WHO IS THE FACIAL SPECIALIST ? HYALURONIC ACID FILLERS : OPTIMISATION OF AESTHETIC DENTISTRY AND PATIENT LOYALTY
Table 1 . Facial analysis . Main elements to evaluate during skin analysis
1 . Colour . 2 . Phototype . 3 . Texture . 4 . Elasticity . 5 . Thickness . 6 . Type of skin ( dry , oily , mixed , sensitive , dehydrate ) and sebaceous and sweat secretion . 7 . Presence od stains ( ipo- or hyperpigmentation ). 8 . Presence of injuries or neoformations ( scars , inflammation , keratosis , fibroids , dermatitis , etc .). 9 . Presence and distribution of nevous . 10 . Presence of wrinkles ( distribution and depth ).
Table 2 . Glogau ’ s aesthetic and anatomic analysis of the aging skin
Type I
No wrinkles . Patient age 20-30 . Early photo aging ( mild pigmentary changes , no keratosis ); minimal acne scarring ; need minimal or no make-up .
Type II
Wrinkles in motion . Patient age 30-40 . Early to moderate photo aging ( early senile lentigines visible , keratoses palpable but not visible , parallel smile lines beginning to appear ); mild acne scarring ; need some foundation .
Type III
Wrinkles at rest . Patient age 50-60 . Advanced photo aging ( obvious dyschromia , visible keratosis , discoloration with telangiectasia , wrinkle present even when not moving ); acne scarring present that make-up does not cover ; need heavier foundation .
Type IV
Only wrinkles . 60 or older . Severe photo aging ( yellow-grey skin colour , prior skin malignancies , wrinkles throughout , cutis laxa of different origin ); severe acne scarring ; cannot wear make-up because it cracks .
amination to classic dentistry approach allows and simplifies the comprehension of the complex and unique harmony of the faces of our patients 14 . Costa and Di Gioia 14 have proposed a simple but complete and exhaustive facial analysis protocol . It is the collection of all the information we gained by observing the patient during a clinical examination and by examining photos and videos of the face . This analysis consists in three phases : ( A ) analysis of facial proportions ; ( B ) skin analysis ; and ( C ) analysis of the expressive quality of a face 14 .
5 . Analysis of facial proportion Analysis of facial proportions must consider soft tissue ( skin , muscles , subcutaneous fat , intraoral soft tissue ) and hard tissue ( bone and dental support , dento-alveolar relationship ). One must gather as much information as possible about the form , the proportions and the symmetries of the face must be gathered . According to Yarbus ’ studies 15 , when we observe a face , our eyes focus on areas of the face known as Region of Interest . They are the areas of maximum curvature of the face , where the transition between these different areas happens . It is necessary to concentrate our attention on these areas . We practice the soft tissue examination in the three projections : frontal , oblique and lateral view ( Fig . 2 ). In the same projections we will perform a series of aesthetic photos of the face . The patient should be evaluated standing up with his head in a natural position meaning with the eyes staring at a point in the horizon on the same plane as his or her eyes . The best point of view is given when the head pos-
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