From 12 to 14 February Dr. Hristova joined the first certification course in Bulgaria in cosmetic medicine for dentists for the application of botox and fillers in the lower part of the face. 

„The dose makes the medicine”: botox therapies

Another substance that is crucial in rejuvenating therapies is the botulinum toxin. This strongly poisonous gas causes paralysis of vitally important muscles.

However, when injected under the skin above affected muscles and in the precise curative dose, its effect is relaxing. It is used in ophthalmology in the treatment of crossed eyes, as well as for in treatment of children’s cerebral palsy and only recently of migraine. It improves the symmetry of the face in both a relaxed position and in mimics.

In the last decade the application of botox has become more common in the area of the middle and lower thirds of the face and of the neck. Its simple use however cannot guarantee perfect results because the procedure requires detailed knowledge of facial anatomy. Another difficulty is in the complex muscle interaction in this area. Its use may bring bad results, when applied unprofessionally. A professionally prescribed and conducted botox therapy is accompanying in many cosmetic procedures with the aim of prolonging their action. For instance: in filling wrinkles and augmentation of the skin with fillers, during laser rejuvenating procedures and surgical lifting.

Applying botox in the middle and especially in the lower third of the face is closely linked with dental esthetics and should be the subject of dentistry. Today it is commonly used to block the hyper-mobile upper lip, to relax mimics causing barcode wrinkles and to prevent too much lifting of the upper lip.

Application of botox in treatment of bruxism (teeth grinding) is a most vanguard method

A dose is injected depending on age, gender and the degree of muscle hypertrophy. The effect comes in up to 14 days and lasts up to 6 months.

HYALURONIC FILLERS

The process of face ageing implies a series of changes at the level of cells and tissues. The structure of the skin changes; lipid metabolism deteriorates, while gravity, the polluted environment and bad habits act invisibly, but incessantly. The eyebrows sink, the volume of tissues around the cheekbones decreases, cheeks slacken and a double chin emerges. Lines appear, followed by the typical wrinkles – worry lines on the forehead, crow’s feet around the eyes, rabbit lines occurring horizontally on the nose, barcode wrinkles vertically above the upper lip, smile lines etc. In the past the restoration of the facial contour and of the harmony of the face were solved by using surgery mostly. Surgical intervention however cannot restore the lost volume of tissues. This explains why after the use of a lancet, like for instance face lifting, esthetic worsening of the patient’s face is often the case. What is behind the mystery of this phenomenon? It is in the further loss of volume after rejuvenating surgery. The new philosophy in the cosmetic medicine of the face is based on understanding the need of 3D restoration of soft tissues, i.e. the need to restore their volume, and not just smoothing wrinkles.

Where is the role of the dentist and of esthetic dental medicine in a territory aparently conquered for good by dermatologists and plastic surgeons? How far do our rights as dentists go, as we intervene and voice opinions beyond tooth pathology? Despite confusion in terms what is the most correct way to call us – dentists, stomatologists or dental physicians (according to the year of graduation)? Our work in the field of esthetic dentistry demands widening of the range of our professional competences. Working in esthetic dentistry we not only treat teeth, but also design a new smile for patients. During orthodontic treatment and after placing dentures we change the position of the jaw and of front teeth resulting in indirect changes in the profile of the lower third of the face. By lifting the bite in cases of advanced abrasion we change the height of the lower third of the face, hence the accompanying positive changes in facial proportions. By correcting the lower jaw we correct facial asymmetry. If one of our patients treated in this way, turns to a dermatologist for botox therapy in the lower third of the face, he or she may end up with undesired outcomes in the area of the lips and with general asymmetry of the face. This will inevitably affect our good clinical results. So in this case, who will be responsible – the dermatologist who applied botox or fillers wrongly, or the dentist?

Hyaluronic fillers are successfully applied for bloodless sculpturing of the face and for smoothing wrinkles. In the skin hyaluronic acid is responsible for skin hydration attracting the molecules of water and forming a matrix in which collagen and elastic fibers are knitted. With age the quantity of hyaluronic acid decreases and this causes reduction of skin hydration. As a result the volume and fullness of soft tissues decreases.

Hyaluronic acid is injected in several forms:

Biorevitalizers are in the form of tonic. They contain amino acids, nucleic acids, antioxidants and pure hyaluronic acid. They are suitable for the rehydration of the skin and for wrinkle prophylaxis in young people.

Dermal fillers are applied in the form of injection gel. The action of the hyaluronic filler lasts 6 to 12 months and is reversible.

Gels based on hyaluronic acid are most often used for changing the contour of the face. They are injected to serve as fillers of facial tissue that has lost elasticity and juiciness. Apart from the lifting effect, the contours of the face regain their previous suppleness and volume.