Cosmetic Dentistry & Facial Aesthetics

Facial aesthetics is the non surgical treatment of fine lines/wrinkles and folds. It normally consists of injectables, whether this be Botulinum Toxin or Dermal Fillers.

In this article, Dr Harry Singh discusses the developing trend of facial aesthetics and how it can be incorporated into the practice of dentistry.

Dr Harry Singh | BChD, MFGDP

Founder & CEO- Botox Training Club

Founder & CEO- Dental Propety Club

Dr Harry Singh has been carrying out facial aesthetics since 2002 and has treated over 3,000 cases. In his last dental practice (aesthetics) he ended up doing more facial aesthetics than dentistry. Due to the very high profit margins associated with facial aesthetics he decided to just concentrate on facial aesthetics. He currently has over 700 facial aesthetic patients.

He is not only a skilful facial aesthetician but a keen marketer which he feels is vital to attract and retain patients requesting facial aesthetic services. He has published numerous articles on the clinical and non clinical aspects of facial aesthetics and spoken at dental and facial aesthetics conferences on these topics

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Trends in Cosmetic Dentistry

The level of aesthetic requirement in clinical practice has increased over the past decade, and this has made it necessary for dentists to explore this field in order to satisfy the existing demand from patients.1

The ever expanding rise of social media and celebrity gossip magazines has made the public more educated and more driven to enquire and undertake cosmetic dental procedures.

Trends in Facial Aesthetics

The trend today is away from traditional cosmetic surgery and toward less expensive minimally invasive procedures.2 The use of cosmetic procedures to reduce the signs of ageing has increased dramatically over the past 10 years.3

However the rapidly rising demand for botulinum toxin and dermal filler treatments together with increasingly complex injection procedures present a growing challenge for todays expanding aesthetic community. According to current industry estimates for 2013, a total of 1.5 million toxin and dermal filler procedures were carried out in the UK.4

We live in a world where people will make snap judgements about others from their appearance. Numerous studies5 have shown the importance of a warming attractive smile. People with straight teeth are perceived as more successful, smarter and having more dates

If you lack confidence because of your smile, you may hide away or reduce the number of social interactions both personally and in business.

As well as an improvement in the appearance of your smile, cosmetic dentistry also has health benefits. Solving such problems as cracked, decayed, missing or misaligned teeth. Thus as well as improving your appearance, cosmetic dentistry can also solve such problems as periodontal disease, TMJ problems and masticatory issues.

Many patients prefer non-surgical procedures compared to surgical procedures for a number of reasons:6

  • More affordable – patients don’t have to invest in a large one lump sum payment. With facial aesthetics, its more regular, smaller and affordable payments.
  • Minimally invasive treatment – the public are past the fake look. They want the natal look that complements them. Not a ‘wind tunnel’ look that looks artificial and others will notice immediately.
  • Recovery times and side effects – we are all busy people. We can’t take weeks off to have a surgical procedure. The public are demanding quick, hassle free procedures so they can resume their hectic lifestyle as soon as possible.

Combining Both

The commonality between cosmetic dentistry and facial aesthetics is that the patient is the driving force behind there requests. both modalities are ‘want’ driven and not ‘need’ driven. No one needs cosmetic dentistry or facial aesthetics!

We regularly perform injections several times a day. We are comfortable in this procedure and have mastered how to give injections as comfortable as possible. Dentists are experts in the facial anatomy and structures. We spend hours everyday performing in this region.

Our patients trust us. We have empathy and have built rapport with them. We can offer facial aesthetics in a secure and controlled environment.

In my experience, patients that have undertaken facial aesthetics are more inclined to explore cosmetic dental procedures and vice versa. My cosmetic dental patients were eager to explore the benefits of facial aesthetic treatments.

How can facial aesthetics compliment cosmetic dentistry

The most obvious is the lips. Patients may have perfect, straight, white teeth, but if the lips are thin or out of proportion, the observers eyes will be drawn to this imperfection and not to your wonderful dentistry. Plumping up the lips either subtly (injecting hyaluronic acid dermal filer just in the boxers of the lips) or increasing the volume (injecting in the body of the lips) will enhance their new sparkling smile.

Another common request from my dental patients is volumisation in the mid-face area, notably around the cheeks, where the patient may have lost some teeth. As we know, once the teeth have been lost, the bone density will decrease and hence result in a loss of volume. The patient may not be able to afford to restore the gaps with implants or bridges, but are concerned with the loss of volume, which they can afford to restore.

We can apply the same logic as above and look to replacing loss volume due to lost teeth, or filling out deep lines in the nose to mouth (naso-labial folds) and mouth to chin (marionette lines) with dermal fillers.

Now, lets look at where we can use Botulinum Toxin to target dynamic muscles. As well as considering to treat the upper third of the face with Botulinum Toxin Type A (the most common areas requested by patients) the dentists can consider specific areas that will complement any cosmetic dentistry that the patient is undertaking or will have completed.

Gummy smiles – in some smiles the upper lip can rise too high and unveil a lot of gummy space.  In these patients,  you can inject a very small amount of toxin to weaken the muscles responsible for raising the lip. This results in a gentler and softer upward pull when the patient smiles, decreasing the amount of gingivae visible, yet still allowing all of the teeth to be seen. The toxin is injected in small increments into the upper musculature with the aim of affecting the Levator Labii Superioris and the zygomaticus muscle areas, in an effort to reduce the patients upper lip hypermobility.

Corners of the mouth which point downwards and give a permanent sad look can be treated with toxin. You can inject the toxin into the Depressor Angular Oris muscle and therefore diminish the downward pull on the corners of the mouth and allow the muscles that elevate the corners to take over.

As well as it’s use in cosmetic procedures, toxin is also used as a therapeutic treatment modality. For example, TMJ disorders can be treated with toxin as part of an overall treatment plan, whereby toxin can be added to treat bruxism in addition to conventional dental treatments

Conclusion

We can conclude that cosmetic dentistry and facial aesthetics go hand-in-hand and will give your patients the best results from their cosmic dental work. And who else is best positioned to offer these facial aesthetic services than you, their dentist.

Getting involved

To be able to offer facial aesthetic services you will need to attend an accredited workshop. Whichever training provider you choose, make sure you have small groups, models provided and support provided post workshop.

Once trained you will need to be indemnified (dental and specific insurance providers will cover you, but terms and conditions will vary) and you would need to set up a pharmacy account.

Beginners Tips

  • Start slowly and keep it simple

I always recommend to my delegates to just start with the basic procedures, which cover the forehead, frown and eyes. The majority of your initial patients, will just want these three areas treated. Once you have built up your confidence, then look at providing the other treatments.

  • Support is critical

It all looks easy when undertaking these procedures in a workshop environment under supervision. It’s when you go back to your practice, that you may need some extra help. Before signing up to any courses, look into the post-workshop support provided. If there are any cases where you are not sure what to do, it is invaluable to have someone to contact and go through the treatment plan with.

Disadvantages

As with any clinical procedure, there are some associated risks. I have personally found there are less complaints in facial aesthetics, as facial aesthetics is a ‘wants’ based service and not a ‘needs’ based service. In addition Botulinum Toxin treatments are temporary, on average lasting between 4-6 months. I also advocate a baby step approach, you can always ‘top up’ with Botulinum Toxin but if you have over dosed, you cannot remove it. And finally if you are using HA (Hyaluronic Acid) Dermal Fillers, you can reverse the procedure.

Dentists are perfectly positioned to offer facial aesthetics and the growing demand for these procedures means there will  always be a section of the public happy and willing to pay for these services.

  1. AlJehani, Y. , Baskaradoss, J. , Geevarghese, A. and AlShehry, M. (2014) Current Trends in Aesthetic Dentistry. Health, 6, 1941-1949
  2. Goldberg, David “Breakthrough in US dermal fillers for facial soft-tissue augmentation,” Journal of Cosmetic and Laser Therapy, 2009. Vol. 11, pp. 240-247
  3. Riggs, Lauren. “The Globalization of Cosmetic Surgery: Examining BRIC and Beyond.” 12-14-2012. University of San Francisco Master Thesis. (http://repository.usfcaedu/thes) Accessed 1 March 2014
  4. Expert Consensus on Complications of Botulinum Toxin and Dermal Filler Treatment – 2nd Edition
  5. ‘Behind the Smile’ Perception Kelton Study
  6. The Changing Face of Aesthetic Treatments – An ebook based on published research, clinical surveys and interviews with top international aesthetic physicians – Gladerma 2014

 

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