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BALTIMORE —
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, Md., 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.
When Barkeshli
found out Botox was an option at Gol’s office, she said she
was glad to receive the treatments from a doctor she already
trusted. She, too, was a dental patient first.
“The person
who does it does matter, and I think it’s more experience
than anything else,” she said. “He’s super easy on my
teeth, so I like that, and then the same with the fillers.”
The results
keep patients coming back, Gol 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.”
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