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Episode #412: The Future of Facial Esthetics in Dentistry, with Dr. Louis Malcmacher

the best practices show podcast Apr 27, 2022


Botox is just for wrinkles. Right? Not anymore! It is now mainstream in dentistry, and it will continue to grow. And to help you understand the need for dental Botox, Kirk Behrendt brings in Dr. Louis Malcmacher, president of the American Academy of Facial Esthetics, to explain the benefits that offering Botox will have for your patients and your practice. For everything you need to know to get started, listen to Episode 412 of The Best Practices Show!

Main Takeaways:

  • Botox has become mainstream in dentistry.
  • Fillers and Botox are not just wrinkle removers.
  • Dental Botox can offer orofacial pain relief.
  • It can also be a treatment to reduce bruxism.
  • Studies have proven that Botox is safe and effective.
  • Patients willingly pay for this recurring service.


  • “You can learn to do anything, clinically, and be good at it. It’s just training, and practice, and practice. That's the old joke. That's why they call it a “practice,” because you're literally practicing your whole life when you're a dentist.” (6:50—7:03)
  • “Even if you treat 28 teeth with veneers or crowns and implants, they still have great-looking teeth. A great-looking smile is everything around it. It’s the lips, it’s the cheeks, it’s the folds, it’s the skin. That really is everything else.” (13:45—14:00)
  • “Dentists are the only healthcare professionals that can practice total facial esthetics. Why? Because we don't only control the teeth anymore. We control everything else with Botox, fillers, and PDO threads in the face to lift up sagging skin, to fill in the cheeks, fill in the folds, the perioral area, make all these wrinkles in my face disappear and patients’ faces disappear. That's why we coined the term facial esthetic dentistry, because now dentistry is literally from here to here, and we can control the whole thing.” (16:22—16:58)
  • “There are now more dentists doing Botox and fillers than there are dermatologists and plastic surgeons, which, total in the U.S., there are only about 15,000 combined of plastic surgeons and dermatologists. There are at least 20,000, if not more, dentists that are doing this at this point in time.” (17:07—17:25)
  • “That's the thing that dentists really need to wake up to, is always give people what they want. And the number-one most requested esthetic service in the world is Botox. And fillers for volumizing the face is number two. So, that's what your patients want.” (18:28—18:44)
  • “We’re so ingrained that, ‘Oh my gosh, my patients are so cheap. They will not go ahead and pay for this unless it’s covered by insurance.’ Not with Botox and fillers.” (19:55—20:05)
  • “If you're thinking about getting into Botox and fillers, ask this one question on your medical history form as a practice filter . . . ‘Have you ever gotten Botox and dermal fillers before?’ Leave a line, or just give them yes or no. And you will not believe how many patients check yes. And these are the same patients, by the way, that have told you that they don't have the money to fix tooth number 19, the lower first molar, because the insurance doesn't pay enough, or they don't want to fix it.” (20:21—21:01)
  • “Look at the ADA Health Policy Institute. They have great statistics. They literally go week by week as to what's happened in dental offices through the pandemic, even now post-pandemic for that. Now, even post-pandemic, dentists are way behind. During the pandemic, and even last year, 2021, they were way behind. They were still down 20% in terms of patient volume, patients coming in, production. They had to raise their fees. I mean, you raise your fees and you've got lower patient volume, that's typically not a very good mix for all of that. But those dentists that have been doing Botox and dermal fillers, they were up 30% to 48%.” (22:01—22:44)
  • “Botox changes the entire paradigm when it comes to TMJ and orofacial pain. It is so effective in treating the muscles so that they don't work as hard. And if you look at any of the evidence-based studies, up to 85% of orofacial pain, TMJ, comes from muscles. And Botox treats muscles, and they get incredible relief.” (26:48—27:09)
  • “The big misconception is that Botox is just for wrinkle removers — that's all it’s going to do. ‘I can have some fun in my practice.’ But you're going to use it for so many things that it will be amazing. And fillers, that's volumizers, for lip filler, for lip lines, smile lines, really making the patient look so much younger by adding volume around here, total game-changer for that. And they're skills that just have to be learned.” (27:53—28:19)
  • “I love it when I hear this from dentists, ‘I'm just going to do this on family and friends. They’ve been asking about it, my team,’ something like that. And all of a sudden, the lightbulb goes on after they're doing it for a couple weeks in their office, ‘Oh my God, my patients are paying me for this. They're paying $800 for an elective esthetic Botox treatment that takes me five minutes to accomplish,’ once you're well-trained and know what you're doing, and your team is well-trained. There's nothing like it in dentistry.” (28:24—28:53)
  • “[Botox] is not a magic wand. You still want to do all of your other therapeutics and in conjunction with them. But this will get you so much further, get the patient out of pain right away.” (31:51—32:02)
  • “Botox is a recurring treatment. They need it every three to four months. And a lot of dentists think, ‘Oh my God, patients would never accept it.’ It’s the most popular service in the world! They accept it as long as they know what it is and what it can do for them. It’s amazing. So, we’ve got to change our mindset and understand what patients want, and what this is, and what it does.” (33:14—33:38)
  • “These are the safest, proven pharmaceuticals and medical devices in the history of the world. They’ve been around for 30 years. Nothing has been studied more, by the way, than Botox. And that's, by the way, we’re just talking about esthetics and therapeutics in the head and neck. It has about 300 applications all over the body.” (36:58—37:20)


  • 0:00 Introduction.
  • 2:36 Why you need to learn CPR.
  • 7:04 Dr. Malcmacher’s background.
  • 12:17 Why this is an important topic.
  • 14:41 Botox has become mainstream in dentistry.
  • 18:56 Botox can be a growth factor for dentists.
  • 24:31 What dentists get wrong about Botox and facial esthetics.
  • 29:47 How the pandemic affected oral health.
  • 31:51 Patients are starting Botox younger and younger.
  • 36:22 Safety profile for Botox and fillers.
  • 38:44 The future of facial esthetics.
  • 41:49 How to get involved with the AAFE.

Reach Out to Dr. Malcmacher:

Dr. Malcmacher’s email: [email protected] 

Dr. Malcmacher’s Facebook: https://www.facebook.com/dryowza

Dr. Malcmacher’s social media: @dryowza


AAFE website: https://www.facialesthetics.org/

AAFE courses: https://www.facialesthetics.org/aafe-membership-plans/

Dr. Louis Malcmacher Bio:

Dr. Louis Malcmacher maintains a cosmetic and general practice in Bay Village, Ohio. He is an internationally recognized lecturer and author, known for his entertaining and comprehensive teaching style. He has vast experience in total facial esthetics and has taught tens of thousands of healthcare professionals in the areas of smile design esthetics and facial injectable therapy. He has also lectured at many major medical and dental meetings throughout the U.S., Canada, Europe, and the Middle East. Dr. Malcmacher has also been extensively featured in the general media. His interviews have been seen on CNN, Fox, ABC, CBS, NBC, 20/20, Wall Street Journal, New York Times, Jane, Shape, Washington Post, Cleveland Plain Dealer, Detroit Free Press, GQ, Edge, Newsweek, Reader’s Digest, and Men’s Health. Dr. Malcmacher is a master of the Academy of General Dentistry, a fellow of the International Association of Dental Facial Esthetics, a fellow of the World Clinical Laser Institute, and a visiting lecturer at a number of universities. 

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