Facial Rejuvenation as Part of Smile Design
Integration into the dental practice
Warren Roberts, DMD
Once performed mostly only at spas and by medical professionals such as dermatologists, there is definitely a place for esthetic and therapeutic Botox in dentistry. A thorough look at the facts surrounding facial rejuvenation procedures that use Botox may cause a paradigm shift in the dental profession’s attitude toward these treatment modalities.
When I was very young, my father, a famous seine boat fishing captain, instilled the idea in me that the key to success is to use the latest technology to chart your course before the tide begins to change.
Recognizing that the tide in dentistry was indeed changing, we decided to include facial rejuvenation procedures into our “smile design” treatment. Our most exciting adventure to date has been opening a facial rejuvenation/esthetic dentistry clinic, and we are enjoying the practice of dentistry more today than we ever have before.
A cosmetic, dental, or medical procedure used to restore a younger appearance to the face without surgery, facial rejuvenation can include a number of treatment modalities, such as Botox and dermal fillers. These two most common procedures are both minimally invasive and reversible. The treated muscles will return to their pretreatment condition approximately 3 to 4 months after the initial Botox treatment. Hyaluronic-acid dermal filler is naturally resorbed by the body within 9 months to 1 year after treatment. Botox (which is the natural, purified protein of the Clostridium botulinum bacteria) is used to cosmetically soften lines and wrinkles of the face and neck. Hyaluronic-acid dermal fillers restore the volume that is lost through the natural aging process.
Both Botox and dermal fillers are natural adjuncts to esthetic dentistry. With their effect on tooth display and the draping of the soft tissue around the mouth, incorporating these modalities into treatment plans can have a major impact on the esthetic outcome of smile makeovers and comprehensive restorative treatment. Even if dentists are not inclined to provide these treatments themselves, they should educate themselves in how Botox and dermal fillers can influence the dental treatment they provide.
How This Fits in Esthetic Dentistry
Photography has taken on an ever-increasing role in the provision of esthetic dentistry. Photographs are an integral part of cosmetic imaging that allow a patient to preview a potential course of treatment, laboratory communication, and accurate record keeping.
In facial rejuvenation, patients often have difficulty understanding and communicating what they want to improve. A series of photographs that allows patients to view themselves from all angles is required but, until recently, none existed. To fill this need the Pacific Training Institute for Aesthetics (PTIFA) created the Roberts Facial Rejuvenation Photography (RFRP) series of 29 digital photographs. The RFRP series helps the dentist to critically analyze the face and demonstrate how the muscles used in the facial expression affect the smile design.
At PTIFA, we were the first to begin to mark (and photograph the markings) all of the muscles prior to injection. The patients appreciate our attention to detail, our painless injection technique, and complete marking. By varying the dose, we noticed a decrease in headaches, migraines, temporomandibular joint disorder, and myofascial pain. There is a huge crossover and synergy between esthetic and therapeutic Botox treatment. A huge pearl: If you relieve headaches and migraines on a team member, they tell every patient that walks in the door.
When patients are interested in enhancing the appearance and features of their teeth, they also frequently want to improve their overall facial appearance. In the past, they would seek treatment for facial enhancement elsewhere; however, dentists are uniquely skilled to provide these treatments for their patients. Who else has better training and a more solid understanding of facial anatomy than dentists? Who else is more skilled at giving injections in this area of the body? Who else do patients trust to work in the areas surrounding their mouths? If dentists can be trained to perform delicate endodontic procedures, sinus lifts for implants, and other involved procedures, they are certainly capable of performing tiny injections into the superficial muscles of the face and injecting resorbable gels into superficial areas of the skin—especially given the fact that these injections can have a direct influence on other treatments the dentist may be providing. For example, the muscles responsible for the “mid-face expression” can have a drastic esthetic effect on some patients. Have you ever met a beautiful person only to have them smile and show an inch of gingival tissue? Very often, treatment for a “gummy smile” is an invasive surgical Leforte I procedure or surgical crown lengthening. Alternatively, Botox may significantly improve that appearance. Often all that is required to improve the appearance is a 2-unit placement of Botox. In many cases, a 2-minute, $50 procedure every 3 to 4 months can provide an alternative, non-invasive, esthetic improvement.