Dentists are finding another way to make people smile -- Botox treatments. (Karl Merton Ferron, Baltimore Sun video)
After a plastic surgeon’s office botched her dermal fillers, Tima Barkeshli found a different destination for cosmetic treatments: her dentist’s office.
From his suite in Columbia, Dr. Javod Gol is among the ranks of dentists who are increasingly treating not only the teeth, but everything that frames them. In addition to teeth-cleanings, crowns and cavity fillings, he offers patients like Barkeshli Botox, dermal fillers and small sutures that lift and tighten their skin.
“It rejuvenates your face, which is what I’m looking for,” Barkeshli, a 33-year-old Bethesda resident, said of the Botox and fillers she’s received from Gol. “I’m not looking to look different. I’m not even looking to look so much younger. It’s more like I want to look fresh and rejuvenated.”
For more than a decade, regulatory boards have authorized the use of botulinum toxin — known under the popular brand name Botox — and other non-surgical cosmetic procedures by dentists. In addition to its cosmetic applications, Botox can be used to treat temporomandibular joint disorders — which cause pain where the jaw and cheek bones meet — as well as conditions like migraines and teeth grinding.
“This was pretty much a natural extension as more and more regulatory dental boards accepted the use of Botox and fillers as the standard of practice in dentistry,” said Dr. Louis Malcmacher, president of the American Academy of Facial Esthetics, which trains dentists and other health care professionals in applying the treatments. “More and more dentists are adopting the use of them every single day.”
With three levels of certification from the American Academy of Facial Esthetics, Gol’s cosmetic work ranges from procedures as simple as injecting Botox to smooth fine lines on the forehead, to the more complex “Nefertiti lift,” which tightens skin along the neck and jawline.
Dentists’ familiarity with facial anatomy makes them reliable providers for facial injections, Malcmacher said, adding they also understand how to treat complications that could arise.
“The face is where dentists live most of their professional life,” Malcmacher said. “Dentists for years have been certainly taking care of teeth but certainly have been involved in all the soft tissues around the mouth.”
Though the smile is the focus of dentists’ work, Gol said he likes to think beyond patients’ teeth.
“If you spend 10[,000] or 20,000 dollars on your teeth, it’s like a perfect piece of artwork, OK,” Gol said. “You’re not going to go and get a piece of artwork and put it in a $10 frame; you want it framed properly.”
Facial cosmetic work is not a fit for every practice, said Dr. Charles Doring, an instructor at the University of Maryland School of Dentistry. His family practice, North Bethesda Dental Associates, for example, treats patients ranging from young children to centenarians. Cosmetic facial treatments are not something his clients are asking for.
“For me it’s just not something I want to offer,” Doring said. “There’s a place for it, but it doesn’t fit into my practice M.O.”
Malcmacher estimated 18 to 20 percent of dentists have been trained in these procedures.
But about 10 percent of Gol’s dental patients seek Botox, fillers and other non-dental cosmetic treatments, he said. The most common Botox injection sites for his patients are the forehead, “crows feet” on the outsides of the eyes, and the “elevens,” or the glabellar complex between the eyebrows. With fillers, he often injects the lips (thanks, Kardashians), nasolabial folds (also known as laugh lines) and cheeks.
Botox treatments range from about $200-$600, while fillers cost about $500-$700 per syringe. Insurance does not typically cover cosmetic procedures.
Gol said he typically treats dynamic wrinkles with Botox first, to relax the muscles that cause lines on the skin. He then follows by treating static wrinkles with fillers, which help plump areas where people lose fat as they age.
“I would rather give you something that fits your face as opposed to giving something that everybody else gets,” Gol said. “What our body should take is different, so it really needs to be customized to you.”
He also tries to accentuate patient’s natural features, he said.
“Somebody who is like 45 — they shouldn’t be getting fillers to look like they’re 25. When you’re 45 you can still look beautiful at 45, so let’s make you look like a beautiful 45-year-old,” Gol said. “What you want maybe isn’t the best for you.”
Such conversations with patients help determine their best course of treatment.
“That kind of patient-doctor relationship is very special in dentistry,” Malcmacher said. “And where that really comes in on the clinical side is I know my patient’s face, I’ve dealt with them for years.”
Baltimore resident Shane Gabriszeski said he’d been seeing Gol for about three years for his dental needs. He more recently began seeing him for Botox.
“One day in his office he asked me if I’d ever considered Botox for a wrinkle in my forehead that’s been there since I was a teenager,” he said. “It’s always bothered me but never enough to do anything about it.”
He tried it for the first time about 18 months ago, and goes back about every four months for injections. And Gol recently placed a PDO thread — a tiny suture that lifts the skin, dissolves and builds collagen — to give his skin a stronger lift.
“A lot of people might be hesitant to go to a dentist, but he is really good,” Gabriszeski, 33, said.
“Patients are a lot happier getting this than they are getting their dental work” Gol said. “Positive reinforcement has been the biggest thing for it — the fact that it’s something that makes people feel good and makes you want to do it again.”