every problem ourselves , although that is often not in the patient ’ s best interest .”
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Before and after photos of patient with preoperative asymmetric mandibular prognathism , vertical maxillary excess , malar hypoplasia , and a skeletal class III crossbite malocclusion . The patient underwent reconstruction of the maxilla , mandible , and chin , with bilateral cheek implant augmentation .
noses , and large , bulbous , amorphous nasal tips are routinely corrected in Dr . Bates ’ office OR without requiring hospitalization .
Blepharoplasty
Although blepharoplasty is most commonly requested for cosmetic reasons , redundant , excessive eyelid tissue can affect vision . Removing excess tissue and trimming herniated orbital fat results in a more alert and youthful appearance . Routinely performed under IV sedation , blepharoplasty is increasingly requested by men .
Facial Implants
For patients whose underlying skeletal features give them a flattened face or a small retruded chin , Dr . Bates may recommend facial implants to augment the facial bones and accentuate specific areas of the cheekbones , chin , nose , and lower jaw . For mature patients , these implants can also help fill out and tighten the skin of the face , providing a more healthy and youthful appearance without the need for a full facelift . Facial implants are placed from inside the mouth so the procedure leaves no visible scars .
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Facial and Neck Liposuction
Some individuals naturally have unwanted deposits of facial fat that are not significantly reduced by exercise or weight loss . Facial and neck liposuction is performed in the office under IV sedation . This procedure , along with a modified neck lift , genioplasty or chin augmentation , can restore a healthy , youthful appearance without extensive face lift surgery . All patients are evaluated prior to surgery and computer-assisted digital imaging is used to simulate post-surgical results .
Multidisciplinary team approach
Photos courtesy of Dr . Jim Bates
Dr . Bates knows that optimal patient outcomes are achieved when a team of caregivers participates together in managing the treatment of any given patient . “ The days of the Lone Ranger are long gone . We routinely refer patients to other doctors much better suited than we are to treat a given problem . Patients appreciate this open approach , and they always get better results than if we try to manage a complex problem alone . Dentistry is just now catching on to this concept , while physicians adopted it decades ago . I think dental school trains us to try to manage
“ We also know that , while many specialists may participate in a patient ’ s management , the general restorative dentist is always the captain of the team . We keep the entire team in the loop through frequent , open communication . In fact , in today ’ s environment , electronic communication is often the preferred means of communication . We can quickly and easily convey ideas , opinions , images , CT ’ s , intraoral scans and x-rays among many providers , with appropriate HIPAA compliance , of course .”
Many patients require referrals for additional diagnostic studies or consultations , and these are freely and regularly requested . Commonly a patient referred for orthognathic surgery may present with temporomandibular disorders or sleepdisordered breathing , and Dr . Bates will order a polysomnogram , or sleep study , to evaluate the patient ’ s level of obstructive sleep apnea , and a TMJ MRI to evaluate joint health or pathology . A patient presenting with sleep apnea may have nasal polyps and environmental allergies requiring referral to an otolaryngologist or allergist for management of these concerns prior to surgical treatment of sleep apnea . TMJ patients are frequently referred to a neurologist ( for headache evaluation ) or to a rheumatologist for evaluation of systemic joint disorders .
“ Frequently , patients with jaw deformities have tongue thrust and are referred to a speech and language pathologist for perioperative oromyofunctional therapy to reduce the risk of relapse following orthognathic surgery . Another common occurrence is the patient presenting for dental implant reconstruction , perhaps following trauma , who has no restorative dentist and is referred for prosthodontic management prior to implant surgery . So we make a lot of referrals . The team approach can get complicated , both for the patient and for the doctors on the team , so our staff is particularly focused on making referral appointments for the patient while they are in our office , then en-