WHO IS THE FACIAL SPECIALIST ? HYALURONIC ACID FILLERS : OPTIMISATION OF AESTHETIC DENTISTRY AND PATIENT LOYALTY
Table 3 . Characteristics of the dermal filler with hyaluronic acid procedure Duration of the procedure . From five to fifteen minutes .
Necessity of post-treatment observation .
Until one hour from the treatment . It does not require particular environment ( it can be done in the waiting room ).
Type of treatment . Local infiltration ( hyaluronic acid ) absolutely biocompatible .
Necessity of post-treatment medications .
Inability period or post-treatment convalescence .
Post-treatment outcome .
No medication . Useful post-treatment check to evaluate the result and eventual ‘ touch up ’.
None . It is possible to resume activities immediately after the operation ( lunch-time treatment ).
None . The injection does not create any scars and the complete absorption of the hyaluronic acid does not create outcome . Complications are very rare ( usually self-limiting ).
ture respects the parallelism between the Frankfurt plane and the horizon . We will be looking for the same posture of the head in all the other projections as well . In the frontal view we will divide the face in three thirds : the upper third , in between the hairline and the line which links the upper points of the eyebrows ; the middle third , in between the line which links the upper points of the eyebrows and the inter-alar line ; and the lower third , from the interalar line to the chin ( Fig . 3A ). We can now evaluate the proportions between the three thirds , which should have similar dimensions . In the frontal view we also identify several lines , which will be used as reference points ( Fig . 3A ). Some of them ( bitemporal , bipupillar , bizygomatic , bigonial ) can be used to evaluate the shape of the face . The form of the face can vary a lot from one patient to other . This is an important parameter to take into account as the patient ’ s request could modify the form of his or her face . Sometimes , the patient will ask to soften the curves of the face or to emphasise some characteristics . We will have to verify the parallelism between these lines and the inter-commissural line . An eventual lack of parallelism between the inter-commissural line and the horizontal lines of the face should also consider an accurate dental occlusion evaluation . Using the frontal view again , the symmetry of the face can be analysed . Let us draw the vertical plane ( a median line of the face passing through the centre of the glabella and the centre of the upper lip philtrum ); let us examine the deviations , the asymmetries , the deviation of the tip , and dorsum of the nose ( Fig . 3A ). With the comparative analyses of the two hemifaces , it is possible to immediately detect eventual asymmetries without being influenced by the mimic . The second projection is the oblique one ( Fig . 3B ). In the oblique view we can focus on the face at about 45 ° to highlight the angle formed by the buttress of the zygomatic bone on the external profile , which with young women is projected upwards : it is also known as malar projection angle , it becomes more evident with age as it gets smaller and the zygomatic buttress gets lower . From the oblique projection , we will examine the look of the temporal and periorbital area , of the cheek and mandibular angle . These areas , too , lose tone and tend to fall with time . Moreover , we can observe the form and the dimensions of the nose and its relationship with the philtrum . The third projection is the profile ( Fig . 3C ). The division of the face in three thirds , as in the frontal view , gives us information concerning the facial height , especially about the lower third of the face . On the profile we analyse several angles : the fronto-nasal angle ( 115 ° -130 °); the naso-labial angle ( 85 ° -105 °), it shows if the tip of the nose is facing down and it gives us information on the form of the upper lip ; the labio-mental angle ( 110 ° -130 °), which describes the direction of the labio-mental sulcus and allows us to evaluate the form of the lower lip 14 . A profile is defined as concave ( common in the elder patients or edentulous patients ) if the angle formed at the intersection of the line drawn from the glabella to the sub nasal point with the line from the sub nasal point to the cutaneous pogonion is bigger than 180 ° or convex if the corner is smaller than 180 °. This angle gradually changes with age . It becomes increasingly wide until it reaches figures such as 200 ° in edentulous older patients . Once the proportions of the face have been studied as a whole and we have an idea of the unbalanced areas , we can observe the aesthetic regions of the face , following a useful medical division of these parts ( Fig . 4 ); we can now examine each of these areas and each area ’ s relation to the others , to identify the ones , which may need intervention . The lips and the perioral region represent the main areas of aesthetic intervention for the dentist . Therefore , very deep knowledge of its biological and anatomic characteristics of it is required . We will evaluate form , dimension , volume , tone and symmetry of the upper and inferior lip . We will observe the relationship between the upper and inferior lip ( ideally it varies from 1:2 in favour of the lower lip ’ s height ). It is necessary to respect these characteristics even after the corrections , on both intra and extra-oral level , to preserve a natural look . The lip and perioral region is subdivided into at least ten sub-regions with very different characteristics from one another , which require different ways of therapeutic approach ( Fig . 5 ). Each one of
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