WHO IS THE FACIAL SPECIALIST? HYALURONIC ACID FILLERS: OPTIMISATION OF AESTHETIC DENTISTRY AND PATIENT LOYALTY
Figure 4. Aesthetic regions of the face. The main aesthetic regions of the face are: the frontal region( F), the temporal region( T), the orbital region( O), the zygomatic region( Z), the buccal region( B), the nasal region( N), the mandibular( M), and the lip and perioral region( L). Drawn by Aldo Zupi using ZygoteBody™ 3D Anatomy Viewer. Zygote Media Group Inc., American Forks, UT
these areas has particular anatomic features: skin, subcutaneous tissues, muscles, fat, movements and mimic. The therapeutic options will be different for each different area. In addition, we need to consider the changes associated to aging and this allows us to understand how important it is to know the face anatomy before any intervention. Careful attention must be paid to the exterior margin of the vermilion. It is surrounded by a thin line and slightly detected skin called the lip white roll( Fig. 5). It is very noticeable in young lips, which highlights the red border of the lip. The presence of this area is one of the secrets best kept by plastic surgeons. Its presence and its use allow as to obtain excellent aesthetic results with no invasive treatment.
6. Skin analysis The next step is the skin analysis: a glowing and well-maintained skin improves the beauty of a face and a smile. We need to be able to do an initial screening of the status of the skin and eventually we need to be able to spot injuries or diseases, which will be evaluated by the dermatologist. It is important to asses the skin surface. We will examine as many elements as possible( Tab. 1). Hair, eyebrows, eyelashes, colours of the eyes and make up are considered characteristics, which are perceived as parts of a person’ s personality. When the main physiological parameters of function get closer to‘ normality’ the skin will look bright, light, compact, well hydrated, soft, elastic and smooth. An important parameter to evaluate in the analysis of the skin is the texture( also called webbing or skin profile). The skin texture is formed of the set of lines, which fused together on the skin surface surround quadrangular or rhomboid areas with primary and secondary lines. It is very hard to observe this in children and babies with a naked eye. With age, these lines become less frequent, deeper and messy. The skin texture can be evaluated through macrophotography according to Beagley and Gibson 16 or through profilometry 17 and it is conditioned by the form and function of the structures, which cover it. The skin examination is obviously completed with the observation of wrinkles. A good reference for this evaluation is the classification of Glogau 18, which links age, wrinkles and texture quality( Tab. 2). To be able to understand the difference between the wrinkles and the rationale of their treatment it is necessary to remember the structure of the skin. The skin of the face is a layered structure. The main layers are the epidermis and the dermis. Below them there is the adipose tissue. The depth of these layers gradually varies depending on the area of the body and face examined. It is very thin in the periocular region; it becomes thicker on the cheeks, it gets thinner again on the mandibular region to then become once again thicker in the perioral region. The epidermis is subdivided in a keratinized superficial portion with the cellular elements at the end of its life cycle and in a deeper portion with vital cellular elements. In the deepest zones of this layer the melanocytes have been localised, which explains the difficulties in treating the skin spots. Below the epidermis, the dermis and the connective tissue can be found, also with variable thickness. The dermis is the layer where the HA is positioned. Here is where the increase in volume happens, which has an impact on the layers above achieving a filling or smoothing of the wrinkle.
7. Analysis of the expressive quality of the face A last evaluation is the quality of the facial expression. This evaluation has to happen with the analysis of the static and dynamic mimic activity. Each face is unique because of some important characteristics: the mimic, the skeletal muscle activity of the face and the neck, the head posture, the look, and the smile( the heart of the face).
8. Surgical procedure: how and where The filler procedure is extremely simple and it only requires easy injections technique knowledge. Dentists are the best specialists in this field. A dentist, generally, performs dozens of injections everyday; probably thousands every year. For a dentist, an injection is a very familiar act. The layer where the filler injection happens is, in
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