Why are dentists best placed to offer facial aesthetics

You may be wondering why a dentist would be working in non-surgical facial aesthetics. The truth is that dentists are actually ideally placed to perform such treatment, since we have undergone five years of undergraduate education focusing just on the face, never mind the postgraduate training that inevitably follows!

A large part of what we learn involves not just teeth but also the anatomical structures allied to the mouth, as well as providing oral treatment that is in proportion with the patient’s face, and we are experts at administering pain-free injection.

We dentists, just like any other healthcare professional that patients see on a regular basis, are in the fortunate position of being able to build rapport and therefore trust. Who better then, for our patients seeking non-surgical facial aesthetic treatment, to deliver it when that all-important trust is already there?

Perfect partners

In addition, cosmetic dentistry and non-surgical facial aesthetic treatment are ideal bed fellows. In my experience, patients who have elected to undergo cosmetic dental procedures tend to be interested in the possibility of facial aesthetics, and vice versa.

So what are the possible treatments to complement our patients’ smiles? They include, but are not limited to:
1. Plumping of lips subtly (injecting the hyaluronic acid dermal filer just in the borders of the lips) or by increasing the volume (injecting in the body of the lips) to enhance a smile with white, straight teeth
2. Volumisation in the mid face area, especially in patients who have lost some teeth in the cheek area, as well as replacing lost volume or filling deep lines in the nose to mouth (naso labial folds) and mouth to chin (marionette) lines with dermal fillers
3. Botulinum Toxin to target dynamic muscles. One example of its use is to reduce a gummy smile; weakening the muscles responsible for raising the lip with a small amount of toxin results in a gentler and softer upward pull when a patient smiles, allowing all of the teeth to be seen but decreasing the amount of gum on show
4. Temporomandibular joint disorders can be treated with Botulinum Toxin as part of a comprehensive treatment plan, and it can be added to treat bruxism in addition to normal dental procedures.


Don’t be a line chaser

Don’t be a line chaser. Look at the whole face and determine the best course of action to give the patient the best results possible.

However there is a fine balance between under selling and over selling. I’ve seen many patients that initially saw a competitor and only wanted a particular problem sorted, but were handed a treatment plan for over £2k.

I generally address just the concern the new patient comes with. Obviously if their concern cannot be treated in isolation, I would advise them accordingly. If it can be treated in isolation, then I would solve that particular problem. When I see them at the review appointment, I have solved their problem, hence my credibility has skyrocketed and they trust me. Now, I can consider the whole face and a more holistic approach.

However, you don’t want to scare patients away. I use this analogy (by the way, its not mine, heard it in a conference many years ago!). I let the patient imagine I’m a train driver. They have come aboard my train. They can either stay on the train for the whole journey. Or they can get off at any stop. If they do get off at any stop, they are more than welcome to rejoin my train and start the journey again.

This solves a number of problems and possible objections that the patient maybe thinking. They do not necessarily have to have everything that I have prescribed, its ok and I’ll understand. Many patients feel guilty if they don’t undergo everything your recommend or its been a while since they have seen you and may wrongly assume you’ll be upset with them and decide to see someone else to avoid this situation. I explain that they are happy to return to me whenever they are ready.



Whats the difference between Botox® and Dermal Fillers?




Whats the difference between Botox® and Dermal Fillers?

There are 2 main differences between these two types of treatments.

The first is what problems they can solve. Botox® works on motion lines. These are fine lines or wrinkles that occur on movement or contraction of the muscle. Botox® relaxes the muscle by stopping the nerve sending a signal to the muscle to contract.

Patients will fall into one of four groups.

Group 1 – no lines at rest and no lines upon muscle contraction. This group are too early for Botox®, as there is no muscle involvement.

Group 2 – no lines at rest, but lines appear upon muscle contraction. These are the best group to treat because the lines are caused by the muscles only.

Group 3 – some lines at rest and upon muscle contraction these lines worsen and/or new lines appear. We can still treat this group with Botox® as there is some muscle involvement, but we would not be able to guarantee to eliminate those lines at rest.

Group 4 – some lines at rest and upon muscle contraction nothing happens to these lines. These patients are too late for Botox® as there is no muscle involvement.

Whereas Dermal Fillers work on stain lines or folds. These lines/folds are not caused by muscle contraction but due to loss of volume in the skin. Dermal Fillers plump up the skin and restore loss of volume. However they do not lift. This is an important point, where if you have lose/saggy skin and you require lifting, Dermal Fillers would not be your treatment of choice.

Bradley speaking, Botox® is normally used for the upper third of the face and Dermal Fillers for the lower third of the face.

The second major difference is the onset of action and reversal.

Botox® has a delayed onset of action and you would not see the optimal result until two weeks. After the Botox® procedure, you will feel your skin tighten in 3/4 days and then over a period of 14 days see the effects.

In addition, Botox® cannot be reversed. Therefore it is imperative that you are baby stepped and not over dosed. We can add to the botox but we cannot take it away!

In regard to Dermal Fillers you can see the result immediately and you can reverse the effects. 80% of the effects of Dermal Fillers will be instant, in addition most Dermal Fillers attract water, so in the course of the next 10-14 days, the area will be re hydrated causing the skin to plump, hence the remaining 20% of the result is seen at this time.

Most of the Dermal Fillers we use are reversible. If we have over filled or the patient doesn’t like the look, we can reverse the effects and start again.

Botox® – how young can you have it

Dr Singh who runs his botox clinic in Stevenage, Hertfordshire, in his latest blog shares his thoughts on botox and hoy young can you have it.


I personally would not treat anyone under the age of 18.
For more information about botox hertfordshire, please call us on 01438 300111



botox regulation

Dr Singh who runs his botox clinic in Stevenage, Hertfordshire, in his latest blog shares his thoughts on botox and the future regarding regulation.


Earlier in 2014, the new European Aesthetics Surgery regulatory standards gained CEN approval. Much of the legislation will crack down on the inconsistency of botox procedural standards, training requirements and the condition of both surgical and non-surgical aesthetic treatment centres.

On the whole, the Aesthetics Surgery Services bill is designed to provide an overall set of minimum standards and quality guidelines for any practice carrying out cosmetic/botox and aesthetic surgery – and it will apply to any EU member states governed by CEN (European Committee for Standardisation). This includes the United Kingdom, as well as other European countries.

However, the UK has been allowed what’s known as an ‘A-deviation’ to the legislative standards – and this has been approved by the CEN in exceptional circumstances.

What will likely happen upon the legislation’s publication is that there will be two separate drafts – one which applies to surgical procedures (such as face-lifts or breast augmentations), and another which applies more specifically to non-surgical procedures (like Botox® injections).

If you are providing botox within your Dental Practice, then it will come under CQC remit. If you are providing these services away from your premises, then currently it will not come under the CQC remit.

***A word of warning here, if you are treating hyperhidrosis (excessive underarm sweating) with botox, irrespective of the premises, the CQC may feel it comes under their remit due to the fact that this is because, the condition of hyperhidrosis is classed as a disorder which must be diagnosed and then it can be treated. It is further defined as such by the NHS. This makes it a ‘regulated activity’ with the Care Quality Commission (CQC) in England (with similar requirements in Wales, Scotland and Northern Ireland).

Regulation of botox is nothing to be scared of and in fact should be encouraged to outlaw these back street/beauty clinics proving non surgical facial aesthetics in an unsafe and unethical manner. Regulation will improve the patients experience and result and allow them to trust credible practitioners.

For more information about botox hertfordshire, please call us on 01438 300111.

Botox® and regulations

Dr Singh who runs his botox clinic in Stevenage, Hertfordshire, in his latest blog shares his thoughts on botox and regulation.

In 2013, the Department of Health predicted that the value of the cosmetic surgery industry in the UK would rise from £2.3bn in 2010 to £3.6bn in 2015. This is certainly something that many dentists are becoming more interested in offering their patients, since they are ideally placed, once appropriately trained, to deliver non-surgical facial aesthetics complementary to dental treatment. With this in mind, dentists need to know from the outset what regulatory framework exists to help keep patients safe.

Overseeing cosmetic care

Currently, there is no regulatory body or any formal process of regulation regarding the administration of non-surgical facial aesthetics. However this will be changing in the not too distant future – more on this later. In the meantime, there are, of course, bodies that regulate dentists (and their requirements will apply to dentists who carry out facial aesthetics).

Initially, the GDC did not see the provision of facial aesthetics services as part of the act of dentistry but this changed several years ago. Now non-surgical aesthetics comes under there remit of dentistry. Therefore, the GDC expects any practitioner to provide the same level of care and competence for this service as they would for dental treatment.

All of the GDC’s Standards need to be applied to the facial aesthetics business, namely:
• Standards for dental professionals
• Principles of patient consent
• Principles of patient confidentiality
• Principles of dental team working
• Principles of complaints handling
• Principles of raising concerns
• Principles of management responsibility
• Principles of ethical advertising.

If you are providing facial aesthetics within your dental practice, then it will come under the Care Quality Commission’s (CQC) remit. If you are providing these services away from your premises, then currently it will not. However, bear in mind that irrespective of your premises, if you are treating hyperhidrosis (excessive underarm sweating), the CQC may feel it comes under their remit. This is because hyperhidrosis is classed as a disorder that must be diagnosed before any treatment can be provided. It is further defined as such by the NHS. This makes it a ‘regulated activity’ within the CQC in England (with similar requirements in Wales, Scotland and Northern Ireland).

Looking to the future, as a result of the PIP implant scandal, Sir Bruce Keogh was asked by the Department of Health to investigate the cosmetic interventions industry. He was asked to look at:
• Standards for cosmetic surgery practice and training
• Fillers as a POM (prescription only medicine)
• Registration
• Accreditation
• Record of consent
• Advertising restrictions
• Professional indemnity cover.

The Keogh report was produced in April 2013 and the Government responded to it in February 2014. Work is underway to create documentation and, where necessary, legislation to implement a number of the key recommendations, which included:
• A register of everyone who performs surgical or non-surgical cosmetic interventions
• Classifying dermal fillers as a prescription only medical device
• Ensuring all practitioners are properly qualified for all the procedures they offer
• All non-surgical procedures must be performed under the responsibility of a clinical professional who has gained the accredited qualification to prescribe, administer and supervise aesthetic procedures
• A ban on special financial offers for surgery
• An advertising code of conduct with mandatory compliance for practitioners
• Compulsory professional indemnity in case things go wrong
• An ombudsman to oversee all private healthcare, including cosmetic procedures, to help those who have been treated poorly.


For more information about botox hertfordshire, please call us on 01438 300111.

Botox® and ethics

Dr Singh who runs his botox clinic in Stevenage, Hertfordshire, in his latest blog shares his thoughts on botox and ethics.

Needs versus wants – Botox® services are elective and therefore no patient ‘needs’ these services. It’s a ‘wants’ driven business. This is advantageous as patients will seek these services, will be more willing to pay for these services and will be more appreciative of the results of these services. However, it can be a double edged sword in that we need to base our treatments and recommendations on sound based evidence, long term studies and whether we can improve upon the patients current situation.

I look like to follow the 4 P’s in terms of providing ethical solutions to my botox patients:

P – Person – are you the right person to see and treat this patient
P – Patient – are you happy to see and treat this patient
P – Product – are you using the right product
P – Place – are you injecting in the right plane

Advertising – Since Botox® is a P.O.M (Prescription Only Medicine) you cannot advertise this to the general public. The word Botox®® cannot appear in any print media, posters, flyers, etc that is exposed to the general public. Regarding websites, at the moment you cannot have the word Botox®® on the homepage of your website and Google will not allow any PPC (Pay Pert Click) campaigns on this medicine.

As a result of the PIP scandal and the subsequent Keogh report, regulatory bodies such as the ASA (Advertising Standards Agency) and GDC are clamping down on a diverts that include any of the following:

– Time-limited deals
– Financial inducements
– Package deals, such as ‘buy one get one free’
– Offering cosmetic procedures as competition prizes


The GDC have certain requirements regarding advertising as can been seen in section 1.3.3.‘You must make sure that any advertising, promotional material or other information that you produce is accurate and not misleading, and complies with the GDC’s guidance on ethical advertising. All information or publicity material regarding dental services should be legal, decent, honest and truthful.’
Managing expectations – Never treat anyone that you cannot improve upon. The botox patient will be mainly concerned with their appearance and it is vital that you can confidently improve upon this. its the old adage of, under promise and over deliver.

Consent – You cannot stop patients from suing you, but you can stop them from suing you successfully. The GDC has 3 parts in their document ‘Principles of Informed Consent’.

– Informed consent – the patient has enough information to make a decision.
– Voluntary decision-making – the patient has made the decision.
– Ability – the patient has the ability to make an informed decision

Photographs – Take before and after photographs of every botox treatment you perform. This is vital to track and show patients the improvements.

Notes – These should be made contemporaneously. To include, but not limited to; details regarding, patients initial concerns, options discussed, patient input, explanation of procedures, what to expect, duration of results, potential complications, after care, post op instructions.


The rewards from aesthetic treatments can be dramatic in terms of improving patients confidence and financially for the practitioner. These can only be achieved if you adhere to medico legal requirements and offer all treatments in a safe and ethical manner.



For more information about botox hertfordshire, please call us on 01438 300111.