WHO IS THE FACIAL SPECIALIST? HYALURONIC ACID FILLERS: OPTIMISATION OF AESTHETIC DENTISTRY AND PATIENT LOYALTY
and increase the entity. The HA efficiently fills these wrinkles up and can get rid of the imperfection. The filling can happen for each single wrinkle or treat the whole white upper lip with a technique called“ fan”. Thin lips are a congenital imperfection, genetically determined. They are usually very unpopular among women, as today’ s standard of beauty expects full lips. Dermal fillers allow an appropriate correction. The HA, makes the lips fleshier, via the infiltration of the correct quantity. The infiltration happens at different depths depending on the treated area and the volumes are gradually“ redesigned”. Thin lips are complex to correct and it is best to make this corrections in several steps. The HA is fully resorbable; this eliminates the fear of error for“ excess”. Anyway it is always advisable the search for a natural effect and not the“ Hollywood” effect. Less pronounced cheekbones, or anyway the physiological reduction of their volume, flattens the look of the face giving an older appearance. The infiltration of HA allows, in a relatively easy way, to increase the volume of the middle third making the face“ sharper” and younger. This area, however, requires the use of a more dense or reticulated HA filler and its placement in layers“ unusually” deeper. The so-called crow’ s feet are a common imperfection in both men and women. Even though they add‘ depth and interest’ to the eyes and look, they are not very much loved, especially by women. The correction is quite complex because of the extreme thinness of the skin, which can determinate the creation of visible“ cords”( anyway reversible). In addition, the continued contraction of the muscular mimic decreases the effect of the correction. Therefore, the ideal treatment would be a combination of botulinum toxin and dermal filler. The HA must be injected very superficially and in extremely“ controlled” quantities along the main lines. In this case, too, we have to follow the golden rule of not exceeding and eventually subdividing the treatment in several steps. It should not be forgotten that the injections of HA are not absolutely painless. In same areas, such as the lips, the majority of patients who had fillers feel a sense of burning or discomfort during the procedure. To avoid it, it is advisable to anesthetise the area, which is going to be treated. It is possible to do so with topical anaesthetic cream( usually with lidocaine) or with an injection in the oral vestibule( usually with mepivacaine without vasoconstrictor).
REFERENCES
1. Lubbock J. BrainyQuote. com, Xplore Inc [ Internet ]. 2016 [ updated 2016; cited 2016 Aug 7 ]. Available from: http:// www. brainyquote. com / quotes / authors / j / john _ lubbock. html. 2. Treccani. it Enciclopedie on line [ Internet ]. 1934 [ updated 2015; cited 2016 Aug 7 ]. Available from: http:// www. treccani. it / enciclopedia / avebury-sir-john-lubbock-barone /. 3. Sandoval LF, Huang KE, Davis SA, Feldman SR, Taylor SL. Trends in the use of neurotoxins and dermal fillers by US physicians. J Clin Aesthet Dermatol 2014; 7( 9): 14-19. 4. American Society of Plastic Surgeons. 2015 Complete plastic surgery statistics report [ Internet ]. 2016 [ updated 2016; cited, 2016 Aug 15 ]. Available from: https:// www. plasticsurgery. org /
9. Conclusion The treatment of face imperfections with HA filler is a simple procedure, relatively painless and virtually free of complications and side effects( Tab. 3). It requires deep knowledge of the face anatomy and its tissues, understanding of the skin physiology, excellent knowledge of injection techniques, ability to empathise with the patients and aesthetic sensibility. All dentists who have had some sort of dermal filler training are aware of the reason because dentists can and should perform these treatments. Luckily, a constantly increasing number of dentists apply to theoretical and / or practical courses of dermal filler. This tendency is creating more and more professionals who have great knowledge of facial anatomy with its skeletal, muscular, vascular and nervous structure. In addition, these specialists master the injection technique better than anyone else. The HA is just a different substance to inject. The dentist only has to learn the different pressure and speed in a few minutes and a few attempts. If the dentist knows anatomy, the physiology and aesthetic parameters of the face better than any other specialist, is there a more qualified specialist to evaluate the relation between lips and teeth? Or the changes of tissues and perioral volume during the smile? Is there another specialist who works with the face, or at least the portion between the cheekbones and the chin, every single day during his professional career? Is there another specialist who, daily, makes aesthetic choices, which can be immediately evaluated by the patient? If the dentist has taken a serious and complete dermal filler training, is there a specialist who can offer a better cosmetic treatment to that indivisible unity constituted by face and smile? There are many complex treatments performed with HA in anatomic regions and tissues, which have nothing to do with the smile and face. No dentist would have dreamt to perform such treatments. But, when the treatment of the tissue aims to complete the smile, a dentist with aesthetic sensibility, cannot limit himself to just be the doctor of the teeth. He must take responsibility to give or return harmony and health( the sum of which is beauty) to the faces of his patients.
Acknowledgements The author declare no conflict of interest related to this study. There are no conflicts of interest and no financial interests to be disclosed.
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