluidly discuss facial injections, how many of them can you possibly be doing every day?

Most patients are realistic about potential results, but it’s the responsibility of the practitioner to honestly explain what’s realistically achievable. Nothing sucks more oxygen out of the room than a complaining, unhappy injectable patient. Popular media leads many patients to believe that Botox can do it all. Even though the procedures themselves are not very time-consuming, the explanations, education, and expectation modification conversations that have to take place before any needles are uncapped can be lengthy. If communication is not your strong suit, it’s a skill you’ll need to hone.

Helping patients achieve their aesthetic goals is deeply rewarding. But treating patients with cosmetic procedures also comes with its own brew of stressors and potential complications. Just because a patient elects to have treatment and third-party payers are out of the mix doesn’t mean getting paid is always effortless. In my practice, by and large, we receive payment without incident. But we have had our share of “Botox bandits” and “price hagglers.” Fortunately, they are rare. But if you offer these services and you do enough of them, you’re bound to have the occasional bandit or haggler. It comes with the territory.

The field of injectables is young and still evolving. This makes it exciting but requires continued regular education on the part of the injector. Certainly the physical characteristics of each filler will partly determine its effect. And, new fillers with different characteristics are approved every year. Outcomes, however, mainly depend on an injector’s comprehensive understanding of anatomy, aging, and a good esthetic eye. This is a booming industry with continued market expansion forecasted. If injectables interest you and your state license permits, it’s time to get trained. But remember, more important than what you do is why you actually do it.

Dr. Gigi Meinecke is the founder and principal of Facial Anatomy for Comprehensive Esthetic Seminars (FACES), the only facial injectable course to combine cadaver review workshops with live patient training. She has lectured nationally since 2010 on facial injectables and maintains a full-time private practice in Potomac, Md. She is the immediate past president of the Maryland Academy of General Dentistry and a Fellow in the International College of Dentists. She serves on the ADA Council on Communications and the AGD Legislative and Governmental Affairs Council, and she is a national spokesperson for the AGD.

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