EXTRA FILLINGS

As cosmetic surgery becomes less of a taboo, some Tasmanian dentists are now offering Botox, dermal fillers and other treatments to enhance your smile. But the practice has polarised the profession

Entrepreneurial dentists diversify into offering Botox and dermal fillers

It was not former senator Jacqui Lambie’s televised Botox session that drove home for me how mainstream cosmetic injectables have become in Australian society. It was the poster at my kids’ suburban dentist spruiking anti-wrinkle treatment and dermal fillers. “There’s more to your smile than teeth. Complete your smile makeover today!” the poster exclaimed.

Since 2014 the number of Australian dentists offering Botox and wrinkle filler injections has been growing “exponentially”, according to the Australasian Academy of Dento-Facial Aesthetics (AADFA), which is a training provider established in 2009.

“Australian dentistry is still very much in its infancy in terms of the numbers who are offering these services, but that is changing at an exponential rate,” says Myles Holt, a dentistturned-entrepreneur who is AADFA’s managing director. However, he says Australia has been quite late to the party compared with other countries.

“It’s now at a level in the UK where dentists are accepted as the “go-to” people for facial Botox, skin rejuvenation and dermal fillers, especially for lip enhancements,” he says. “It won’t be long before Australia follows suit.”

In Deloraine in Tasmania’s central north, UK-born dentist Stephen Mace offers anti-wrinkle and filler injections. While such cosmetic procedures only account for about 5 per cent of business at his Fresh Start clinic, Mace says demand is growing.

“It’s incredibly popular,” he says. “Around the time we opened the clinic in 2014 the Australian Dental Association changed its policy slightly in relation to Botox. It had always been a bit of a grey area about whether we were allowed to use Botox for a non-therapeutic use. We had always used it for jaw problems, but the more cosmetic side was a bit dubious a first.”

Previously the Dental Board of Australia only permitted the use of botulinum toxin (Botox) by dentists specifically for the treatment of temporomandibular joint (TMJ) disorders such as jaw clenching and teeth grinding. However, the board’s position was relaxed in October 2014, allowing cosmetic use of Botox and fillers, as long as dentists have appropriate training.

Mace argues it makes sense for dentists to be offering such services, which, he adds, do as much to improve self-esteem as fixing a cracked tooth.

“Dentists, much more than general medical practitioners, spend a lot of time on facial anatomy and we concentrate a lot on the nerves and muscles of the face,” Mace says. “But it’s a matter of building it into your dental appointment. We would never inject crows feet or forehead without looking in the mouth to make sure your mouth is healthy.” There are of course risks, Mace says, particularly with filler procedures, which

involve injecting hyaluronic acid gel under the skin to plump lips and other areas such as the nasolabial lines that run from nose to mouth.

“Filler can be lumpy if you’re not careful and is a slightly more dangerous substance than Botox if not administered carefully,” Mace says. “And, with Botox, if the incorrect muscles are neutralised it can cause asymmetry. The most upsetting adverse affect, which can rarely occur, is a droopy eyelid if injecting near the eyes.”

However, he says the safety concerns are minimal. “It’s so much safer injecting Botox than a little bit of anaesthetic in the mouth, which we do all day every day,” Mace says.

Westbury-based hospitality worker Tiana Kirkhope, 36, happily pokes fun at her own and society’s obsession with appearances. Her self-deprecating candour seems to come with the territory. It is hard to be precious when you are the mum of three outspoken boys aged 10 to 18 and the daughter of a couple of hippies. However, when her sons started nicknaming her frown lines between her eyebrows her “growl brow” she decided to try Botox while at the dentist, much to the horror of her husband and parents.

“I was dubious at first but I thought I was starting to look grouchy and I’m not a grouchy person at all,” Kirkhope says. “My husband was totally against it and didn’t want me to do it, but I did it anyway. I had started going to Fresh Start because they were new and didn’t have a waiting list and then I think I saw the posters [for Botox] and, as you know, Botox is everywhere in the media and shoved in us women’s faces.

“It was fairly painless and the results were good and I no longer had a growl brow.”

However, she admits it can become a little addictive. “It’s a bit of a slippery slope and you start to think, ‘What else can I do?’,” Kirkhope says. “Now I get a little bit in my forehead occasionally. But I’m all for keeping it subtle. I want to be able to move my face.

“My husband still thinks it’s a bit unnecessary, but he’s a man so he can get away with having age lines. For men it’s just seen as masculinity.”

According to another dentist in northern Tasmania, who does not want to be named, a great divide is emerging among Australian dentists who perform cosmetic facial procedures and those sticking to traditional dentistry.

“It is quite polarising,” the industry veteran tells TasWeekend. “There is a difference of opinion between more traditional dentists and those who are more entrepreneurial. I don’t do it personally. I’m naturally a fairly risk-averse, conservative practitioner. I’m more of a traditionalist, if that’s the right term.”

He said an oversupply of dentists in Australia’s major cities was putting pressure on clinics to find new ways of making money. “There is fierce competition between practices due to the general oversupply of dentists in Australia because of the increase in dental schools and overseas-trained dentists wanting to emigrate to Australia,” he says. “That puts additional pressures on the practices to be viable.”

Deputy chief executive of the Australian Dental Association (ADA) Eithne Irving tells TasWeekend there are 17,000 dentists in Australia. “Coupled with this is the introduction and growth of allied dental practitioners, which contributes to the total number of dental practitioners now in the order of 22,000,” Irving says.

The ADA is urging the Federal Government to limit the number of university placements for students studying dentistry because of what it calls “an increasing oversupply” resulting in “escalating underemployment and unemployment rates of all dental practitioner categories”.

However, according to the ADA, there remains a shortage of dentists in regional areas including Tasmania, which has no dentistry training institution. There are 254 dentists working in Tasmania. Hobart and Launceston are therefore yet to experience the “dentist glut” affecting Sydney and Melbourne, which is reportedly fuelling the rapid rise of clinics diversifying into Botox and other cosmetic procedures.

However, a Google search shows there are clinics in Moonah, Blackmans Bay, Margate, Launceston and Deloraine offering services from Botox to so-called “instant facelifts”. Tasmania’s Young Australian of the Year for 2018 Jessica Manuela is the principal dentist at Dental South in Blackmans Bay and Margate where she offers the full gamut of cosmetic services including something called a thread lift, which involves lifting sagging skin with resorbable surgical thread.

The ADA’s Tasmanian president Angie Nilsson says: “I’m not sure how many dentists are offering it [cosmetic facial procedures] in Tasmania, but it is growing.” Nilsson, a dentist with the state-funded public oral health service in Hobart, says: “For me it’s not something I want to do, that’s not why I did dentistry. But I can see why dentists want to do it. It makes sense because they’re trained in facial anatomy. If someone goes to a dentist to improve the cosmetics of their teeth and they have an asymmetrical lip line and want a bit of filler put in their lip, it makes sense for the dentist to do the whole package.”

Sandy Bay dentist Gordon Henry has similar views, saying he does not personally give cosmetic injections to patients, but is not judging his colleagues who do. “I’ve done a course on Botox but I haven’t actually done it on any patients,” Henry says. “I definitely wouldn’t put any filler in a patient, but I know of cosmetic dentists who do. It’s purely a personal choice and I wouldn’t deride any dentist who uses it. Because we give needles all the time we’re quite proficient and we are good at dealing with people who have a phobia of needles, so we’re probably the right people to do it.”

According to Myles Holt at the Dento-Facial Aesthetics Academy, demand for Botox and filler injections as an add-on to dental appointments is growing daily. “Our office receives dozens of calls a day from patients seeking a dentist in their area,” he says. “While dentists are not stopping being dentists, these are two new services being offered in Australian dental practices that are seeing considerable growth.”

Former Tasmanian senator Jacqui Lambie has always been candid about her love of Botox [and recently appeared on commercial TV receiving lip filler in readiness for a date]. However, dentists say it has only recently stopped being taboo within the wider community. “People used to go to hidden clinics, but it’s more acceptable now and people are happy talking about it,” says the ADA’s Angie Nilsson.

In Deloraine, Stephen Mace says typically it is women aged 30 to 70 who are after Botox, while women as young as 20 are keen for lip filler. “It is predominantly women and they often come in for the first time ahead of a 40th or 50th birthday,” Mace says. “We only have five to 10 male patients, but I think that will change over time as people become more aware of it.

“It seems to be becoming more acceptable. People will speak quite openly about it now and not be embarrassed.”