WHO IS THE FACIAL SPECIALIST? HYALURONIC ACID FILLERS: OPTIMISATION OF AESTHETIC DENTISTRY AND PATIENT LOYALTY
Figure 1. Simulation of the treatment on the same patient( A) by different specialists. Traditional dental treatment without HA fillers( B). Treatment with HA fillers without any dental intervention( C). Combined treatment of aesthetic dentistry and HA filler.( D). N. B. Images( A) and( D) are real, images( B) and( C) have been created by the combination of the first two. Modified from: Costa E( ed). Estetica dei tessuti orali e periorali in odontoiatria. Parma, Italy: Acta Medica Edizioni; 2014. Courtesy of the author
in the United States strongly preferred injectable or minimally invasive procedures 4. The percentage increases for facial rejuvenation: more than nine million people, only in the United States, have chosen facial filler and botulinum 4. The facial rejuvenation procedures with dermal filler( together with botulinum) represent the area of higher growth in cosmetic treatments. In the United States alone, in 2015, patients have paid over 1.6 billions of dollars for facial fillers 4. The increase in demand of this kind of treatment also increased the number of practitioners who offer this service. This meant that a lot of new figures entered this area of expertise that were not traditionally involved in it. The dermal filler procedure in general, and facial filler in particular, initially neglected by plastic surgeon because it was considered minor, has now become a land to conquer by many specialists. Dermatologists in primis; followed by gynaecologists, anaesthesiologists and so on: clinicians and nonclinicians 5. And last, dentists, who finally decided to enter this area. However, still today, with differences from country to country, dentists hesitate to join this area. The most of us in the dental industry are quite ignorant of what these procedures even are, the theories behind them, the way they are delivered and the benefits for the patients. The aim of this paper is to gain the tools to integrate the examination of the soft tissue of the face, with their anatomic and functional characteristics, in the clinical routine, following a simple and well-tested protocol. In this way, dentists will be able to extend their view of the characteristics of a smile and a face and to propose innovative therapeutic solutions, which will meet the patient’ s request and expectations.
2. Hyaluronic acid: what it is, where and how it works The hyaluronic acid( HA) is the most used filler for the correction of wrinkles, skin imperfections and the remodelling of the face 6, 7. HA is a substance normally found in the skin and it gives its characteristics of resistance and maintenance of the form 8. With age, the physiological production of HA decreases and the skin loses elasticity and tone; this is what determines the creation of expression lines and wrinkles 6, 7, 9. The HA is a glycosaminoglycan, which consists of regular repeating non-sulfated disaccharide units of glucuronic acid and N-acetylglucosamine 8. Binding to many water molecules, the HA gives hydration, elasticity and softness of the tissues, protecting them from excessive solicitations 6, 7, 9. The concentration of HA in the connective tissue of the skin gets gradually reduced with time. For this reason, a mature skin appears less elastic and hydrated compared to younger skins. Although it is a normal physiologic phenomenon, many people want to fight the advancing age, therefore prevent wrinkles and other skin imperfections. HA fillers were developed at the end of the eighties 10. They represent an efficient minimally invasive solution for the imperfections of the face mainly caused by the aging of the skin, but also“ congenital” 7. The infiltrations can be performed alone or as a completion of a plastic surgery operation such as lifting. With the injection of HA intradermal the filling of the wrinkles and the increase of the volume of the face is achieved. There are different types of HA filler with different characteristics. The HA does not have side effects, it does not require an allergy test, gives a natural modelling to the treated area and it gets gradually absorbed in a few months( from four to twenty-four months) 6, 7, 9, 11. The time of reabsorption depends on different factors. The most important ones are the type of skin, the treated area, tobacco use, eating habits, overexposure to UV rays( both natural and artificial) the quantity and the density of the injected filler 7, 11. HA fillers are injected intradermally with pre-measured syringes and thin needles( from 20 to 30 gauge).
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