WHO IS THE FACIAL SPECIALIST ? HYALURONIC ACID FILLERS : OPTIMISATION OF AESTHETIC DENTISTRY AND PATIENT LOYALTY
Figure 1 . Simulation of the treatment on the same patient ( A ) by different specialists . Traditional dental treatment without HA fillers ( B ). Treatment with HA fillers without any dental intervention ( C ). Combined treatment of aesthetic dentistry and HA filler . ( D ). N . B . Images ( A ) and ( D ) are real , images ( B ) and ( C ) have been created by the combination of the first two . Modified from : Costa E ( ed ). Estetica dei tessuti orali e periorali in odontoiatria . Parma , Italy : Acta Medica Edizioni ; 2014 . Courtesy of the author
in the United States strongly preferred injectable or minimally invasive procedures 4 . The percentage increases for facial rejuvenation : more than nine million people , only in the United States , have chosen facial filler and botulinum 4 . The facial rejuvenation procedures with dermal filler ( together with botulinum ) represent the area of higher growth in cosmetic treatments . In the United States alone , in 2015 , patients have paid over 1.6 billions of dollars for facial fillers 4 . The increase in demand of this kind of treatment also increased the number of practitioners who offer this service . This meant that a lot of new figures entered this area of expertise that were not traditionally involved in it . The dermal filler procedure in general , and facial filler in particular , initially neglected by plastic surgeon because it was considered minor , has now become a land to conquer by many specialists . Dermatologists in primis ; followed by gynaecologists , anaesthesiologists and so on : clinicians and nonclinicians 5 . And last , dentists , who finally decided to enter this area . However , still today , with differences from country to country , dentists hesitate to join this area . The most of us in the dental industry are quite ignorant of what these procedures even are , the theories behind them , the way they are delivered and the benefits for the patients . The aim of this paper is to gain the tools to integrate the examination of the soft tissue of the face , with their anatomic and functional characteristics , in the clinical routine , following a simple and well-tested protocol . In this way , dentists will be able to extend their view of the characteristics of a smile and a face and to propose innovative therapeutic solutions , which will meet the patient ’ s request and expectations .
2 . Hyaluronic acid : what it is , where and how it works The hyaluronic acid ( HA ) is the most used filler for the correction of wrinkles , skin imperfections and the remodelling of the face 6 , 7 . HA is a substance normally found in the skin and it gives its characteristics of resistance and maintenance of the form 8 . With age , the physiological production of HA decreases and the skin loses elasticity and tone ; this is what determines the creation of expression lines and wrinkles 6 , 7 , 9 . The HA is a glycosaminoglycan , which consists of regular repeating non-sulfated disaccharide units of glucuronic acid and N-acetylglucosamine 8 . Binding to many water molecules , the HA gives hydration , elasticity and softness of the tissues , protecting them from excessive solicitations 6 , 7 , 9 . The concentration of HA in the connective tissue of the skin gets gradually reduced with time . For this reason , a mature skin appears less elastic and hydrated compared to younger skins . Although it is a normal physiologic phenomenon , many people want to fight the advancing age , therefore prevent wrinkles and other skin imperfections . HA fillers were developed at the end of the eighties 10 . They represent an efficient minimally invasive solution for the imperfections of the face mainly caused by the aging of the skin , but also “ congenital ” 7 . The infiltrations can be performed alone or as a completion of a plastic surgery operation such as lifting . With the injection of HA intradermal the filling of the wrinkles and the increase of the volume of the face is achieved . There are different types of HA filler with different characteristics . The HA does not have side effects , it does not require an allergy test , gives a natural modelling to the treated area and it gets gradually absorbed in a few months ( from four to twenty-four months ) 6 , 7 , 9 , 11 . The time of reabsorption depends on different factors . The most important ones are the type of skin , the treated area , tobacco use , eating habits , overexposure to UV rays ( both natural and artificial ) the quantity and the density of the injected filler 7 , 11 . HA fillers are injected intradermally with pre-measured syringes and thin needles ( from 20 to 30 gauge ).
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