WHO IS THE FACIAL SPECIALIST? HYALURONIC ACID FILLERS: OPTIMISATION OF AESTHETIC DENTISTRY AND PATIENT LOYALTY
Figure 2. Facial proportion analysis. Soft tissue examination is performed in the three projections: frontal( A), oblique( B) and lateral view( C). The patient should be evaluated standing up with his head in a natural head position, with the eyes staring at a point to the horizon on the same plane of his or her eyes. Drawn by Aldo Zupi using ZygoteBody™ 3D Anatomy Viewer. Zygote Media Group Inc., American Forks, UT
Contraindications are rare: skin diseases, infections or viruses( e. g. herpes labialis) in progress, autoimmune diseases of the skin and collagenopathies 12. Although there is no evidence of contraindication, it is safer not to administer HA fillers during pregnancy and breastfeeding 12.
3. Who is the facial filler specialist? The first objection raised from the dentist( about filler procedure) is always the same:“ can the injection technique be done in a dental clinic?” or“ wouldn’ t it be better if specialists such as dermatologists and plastic surgeons did the facial filler?” Surely, from an historical point of view, dermatologists and plastic surgeons have been the first to focus and take care of people’ s faces and use therapies( more or less invasive) for the maintenance and the recovery of the health and beauty of the patients. In the last years, minimally invasive procedures( such as fillers) started to spread around and different professional categories such as anaesthesiologists, medical aestheticians, ophthalmologists, internists and so on, started to be interested and so they also begun to use facial fillers in their every day practice. In some cases, the filler practice left the medical area to cross into the paramedical area( in the best case scenario). It is not rare that non-medical staff performs procedures such as filler, botulinum, sclerotherapy, and mesotherapy 5, 13. Usually, the training for these procedures is only focused on the technical aspects. Teaching focuses on just a few concepts. They are surely important, but, perhaps, not enough to create the facial filler specialist. Many facial filler courses are focused
on“ where”,“ how much” and“ how” to inject. They offer a very quick refresh of our facial anatomy knowledge and of its critical and dangerous areas. The whole aging physiology is discussed rapidly in a couple of sentences. This is enough to gain all the necessary techniques for the surgical procedure. However, they give the necessary anatomical and functional knowledge for granted. A dentist, any dentist, has spent his whole professional training( from the first day at university) studying and mastering the anatomy and physiology of the oral and perioral area. They have studied and mastered all the aspects and they know the characteristics better than any other medical specialist. In addition, the dentist is the only specialist who spends every day of his profession working on this area, dealing with its singularities and the changes that happen with time. If this were not enough, everything is subject to the aesthetic judgement of the patient every single day. Therefore, dentists have to accept the ugly truth of being the‘ real’ specialists of the oral and perioral region( or rather from the chin to the cheekbones) and that their very specific scientific background and their daily work is not comparable to that of any other specialist’ s. No dermatologist, plastic surgeon or other, will be as competent and confident as the dentist. With increasing frequency, patients ask us, or our colleagues, for a generic improvement of their physical conditions( Fig. 1A). In these cases, usually, the approach is different depending on the specialist. If the interlocutor is a traditional dentist, the operation will be limited to the teeth and mouth. A traditional dentist sees the patient ex-
170 STOMA. EDUJ( 2016) 3( 2)