The aesthetic landscape is changing driven by new innovations and a pubic demand for less invasive aesthetic solutions. The market has witnessed a 45% increase in the use of cosmetic injectables (Botulinum Toxin and filler) in the last year. Specifically, 1 in 4 dental practices in the UK offer non surgical cosmetic procedures.1
As Dental Hygienists and Therapists, we can already offer cosmetic treatments, such as tooth whitening (under prescription) and airflow. The addition of non surgical cosmetic procedures into our clinical repertoire is a way that many of us can add further variation into our day. Non surgical injectable treatments also allow both the clinician and the practice to create an additional and potentially lucrative revenue stream.
Dental Hygienists and Therapists are ideally placed to offer non surgical cosmetic injectable treatments for many key reasons including:
We have an in-depth knowledge of facial anatomy;
We are expert injectors;
We tend to have a good rapport with our patients – dental patients new to aesthetics particularly appreciate the reassurance provided in being treated by someone they know and trust;
We often book our patients for longer treatment sessions than dentists meaning there are less time constraints to discuss aesthetic treatments;
We practice excellent cross infection and medical emergency training.
Nature and uses of dermal filler Most dermal fillers are made from hyaluronic acid, which is injected under the skin to recreate lost fullness by replacing naturally occurring hyaluronic acid. Dermal fillers are classed as a medical device and do not require a prescription. However, the dissolving agent (hyalase) that is required as part of a facial aesthetics’ emergency kit is prescription only. The longevity of the results experienced depends on the type of filler used. In simple terms, the thicker the viscosity of the filler, the longer it will last. One of the great advantages is that the effects are instant.
Nature and uses of Botulinum Toxin Botulinum toxin is a protein that is injected into muscle to relax it. The toxin temporarily inhibits the movement messages to the muscle so the muscle stays smooth and cannot crease and create wrinkles. The full effect is reached two weeks post treatment. Botulinum toxin is a prescription only medication (POM), which means that Dental Hygienists and Therapists need to work with a prescriber, who must see the patient face to face to write the prescription, but are then free to inject without the prescriber present (much the same way as they do for LA). A face to face consultation is required with the prescriber each time and remote prescribing is against the law.
Advantages of offering non-surgical injectable treatments Clinicians entering the market thinking that facial aesthetics is a way ‘to make a quick buck’ will very quickly become disillusioned! Building up a loyal patient base of returning customers can take several years. It is advisable to enter this aspect of your clinical work focussed on the many elements that facial aesthetics can bring outside of mere financial reward. Some of these elements include:
Increased confidence: Learning new skills increases your confidence both within and outside the clinical environment.
Increased skillset outside of clinical practice: Those clinicians offering facial aesthetics often find themselves creating their own brand, designing a website and managing a professional social media profile to market themselves.
Diversification of offering: Many clinicians choose to train further in other aspects of facial aesthetics, such as chemical peels, derma-planning or offer facials from skin care ranges that they also sell. Patients attending for such treatments are often ideal candidates to upsell other treatments to.
Diversification of work place: There is no reason to stop you working from a salon or even out of your own home.
Job satisfaction: Many practitioners find that facial aesthetic patients look forward to their treatments in a way that hygiene and therapy patients do not. It is worthy of note that many facial aestheticians refer to the people they treat as clients drawing a further distinction between the two fields of work (but for the purposes of simplicity in this article the word patient is used throughout).
Disadvantages of offering non- surgical injectable treatments Those thinking about embarking on facial aesthetics training should not expect it to be all plain sailing. Dental Hygienists and Therapists in particular come across the following challenges by offering facial aesthetics treatments:
1. Botulinum Toxin and Hyalase (but not dermal filler itself) are prescription only medications, therefore:
It is highly advisable to secure a potential prescriber in advance of embarking on your training.
A dentist who you work with can only prescribe to you if they are also trained in facial aesthetics and there is no guarantee that they will prescribe to you especially if they themselves already have a lucrative revenue stream.
There are independent agencies who you can contact to help you find a prescriber but many prescribers insist on a minimum number of patients per clinic and for those starting out this is not always possible.
However, many Dental Hygienists and Therapists have found prescribers through their friendship network. There are also social media groups that can help you in this process.
2. The newly trained clinician can feel isolated. It can be a daunting task to get going and start injecting, especially if you do not know any other clinicians who currently practice in the facial aesthetics arena. It is therefore highly advisable to:
Get as much practise on family and friends as soon after training as possible (they will also help you build up an important before and after photographic portfolio).
Form a network of contacts within the facial aesthetics field prior to starting and during training who can be contacted for advice and support.
Discuss mentorship, both formal and informal with potential prescribers.
Join the BACDP (British Association of Cosmetic Dental Professionals). The association has been instrumental in fighting for the rights of Dental Hygienists and Therapists to work and train to the highest standard within the field of facial aesthetics. The association also advocates and campaigns for our right to practice within the field.
3. There is a culture of resistance to Dental Hygienists and Therapists practising within the facial aesthetics arena. Whilst the JCCP (Joint Council of Cosmetic Procedures) recognises our profession within the field, not everyone supports us. Currently we cannot join ACE (Aesthetic Complications Expert Group) and not all prescribers (especially those outside of the dental world) will prescribe to Dental Hygienists and Therapists.
4. Lack of prescribing rights is an issue. Unlike dentists, Dental Hygienists and Therapists do not currently have the administration of non-surgical injectables in our scope of practice. They were also not included on the exemptions list along with drugs such as local anaesthetic or fluoride. We are not listed as Allied Health Professionals and as such cannot apply to undertake a prescribing course.
5. New practitioners often feel pressured to offer discounts initially. It is very tempting on embarking in facial aesthetics to try to encourage patients to take up your services with discounts. This should be done with caution for multiple reasons:
Botulinum toxin is prescription only and thus cannot be discounted by law.
Offering discounts from the outset can set up the clinician to have to offer discounts from that point on to maintain a flow of business.
Some patients, especially those who already have had multiple facial aesthetic treatments, tend to be deal driven. It can be very hard to keep these patients in the long term (and they are often very hard to please).
Facial aesthetics in practice It is the author’s experience that building your business based around providing natural looking results for patients who do not want to look over treated is the way forward. Results are built up gently: providing one treatment at a time to achieve the desired look and then progressing to the next treatment.
The author has found that patients that are looking for realistic fresher natural looks tend to be the happiest with their results. Building up treatments gradually allows the patient (and their nearest and dearest) to get used to each element and allows for adjustments to be made if required.
Whilst many patients request multiple procedures at a time, any drastic change in appearance can be off-putting both for the patient and others who in turn might comment negatively. This can then leave the patient unsure about the result even if it is what they asked for. Further, multiple treatments at a time can leave the patient unsure about which element they are unhappy with.
The other advantage of building up treatments gradually over time is that this technique builds up its own word of mouth business. Patients receive positive feedback from friends and family (normally along the lines of how much fresher or well rested they look). Having been nervous to do so before, the patient might choose to share with their friends and family that they have had a treatment and might even bring intrigued parties with them to their next appointment. This holistic approach in turn builds prospective patient trust and rapport as current patients’ friends can witness first hand a treatment as it is conducted, meaning they are more relaxed if and when they do book in.
Introducing facial aesthetics into your clinical repertoire can be highly rewarding especially for those not seeking instant financial success. A truly financially buoyant business of loyal returning patients might take slightly longer than most new entrants into the field think. As working within the facial aesthetics arena is not without its challenges, the author highly recommends joining the BACDP and considering mentorship in the early phase of embarking in this new aspect of clinical work.
Reference:
1. Dermamedical Combined training manual Level 7 v 5.0
About the author: Nick qualified with an MA (Oxon) from St Catherine’s College Oxford, in French and German. He worked for 10 years in Marketing, Communication and Business Strategy before changing careers into Dentistry. He was awarded the Tutor’s Award from Kings College Hospital where he studied a Diploma in Dental Hygiene and Therapy. Nick currently works across a variety of specialist private and mixed practices in Central and South West London. He also runs his own facial aesthetics business.
Dental Health November 2019 Article P23