Expert Interview: Botox

This week’s Expert Interview focuses on the elements around the smile, such as the skin and the lips. DentalFind sat down with leading Chicago-based dentist Ramy Bahu, D.D.S., a general dentist who offers an expanded array of cosmetic procedures.

Not many people associate Botox with dentistry. Can you talk about its use in the creation of an attractive smile?

It presents an overall attractive “headshot,” if you will. Botox works best around the eyes and on the forehead. The framing of a smile doesn’t really end at the teeth. What people notice is not only the teeth. A dentist might notice the teeth, but the center point of what most people notice is the eyes and smile. Being able to place Botox to smooth out the wrinkles around the eyes and on the forehead makes a lot of people have a younger look and in turn gives them more confidence. It is truly a pleasure to improve a patient’s appearance and confidence with Botox.

Getting more to your question “why is it good for dentists to do this?” No one gives more injections into the head or neck than a dentist. We give hundreds of injections inside the mouth in a week. Since a dentist is almost always injecting dental patients while they are not sedated—there is no transition for us to go through for Botox injections. The injections for Botox are given by a small needle and most of the time it’s without any anesthetic whatsoever, not even topical anesthetic. Dentists are used to treating patients this way and can make the procedure very comfortable and painless. Once you understand what the actual mechanics are of the treatment and what’s involved in getting the injections it’s actually perfect for dentists!

"It presents an overall attractive “headshot,” if you will."

Are there certain types of wrinkles, or skin types, that are most amenable to Botox?

There are people that are better candidates for Botox. Botox does not fix sagging skin--it cannot take the place of a “facelift” procedure. It’s more for those people who have some folds or lines around the eyes usually between 25-65 years old. The crows feet lines, the area above the forehead when you raise your eyebrows, which give you lines across your forehead, and the frowning or “angry” lines that appear between your eyes when you are upset or concentrating. It’s great for smoothing out those wrinkles. The people it really works best on are the fairer skinned and relatively thin people. Heavier people don’t have as many wrinkles because the fat has flattened them out. Darker skinned individuals also doesn’t show wrinkles as much.  

Botox is famous for its cosmetic use in the skin, but there is also a use in teeth grinding? Is that right?

Yes there is. I have actually treated my wife for that. The area of the face where the muscles are when you clench is called the masseter muscle. That muscle is the one that people flex when they are just clenching and/or grinding their teeth. You can reduce the tension that is there with Botox. Botox inhibits the muscle from contracting, from flexing – not completely but it makes it weaker. Reducing the force that the muscle can produce helps decrease the soreness of those muscles and the damage it does to the teeth. This decrease in muscle movement is how the wrinkles around the eyes and on the forehead disappear.

Are there dental procedures that are most commonly done alongside Botox treatment?

Dermal fillers can also be used in the head and neck, it can be in other areas of the face but the combination with dermal fillers is what a lot of people end up doing. They’ll work on the upper face with Botox and they’ll work on the lower face with the dermal fillers. A lot of people want to get their lips enhanced, or remove the smile lines as we call them. Those are the areas that people tend to want to work on as well as bags underneath the eyes. Dermal fillers are commonly used on these areas.

Can you paint a picture of what coming into your office for Botox treatment looks like? Roughly how much will I pay, how long will the procedure take, and is there discomfort?

It’s a lot more affordable than people think. You come in, fill out the necessary paperwork, we assess the problems, take photos, have you raise your eyebrows, try and bring up an angry face, which is difficult when people aren’t really angry, and then have patients smile to check for crows feet wrinkles. We’ll take pictures of where the creases are; you can look in a mirror yourself and do it again. We can show you what areas we can treat. Botox is delivered in units and it’s charged at $15 a unit. Typically people will treat the three areas that I mentioned, the crows feet, between the eyes, and also the forehead. Most patients will use 30-50 units in treating all three of those areas. There is usually no, or very little discomfort, during the injections.

We then have the patients return in two weeks so that we can take photos again and perform enhancements, if necessary. It takes about 10 to 14 days for the Botox to get to its full effect. Then, we’ll set up their next visit which is usually 3 to 6 months later when the material starts to wear off and the patients start to notice the wrinkles again.
Patients are very good about policing themselves. A lot of them will come in on the early side to keep from getting the wrinkles again. They’ll return every 3 months but then they’ll need less material at each visit. Many patients are happiest when they can stay ahead of the wrinkles reappearing!

You will soon be offering dermal fillers. What are the main conditions you foresee treating with these, and how do they differ from Botox treatments? 

Dermal fillers work differently; they fill space. So you’re removing a line by filling space rather than weakening a muscle (like Botox). Dermal Fillers work by plumping out the wrinkled tissue. The areas that it works really well on are those lines that come down from the nose across to the corners of the mouth and underneath the eyes as well.



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