The Millionaire Dentist Podcast

Episode 27: The Growing Practice Revenue Series Part 1: Botox with Dr. Amy Marckese

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On today’s episode of The Millionaire Dentist podcast - are facial esthetics a possible revenue stream for your practice? Listen to Dr. Amy Marckese, practice owner of DentalSpa Indianapolis, share how she sets herself apart by offering the application of both Botox and dermal fillers for a variety of cosmetic concerns.

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Podcast Transcription:

Speaker 1:

Hello everyone. Welcome to the Millionaire Dentist podcast, brought to you by Four Quadrants Advisory. On this podcast, we break down the world of dentistry, finances, and business practices to help you become the millionaire dentist you deserve to be. Please be advised we do speak with an honest tongue and may not be safe for work.

Casey Hiers:

Hello and welcome. This is Casey Hiers and I'm thrilled to have our guests, Dr. Amy Marckese with us in studio today. Dr. Marckese is a skilled dentist who owns a dental spa in Indianapolis that provides a unique dental experience for every patient. She's the perfect guest for our topic today, which is titled, Growing Revenue Streams in Your Practice. If there was ever a time for this topic, it is now. Dr. Amy Marckese, welcome and how are you today?

Amy Marckese:

I'm awesome, Casey, thanks for asking and please call me Amy.

Casey Hiers:

Thank you. Well, let's jump into it. I like to start with dentists by asking, why did you want to be a dentist? Why did you get into dentistry? Give us a brief little summary of that.

Amy Marckese:

I was always interested in science, biology. I knew I wanted to do something in the medical profession. And I remember in high school shadowing a couple different of my friends' parents, I don't have any dentists or doctors in my family. And I kind of quickly figured out that dentistry was an awesome profession for women in particular who weren't attached to a pager, could have, I still wanted to raise a family and so forth. That's really, it was that or an orthopedic surgeon. I realized those have really not a whole lot in common, but that's really how it started.

Amy Marckese:

And I grew up in a family where my mom was a secretary for the Detective Bureau my whole life. My dad is a retired construction worker and I knew what it was like to pinch pennies, I'm sorry, and not have the designer jeans or not have this or that. Not go on vacations. Vacations for me growing up was a night at the Holiday Inn and I wanted to be able to do some of those more fun things and I didn't want to have to rely on finding somebody to do that for me and provide for myself so to speak.

Casey Hiers:

Looking back, did you make the right decision?

Amy Marckese:

I think I did all right.

Casey Hiers:

Good. That's good. Tell me a little bit about your practice. What would you say your recipe is for delivering a spa like experience to your patients?

Amy Marckese:

Sure. First of all, we just celebrated our 15 year anniversary. Yay!

Casey Hiers:

Congratulations.

Amy Marckese:

Thanks. Yay us.

Casey Hiers:

Did you do anything fun to celebrate that?

Amy Marckese:

We all went to, I took my entire staff, including some girls who have moved away, who helped me get to 15 years, to Turks and Caicos.

Casey Hiers:

Wow. That's what I call a perk.

Amy Marckese:

Yeah, it was awesome. Anyway, I graduated in 2000, so hard to believe going on 20 years of practicing dentistry. The practice is, as I just said, was 15 years old last year, I was an associate for two years before building Dental Spa. And I knew then, I wanted to do something different. I realized quickly kind of the ho hum of people coming in and saying, I'm a genuinely happy and fun person and so going in and hearing, "Oh, hey Casey, how are you today?" "Oh, how do you think I am? I'm at the dentist." I didn't want to do that. I wanted to do all I could to make it a positive experience. And I pretty much went through and tried to negate the worst thing you think of, of all five senses when it came to the dentist, taste, smell, sound, feel, and what could I do to make something better with our five senses? And that's how I came to, how I did Dental Spa, from massages, to smoothies, to headphones, to TVs on the ceiling, which nobody did 15 years ago. And quite frankly, everybody told me it wouldn't work.

Casey Hiers:

Joke's on them.

Amy Marckese:

Joke's on them.

Casey Hiers:

That's right. That's right. Growing revenue streams in your practice, you've been an owner for 15 years, so you've experienced ups and downs. The market in 08. 09, there was different challenges and so you've been an owner for a while, you've seen a lot. From growing revenue streams in your practice, which is the title of today, talk about that a little bit as you decided, maybe you wanted to add some things to your practice to grow revenue streams, what those were. And then we'll talk about our topic today, which is Botox. I've got some questions around that, but I just wanted to kind of get a before and after of how this has evolved, the offerings you've given to your patients. Did you start Botox the day Botox came out? Or was that an evolution?

Amy Marckese:

That was an evolution. It's funny you mentioned 08, 09. We've kind of had that talk with, I've had that talk obviously with a bunch of dentists. We opened in November of 2004 so ironically right when 08, 09 hit, I opened literally from the ground up, not one patient. I didn't buy a practice. It took that long really where I was finally starting to breathe and so forth. And then the shit hit the ceiling. I remember that day, those days vividly. Anyway, I at one point started doing implants. That was one thing that I really enjoyed, a class I took. I don't do them as much anymore because I didn't enjoy doing sinus lifts, et cetera. It kind of came out to, it just, I felt like it was better, not because anything happened or so forth, but it was easier to refer them out.

Amy Marckese:

But I learned a ton. I don't regret taking that class. I learned a ton. I can talk so freely with patients about it. And the Botox thing happened quite honestly. Almost by mistake. I had a fair amount of patients ask me if I did Botox and I was like, no. And then I looked into a class put on by the American Academy of Facial Aesthetics or the AAFE and it is taught primarily to dentists for dentists. I went to a two day class with a friend and colleague of mine. And quite honestly part of it was like, okay, if we just go and learn this, we get, first of all a girl's trip away to Chicago for the weekend. And second of all, hey, we'll shoot our friends and our staff. And it wasn't even really about making money. It was about kind of going to see it.

Amy Marckese:

And then about, and I loved it. I absolutely loved it. And just to be clear, I do Botox and filler. And so I learned, when I say the basics, it was very basic. And then I was at a women in dental health meeting and I happened to be sitting next to a girl whose uncle is a big wig with Allergan. He's the number 15 producing doctor in the world of Allergan and Botox. And she said, "My uncle does this, you should fly out to Denver and learn from him." And I was like, "Call him right now. I'm getting on a plane and going out there." And I spent three days with him. He sees 50 patients a day and go, go, go. And I learned more from him. He's, I call him Yoda. I've been out there three times since and that's how it happened. I don't know how much more you want me to get into it.

Casey Hiers:

You really didn't have any hesitation. You took the girls trip, did the class and then from there, once you were in Denver, you were all in after those days.

Amy Marckese:

I was all in immediately. And I hit, my confidence was through the roof. I think all of us has dentists know, you're confident. You can't go to a class, rather it's on practice management or a skill that you're learning and not go back and do it. Because if you don't go back and do it right away, you're not going to do it. You're not going to do it next month. You've got to go do it right away. Well I can assure you that no staff out there isn't eager for you to, do me, do me, pick me, pick me.

Amy Marckese:

And so anyway, learned it. And then as we just started talking about it amongst patients, it just took off. I cannot explain the number of patients who are like, "Well, if I'm going to be here anyway, can I just do it during my cleaning appointment?" Sure. And then it turned in to, I think a lot of people don't realize when you go to some of the bigger name cosmetic surgeons around here, they're not doing your Botox or filler, a nurse practitioner is. And you might not see the same one every time. It was the word just grew very quickly. And then what happened was, Susie comes in for a cleaning appointment, she decides she's going to try Botox either for the first time or say, "Hey, I've been getting it, but if I'm here, wonderful." Then she tells her friends and then she says, "Well, do you have to be a patient to do it?" No, of course not. Love it. Just come in.

Amy Marckese:

Well then those patients come in and then they realize that, oh, this is pretty nice. This is nicer than my dental office. These people here are pretty cool and now suddenly I have a new dental patient and then that new dental patient's husband comes in and kids come in. It goes way beyond what you're making off the Botox and filler. It's just one more way to get people in your door.

Casey Hiers:

That's great for our listeners. I didn't even necessarily connect those dots that specialists need a referral network to be busy. As a general dentist, this was your referral base and it really boosted patients. Now give me an idea how many patients percentage do Botox?

Amy Marckese:

Oh gosh. I would say at least 25%.

Casey Hiers:

That's a big number.

Amy Marckese:

It's a big number and I don't know what you know about Botox, Casey, and I wouldn't out you here or anything, but first of all, just so you know, yes, men do Botox. It's all about how you quote unquote sell it. We don't have Botox for men at our office, we have Brotox.

Casey Hiers:

Brotox.

Amy Marckese:

Brotox. Yes. I just lost my total chain.

Casey Hiers:

That's good.

Amy Marckese:

I lost my train of thought with it.

Casey Hiers:

Well, in terms of how many patients, a huge number of patients.

Amy Marckese:

Oh, Oh, I know what I was going to say. Botox lasts from three to four months. It wears off. The good news and the bad news is it wears off. If you love it, the bad news is it wears off. If you hate it and nobody hates it, it wears off. Being that we see patients every six months, it works perfect. If everybody gets Botox at their cleaning, they're only coming in one, two extra times a year for their Botox instead of having to go to their cosmetic place four times a year there. They're already there.

Casey Hiers:

Yeah, no, that makes total sense. When did Botox get hot in dentistry?

Amy Marckese:

I knew one or two other dentists, girlfriends from my class who were doing it. They were more on the West Coast. There wasn't a ton doing it around here even three years ago when I started. But I think it's getting hotter. Like I said, this AAFE who I did it through, it's geared all towards dentists, so it's hot enough that there.

Casey Hiers:

Well, that leads me to my next question because, so I lived out in Southern California for a time. Botox, any enhancements or any cosmetic improvements that people would get out there, they celebrated it. You know how in Indiana and the Midwest you can have late adopters to things. And so I guess my question in Indiana, were you worried that it was going to maybe not take off or be viewed in a negative light in some regard?

Amy Marckese:

No, the biggest obstacle I was, was really, you're a dentist, you do Botox? That's the only thing I was ever worried about. Look, I know enough to know all my friends get Botox. You guys out there who think your wife doesn't get Botox, they probably do get Botox. And so that same, the other big thing is I do a lot of filler. I do cheeks and cheeks can kind of lead into under eyes. I do a ton of lip filler and I think the big thing with lip filler is it's a great enhancement to any cosmetic stuff we do, but it takes trust. People are mortified that they are going to look like whatever freak you want to see on, we all have seen that lady and so what you have to have when you're doing Botox and filler with somebody is trust.

Amy Marckese:

You have to have established trust. You have to say, "I'm not going to make you look like that. The only person who wants you to look amazing besides you is me because you're my walking advertisement. If I make you look like a freak and you go out and people ask you who did that? Nobody's going to come to me." One thing we have as dentists is we already have established trust because if you let me do dentistry on you, then everything else from there, that's more invasive than anything.

Casey Hiers:

No, that in reality it makes more sense that a dentist do Botox.

Amy Marckese:

Right, of course.

Casey Hiers:

Then what you were saying, the nurse practitioner, it's a different one every time. That makes a lot of sense.

Amy Marckese:

By the way, there's like OB/GYNs out there doing it.

Casey Hiers:

That are hopping on board now. Yeah. Let's give our listener an idea of the impact on revenue. We want to stay away from hard numbers, but percentage wise, if you had to ballpark it for somebody who is listening to this saying, "Yeah, I'd like to grow some revenue streams." To your practice, what percentage of monthly production would you say Botox is? If you had to ballpark it.

Amy Marckese:

You know what? I would say 15% is Botox and filler. Now to be clear, a bottle of Botox, which is a 100 units, costs about $600 so my cost not including syringes is $6 a unit. I do $10 a unit to be quite honest because it's really easy math. You need 20 units, you need 42 units. I can multiply by 10 really easy. Most cosmetic surgeons or medical spas, et cetera around here do $12 a unit. People on the average, women on the average are $40 a unit. I'm sorry, are 40 units total. That $2 a unit difference is 80 bucks every three to four months.

Amy Marckese:

And the thing is, again, at the end of the day it's not my bread and butter. I love doing it. I don't know about you guys, but nobody runs into my chair and is like, "Yes I'm getting fillings done today." But they will this, this whole pandemic, I can't tell you I could be doing underground Botox like crazy right now because that's what everybody's worried about. As much as people, you guys want to get your haircut, women want their Botox. Again, it's not just the dollars made off of the Botox. Filler you get a little more revenue off of, to be quite honest, it's the number of new patients I've gotten from it.

Casey Hiers:

Well we found that dentists like to help people, that there is that innate quality and so this takes it to the next level and it's something more positive as you alluded to instead of a cavity or something that brings them down, you're actually bringing them up. They're more excited.

Amy Marckese:

Yeah, and it breaks up your day.

Casey Hiers:

And that culture in your office I think probably helps a lot as well. Let's talk about negative feedback or unintended consequences. You've been doing this Botox for a while and filler. Has there been any negative feedback, unintended consequences of any concern or that bother you? Is it really just been some static?

Amy Marckese:

Zero.

Casey Hiers:

Okay, zero. For a practice owner out there, what's the first step that they need to do to potentially offer this? If you were to say, "This will potentially help grow your revenue 15%, it's going to help bring on new patients. There's a positive vibe and culture to it. You're helping people. It's been so positive for me." What would somebody need to do to start this?

Amy Marckese:

You have to get trained. That I would highly recommend, excuse me, that AAFE. Again, it's the American Academy of Facial Aesthetics. I would highly recommend doing it through them. I can't remember the cost off the top of my head. I want to say 1,500 to $2,000 for a weekend.

Casey Hiers:

You can't remember, that tells me it wasn't that significant.

Amy Marckese:

Yeah, it wasn't that significant. I would recommend that. And again, to be crystal clear, that was my basis. That's where I learned the basics and I mean even from mixing Botox and so forth, and I did take, side note, I took two assistants with me because you have to have your office excited. That's the other thing. Your biggest expense is shooting all your girls in your office because the first thing the patients ask is, "Well do you have it? Where do you have it? Who else has their lips done? Oh, her lips look good. You're right. It looks very natural. I would have never guessed she had her lips done."

Amy Marckese:

I took staff with me. I can't remember what I paid for them. But then learning and getting in with your Allergan rep or your Galderma rep. Botox's evil twin, so to speak, is Dysport. Nothing against Dysport but those are the competitors. And so you have to get in with one of those two reps to help you. My rep gave me 10 sample bottles. That's a 1,000 units of Botox. I did a a drawing, so to speak, where you put your name on it, your name, your phone number, and then you answered if you've ever had Botoxer before and everybody who had answered no to that, won 20 free units of Botox.

Casey Hiers:

Nice.

Amy Marckese:

They thought they won the jackpot. But I worked that gig with my rep. All those people who got, listen, once people, one of the main questions somebody who's never gotten Botox asks is, once you get Botox, do you always have to have Botox? And the answer to that is of course not it. Once it wears off, you're right back to where you were. But once you get Botox, you always want Botox.

Casey Hiers:

Okay, once you get it, once you get a taste.

Amy Marckese:

I won't tell you what I tell patients, I compare it to sometimes. We'll leave that.

Casey Hiers:

We'll leave that up to the imagination of our listeners. In terms of male versus female, what would you say the ratio is of folks who get Botox in your practice?

Amy Marckese:

I'd say maybe only 10% is guys. And if I really, I am to the point now, I don't know if you've noticed this, but I'm not really shy, but I've to the point now where I don't have a problem saying, and it wasn't that way for the first year or two. I'm not joking around, but have you ever thought about Botox? I think it would look really good. I won't do too much. I won't tell anybody. It'll be our little secret and all you have to do is get them to do it once. Listen, It's like being a fricking drug lord, okay?

Casey Hiers:

It's that case acceptance.

Amy Marckese:

Want some candy, little boy?

Casey Hiers:

Once you can get them to accept Botox, you know you're going to have them.

Amy Marckese:

Yeah, and I tell them, "Welcome to the dark side, baby." I should play some tunes. But and there's different levels. You don't have to freeze somebody's face. You can just soften it up so that their lines aren't getting worse. It's also a younger crowd. I'm telling you that there are people who will come in, we have signs and posters up about Botox and filler and I can have a new emergency patient with a broken tooth and tell them they need a build up and crown and give them the treatment plan and them say, "I can't afford my $6 copay today." And then I'm like, "Okay, we'll get you back." And then I go to take two steps out. "Hey, I noticed you do Botox and filler." "Yeah." "How much? What do you think it would cost for me to do Botox?" And I'll give them. I'm like, "Oh, you'd probably be around 400, 500 bucks." "Well, can I do that today?" This happens all the time. All the time.

Casey Hiers:

There's probably a lesson in the human psyche around this.

Amy Marckese:

Absolutely.

Casey Hiers:

You've seen some amazing things with people's reaction to Botox. Overall you probably couldn't imagine not offering it. What is, we'll wrap up with this on this topic of Botox. What would you tell a practice owner who doesn't offer Botox and is mildly interested in it? Is there anything you would tell them?

Amy Marckese:

First of all, I am more than happy to talk to anybody about this. I love talking to them about it. And look into that AAFE course. It does. We've spent more on less. It's worth going and take a couple of your staff members. And you guys out there, you're kidding yourself if you don't, you don't realize how many women do it and I can't tell you how many women come in and, I don't want my husband to know or they want to pay in cash so it doesn't show up on their credit card.

Casey Hiers:

Well I do not have a strong opinion for or against Botox. But what you've told me today and the growth of patients is an indirect benefit that I think is probably one of the most valuable things. Sure, 15% revenue growth in a practice is strong, but getting more patients almost organically.

Amy Marckese:

It's huge.

Casey Hiers:

Is worth its weight in gold. This has been great information, Amy. I appreciate you joining us today and talking about just one revenue stream that has helped your practice and I can hear it in your voice. You enjoy it, you like it.

Amy Marckese:

I love it.

Casey Hiers:

You're enjoying that more than just doing a cavity, just drilling. And so there is a lot of benefit. And for you to offer to talk to somebody out there who may have some questions is incredibly generous. I appreciate you coming on. Thank you.

Amy Marckese:

Can I say one more really quick thing? I would say the one thing I would liken it to is we all know what it feels like to deliver a veneer case or do some anterior bonding on somebody and that change in their persona when they feel confident about their smile. It's the same thing. It's that mom who comes in beat down and exhausted and I say, "These are before and after pictures." They should be called tired and rested. And when I get a text message, 10 days later that says, "Oh my gosh, I'm so glad I did that. I should have done it sooner. I love the way it looks, thank you so much. I feel like myself again." It's, that's what most of us dentists did this for. We want people to feel better about themselves.

Casey Hiers:

Nice.

Amy Marckese:

That's it, sorry.

Casey Hiers:

Well I'm going to look into Brotox. I've got a 10 year old wrinkle I just don't like.

Amy Marckese:

I see it. I see it.

Casey Hiers:

Oh thank you. Thank you. It's taken me a while, but you have made me comfortable with this topic just talking about it. I hope our listeners got something out of it and heard the value of what an adding procedures can be. We advise our clients to add one procedure a year and the results are absolutely stellar. Amy, thank you again for joining us today.

Amy Marckese:

My pleasure.

Speaker 1:

That's all the time we have today. Thank you to our guest for their insight and for sharing some really great information. And thank you to you, the listener for tuning in. The Millionaire Dentist podcast is brought to you by Four Quadrants Advisory. To see if they might be a good fit for you and your practice, go on over to fourquadrantsadvisory.com and see why year after year, they retain over 95% of their clients. Thank you again for joining us and we'll see you next time.