A perfect smile cannot be achieved with asymmetrical lips, deep nasolabial, marionette lines or smoker’s lines
Smile design
There are two main components of a smile design: facial and dental (Bhuvaneswaran, 2010), each one is equally important. Ten years ago for a patient to change their facial appearance required treatment from a plastic surgeon or maxilla-facial specialists. Today, with a rapid expansion in minimal intervention dentistry and medicine, dentists have a great opportunity to develop their skills in facial aesthetic medicine.
These skills will help clinicians not only improve patients’ smiles, but overall appearance and with it their wellbeing. Let’s take the gummy smile as an example. To treat this condition a dentist may use different approaches; one option may be crown lengthening surgery and crowns or veneers after. This treatment can be uncomfortable, invasive for the patient and involves a high cost with a long treatment time.
A different approach with similar results may be achieved with the injection of botulinum toxin. Small amounts of Botox into the peri-oral musculature (levator labii superiors alaeque nasi) on each side of the upper lip (de Maio and Rzany, 2007). The patient will find this approach affordable with minimal or hardly any discomfort, much less expensive with the effect of treatment noticeable within one week.
Integration
Dentists are in a perfect position to integrate facial aesthetic treatments into their practice.
In my opinion there are three competitive advantages that the dentist has over other medical professionals who perform aesthetic treatment.
1 Working environment: dental surgeries are perfectly designed to perform aesthetic treatments with an adjustable treatment chair providing easy access from all sites, good light, cross infection control and safe disposal of sharps. This compares favourably to the health spa/beauty salon where a vast majority of these treatments are offered
2 Captive audience: the aesthetic appearance of their smile is important to patients and medical cosmetics can help. You can discuss these treatment options during your consultation and advertise them throughout the practice, or mail shot to an appropriate demographic in your database
3 Vast experience of oral injections and understanding of facial anatomy: for me this is the most important point. When it comes to injection experience, technique and the understanding of oral and facial anatomy, dentists already have a clear advantage over other practioners. GPs and nurses offer a lot of these treatments, but how many offer facial injections as part of their day-to-day practice?
Case study Female patient 59 years old. Patient had a course of four TCA skin peels and Juvederm Volift dermal filler for treatment of marionette naso-labial lines and jaw line. Patient was advised to used spf 50 sun block ‘Heliocare’. Recommended to repeat a course of TCA peels in three to six months and in eight to 12 months repeat Dermal filler treatment. |
So how big is the market for these treatments?
The market for aesthetic medicine (surgery and nonsurgical procedures) will reach £3.6 billion in the UK this year. Of this, non-surgical treatments account for 90% of the procedure and 75% of the market value.
Three or four years ago the main patients in aesthetic clinics were women of a certain age. The treatments were expensive and scare stories in the press limited the appeal. Today I treat a much greater variety of patients, men as well as women, ranging from early 20s (mostly lip augmentation) to late 60s.
These types of treatment have minimal risk (none are permanent), quick to administer and have minimal recovery time. The treatments fall into three main categories; wrinkle injections (the lion share of any practice), fillers (for deeper lines, wrinkles and to replace lip volume associated with aging) and superficial skin treatments (such as peels, microdermal abrasion, mirco-needling etc).
Botulinum toxin
Botulinum toxin is a protein produced by thebacterium clostridium botulinum. It was approved by FDA in 2002 for cosmetic use. It works by binding to the nerve terminal, stopping it from passing a signal to the muscles. Therefore it works like a muscle relaxant. The results of Botox can last on average between three to four months and may vary with each patient.
Specifically in dental Botox it can be used to treat gummy and asymmetrical smile, bruxism, hyper activity of the masseter muscle.
Dermal fillers
Dermal fillers are the most common products used and are based on hyaluronic acid and calcium hydroxyl apatite. Dermal fillers are used for the treatment of static lines, deep wrinkles such as nasolabial marionette lines, volume loss in lips, cheeks, they can also can be used for remodelling the shape of the chin, nose and jaw line. The latest approach to dermal filler treatment is an eight point face lift – that is a none surgical alternative to surgical face lift.
Micro-needling
Micro-needling is an aesthetic medical procedure that involves repeatedly puncturing the skin wit tiny, sterile needles in order to induce the production of collagen.
The procedure usually involves a specialised device that can take the form of a manual rolling device or an automated stamping device. This is an effective treatment for general rejuvenation of the skin as well as an effective treatment for scarring and acne scaring, stretch marks and also hair loss.
Although in practice the treatment proved to be effective for hair loss, there is no published research available to support this statement.
Training requirements
To deliver these treatments safely and effectively it is necessary to complete appropriate recognised training.
Health Education England is currently reviewing the aesthetic industry and trying to introduce ways to improve regulation and ensure patient safety (NHS Health Education England, 2014). At present there are a high number of providers that offer training in aesthetic medicine for doctors, dentists and nurses.
Dentists can easily integrate these treatments into their practice and the numbers trained in these procedures (as a percentage) now outnumbers their medical colleagues
The training can range from a one-day course to a diploma or masters degree.
It is important to make sure that you are making a right choice and go with a reputable provider. A certificate of completion will be required by the main insurance companies. A one-day course can be a good way to get a feel for aesthetic medicine.
Points that you need to consider when selecting the aesthetic course:
- How long have they been providing training?
- What support you will receive after completing the training. For example if your patient experiences a complication after treatment - Is it recognised by all insurance providers (dentist can add some non-surgical treatments to their indemnity cover without any extra cost)?
- How much of a practical experience will you get on the course?
- What is the ratio of trainers to trainees?
- Do they provide you with business advice as well as the particle aspects of treatments?
Legal issues
In all spheres of our practices, we as practitioners need to do the very best for our patients and to abide General Dental Council (GDC) standards (Standards for the Dental Team) and facial aesthetic is no exception.
According to the GDC standards (standard 7.2) dentists should work within their knowledge, skills, professional competence and clinical ability. Therefore, you should only perform the treatments that you are trained to do and feel confident to administer. If you do advertise facial aesthetic services according to the GDC standard 1.3, it should be accurate and not misleading. There is no clinical necessity for a dentist to perform a cosmetic treatment. Valid consent is obtained and supported with photographic before/after photos and post procedure written advice is given. Patients should never feel pressurised to undergo any cosmetic intervention and expectations must be addressed pretreatment to reduce the risk of dissatisfaction.
Additional information on regulation and legal issues for facial aesthetics and aesthetic medicine can be provided by the new regulatory body for aesthetic practitioners, Safe Face (www.saveface.co.uk, 2015)
Potential for growth Aesthetic medicine continues to grow rapidly in the UK. Dentists can easily integrate these treatments into their practice and the numbers trained in these procedures (as a percentage) now outnumbers their medical colleagues. Facial aesthetics can help you to increase your revenue, attract more private patients and will help your practice to standout.
References
General Dental Council. Standards for the dental team, 2013
Mauricio de Maio, Berthold Rzany (2007) Botulinum toxin in Aesthetic Medicine 1st ed. Springer New York: 79
Mohan Bhuvaneswaran (2010) Principles of Smile design. J Conserv Dent 13(4): 225–232
NHS Health Education England final report, 2014
http://www.saveface.co.uk/ Retrieved 17/4/15