WHO IS THE FACIAL SPECIALIST? HYALURONIC ACID FILLERS: OPTIMISATION OF AESTHETIC DENTISTRY AND PATIENT LOYALTY
Table 1. Facial analysis. Main elements to evaluate during skin analysis
1. Colour. 2. Phototype. 3. Texture. 4. Elasticity. 5. Thickness. 6. Type of skin( dry, oily, mixed, sensitive, dehydrate) and sebaceous and sweat secretion. 7. Presence od stains( ipo- or hyperpigmentation). 8. Presence of injuries or neoformations( scars, inflammation, keratosis, fibroids, dermatitis, etc.). 9. Presence and distribution of nevous. 10. Presence of wrinkles( distribution and depth).
Table 2. Glogau’ s aesthetic and anatomic analysis of the aging skin
Type I
No wrinkles. Patient age 20-30. Early photo aging( mild pigmentary changes, no keratosis); minimal acne scarring; need minimal or no make-up.
Type II
Wrinkles in motion. Patient age 30-40. Early to moderate photo aging( early senile lentigines visible, keratoses palpable but not visible, parallel smile lines beginning to appear); mild acne scarring; need some foundation.
Type III
Wrinkles at rest. Patient age 50-60. Advanced photo aging( obvious dyschromia, visible keratosis, discoloration with telangiectasia, wrinkle present even when not moving); acne scarring present that make-up does not cover; need heavier foundation.
Type IV
Only wrinkles. 60 or older. Severe photo aging( yellow-grey skin colour, prior skin malignancies, wrinkles throughout, cutis laxa of different origin); severe acne scarring; cannot wear make-up because it cracks.
amination to classic dentistry approach allows and simplifies the comprehension of the complex and unique harmony of the faces of our patients 14. Costa and Di Gioia 14 have proposed a simple but complete and exhaustive facial analysis protocol. It is the collection of all the information we gained by observing the patient during a clinical examination and by examining photos and videos of the face. This analysis consists in three phases:( A) analysis of facial proportions;( B) skin analysis; and( C) analysis of the expressive quality of a face 14.
5. Analysis of facial proportion Analysis of facial proportions must consider soft tissue( skin, muscles, subcutaneous fat, intraoral soft tissue) and hard tissue( bone and dental support, dento-alveolar relationship). One must gather as much information as possible about the form, the proportions and the symmetries of the face must be gathered. According to Yarbus’ studies 15, when we observe a face, our eyes focus on areas of the face known as Region of Interest. They are the areas of maximum curvature of the face, where the transition between these different areas happens. It is necessary to concentrate our attention on these areas. We practice the soft tissue examination in the three projections: frontal, oblique and lateral view( Fig. 2). In the same projections we will perform a series of aesthetic photos of the face. The patient should be evaluated standing up with his head in a natural position meaning with the eyes staring at a point in the horizon on the same plane as his or her eyes. The best point of view is given when the head pos-
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