Flávio Botulinum Toxin for Facial Harmony

1. Auflage 2019
ISBN: 978-0-86715-998-1
Verlag: Quintessence Publishing Co, Inc
Format: EPUB
Kopierschutz: Adobe DRM (»Systemvoraussetzungen)

E-Book, Englisch, 148 Seiten

The mastery of dentistry brings esthetic knowledge of the face that is applicable to more than just the teeth. In the process of performing a complete facial analysis, the practitioner can identify asymmetries and concerns localized to an area-such as the forehead, eyebrows, nose, or lower face-and offer Botox therapy to increase facial harmony. This book outlines the many clinical uses for Botox, with detailed illustrations and case presentations to support each procedure. The first part of the book covers systematic facial analysis, photographic documentation, and how to plan treatment. Special attention is paid to the anatomy and physiology of the face and the identification of injection points. Detailed treatment instructions for dosage, syringe type, and needle size are included for each procedure, as well as guidelines on how to evaluate results anthropometrically to determine whether esthetic treatment goals have been met. This stunning book will change the way you approach facial analysis and widen your esthetic treatment options for patients.

Altamiro Flávio, DDS, graduated from the Federal University of Goiás College of Dentistry in 1990 and went on to become a specialist in dental prostheses at the Federal University of Uberlândia in 1992. In 2010, he created a continuing education course called 'A Smile for Each Face,' which included topics such as facial analysis, digital planning, dental anatomy, direct and indirect veneers, restorations, botulinum toxin, facial fillers, and viscosupplementation. He continues to teach courses like this all over the world, and he also teaches the specialization course in restorative dentistry at the Brazilian Association of Dentistry in Goiás. Dr Flávio is an accredited member of the Brazilian Society of Aesthetic Dentistry and a founder of the Brazilian Society of Botulinum Toxin and Facial Implants. He maintains a private practice in Goiânia, Brazil.

Autoren/Hrsg.

Flávio, Altamiro

Leseproben

CHAPTER 02 Facial Analysis and Photographic Documentation Dentistry goes beyond treating the oral cavity and smile. A complete facial analysis and use of esthetic references allow the professional to identify changes that can be made to establish facial harmony. During the first appointment, the patient should fill out a medical history form at the front desk. The clinician should then review this history with the patient considering the following: • Main complaints • History of present medical conditions (location, onset, evolution, previous treatments, and possible causes) • Dental history, including all relevant previous treatments not related to the main complaint • Medical history, including all medical conditions and medical interventions • Personal and social history, including oral hygiene, parafunctional habits, and diet habits (sugar, acid) It is important for the clinician to observe the patient at rest, when speaking, and when smiling during this consultation (Fig 2-1). All spontaneous facial expressions should also be observed and recorded. This will allow the clinician to fully evaluate the patient’s face and determine any asymmetries or hyperkinetic muscles. Fig 2-1 First impression. During the initial patient consultation, the clinician should record all facial aspects with the muscles at rest as well as the problems that might arise during the natural smile and speech. Complete Facial Analysis The facial analysis should be as thorough as possible. A complete diagnosis will provide the most effective treatment plan. Therefore, all aspects of the face—the positive and the negative—should be considered from multiple perspectives: • Frontal view at rest and smiling • Profile view at rest and smiling • Photographs of frontal view at rest and smiling • Photographs of profile view at rest and smiling • In case of asymmetries during speech, video of the patient speaking Each facial characteristic and its possible correction should be recorded. The clinician should continue the facial analysis with the following steps: 1. Evaluate the findings according to several esthetic references. 2. Create a numbered list of priorities. At the top of the list should be the least esthetic features that require the most attention. This list will help to explain the treatment priorities to the patient. 3. Subdivide the list of characteristics by type of treatment: therapeutic, structural, and aging. Any therapeutic treatment is most important, followed by structural. A frequent mistake is to only consider the aging process of the patient. 4. Make a presentation using the patient photographs and respective injections points. 5. Discuss the treatment plan with the patient. This should be an interactive discussion. Sometimes patients are surprised when looking at their own photographs because they are used to looking at themselves only through a mirror, which provides fewer details than a photograph. This conversation will provide the clinician the opportunity to readjust the plan according to the patient’s desires for treatment. Figure 2-2 summarizes this process. Fig 2-2 Facial analysis and patient presentation. Photographic Documentation Photography can be used in dentistry for many different reasons, including assisting the clinician during initial examination of the patient; helping with diagnosis; evaluating treatment over time; storing legal documentation; capturing digital material for publication; educating patients or students; communicating with patients and professional team members, colleagues, and technicians; and finally, marketing. Each of these applications enhances and elevates the status of the practice as well as improves delivery of care to patients.1 Regardless of clinical experience, the treatment plan should never be based on a clinician’s intuition. Instead, it should be guided by esthetic, facial, and dental analysis. Evaluation of esthetic references should be performed over the photographs of the patient. Rulers, masks, and projections can be placed over the images and used as tools for facial analysis. This should be done when the patient is not present. Photographs taken during the first appointment help the operator to perform facial analysis and can be used to help the patient understand the treatment plan and diagnosis. The clinician can also obtain facial data by performing measurements directly on the patient’s face. This is faster and more practical than using images for the measurements, which are scale representations. At least one actual measurement on the patient’s face should be recorded when the patient is present so that the other measures can be proportionally performed using an image. Studio infrastructure It is important to equip the dental office with a photographic studio to ensure that any photograph taken is good quality and captures the necessary information. A proper photographic studio includes the following (Fig 2-3): • Two medium-sized soft boxes to diffuse a smooth and regular light to the patient’s face. They should be slightly longer than the vertical measurement of the patient’s face and neck. Avoid smaller light sources because they tend to concentrate the light at the center of the face. Modern digital cameras are able to remotely command the soft box, shooting with no need for cables. • One hair light to delineate head contour, thereby improving the contrast with the black background. Black backgrounds are neutral and do not compete with the face. Position this light above or below the face so that the device is not displayed. • Three tripods to support the flash units and hair light devices. They should be positioned higher than a tall standing patient. • One black background with its own support to standardize the photographs. Avoid a white background, as it will compete with the face because it is brighter than the skin. A matte background is preferred to avoid shadowing. Fig 2-3 Studio infrastructure. A, soft box. B, hair light. C, tripod. D, black background. Preparing the patient Certain procedures must be performed before photographs are taken to ensure that the photographs capture the necessary information: 1. Remove all makeup from the face, because it blocks the visualization of the skin. Keep the face dry at all times to avoid reflexes from the flash. ? Provide makeup removers and cotton pads. 2. Neutralize the hair by tying it up and using headbands. ? Provide the most discreet type of headband. 3. Ask the patient to remove all jewelry (eg, earrings and necklaces) to eliminate the distraction. ? Focus on the anatomical aspects of the face. 4. Instruct the patient to look horizontally and not tilt or turn the head. ? Consider the patient’s height and indicate on the wall or the flash unit where he or she should look. Facial photographs should be taken with the lips closed, with the lips relaxed, and with the patient smiling (Fig 2-4). Lips closed: Instruct the patient to avoid moving the face so that the facial muscles will not be activated. Also instruct him or her to slightly close the lips. Lips relaxed: Instruct the patient to keep the same position but relax the lips. Ask the patient to breathe through his or her mouth. Smile: Ask the patient to smile as spontaneously as possible. The photographer should also smile and say something funny to encourage a natural smile. Ask the patient not to incline the head sideways when smiling. Fig 2-4 Facial photographs. Protocol Frontal and profile facial views should be captured (Figs 2-5 and 2-6). Facial views should also be taken with the patient sitting to diagnose wrinkles, grooves, and volume deficiencies (Figs 2-7 and 2-8). Frontal view Fig 2-5 The photographer should bend the knees so that the camera is parallel to the ground and at the same level as the patient’s face. The flashes are positioned almost perpendicular to the face. Profile view Fig 2-6 Only one flash is moved laterally, almost perpendicular to the frontal plane of the face. Sitting view (“shower technique”) Fig 2-7 The patient should sit on a stool so that his or her face is below the flash. The seat should not have a back support so that the patient can keep the head in a natural position. Flash positioning Fig 2-8 Flash positioning is important when taking photographs to diagnose wrinkles, grooves, and volume deficiencies. (a and c) Photographs used for diagnosis with the flashes positioned in a conventional way, that is, at the same height as the patient’s face. (b and d) Photographs taken on the same day but with the flashes positioned above the patient’s face, similar to a shower technique. Note...