Interview with Dr. Bill Blatchford on incorporating Botox® into a dental practice

Bill Blatchford, from Blatchford Solutions, recently interviewed Dr. Warren Roberts on incorporating botulinum toxin (aka Botox^®/Dysport^®) into a dental practice. To listen to a recording of the audio click here, or read the interview below.

Bill: This is Dr. Bill Blatchford and today, I have Dr. Warren Roberts. Warren and his wife, Jan have been clients of ours, clients of Blatchford in the past and we actually were just talking relationship and it's been almost 20 years but in the last 20 years, Warren and Jan who have always emphasized our cosmetics- cosmetic dentistry, facial aesthetics- in their practice, I've actually heard of-- one of heard you referred to as the Botox king. How did you get that name?

Dr. Warren: It was interesting. Jan and I in our clinic are the number one dental provider of neurotoxins in North America and I guess I talk about my dad who is a famous fisherman and a fisherman team captain and he was the sockeye king and so they gave me that nickname as the Botox^® king.

Bill: Alright, so what we're going to do today, and Warren is supposed to get a training program for dentists on this subject, it's Pacific Training Institute for facial aesthetics in Vancouver and you also have a syllabus whole thing for team members and well, we all know training a team to present and be enthusiastic about anything in your offices is really important, without that nothing actually happens but today I'm going to ask Warren some questions about just a little background on what he's; how he markets this, how they present it and we're also going to talk about the economics of introducing Botox, that is neurotoxins and dermal fillers in your practice. I'm also going to be asking some questions about what would be your next step to get involved in Pacific Training Institute for facial aesthetics. So, Warren why don't we start right in, why don't you give me a little thumbnail sketch of how you got interested in neurotoxins and dermal fillers?

Dr. Warren: Well, it came actually from my wife, Dr. Janet Roberts, of course from a woman's point of view, she was wondering why does a woman have to go here for a tooth alignment, here for orthodontics, here for some laser hair removal, another place for Botox, another area for dermal fillers, why couldn't it be done in one office? And so in the turn of 2002 to 2003 in there, her and another orthodontist actually started looking and touring North America to areas that said they did this and of course we found they didn't do it. So what we did is did a new office from scratch with no patients in downtown Vancouver, actually called Harbor Vancouver based on incorporating all these different treatment modalities that treat the head and neck.

Bill: Very good. So a one stop shop?

Dr. Warren: Yes, and you know people, if you actually look at the skill set of dentist it's very easy for them to incorporate it.
Bill: Now, you've lectured all over the country, all over America for the last several years and you're probably turning a lot of people into this but let's talk today about-- most of people listening to this are general dentists, we have a few specialists, but mostly general dentists, existing practices and this would be added to add on their practice, another service they can add. How would you-- what are the things that you suggest in marketing this service?

Dr. Warren: The key thing that I found over 40 years of experience in dentistry is that if you don't train your team, it never gets instituted and accomplished. So the key thing of Pacific Training Institute is that we have a-- while I'm training the hands-on portion of the physicians, nurses and dentists, we have my wife who's training all the team so that would be the hygienists, the front desk, the office managers, reception so you're training the entire team so that when they're you know, in the office, everyone's on the same page so that is the key thing. Then look, we develop, coming from a dental perspective, our physician colleagues really don't take a lot of photography and in dentistry, we tend to take a lot of photography and actually the way you improve clinically and particularly aesthetics is you take some photographs and you look at it and say "Wow, I need to improve on that a bit." So what we started doing is we started doing a series of different angle photographs of the head and neck and we refined it to 29 photographs and this is called the 'Roberts Facial Rejuvenation Photography Series'. In Canada now, there is a platinum standard that has been set by the [00:05:36] in Alberta and basically that is mandatory. So for licensing and for legally in Canada, it's now the standard so if you weren't taking it, you're sort of not quite up to the standard but what happens with that, not only is it a medical legal document, we let the patients look at their own photographs. We don't tell them what we think they should do. And when they look at their own photographs, we print out one of their first photographs of them and they take a yellow marker they mark as many things as they want treated so what happens with that is that you're treating what a patient wants and from a dental perspective, you tend to think that well, their teeth should come first and it could be one wrinkle or one mole and you treat that first then they have the complete smile design done. So basically it's team training and then we have the team take photography and in our office, we bet 100% that it's the patient that does the photography and looks at that: we're doing treatment that area.

Bill: Okay, very good. So that's really how to present it and I like the fact that you still find out what the patient wants, somebody must have taught you that sometime ago. Let's go back a little bit to my original question. If a dentist were to-- do you do any external marketing of this or you're strictly doing it with your patients who are coming into your practice? Now, at this point, you've been doing it long enough that you probably have people coming in asking for this but for general dentists out there that are doing cosmetics and reconstruction and placing implants and have the big recall program, would you be doing any external marketing as well or just the marketing to those stations or are you in the practice?

Dr. Warren: We've found initially we thought we had to go out at the early stages and market and we did a couple ads in papers and really didn't get anything then I was privy to a document from the elegant corporation that they had done for neurotoxins and they found that in physicians' offices- and it's the same in dentists- that two thirds of your clients are already in your practice.

Bill: Okay, very good. So now, you mentioned to me as well the team being involved in this and I know in the sales it's active, I mean many of our clients have multiple hygienists so they're seeing you know, multiple opportunities a day to present this and you've mentioned the importance of having a team and the excited about getting the team trained so they're trying then to start the conversation, take the photograph and get the conversation going.

Dr. Warren: Yes and once they've shared and my team, what we do is we say you know, any person that wants to have Botox is going to look at you as a practitioner, and you as a team member first so all on my team have Botox or some facial rejuvenation and they share that with the patient. It's like for example you walk into a dental office and the receptionist smiles and she needs her orthodontic treatment or she needs veneers. I don't think you're going to be doing orthodontic treatment or you're not going to be doing a lot of veneers.

Bill: That's correct, that's something we've talked for years is dentists and the same need to have the best treatment available in the office themselves in other words to sell it. So okay, so you're saying then that at least two thirds of the patients at this point are already in the office and you're not going to-- you've tried some external marking but it didn't really produce much so you're not recommending that, let's move on and let's talk a little bit. My clients are probably very [00:09:33]. I'm going to ask you some questions. It looks like there's a fairly easy entry level if you and I were to step in implants and what it costed you in implants for example. What would be the investment-- let's say a doctor goes to your training, puts his team through your training, gets the initial supply to get started, what are we looking at?

Dr. Warren: just to have a Botox tray set up-- to set up a system, one Botox tray would cost you $250.

Bill: Alright, so one Botox tray, you're referring then to a tray for today's appointment?

Dr. Warren: Yes. So if say for example you were coming in for Botox treatment, that tray would be out, it would take the photographs and they would go. If it was done in a re-care appointment where the hygienist was doing some work first, she would have her other tray out with her clinical dental tray set up and then right near that, she would have the Botox tray set up so they would just change right over.

Bill: And so then are the doctor would come in with that patient and so typically, I know they're all different and I know that different appointments, you have different number of injections etc, typically what would be the return say in that hygiene visit for that patient? Well, let's break it down. One would be the initial, the initial treatment. What would the typical fee for that be?

Dr. Warren: Typical fee for initial treatment is anywhere between six and nine hundred dollars.

Bill: Okay, and then how often then-- let's say six months later, you have to renew that, a re-call visit?

Dr. Warren: Yeah, most people come in about three and a half months now, used to be three but the neuromodulators we're using now are pushing it to about three and a half to four and that's just cosmetic and then therapeutically for bruxism, clinching, TMD, headache, migraine we tend to be pushing four to six months with the proper dosage.

Bill: Okay. Alright so we're looking at six to nine hundred dollars on initial visit and the fee and recall of $250 do were looking to $350 to $650 of net for the practice on that visit and of course anything we do-- a visit a patient is already on the chair, there's a lot of net in that procedure. So then the fee for the follow-up visit, so they're the same?

Dr. Warren: Yes. What we've found and what we try and teach is this is that if you had to patients and the average re-care patient probably has to be called or there's a correspondence of about three or four telephone conversations and what happens with that, they may re-book or cancel the appointment. We don't find the same thing happens with a neuromodulator or a Botox week so if you're linking them together, you don't get that cancellation because the wrinkles are there.

Bill: The wrinkles will come back and they don't like that so they're going to not cancel. So it's actually got two benefits that you see: number one is your helping with the facial aesthetics and secondly, you're helping their dental health with the recall so they don't miss that recall visit.

Dr. Warren: That's correct.

Bill: Very good. So okay, well this looks real good. I'm asking a little bit now, what about dermal fillers? Are you also doing some of those?
Dr. Warren: Yes we do and we teach dermal fillers and that's sort of the new standard is a different training technique, okay, and a lot of individuals have problems with it. I think the best way to describe it is that if I said to you I'm going to teach you veneers on Friday and I'm going to teach you implants on Saturday, I hope the dentist would run, okay, and the same thing is when we say we're going to teach you Botox on Friday and fillers on Saturday, the same thing. There's different learning curves and the key premise of Pacific Training Institute is patient care and no negative side effects, just good results. So our physician colleagues have between two and nine percent of negative side effects whereas we in the Pacific Training Institute don't even have anywhere near that, it's not even one percent, I mean just--

Bill: Well, I think it's-- and you know, you and I were talking about this earlier, but dentists have a very unique skill set, you're working with your hands all day long, you're very much in tune with aesthetics, you're very much in tune with the head and neck/face and I'm not going to even comparatively vision but we know the dentists have that skill set and the other thing that I think the dentist have, of course, is the people skills that to get the acceptance of the essential work with the patients on this then I think also the people skills that dentists develop are probably part of the reason why we don't have the complaints that physicians have, is that they just don't have-- well, I won't say that again, I'm not comparing the physicians, I'm just saying that dentists have excellent communication skill and we tend to hire auxiliaries also with good people skills and so as you know, a lot of the complaints that come from any business whether it be medicine, dentistry or computer stores or a coffee shop is very often not the quality of the service that they're provided but the communication skills of the providers. So this is very interesting and I've heard you also besides being known as the Botox king, I've you referred to as the John Kois of neurotoxins and dermal fillers and I heard that at AACD last year and I thought that was a very nice compliment everybody to everybody on this call knows and respects John Kois a lot so to put you in that same category is a feather in your cap. So we're saying here that a doctor could add this to practice; it doesn't take any additional marketing expense, we've already got the patients coming in and this is just an adjunct to service that someone can add and the entry cost is fairly slow, the return is quite high.

Dr. Warren: It is you know, the return is really high and you get patient satisfaction whereas you know, when you do some really nice aesthetic work, the patient doesn't always come up and give you a headache, not a headache, a hug, whereas in facial rejuvenation, when you're doing the actual neuromodulators, you basically-- if I open my hands in two weeks, you would actually basically-- they'd come up and give you a hug. One of the key things we developed in our at training institute is that there wasn't software to help us and what's helped us immensely is we've developed a software called Facetec and what happens is that you could go with the click of a button and you basically see all the 29 photographs that you were just taken that day so say for example Bill, you had that come to see us two weeks ago or maybe even 6 months ago and what happens is that you come in and you look at your photographs, you can push on one button and it will go compare and I can compared to 2 weeks ago or 6 months ago and it's so powerful like I mean that photographic series helping the team and I get treatment acceptance but what happened the other day, I had a lady in in January and she was going to get married and she's getting married at 58 years of age for the first time in August. She came in and wanted some work, I said yes so we do it slowly upper face, mid face treatment, lower face treatment, neck, this is with neuromodulators and I came in and she was looking at Facetec and she had the comparer and it looked like her grandmother on the left and her on the right and I said, "It looks really good, doesn't it?" And her mouth was hanging open when I walked in the room, her eyes were bulging out and she basically said-- I said to her, "do you want to continue?" Which means that do you want to do the treatment all over again, that was three and a half months ago, "Yes."

Bill: Well, excellent. This has been just a very enlightening interview, Warren, I really appreciate this. You also mentioned something, probably not interesting to our listeners as could be but you're also- just to give our listeners the scope of what you're doing- your syllabus is now being translated into nine languages so this is having quite a-- you're having quite a reach across the planet out there.

Dr. Warren: Yes, what's interesting is that we always have taken the attitude that our best syllabus is not written yet meaning that if you can show me a better way to do something or we can improve, we're always improving and so the syllabus has reached a level that it's a university-level syllabus. And with it in nine different languages, we see people- physicians, nurses and dentists- coming from all over the world.

Bill: Excellent. Alright, could you give us your contact information for our listeners and clients who want to get a hold of you?

Dr. Warren: Our contact information is 1-855-681-0066. There's one other thing that I should maybe mentioned here is that a lot of times when you go and take a course, there's no real follow-up in the course since 10 years ago, we developed the Botox study club and there's no real other Botox study club in the world so if a practitioner needs assistance with that case, it's not going as well as they want, there's a system whereby they can upload the photographs into the Botox study club and we can help them online. Again, we have webinars just like we're doing now but we have on every muscle of the head and neck and they're about an hour, an hour and a half, in-depth procedures to help a person advance or if there's an area of the face they're injecting and they need more help then they can sit at home and see all these different webinars and they're all recorded.

Bill: Yeah, I just have one more question that might take you just a few minutes to explain but also, when we first started talking about this, you were talking about the therapeutic advantage of this as well. Could you take two or three minutes and just tell us some of the things you're doing there?

Dr. Warren: It's huge. When you mention this topic, I really get excited. Originally, I was taught by a physician and of course, all they really did was cosmetic treatment and mostly on the upper face and if you've read the book called 'The Outliers' it was the ability of say the Beatles, or Bill Gates to see something 10,000 times or to go over 10,000 times and the reason I'm explaining this is that on my way to work every day, I would take the commuter and I would look at the photography series and there was some cases that I would just try to get a cosmetic result and we started playing with concentrations of the neuromodulator and the dosage of the neuromodulator and I was trying to get an aesthetic result and what happened is we discovered that we were starting to get rid headaches and we would start to get rid of migraines and this was before the allergen preamp study on migraines, we had figured it out. So what had happened is that what we were doing was modifying a cosmetic injection template with dosage and concentration and getting a huge therapeutic result but what we got was the synergy and this is the key thing is that they also look better so when a person is down in the dumps whether it's TMD, migraine, headache, anxiety and depression and all of the sudden they look better, that could be 50% of your treatment so this-- it's huge. So for example, one of our presentations that we did at the AACD was on me cosmetic a serious therapeutic usages of Botox and their cosmetic side effects but we went through all the specialties of dentistry and showed you how it's applicable. The biggest one that is amazing is implants, okay, and how implants and you look and you have failures in implants, a lot of it is muscle related. Now in 40 years of dentistry if you had tooth, muscle, joint, teeth and bone and soft tissue, you know muscle always wins so prior to implant therapy, relaxing muscles to get a better integration but also to go one step further to keep the aesthetic look, really nice. It's basically keeping the muscles under control and so are one of our biggest courses is actually on that and people just you know, are amazed that no one else is talking about it.

Bill: Well, in some states, there are some states in the United States that are going into therapeutic use of neuro-- now I say neurotoxins, you say neuromodulators, are we talking the same thing?

Dr. Warren: Same thing, same thing.

Bill: Okay, very good. Well, Warren, thank you so much. This has been a wonderful interview. You've covered a lot of material with it and I hope it generates some interest for some of our clients and I would hope that some of them will join you in your institute and add this to the practice. Thank you very much.

Dr. Warren: Okay, thank you.