IS FACIAL AESTHETICS REALLY FOR US, DENTAL PRACTITIONERS?
As many patients visit their dentist regularly to improve the appearance of their teeth, many are also becoming aware about the whole cosmetic picture.
What do I mean by that? Patients are starting to notice not only the teeth but also its surrounding external tissues. This involves aspects of the lips, cheeks, chin structure, jaw position and the overall appearance and quality of the skin.
In today’s practices, this is the tipping point where many dental clinics may lose their patients to other practices who can deal with these issues if they are not offering facial aesthetic services themselves. We, as dentists, should not be the last to offer such treatments. It’s a natural progression for dentists to offer facial aesthetic treatments due to the increase demand from patients in conjunction with the anatomical knowledge of the face and injection skills in this area. However while some clinics are eager to keep their patients and introduce facial non-surgical aesthetic treatments, many find it hard to delve into this new market and struggle to go about doing so successfully.
On this post, kindly allow DMD cEnter to discuss the introduction on how dental clinics can successfully fit facial aesthetic procedures alongside others into their treatment portfolio. And, if you want to learn more about it from an expert of this field and has been practicing this for more than 20 years, then, check out the live lecture we did with Dr. Ivona Igerc of AFD, London, UK here: EXTENDING DENTAL PRACTICE TO FACIAL AESTHETICS
DERMA FILLERS
What are Dermal Fillers?
Dermal fillers are smooth injectable gels made from naturally occurring hyaluronic acid. Dermal fillers add volume to weakened facial features and can stimulate collagen growth. Each dermal filler is unique on its own way but similar in two. First, they plump skin and gently lift it to restore collagen loss due to the normal aging process. Secondly, dermal fillers motivate the body to create its own natural collagen and restore your face to a more natural, youthful appearance.
Dermal fillers approved by the FDA are minimally invasive and very safe. As with any procedure, there are possible risks, the most common being post-procedure bruising and swelling which are usually very minimal and resolve quickly.
Dermal filler treatments typically take 20-40 minutes and the amount of dermal filler needed will depend on volume loss and the areas you would like to restore to its natural beauty. You will see results immediately after treatment.
In Aesthetic dentistry, it shouldn't begin and end inside the lips only. Teeth need to relate into the entire framework of the face. This is especially true on the immediate areas which surrounds and outline the mouth. While expectations include a perfect midline, golden proportions, white teeth, and exquisite occlusion on your completed aesthetic makeover case; if there exists unsightly nasolabial folds, marionette lines, and downward facing oral commissures frame your patient’s nice white teeth, then, there is still something missing from the overall aesthetic result that you are trying to create.
Dentistry and dermal fillers can work hand in hand to further enhance aesthetic results to your patients. As new technology and studies arises, it is time that we provide a complete case of aesthetics that would include both hard and soft tissues, in and out of the mouth.
TYPES OF DERMA FILLERS
A. CALCIUM HYDROXYLAPATITE
Calcium Hydroxylapatite is found naturally in human bones and a mineral-like compound. Calcium Hydroxylapatite is biosynthetically produced, which means that no animals or animal products are used. This lowers your risk of an allergic reaction and no skin testing is required. This type of dermal filler is known to produce a very natural result; it doesn't migrate and side effects are rare. This dermal filler was first used in dentistry and reconstructive surgery and has a long safety record.
EXAMPLE BRAND: Radiesse
It's Best Used For:
➢ Moderate to severe creases such as nasolabial folds, marionette lines and frown lines.
➢ Enhance fullness of the cheeks and other facial contours.
➢ Improve volume in areas of facial wasting which may occur in HIV-positive people taking certain medications or people recovering from chemotheraphy.
B. HYALURONIC ACID
Hyaluronic Acid is a natural substance found in your body. High concentrations are found in soft connective tissues and in the fluid surrounding your eyes. It's also in some cartilage and joint fluids, as well as skin tissue. It is extracted and reformulated and now has become one of the most popular kinds of injectable fillers. If the term sounds familiar, it's because the same substance is often injected into the aching joints of people with arthritis to ease pain and provide extra cushioning. Hyaluronic acid injections can also be used to improve the skin's contour and reduce depressions in the skin due to scars, injury or lines.
EXAMPLE BRAND: Captique, Esthélis, Elevess, Hylaform, Juvederm, Perlane, Prevelle, Puragen, Restylane
It's Best Used For:
➢ Acne scars
➢ Cheek depressions
➢ Crow's feet at the corner of your eyes
➢ Deep smile lines that run from the side of the nose to corners of the mouth (also known as nasolabial furrows)
➢ Frown lines between the eyebrows
➢ Marionette lines at the corners of the mouth
➢ Redefining lip border
➢ Scars including burns, acne and those caused by wounds
➢ Smoker's lines; vertical lines on the mouth
➢ Some facial scars
➢ Worry lines that run across your forehead
C. POLYALKYLIMIDE
Polyalkylimide has very little reaction with human tissue, meaning its biocompatible, and no allergy test is required. It is radio transparent, meaning it won't interfere with x-rays. It's a semi-permanent dermal filler
EXAMPLE BRAND: Aquamid
It's Best Used For:
➢ Treat deeper wrinkles such as nasolabial folds or depressed scars
➢ Plump thin lips
➢ Enhance cheekbones and the jawline, and to replace facial volume lost due to age
➢ Treat facial wasting from HIV medications
D. POLYACTIC ACID
Polylactic Acid is a synthetic dermal filler that is injected into your face, causing your body's own production of collagen. This type of dermal filler is known as a stimulator. This is non-toxic, biodegradable substance has been used for more than 40 years as suture material. Polylactic acid is known to work particularly well in the lower half of your face.
This substance is unlike other dermal fillers because it doesn't produce immediate results. Instead, it stimulates your own body's collagen production, so results appear gradually over a period of a few months. You will likely need about three monthly treatments to achieve your desired results. With each treatment, there is re-stimulation of your own collagen. Then, it can take four to six weeks to see the full effect. While this type of dermal filler is considered semi-permanent, you may still need occasional touch-ups.
EXAMPLE BRAND: Sculptra
It's Best Used For:
➢ Fill the lines caused by laughing
➢ Plump thin lips
➢ Treat deep nasolabial folds
E. POLYMETHYL-METHACRYLATE MICROSPHERES (PMMA)
PMMA is considered as a semi-permanent filler. And, when desired, PMMA is often used instead of collagen replacement therapy or hyaluronic therapy. PMMA has been used for many years in permanent surgical implants. Because of this, your surgeon will likely under-fill on the first treatment, adding more later if needed. One of the downsides of PMMA is that a number of injections are needed to create volume and it can take up to three months to realize the full effects. It may also be visible under the skin. To avoid any unwanted results, it's key that your plastic surgeon is familiar with the proper technique, which involves injection at the dermal subcutaneous junction using threading or tunneling methods.
EXAMPLE BRAND: Bellafill
It's Best Used For:
➢ Medium to Deep wrinkles.
➢ Folds and Furrows particularly nasolabial.
➢ To fill outfolds pitted scars and to augment thin lips.
➢ A more permanent solution to facial wrinkles.
BOTULINUM TOXIN
Botulinum toxin is a type of bacteria which go to a process that the form the purified protein. The mechanism of action for Botox is really quite simple. Botox is injected into the facial muscles, but, really doesn’t affect the muscle at all. Botulinum toxin affects and blocks the transmitters between the motor nerves that innervate the muscle. There is no loss of sensory feeling in the muscles. Once the motor nerve endings are interrupted, the muscle cannot contract. When that muscle does not contract, the dynamic motion that causes wrinkles in the skin will stop. The skin then starts to smooth out, and in approximately three to ten days after treatment, the skin above those muscles becomes nice and smooth. The effects of Botox last for approximately three to four months, at which time the patient needs re-treatment.
EXAMPLE BRAND: Allergen Botox
It's Best Used For:
➢ Smoothing facial wrinkles in the forehead.
➢ Crows feet.
➢ Treating high lip line cases.
➢ Denture patients who have trouble adjusting to new dentures.
➢ Lip augmentation.
➢ Has uses in orthodontic cases where retraining of the facial muscles is necessary.
CONCLUSION:
It is ironic to know that most dental treatment is much more invasive than, for example, dermal filler therapy. It is important to take note that the nature of these dermal filler materials are very temporary, in fact, the areas that you have treated with dermal fillers will completely return to normal within 6 to 12 months. In other words, for those who fear or hesitant to do this, it's worthy to remember that there is no long lasting effect that occurs with this treatment. So, if our worry are liability issues because the treatment may go awry, the untoward result will only last at a limited time, and, there are steps to properly handle this to assuage the patient's concerns. At the end of the day, its success or failure is in the control of the clinician.
The truth of the matter is, with unparalleled levels of practical skills and anatomical knowledge of the facial region, dentists are the very best people to be providing facial therapies to the public in a safe and hygienic clinical environment for both aesthetic and therapeutic needs. Dentists are the only practitioners able to ensure the establishment of a strong, healthy, supporting dentition which then blends harmoniously with an enhancement of the external soft tissues to achieve the best, safest and most natural overall results. Thus, in order to really incorporate facial aesthetics to your dental practice, it is critical that we fully learn and be trained to do this before we offer this to our patients. To explore this type of treatment, you may attend a foundation course here at DMD cEnter as your first step to the world of Facial Aesthetics, check it out here: WHEN DENTISTRY MEETS FACIAL AESTHETICS by Dr. Ivona Igerc. After all, DMD cEnter believes, "Smile is not Just Teeth...It Is Skin Deep" and, we, dentists are the best people to give this kindly of smile to our patients.
CONTRIBUTORS:
Dr. Bryan Anduiza - Writer
Dr. Mary Jean Villanueva - Editor
