As a British Plastic Surgeon, I admit I was ignorant of the positive esthetic and emotional impact of cosmetic dentistry for the majority of my career. Embarrassingly, this is despite treating the same ‘real estate’ as my dental colleagues on a daily basis. However, I am confident that most, if not all, of my medical colleagues involved in esthetics are equally naïve. Despite this, events over the past nine months have transformed my understanding and appreciation of cosmetic dentistry, leading to significant changes within my facial esthetic consultations and my business.
My background is somewhat unconventional. After undertaking plastic surgery training, I moved into pharmaceutical medicine to develop an understanding of the ‘health care business.’ Given my background, joining Allergan, the manufacturer of Botox® and Juvederm® dermal fillers and the leader in medical esthetics, represented the perfect opportunity for me. As Medical Director for Europe, Middle East and Africa, I was responsible for all post market clinical studies, new product evaluations, medical education and physician interactions across the region.
The role, which I held for three and a half years, gave me unprecedented access to how the esthetics market is evolving and those within it adapting. Following this spell, I decided to head back into full time clinical practice, and I now primarily focus on non-surgical and minimally invasive esthetic procedures.
One of the most striking discoveries during my time at Allergan was my observation of how dentists were beginning to take up injectables in large numbers. They either added them in addition to their dental procedures or, in some cases, they solely focused on soft tissue esthetics. This behavioural shift is not surprising, given that dentists are in a unique position to treat the ‘whole face,’ both the teeth and soft tissue. By providing injectables, they were preventing patients from going to other clinics, thereby strengthening the dentist-customer relationship as well as maximizing patient profitability from a procedure that takes 15 to 30 minutes.
The other advantage of adding injectables into a dental clinic is the regular repeat business it provides. Botulinum toxin lasts, on average, three to four months and dermal fillers six to 18 months, meaning patients must come back regularly. The dentists who grasped this opportunity were clearly able to capitalize on a rapidly growing market. The American Society of Aesthetic Plastic Surgery data report of 2017 revealed there was a 40.6% increase in injectable based procedures (botulinum toxin and dermal fillers) from 2012 to 2017. Suddenly, these dentists were able to maximize profitability from their existing database without having to rely on recruiting new patients.
One serendipitous conversation with a cosmetic dentist led me to undergo a consultation myself. This was the beginning of my dental journey. The consultation was a revelation; where I had spent years focusing on the development of static forehead lines or chronic volume loss in my medial cheek worsening my tear trough, I was now all too aware of the poor esthetics of my teeth, which as it turns out superseded any of the soft tissue problems! After being convinced that my concerns of ‘fake’ looking ‘super white’ teeth were unfounded, I agreed to undergo a smile makeover with a mixture of porcelain veneers and minimally invasive orthodontics.
After treatment, I was surprised how natural the result was as well as the immediate impact it had on my confidence when smiling. The experience and outcome also highlighted the limitations of my clinical consultations, an experience I firmly believe should address facial esthetics holistically. My ‘old’ consults took into account three key principles: First, Proportions of the face, followed by what Emotions I believe were being projected by the face (tiredness, anger, sadness, for example) and finally skin quality and whether it has lost its ‘Glow’ (PEG assessment). At no stage did I ever take time to appreciate the importance the smile has on an individual’s facial esthetic.
Although good dentition is essential to anterior projection of the lips, esthetically pleasing teeth can improve the smile whether or not a lip augmentation has been performed. Most negative emotions can be corrected with dermal fillers or botulinum toxin, however bad teeth in the presence of corrected negative physical emotions of volume loss only brings down the quality of the corrective treatments to the soft tissues.
Consequently, I now incorporate a very basic assessment of the dentition and smile purely in terms of its cosmetic appearance. I may decide to refer patients to a dentist before they undergo treatment with me, particularly if they are looking to rejuvenate the peri-oral area. I also may advise a dental consultation with a colleague to complement any facial soft tissue augmentation. PEG has now evolved into PEGS(mile)!
The profound impact of cosmetic dentistry on myself and my patients has led me to open a clinic that brings the worlds of facial and dental esthetics under one roof. The difference with this office is we will have dedicated staff for each field, allowing true expertise to be put into practice. This will be the first center of its kind in the U.K. I believe this model is the blueprint for the whole face approach in our quest for greater patient satisfaction.