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Best Clinics Australia 📍Bribane Edition•

Sun, 11 Feb 2024 22:16:25 GMT

Best Clinics Australia ��Brisbane Edition•

Join us as we visit one of Australia’s Best Clinics in Newstead an inner northern riverside suburb of Brisbane.

A former wool-store converted into a modern dental clinic in one of Brisbane’s landmark buildings.

Dr Cate Gerber the owner & founder of Smile Studio Newstead has set up the practice to involve all of the facets of Dentistry and Facial Aesthetics.

Dr Cate Gerber is one of the early adopters of Facial Aesthetics, expanding her services beyond the oral cavity, to successfully offer her patients a higher level of care.

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3 Lies Dentists are told about “Botox”

Mon, 22 Jan 2024 17:58:53 GMT

3 Lies Dentists are told about “Botox”

There is certainly no denying the fact that when Botox injections, and other facial rejuvenation therapies like dermal fillers and thread lifts, were first pioneered and introduced to Dentists in Australia, by the Australasian Academy of Dento-Facial Aesthetics (now AADFA INTERNATIONAL) www.AADFA.net back in 2009, it was a controversial move for the profession.

While it’s debatable as to whether any controversy was ever really warranted, especially as there has never been a complaint upheld by regulators or any litigation from patients in relation to a Dentist performing facial rejuvenation procedures (unlike the scores of cases involving Dentists performing implants, orthodontics, root canals and prosthodontics); it was not entirely unexpected given that anything new in dentistry seems to set the proverbial cat amongst the same old groups of pigeons.

The same was true with the introduction of implants, short-term orthodontics, considerations around airways and sleep disturbances, there was even push-back over teeth whitening. Commonly, the resistance and negative commentary around innovative steps for the profession often come from people with no real knowledge, insight or experience with the new offering. The most vocal detractors across different forums tend to be those who are either inherently nervous about change and/or those feeling insecure, jealous or uneasy about being left behind, realising they lack the ability, knowledge or understanding to provide new offerings and keep pace with the ever-evolving nature of dentistry. Such voices will always try and hold others back to a level on which they feel comfortable, such is life.

Thankfully, most rational and confident Dentists accept that while they may not wish to, or be able to, personally engage in new areas, they would never begrudge their colleagues from doing so, nor undermine the advancement of the broader profession, recognising that it would simply be petty, spiteful and unprofessional to claim that those who can, shouldn’t. Ultimately, true professionals live by a “to each their own, as long as the patient is happy and well-cared for”, philosophy.

However, now that Botox injections and other skin rejuvenation procedures have become an accepted part of the dental profession; with AADFA having worked with the Dental Board, the ADA and indemnity insurers to have clear policies in place stating as much; what continues to be inexplicable are the blatant lies some people continue to promote among their fellow dental professionals. At this late stage, after all has been said and done to advance the profession in this sphere, to continue to deal in untruths and scaremongering must only be to hide their own personal and/or professional inadequacies.

Here are the TOP 3 lies (and the truth behind them), that continue to permeate through the dental profession in relation to performing facial aesthetic procedures, paradoxically, some told by practitioners performing Botox injections already – a sign that while they may have dabbled in some basic training, they are a long way from professional mastery:

1. “Certain facial procedures are outside your scope of practice”

Seemingly, few Dentists realise that AHPRA and the Dental Board do not dictate which clinical procedures can and cannot be performed by practitioners. While regulators are responsible for laying down a broad set of general codes, guidelines and standards, there is (necessarily) considerable clinical freedom afforded to practitioners so that they can provide their patients with the best care for their individual circumstances. Policies put in place by responsible regulators are deliberately open-ended in recognition that healthcare delivery is constantly evolving. To be overly restrictive would ultimately stifle innovation, to the detriment of the public they serve.

This is true of all facets of modern dentistry, with facial rejuvenation procedures viewed no differently by regulators than any other procedure performed. Essentially, provided a Dentist is appropriately trained/educated; provided they have indemnity insurance to cover the procedures being performed; provided they are working within their own competency, following accepted protocols backed by scientific literature; and so long as they are adhering to the over-arching principles around professional ethics; then practitioners are free to provide any services they wish across their area of expertise. That area of expertise is best thought of as the complete oral and maxillofacial regions, given it is that anatomy which forms the foundation knowledge a Dentist attains at university.

The Dental Board has made this position abundantly clear and have published some great resources on their website, in the form of recorded webinars, Q&A sessions, position statements and reflective practice tools, to help practitioners understand the landscape without having to listen to those who troll the profession from the peanut gallery.

Ultimately, the key to ensuring safe and compliant practice with new procedures, like Botox, facial thread lifts and fat dissolving injections, is for Dentists to engage in comprehensive, recognised, and accredited continuing education programs, run by industry leaders, not dabble in dubious short courses.

2. “You should become a Cosmetic Injector”

15 years ago, AADFA developed the concept of “Complete Dento-Facial Health & Aesthetics”, which focused on having Dentists stepping comfortably into a broader facial health screening, prevention, and maintenance role. A focus on health first, with aesthetic improvement flowing as a natural consequence of improved health, allowed Dentists to successfully offer patients a higher level of care across the dento-facial region, while still being Dentists, focusing patients on the right goals – the attainment of better health, rather than overdone cosmetic distortion.

This approach revolutionised the broader cosmetic industry, with doctors and nurses now following AADFA’s lead, moving away from the antiquated and dangerous “cosmetic”; “anti-wrinkle”; “youth-restoring”; messaging of the past, which only serves to play on patients’ insecurities.

Yet we are now seeing some Dentists, encouraged by inexperienced, opportunistic, and derivative “educators”, set to repeat the mistakes of the past by calling themselves “Cosmetic Injectors”, who offer “Cosmetic Injecting”. This is a move solely designed to mislead patients into thinking these individuals possess some specialized qualification or ability when compared to other practitioners. It is narcissistic behaviour that puts the practitioners’ ego and desire to make a quick buck ahead of the best interests of the patient. Often such practitioners are prolific across social media platforms, trying to lure people by sprouting the latest fad treatment approaches, with catchy names like Russian Lips, Lip Flip or the Fern technique, rather than focusing on proven, safe and reliable methodologies.

Thankfully, a current review by regulators into this, and broader issues around the use of the term “Cosmetic Surgeon”, is set to crackdown on such unscrupulous behaviour. Patients and fellow practitioners are being warned to run a mile from anyone promoting themselves as a “Cosmetic Injector”.

3. “Thread Lifts don’t work; Botox & Dermal Filler are all you need”

An extension to falsely claiming that specific facial procedures may be out of a Dentists’ scope of practice, a common misgiving is that training in Botox and Dermal Filler injections is all that is needed for Dentists to successfully move into this sphere.

The facial deterioration process with age is a multi-factorial, three-dimensional, constantly evolving process. It spans multiple different tissue types, from underlying skeletal and structural changes; shifting contours and volume loss across various fat compartments; changes in facial muscle activity; as well as a reduction in the quality and integrity of dermal components. With so many changes occurring, in conjunction with the peculiarities of any given individual, there is no single treatment that can fix everything and only a multi-pronged treatment plan will achieve the best clinical outcomes and patient satisfaction.

In days of old, practitioners and patients were limited in the materials and treatment options available for facial rejuvenation, like life for the edentulous prior to the advent of dental implants. This meant that clinical results were always compromised, and complication rates were much higher, when all we had available was Botox and Dermal Filler. Nowadays, Botox and Dermal Filler, while still important aspects of overall facial rejuvenation, are used to a much lesser extent, in favour of safer, more effective, and less costly treatment developments.

When a single tool is being applied as a cure-all, problems soon follow. A failure to understand ALL the available treatment options and the proper sequence of their use; limiting treatment to certain isolated areas of the lower face; and an over-reliance on a limited range of tools, leads to a multitude of problems, from a lack of informed consent, through to inappropriate treatment approaches causing unnecessary clinical complications and poor aesthetic outcomes.

Invariably, those who only promote, teach, or provide a limited range of treatment options, telling others to avoid various procedures, only do so out of their own inability to understand or successfully deliver said procedures. It has reached a point now where, if a practitioner is only learning, promoting, or delivering Botox and Dermal Filler for facial rejuvenation, they should STOP immediately! This also extends to practitioners who say that procedures should only ever be performed in a certain way, such as with a cannula instead of a needle. Such commentary displays a dangerously limited level of comprehension, skill, and experience.

Successful Dento-Facial rejuvenation can NEVER just be about learning Botox and Dermal Filler injections. Dentists need to become knowledgeable in the full spectrum of facial rejuvenation, able to appropriately consult patients; diagnose and treatment plan utilizing an array of techniques, ranging from scientifically proven at-home skincare products and sunscreen, through to dissolving fat deposits and performing thread-lifts to address skin laxity.

The only way to achieve this is to engage in a comprehensive, accredited pathway of learning, which culminates in a deep understanding of dento-facial health and rejuvenation, including the full array of available treatment options. The easiest way to do that is to align yourself with the pioneers in the industry, who have been there every step of the way and understand what you need to succeed, which, these days, MUST include the very latest in ultrasound guided injecting protocols, such as those developed and taught during the AADFA Fellowship Program.

Contact AADFA to find out more about learning to perform facial rejuvenation the right way:

clinical@aadfa.net

Best Clinics Australia 📍Adelaide Edition

Thu, 30 Nov 2023 17:41:10 GMT

Best Clinics Australia ��Adelaide Edition•

Join us as we visit one of Australia’s Best Clinics in vibrant Henley Beach, a coastal suburb of Adelaide.
Dr Deb Rea, founder of Azura Dental & Cosmetics has been offering Facial Aesthetic & Rejuvenation treatments for over 10 years when her journey first began with AADFA International.

Dr Deb completed the AADFA Fellowship to become one of the most-highly trained, early adopters of new treatment options, like facial thread lifting procedures and portable ultrasound technology which offer safer, more natural and more effective options for patient care.

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Private Training in BOTOX & Beyond, AADFA pioneers a new industry standard!

Fri, 01 Sep 2023 04:16:50 GMT

From July 1st , 2023, new rules around the use of facial injectable treatments took effect in Australia, coinciding with the introduction of new, industry-leading, private practical training by AADFA.

Private, 1-on-1 training as standard.

Since AADFA first introduced the award-winning, “health-based”, Botox concept and training in dento-facial aesthetics back in 2009, the practices and patients of thousands of Australian Dentists have benefitted greatly from the opportunity to offer skin health and rejuvenation services alongside traditional dentistry.

Now, as new rules around education, patient consultation and treatment delivery come into effect, AADFA continues to pioneer the industry, moving beyond out-dated group training sessions to offer private, 1-on-1, practical training for all Dentists, through AADFA Private Atelier Clinics across the country and around the world.

This new, personalised approach continues to position AADFA trained Dentists as the gold-standard in the industry, providing them with unparalleled levels of support and increasing opportunities for Dentists to excel in this field.

Botox and Dermal Filler are not enough.

I n the last few years, we have seen the convergence of two phenomena in the facial aesthetic arena ; patient’s increasingly seeking more natural results and the development of safer treatment approaches. To keep pace with this evolving field, Dentists can no longer simply learn and rely on the old Botox and Dermal Filler treatments.

AADFA’s Fellowship Pathway of Learning, ensures that Dentists gain a comprehensive knowledge and practical skill in ALL aspects of facial rejuvenation allowing them to achieve results like never before. For the first time, new regulations now make it abundantly clear that Dentists can no longer simply offer Botox and Filler injections without a comprehensive understanding of the many other treatment options for facial rejuvenation that make the process safer and more effective.

While Dentists do not have to provide all the alternate services themselves, in order to gain fully informed consent, it is now a requirement that practitioners must be educated in; understand and discuss all treatment options in the patient consultation, including procedures that can make even basic Botox and Filler treatments safer.

In line with the National Safety and Quality Health Service (NSQHS) requirement for practitioners to minimise risk to patients, AADFA Fellows are now the leading operators of portable ultrasound technology in the industry. Ultrasound Guided procedures allow AADFA Dentists to directly visualise anatomy in real-time and eliminate potential complications like blindness and skin death from dermal filler.

Hundreds of responsible Dentists have already recognised this inherent professional duty, engaging in the AADFA Fellowship to become among the most-highly trained, early adopters of new treatment options, like facial thread lifting procedures, which offer safer, more natural and more effective options for patient care, allowing them to reduce their reliance on older, more dangerous, and more expensive materials like Botox and Filler.

The full AADFA Fellowship pathway involves extensive blended learning, completed at the Dentists’ own pace and supported by an abundance of FREE resources including textbooks, research papers, detailed training manuals and technique videos. Regular video conferencing allows Dentists to connect with educators and who then guide them through their private, 1-on-1 practical patient training sessions in one of AADFA’s modern Atelier clinics.

W ant to learn more?

For further information on gaining a comprehensive education in facial rejuvenation procedures, and to ensure you receive the best possible private training and ongoing support, visit www.AADFA.net or

email: clinical@AADFA.net

Facial injectables in dentistry

Mon, 17 Jul 2023 10:08:36 GMT

A decade ago Dr Myles Holt found himself at the centre of a major dentistry dispute concerning the future of facial injectables.

Now he’s having the last laugh.

By Tracey Porter

A pioneer in the art and science of aesthetic dentistry training, the training institution Dr Myles Holt started in Australia, the Australasian Academy of Dento-Facial Aesthetics (AADFA), has recently been the subject of a corporate acquisition. It now operates across 20 countries worldwide with a 12,000-strong membership base.

Injecting credibility

Y et just a decade ago, Dr Holt’s attempts to offer greater freedom for Australian dentists to use facial injectables in their surgeries were roundly criticised.

At the time, he drew the ire of several regulatory bodies as well as others in the profession who, on the back of horror stories about the use of botox and dermal fillers in the cosmetics industry and its links to body dysmorphia, felt allowing dentists to administer facial injectables risked blurring the line between necessary and unnecessary healthcare.

Back then no structured training programs existed for clinicians, and no clear standards and protocols had been developed to guide them.

Dr Holt says while it has never been illegal for dentists to provide such services, he and his team didn’t expect the level so much resistance from within their own profession.

He says “the establishment’s” initial hesitancy stemmed from “a lack of understanding. Despite these treatments having a long history of safety and efficacy, they were occasionally the centre of controversy simply because they were being delivered by lesser trained, less well-regulated individuals.”

As a result, Dr Holt says the AADFA spent considerable time working with various stakeholders and advising on policy development.

These efforts have now come full circle. In recent years both the Australian Dental Association and the Dental Board of Australia have put clear guidelines and policies in place for dentists wanting to offer these services.

"Despite these treatments having a long history of safety and efficacy, they were occasionally the centre of controversy simply because they were being delivered by lesser trained, less well-regulated individuals. "

Dr Myles Holt, founder, AADFA

E arlier this month new regulations were introduced by the Medical Board of Australia (MBA) and the Australian Health Practitioner Regulation Agency (Ahpra), to weed out unscrupulous operators in the broader cosmetic injectables sector.

Beyond the smile

D r Andrew Molloy, principal dentist at The Practice , in Bris bane’s West Village, oversees four clinicians, who each provide facial injectable treatments alongside more traditional dentistry services.

Dr Molloy says these treatments are extremely popular because of the impact teeth positioning, crowding, bite types, missing teeth and collapsed bites have on facial anatomy and facial aesthetics.

Dr Molloy says when he first began offering injectables as a service, the most popular treatment was using botox as a targeted muscle relaxant injection for TMD cases, bruxism, gummy smile, facial pain and, on occasion, migraines.

However, as training standards improve and regulations tighten, more patients are seeing the value in selecting a dental clinician to administer ultrasound-guided botox, filler injections or thread lifts to avoid adverse outcomes from untrained operators, or to supplement any dental treatment they may have already had, such as the correction of chipped teeth, and the installation of dental implants, crowns and veneers. Treatment of the surrounding tissue often provides further benefit.

A changing audience

Dr Holt says it could justifiably be said that the ‘typical’ patient seeking these treatments in the cosmetics industry tends to be female and getting younger. However, AADFA member surveys paint a slightly different picture.

“As these are often just adjunctive services offered by dental practices, typically we see that patients receiving treatment in these settings are existing patients of the dentist who are already getting the services done elsewhere but would prefer to receive treatments alongside their regular check-ups and dental cleanings for the sake of convenience.”

The number of patients who may have wondered about these services but never felt comfortable walking into a ‘cosmetic clinic’ is also increasing, he says.

What’s interesting is that the fastest growing demographic in this sector is men over 40, and they definitely love being able to receive treatment from their trusted dentist, without the stigma that can be attached to attending a cosmetic clinic.

Dr Myles Holt, founder, AADFA

“These patients have developed a rapport with their dentist, they appreciate that dental practitioners have high levels of training, skill in delivering injections and are well-regulated in terms of infection control and responsible care.

“What’s interesting is that the fastest growing demographic in this sector is men over 40, and they definitely love being able to receive treatment from their trusted dentist, without the stigma that can be attached to attending a cosmetic clinic.”

Dentists leading the way

Dr Holt, who is now based in the AADFA International corporate office in Spain, with the new role of global clinical director, says as early adopters, dentists now lead the broader industry in the provision of new technology and treatments offering safer and more effective patient care.

Dentists are the number one providers of facial thread lifting procedures and the number one users of portable ultrasound technology to be able to directly visualise anatomy and eliminate complications from dermal filler, like blindness and skin death.

Dr Holt says the provision of facial injectable and skin rejuvenation procedures by dental practitioners is now viewed no differently by regulators than for any other procedure performed by the profession.

Whether it is traditional restorative dentistry or more advanced fields like implantology, orthodontics or facial rejuvenation, Dr Holt says there are clear guidelines and expectations that practitioners will have undergone appropriate levels of training; possess indemnity insurance for the specific procedures performed; gain fully informed consent; and taken the time to develop competency in their clinical practice.

The regulations governing these types of procedures were tightened even further on 1 July 2023 where everything from levels of education to predatory advertising and the use of certain misleading professional titles were targeted.

The reforms, introduced by MBA and Ahpra, have built-in safety nets such as the requirement for psychological screening for all cosmetic surgery patients, as well as mandatory cooling-off periods aimed at removing the risk of adverse outcomes.

Visit Bite Online HERE: https://www.bitemagazine.com.au/facial-injectables-in-dentistry/

READ the latest Bite Magazine HERE: https://mags.engagemedia.com.au/bite-magazine-july-2023.html?p=14

In Your Face

Wed, 05 Jul 2023 10:50:24 GMT

In your f a c e

A decade ago Dr Myles Holt found himself at the centre of a major dentistry dispute concerning the future of facial injectables. Now he's having the last laugh. By Tracey Porter for Bite Magazine

READ THE Bite Article HERE

BOTOX Update: New Laws, New Products, New Opportunity!

Mon, 15 May 2023 03:17:17 GMT

BOTOX Update:

New Laws, New Products, New Opportunity!

From July 1 ^st , 2023, new rules around the use of facial injectable treatments are set to take effect, coinciding with Australia receiving the first new Botox product in almost a decade. Dr Markus Weber discusses how these long-awaited developments present a BIG opportunity for Dentists.

Since AADFA first introduced the concept and training in dento-facial aesthetics back in 2009, the practices and patients of thousands of Australian and New Zealand Dentists have benefitted from providing Botox and Dermal Filler injections.

Yet despite the excitement and success, practitioners and their patients also had to manage certain limitations, inherent with these products and procedures. Chief among these issues was products were expensive to buy, with that cost necessarily passed along to patients, placing it beyond the financial reach of some.

Additionally, unscrupulous practices in the broader “cosmetic” industry created difficulties for some Dentists being able to compete on an even playing field, while the risk of significant complications, like blindness from dermal filler injections, loomed large in the minds of practitioners with no direct imaging techniques available to guide them and keep them safe.

Thankfully, a long overdue review of the “cosmetic” industry has brought about sweeping changes to regulations governing the provision of Botox and Dermal Filler treatments. The new regulations commence mid-year and along with a newly launched Botox product; ultrasound guidance for injections; and enhanced treatment protocols and training programs, mean that Dentists are now better placed than ever before to take the responsible lead in the field of dento-facial aesthetics.

NEW LAWS

The “cosmetic” industry has been cowboy country for far too long, with horror stories becoming regular headlines. Thankfully, starting on July 1 ^st , regulations are being tightened, targeting everything from levels of continuing education and the process of patient consultation, through to predatory advertising and the use of certain misleading professional titles.

AADFA fully supports these long-overdue changes and yet there has been some inaccurate commentary around the true implications of these changes for Dentists.

While the new regulations have been initiated by the Medical Board of Australia and initially focus primarily on cosmetic surgical procedures, performed by medical practitioners, there are also clear guidelines for the provision of non-surgical procedures, including Botox and Dermal Fillers. Some commentators have suggested that as these regulations are directed toward medical practitioners, they have no bearing on Dentists providing the same services – this is short-sighted.

It stands to reason that Dentists would be expected to be in line with their medical colleagues providing the same services, with the Dental Board already stating in their fact sheet on the topic that they will draw on such advice to other health practitioners, when managing and assessing a notification against a Dentist. Dentists are already expected to avoid inappropriate social media promotion and advertising which glamorises cosmetic procedures and minimises the complexity and risks of procedures, and they are already warned against the use of deliberately misleading and deceptive titles like “cosmetic injector”.

However, what’s comforting is that because of AADFA’s industry-leading approach to comprehensive education and responsible patient care from the beginning, AADFA trained Dentists are well-positioned in relation to the new rules, already representing the higher standard and following the proper protocols that regulators are now trying to replicate and enforce within the broader cosmetic industry.

In fact, the new requirements for all practitioners will now serve to level the playing field, reducing the negative impact of unscrupulous budget cosmetic chains and allowing the high standards maintained by Dentists to become the preferred option for patients and the gold-standard in the industry, increasing opportunities for Dentists to excel in this field.

However, there are a few points in the new regulations that should concern some Dentists, especially those who trained in these procedures a long time ago, or who undertook training as a basic short course, with an unrecognised provider.

1. Ongoing recognised education:

Aside from the existing Dental Board requirement for Dentists to ensure they undertake initial training at an appropriate standard, by a recognised provider, the new regulations take this further, requiring practitioners whose scope of practice includes cosmetic procedures, to undertake regular continuing education that includes activities related to those procedures and which involve reviewing their performance and measuring their outcomes.

This means that a Dentist who underwent basic training once and has done nothing since to maintain and update their knowledge, skills and competencies, will now be in breach. It is also insufficient to simply read a textbook or journal article; watch a YouTube video or webinar; or even attend a conference. Dentists are required to engage in an activity, like AADFA’s “Refresher” programs, which test and provide mentoring feedback to ensure ongoing professional competency in this field.

2. Botox and Dermal Filler are not enough:

In the last few years, we have seen the convergence of two phenomena in the cosmetic industry - patient’s increasingly seeking more natural results and the development of safer treatment options, beyond the old Botox and Dermal Filler approaches. For the first time these new regulations make it abundantly clear that Dentists can no longer simply offer Botox and Filler injections without a comprehensive understanding of the many alternate treatment options for facial rejuvenation.

While Dentists do not have to provide all of the alternate services themselves, in order to gain fully informed consent, it is now a requirement that practitioners must discuss all other treatment options in the patient consultation, including procedures that may make treatments safer and are available and offered by other practitioners.

Many responsible Dentists have already recognised this inherent professional duty, engaging in AADFA’s comprehensive Fellowship Pathway of Education, becoming highly trained early adopters of new technology and treatments which offer safer, more natural and more effective options for patient care, beyond Botox and Filler. This includes AADFA Dentists currently being the number one providers of facial thread lifting procedures and the number one users of portable ultrasound technology, allowing them to reduce their reliance on older, more dangerous materials and - now able to directly visualise anatomy in real-time - eliminate complications from dermal filler, like blindness and skin death. This is also in line with the existing National Safety and Quality Health Service (NSQHS) requirement for practitioners to minimise risk to patients.

3. Psychological Screening:

In todays’ social media driven world, it is an unfortunate fact that an increasing number of patients, of all genders and ages, seek cosmetic treatments in response to feelings of inadequacy and negativity, in the hope that they will somehow find an inner peace through external enhancement.

While well-trained Dentists are already aware of this growing potential, and include an assessment of common signs associated with these psychological conditions in their consultations, new regulations now make it compulsory for practitioners offering cosmetic treatments to specifically screen for conditions like Body Dysmorphic Disorder (BDD), using a recognised and appropriate screening tool.

If the screening tool indicates that the patient may have underlying psychological issues making them unsuitable for the cosmetic procedure, they must be referred for evaluation to a psychologist, psychiatrist or general practitioner who, importantly, does not provide cosmetic procedures themselves.

NEW PRODUCTS

One of the issues facing practitioners entering the facial injectable arena in Australia has traditionally been the high cost and limited choice of available Botulinum Toxin (Botox) products. This was also a major concern and obstacle for many patients, coupled with a limited treatment longevity of around 3-4 months. Despite numerous products being available overseas, and many more under development, this lack of competition in the marketplace remained frustrating for local patients and practitioners for many years, with it being close to a decade since the last new Botox product arrived.

This status quo is set to change thanks to a flurry of new products entering the market in coming years, starting with Letibotulinum Toxin (Letybo®, Hugel Aesthetics), which is currently the only new product available to Australian practitioners right now.

Letybo® is a product that dilutes; has a unit system; and injects in line with that of the current Australian market leader, Botox®. While new to the Australian market, it has a long history, having been developed in South Korea over 12 years ago; registered, used and extensively researched in over 50 countries worldwide; with over 26 million vials being used to date.

However, the first important thing to note is that none of these new products will be “game changers”. A game changer would denote a product that somehow revolutionised the way the treatment was delivered (e.g. a topical versus injectable); making it more simple; improving the safety profile of the treatment; or that delivered spectacularly better results that the others couldn’t – none of these new products do any of that. What they do is increase industry competition and drive down prices.

New products fall broadly into one of two categories: A) those that deliver exactly the same treatments we are all used to, but at a much lower cost for practitioner and patient (e.g. Letybo® and Jeavenu®, Evolus), or, B) those that claim to last longer but are considerably more expensive, difficult and different to use (e.g. Daxxify®, Revance Aesthetics). AADFA believes that the lower cost predictable products will better drive industry competition that has been long overdue, ultimately benefitting our patients financially and making them accessible to more people - but they won’t change the clinical landscape at all.

While the clinical landscape could potentially be changed by longer-lasting products, which certainly sound appealing, what some who have drunk the cool-aid and swallowed the marketing hype of product manufacturers, describing them as “game changers”, simply fail to understand, is that products rarely behave in the real world as they do in sponsored research projects.

To date, this category of products is largely untested globally in real world settings. Practitioners in a single country have only been using this product for less than 6 months and all reports are that, while the thought of (maybe) achieving a month or two longer clinical duration is appealing, it is substantially outweighed by the higher cost of each treatment and the fact that the product requires practitioners to operate completely differently to how they have been working for years.

Perhaps most importantly, even if the longer duration does prove to be a reality, this would also mean that any potential complications experienced would also last considerably longer – 6 to 9 months of a drooping eyebrow or asymmetrical smile hardly sounds appealing to many patients. Given the fact that the first new product to hit the Australian market in a decade is easy to use, requires no change in behaviour, presents no new risks, and will drive down consumer pricing, it’s hard to see a day when a more expensive, more complex product will significantly move the needle (pardon the pun), just in the hope that it may last a little longer.

Want to know more?

AADFA recently held a series of webinars with in-depth discussion on the new regulations and product developments, including information on the best psychological screening tools to use in clinic during cosmetic consultations.

For further information, and to ensure you receive the best possible ongoing training and resources to remain compliant, contact AADFA for a recording of those sessions by visiting www.AADFA.net or emailing clinical@AADFA.net .

Injecting Botox & Dermal Filler the old way? Stop now!

Wed, 01 Jun 2022 14:35:06 GMT

AADFA INTERNATIONAL discusses the new clinical & legal standard that has now commenced for practitioners performing facial aesthetic procedures.

Coinciding with the development of new technology and clinical protocols for the delivery of Botox, Dermal Filler

and other facial aesthetic procedures, several new regulatory and legal standards, concerning dental practitioners, took effect this month. The upshot for Dentists performing facial aesthetic procedures is – continue injecting the old way at your own peril!

What was wrong with the old way of injecting Botox and Dermal Filler?
In almost every aspect of modern dental practice, clinical procedures are made safer and more effective by using routine imaging.

Yet, until recently, a blind approach to treatment provision was the only option practitioners had when performing facial aesthetic procedures like Botox and Dermal Filler, as no appropriate chairside imaging method was available. This meant that, no matter how experienced a practitioner was; how well they understood facial anatomy; or how they tried to deploy supposedly “safer” techniques; the extreme variation and complexity of individual facial anatomy made encountering complications and poor clinical outcomes practically inevitable at some point.

While, thankfully, serious complications from Botox and Dermal Filler are rare, they have been increasing dramatically as the popularity of such treatments grows exponentially. Given the devastating potential of some of these complications; ranging from scarring, permanent disfigurement, blindness and stroke; even a low risk means that practitioners are ethically and legally obliged to utilise safer methods as they become available.

What’s changed clinically?

Ultrasound technology has been recognised for decades as being a reliable method for accurately assessing the anatomy of various soft tissues and guiding injection procedures in numerous fields of medicine. However, until recently, ultrasound devices were cumbersome, difficult to operate and prohibitively expensive, making point- of-care use in a dental clinic unviable. This has all changed with the advent of the latest portable, wireless, hand-held, ultrasound technology, together with the establishment of clear and simple clinical protocols for guided Botox and Dermal Filler injections.

These new low-cost devices; costing less than a standard dental x-ray unit and being no bigger than an iPhone; are able to deliver real-time, high-quality diagnostic images direct to a tablet or smartphone, painlessly and seamlessly, at chairside, without ionising radiation. With special settings allowing for the colourful visualisation of blood vessel location, size and velocity of flow, Dentists now have an imaging tool and protocols allowing them to diagnose and pre-plan like never before; as well as visualising precise target tissues for injection; danger areas to avoid; and to be guided in their treatment delivery, eliminating the risky blind injecting of the past.

What are the legal and regulatory implications?
With the introduction of ultrasound imaging protocols for Botox and Dermal Filler injections, facial procedures have now been brought into line with the long- standing norms of traditional dentistry. As such, the revised Code of Conduct for Dental Practitioners launched this month by AHPRA; together with the recently released position statements and standards of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) and the National Safety and Quality Health Service (NSQHS); make the obligations of dentists and the expectations of regulators, abundantly clear.

In relation to the new Dental Board Code of Conduct, AHPRA has stated the Board “will use this code when evaluating practitioners’ professional conduct,” where a failure to meet the code, risking patient harm, could have “consequences for registration”. The new code states that dental practitioners “should practise safely” and “make responsible and effective use of the resources available to practitioners” (Principle 1).

The Code states that, “Good practice involves putting patient safety ... first. Practitioners should minimise risk by ... applying the principles of clinical governance, risk minimisation and management in practice.” (Principle 7). Notably, NSQHS states clearly that effective clinical governance involves taking all available and appropriate steps to eliminate, reduce and manage the risk to patients in order to achieve good clinical outcomes.

Following the code, dental practitioners are expected to, “develop and implement risk management processes that identify and minimise risk to reduce harm to patients”, and they should, “work to reduce error and improve patient safety”. On this point, the EFSUMB has stated clearly that, “Percutaneous ultrasound guidance of non-surgical aesthetic procedures is recommended as it increases precision and decreases the potential for unwanted effects or neighbouring injuries”.

So, in summary, failure to utilise an easily accessible imaging protocol during Botox and Dermal Filler procedures, which represents the new professional standard, would fall substantially below the level of care expected of a responsible dental practitioner. Continuing to inject blindly, would expose practitioners to regulatory action and even patient litigation in the event of sub-optimal outcomes or complications emerging that could otherwise have been avoided. Additionally, a failure to disclose to patients that a method of visualisation exists which would make procedures safer and more effective, would undoubtedly mean a failure to gain informed consent, in breach of Principle 4 of the Code of Conduct.

Where can I find out more?

To assist dental practitioners understand their responsibilities in relation to the new clinical and legal standard for injecting Botox and Dermal Filler, AADFA International hosted a series of FREE webinars. TO VIEW the series CLICK HERE

Masseter Muscle Botox injections – the new clinical protocol

Tue, 31 May 2022 14:45:52 GMT

Masseter Muscle Botox injections – the new clinical protocol

AADFA International, outlines how to perform Masseter Botox injections that are compliant with the new clinical standard. This is the first in a series of articles drawn from Dr Holt’s recent presentations as the only dentist ever invited by the Australasian Society of Aesthetic Plastic Surgeons to speak at their annual Non-Surgical Symposium.

There is no denying that the last couple of years have been challenging for everyone, with those challenges going beyond just the risk of contracting a new virus. The need to adapt rapidly and repeatedly to changes in life as we knew it, while dealing with the unique pressures of forced lockdowns and the increased stress that comes with a reduction or complete loss of income, have resulted in far reaching physical and psychological implications for a great number of people.

Dental practitioners across the globe have been reporting a dramatic rise in the rates and severity of manifestations like orofacial pain, TMD and bruxism. A study of more than 1800 people, from Tel Aviv University, found that people aged 35-55; women more than men; experienced the most significant rise in symptoms, with daytime jaw clenching increasing from 17- 32%; nocturnal bruxism increasing from 10-36%; and a 15% rise in symptom severity in people who had suffered from these conditions prior to the pandemic.

Over the past decade, Botulinum Toxin (Botox) injections, primarily targeting the Masseter Muscles, have become a proven front-line treatment option to address bruxism, TMD, jaw-clenching and resultant muscle hypertrophy. Yet, while Botox injections have a good safety and efficacy profile, they have not been without their problems. This article outlines the new clinical protocol for Masseter Botox injections that dental practitioners are now expected to follow, in order to maintain the appropriate professional standard; minimise risk; and enhance patient outcomes.

What was wrong with the old way of injecting Botox for Masseter Muscles?

The problem with the old way of injecting Botox was that it was a blind injection, based purely on presumption;

a practitioner’s generic knowledge of textbook anatomy; and largely unreliable physical palpation. Given the extreme variation and complexity of individual facial anatomy, injecting blindly is far from ideal, with research showing this issue of unpredictable, blind technique, being solely responsible for the occasional complications and poor clinical outcomes experienced from an otherwise safe and reliable treatment modality.

While the Masseter Muscle may seem like a uniform structure, its internal anatomy can be quite complex, while it also inhabits a position intimately entwined with several other key facial structures. It is a failure of the practitioner to be able to truly understand the individual anatomy of a patient’s Masseter, and how it interacts with structures like the Parotid Gland and Risorius Muscle, that has been shown to directly impact the safe and effective delivery of Botox injections.

Recent studies, using ultrasound, have shown that the old method for clinically selecting the site of proposed injection based on palpation and surface anatomy, showed a frequently erroneous location, with injection points in up to 40% of cases being placed too anteriorly, such that they were actually outside of the Masseter muscle altogether. In 20% of cases, it was shown that the needle selected for the procedure was too short to reach the deeper portions of the muscle, in certain individuals.

As a direct result of the limitations of a blind approach to treatment, three main iatrogenic side effects have been frequently reported following Masseter injections:

1. An asymmetrical smile (Fig.2)

The origin of the Risorius muscle generally covers the anterior third of the Masseter on the Superficial Musculoaponeurotic System (SMAS) layer. Injecting Botox too medially and/or shallowly, as has been shown to occur in up to 40% of cases, can result in the unintended paralysis of the Risorius muscle.

Studies show this to be the most common complication following injections to the Masseter, occurring in up to 27% of cases treated. The resultant unnatural or constrained facial expressions, most commonly a shortened, asymmetrical smile caused by reduced lateral extension, presents both functional and psychosocial issues for the patient and can last several months before returning to normal, as there is no active corrective treatment available.

2. Xerostomia

Cadaveric studies have demonstrated that up to 65% of individuals display anatomical variants of the size and position of the salivary glands compared to the generic textbook description. Inadvertent injection of Botox too laterally can impact the Parotid Gland, thereby reducing salivation and causing dry mouth – one of the reasons that Botox injections are now a frontline treatment for cases of Sialorrhea. The reported incidence rate for Xerostomia following Masseter injections is up to13%, and the recovery time is typically 3–4 weeks, with no active corrective treatment possible.

3. Paradoxical Masseteric Bulging (PMB, Fig.3)

PMB is the result of the injected Botox medication not diffusing evenly throughout the Masseter as intended, leaving active portions of the muscle to become hyperactive to compensate for areas of partial paralysis.

Occurring in up to 19% of treated cases, PMB creates isolated areas of unsightly muscle bulging when the Masseter contracts during mastication and other facial expressions/functions. While not painful or effecting normal function in any way, PMB presents considerable psychosocial issues for patients. Thankfully, this can usually be overcome using further targeted Botox injections into the areas of hyperactivity, though this presents the problem of having to use a higher cumulative dose of the toxin than would otherwise be needed.

Substantial research has clearly demonstrated that the anatomic reason for the occurrence of PMB is to do with the orientation and positioning of the Deep Inferior Tendon (DIT) of the Masseter muscle in any given individual, which prevents the Botox from dispersing uniformly during injection.

Furthermore, three distinct patterns of DIT positioning in relation to the muscle bellies of the Masseter have been shown to exist, with an even spread of about a third of patients having each variant. In order to ensure even drug dispersion and the avoidance of PMB, practitioners need to adopt a different pattern, location and depth of Botox injection, depending on which type of DIT arrangement exists. However, the traditional problem has been that it is nearly impossible to determine the internal location and arrangement of the DIT based simply on the appearance of surface anatomy or through palpation.

So, what is the new protocol?

In line with the new regulatory and legal standards which are now in effect, dental practitioners are ethically and legally obliged to utilise the safest approaches to treatment available and to minimise risk. Portable, wireless, hand-held, ultrasound technology must now be used in the dental clinic to allow direct imaging of the Masseter muscle both before and during the injection of Botox, in the same way that dental x-rays are used routinely to diagnose; guide treatment; and avoid complications.

Practically, ultrasound must now be used by dentists looking to perform Masseter Botox injections in two ways:
1. An ultrasound analysis must be recorded during the examination prior to performing the injections (Fig.5.). This allows the practitioner to evaluate the precise structural pattern of the DIT in each individual, as well as determining the exact location of the masseteric boundaries and the positioning of the adjacent Risorius muscle and Parotid Gland. From this pre-treatment analysis, an appropriate, individualized, injection plan can be developed in relation to the site; depth and dosage of Botox injections required.

2. Ultrasound must then be used to actively guide the injection of Botox into the Masseter muscle, in real-time (Fig.6). Practitioners can avoid causing PMB, Xerostomia and asymmetrical smiles by directly visualising the injection process to target the correct parts of the muscle and avoid danger zones. Additionally, with the greater accuracy of injection afforded by ultrasound guidance , it has been shown that a significantly lower dose of Botox can be used to achieve the desired clinical result, further enhancing treatment safety.

What more do dentists need to know?

Until now, dentists had no other option but to inject Botox in a blinded fashion and this was the old accepted clinical standard which is now out-dated. In order to continue providing facial injections of Botox and Dermal Filler, dentists need to undergo a bridging course on how to utilise ultrasound protocols for increased safety and efficacy. As the use of ultrasound technology is not a regulated procedure, it is wise for dentists to ensure their assisting staff members are also fluent in the use of the technology, as this allows for greater clinical efficiency in practice.

A failure to utilise easily accessible imaging protocols would fall substantially below the level of care expected of a responsible dental practitioner and continuing to inject blindly would expose practitioners to regulatory action, and even patient litigation, should sub-optimal outcomes or complications occur, that could otherwise have been avoided. Additionally, a failure to disclose to patients that a method of visualisation exists which would make procedures safer and more effective would undoubtedly mean a failure to gain informed consent.

Practitioners who are unable to utilise ultrasound protocols for Masseter Botox injections, would now be expected to refer to someone who can.

For Guided Ultrasound Training in Facial Aesthetics , CLICK HERE to book.

Article references available from the author by emailing: clinical@AADFA.net

Lip Filler Injections – the new protocol

Mon, 30 May 2022 21:37:03 GMT

Lip Filler Injections – the new Ultrasound-Guided protocol.

AADFA International, outlines how to perform Lip Filler injections that are compliant with the new clinical & legal standard. This is the second in a series of articles drawn from recent AADFA presentations as the only Dentists ever invited by the Australasian Society of Aesthetic Plastic Surgeons to speak at their annual Non-Surgical Symposium.

In the last AADFA news article, we outlined the importance of dental practitioners now only performing injections of Botox and Dermal Filler while under ultrasound guidance, for improved safety and efficacy.

Advances in portable, wireless ultrasound technology, combined with the development of clear and easy-to-follow clinical protocols by AADFA, meant that ultrasound guided facial injections now set a new clinical and legal standard which responsible practitioners would be expected to follow and the only way in which they ought to continue providing such services.

Indeed, there has been repeated confirmation from healthcare regulators that they would view a failure to utilise such easily accessible imaging protocols during Botox and Dermal Filler procedures, as a failure to take all reasonable steps to ensure patient and procedural safety. This would be considered to fall substantially below the level of care expected of a responsible dental practitioner, exposing them to regulatory action and even patient litigation in the event of sub-optimal outcomes or complications emerging that could otherwise have been avoided. Additionally, a failure to disclose to patients that a method of visualisation exists which would make procedures safer and more effective, would undoubtedly mean a failure to gain informed consent.

This series of clinical articles, highlighting how dental practitioners should now look to utilise ultrasound guidance for facial injectable procedures, commenced in the last edition looking at the injection of Botox into the Masseter muscles. In this article, we review how ultrasound guidance can improve the clinical outcomes from dermal filler lip enhancements, while at the same time, making them safer.

What was wrong with the old way of injecting Dermal Filler in Lips?

The problem with the old way of injecting Dermal Filler was that it was, essentially, a blind injection, based purely on presumption; a practitioner’s generic knowledge of textbook anatomy; and largely unreliable, subjective physical examination. Given the extreme variation and complexity of individual facial anatomy, injecting blindly is far from ideal, with research showing this issue of unpredictable, blind technique, being solely responsible for the occasional serious complications and poor clinical outcomes experienced from an otherwise safe and reliable treatment modality.

While the lips may seem like uniform structures, their internal anatomy can be quite complex and variable, with them also inhabiting a position intimately entwined with several other key facial structures, meaning they influence not only the aesthetics of the lower face, but vital functional aspects, ranging from expression and speech, through to mastication and proprioception. It is a failure of the practitioner to be able to truly understand the individual anatomy of a patient’s lips, especially in relation to the precise location of the labial arteries, that has been shown to directly impact the safe and effective delivery of dermal filler injections.

With the number of dermal filler lip treatments being performed growing exponentially over the last decade, so too has the frequency of complications experienced. As a direct result of the limitations of a blind approach to treatment, three main iatrogenic side effects have been frequently reported following dermal filler lip injections:

Vascular Occlusion / Skin Necrosis

With the high vascularity of the lips and facial soft tissue, the most dreaded potential complication of any injection of dermal filler, is that of vascular occlusion, where the implanted filler gel compromises blood supply, leading to sequelae which may include tissue necrosis, secondary infection and scarring. The mechanism by which dermal filler gel can cause vascular compromise is either by inadvertent direct intravascular injection, or by compression of the vasculature resulting from pressure exerted by adjacent filler in the tissues. Regardless of the mechanism, vascular occlusion is a serious condition which presents aesthetic, functional and psychosocial issues for patients and requires active emergency management.

While practitioners have previously tried their best to mitigate the risk of this complication by diligently studying textbook anatomy and being guided by the typical patterns of the labial arteries dissected in cadaveric studies, there was simply no way to know for sure where these vital vascular structures lay, in reality, for the individual patient about to receive the treatment. Practitioners, despite their best efforts, previously had no choice but to fly blind!

While research and texts have traditionally claimed that a superficial plane in the lips was a safe approach, given, in most cases, the labial arteries transverse a deeper plane, below the orbicularis oris muscle, recent ultrasound studies of living individuals have shown there to be far more variation in the location, size, orientation and trajectory of the labial arteries than previously thought. Indeed, in more than a third of patients, the labial arteries lie above the muscle, in areas traditionally believed to be safe, and in many patients these structures switch tissue layers frequently in their journey across the lips.

2. Lumps / irregularities

Non-inflammatory lumps are the most common complication seen after dermal filler lip injections. While not usually causing the patient discomfort or functional issues, they certainly create aesthetic and psychosocial challenges.

To achieve the best clinical outcomes from dermal filler placement in the lips, injecting into the orbicularis oris muscle layer needs to be avoided, especially in the region of its attachment to the overlying dermis, and deposition of the product needs to be as consistent as possible. Filler placed intramuscularly or in the incorrect tissue plane, will tend to clump and distort during normal lip function and muscle contraction.

Such accuracy, when working within thin lip tissue, is rarely able to be achieved, even by experienced injectors, when performing injections in a blinded fashion. Without the ability to directly visualise the precise anatomical location of your needle, traversing different tissue layers is practically inevitable as they cannot be readily discerned clinically.

This is especially true if a practitioner is using a blunt cannula rather than a needle. Ultrasound studies have shown that dermal filler placed using a blunt cannula in lips, results in a far more inconsistent deposition, with the cannula regularly passing too deep and entering muscle layers, increasing the risk of post-operative lumps and irregularities.

3. Filler Migration

Dermal filler migration, predominantly a spreading of product across the vermillion border into the white lip, is an increasingly common problem, which has a significant aesthetic and psychosocial impact on patients.

The rise in this complication can be directly attributed to the use by inexperienced practitioners of “fad” injecting techniques – like the “Russian technique” – which displays a fundamental lack of understanding and respect for natural lip anatomy.

The “Russian technique” creates a series of vertical channels, puncturing down through the vermillion border, into the body of the lip vermillion. Unfortunately, breaching the integrity of the dermal attachment of the orbicularis oris muscle in this way; which would usually contain filler within the lip itself; permits filler to spread along a path of least resistance, across the lip border and on into the white of the lip, compromising definition and establishing a problematic lip thickening.

Additionally, this method, as with the routine use of blunt cannula instead of needle for lip enhancement, invariably results in filler being injected too deep, beneath the orbicularis oris muscle. In this position, during normal lip function, muscular contraction forces filler to spread through natural deep tissue layer communications to the white lip, leading to the same risk of filler migration, but in this case, causing more of a “duck bill” appearance.

No matter how experienced a practitioner thinks they are, this risk can only be avoided by ensuring filler is placed in appropriate and favourable anatomical positions with the use of ultrasound guidance.

So, what is the new protocol?

In line with the new regulatory and legal standards which are now in effect, dental practitioners are ethically and legally obliged to utilise the safest approaches to treatment available and to minimise risk. Portable, wireless, hand-held, ultrasound technology must now be used in the dental clinic to allow direct imaging of individual lip anatomy both before and during the injection of dermal filler, in the same way that dental x-rays are used routinely to diagnose; guide treatment; and avoid complications.

Practically, ultrasound must now be used by Dentists looking to perform lip filler injections in two ways:

1. An ultrasound analysis must be recorded during the examination/consultation prior to performing the injections (Fig.6.). This allows the practitioner to evaluate the precise location, orientation and pathway of the labial arteries in each individual, as well as determining the most appropriate depth and tissue plane in which to inject the filler, rather than relying on a generic hypothesis of where these structures may be located. From this pre-treatment analysis, an appropriate, individualized, injection plan can be developed in relation to the site; depth and dosage of dermal filler injections required.

2. Ultrasound must then be used to actively guide the injection of dermal filler into the lips, in real-time (Fig.7). Practitioners can avoid causing vascular occlusion, lumpiness and product migration by directly visualising the injection process to target the correct parts of the lips and avoid danger zones. Additionally, with the greater accuracy of injection afforded by ultrasound guidance, it has been shown that a significantly lower volume of filler can be used to achieve the desired clinical result, further enhancing treatment safety.

If those two methods are performed appropriately, there should never be a need for the final way in which ultrasound can be used to improve the placement of dermal filler and bring the procedures in line with mainstream healthcare protocols, but it’s nice to know it exists. While the preceding two steps are designed to eliminate the potential for dermal filler complications, should they occur - perhaps in a patient referred by a practitioner who isn’t yet uses ultrasound guidance – the final use for ultrasound is to more accurate diagnose and guide the emergency treatment of complications, like vascular occlusion.

Medications exist which readily facilitate the dissolving of dermal filler in situ when serious complications occur, though they are not without their own side effects and ought to be used sparingly. However previously, when working in a blinded fashion, diagnosing, locating and treating offending masses of filler, especially those causing vascular compromise deep within tissues, was clinically challenging, often requiring blanket, widespread, high dosing of the skin with emergency drugs in the hope of achieving the desired response.

With ultrasound guidance, clinicians are now able to accurately visualise the precise location of complications and blockages, delivering targeted, low dose procedures, with real-time imaging, meaning both the placement and ongoing management of dermal filler, is safer and more effective than ever before (Fig.8).

What more do Dentists need to know?

Until now, Dentists had no other option but to inject dermal filler in a blinded fashion and this was the old accepted clinical standard which is now out-dated. In order to continue providing facial injections of Botox and Dermal Filler, Dentists need to undergo training in how to utilise AADFA’s ultrasound protocols for increased safety and efficacy. As the use of ultrasound technology is not a regulated procedure, it is wise for Dentists to ensure their assisting staff members are also fluent in the use of the technology, as this allows for greater clinical efficiency in practice.

While the ability to offer safer procedures under ultrasound guidance also creates a marketable point-of-difference for leading practitioners, those who remain unable to utilise ultrasound protocols for dermal filler lip injections, would now be expected to refer to someone who can.

Article references available by emailing: clinical@AADFA.net

www.AADFA.net

Chairside Ultrasound – the new standard for Dento-Facial injections

director@aadfa.net (Myles Holt) — Sun, 06 Feb 2022 11:34:02 GMT

Chairside Ultrasound – the new standard for

Dento-Facial injections

by Dr Myles Holt
BDS, LLM (Heath&Medical), MSc (Aesthetic Medicine), FIADFE
AADFA Director & Head Trainer
Medico-Legal Advisor
Honorary Lecturer, MSc Aesthetic Dentistry, King's College London
Dental Surgeon

Flying Blind

In almost every aspect of modern dental practice, clinical procedures are made safer and more effective through the use of routine imaging.

Whether it be digital or conventional film; OPG, bitewing, periapical or CBCT; the use of some reliable method of imaging is considered best practice for all manner of dental treatments, from implants and RCT, through to extractions and simple restorations. Indeed, the failure of a dental practitioner to properly utilize available imaging to aid in everything from patient screening and diagnosis; to actively guiding treatment delivery; and conducting appropriate post-operative evaluation and complication management, would be considered a substantial departure from accepted standards, exposing them to regulatory action and litigation.

Essentially, it would be irresponsible and inappropriate to “fly blind” in traditional dentistry and indefensible if you did. Yet, until recently, a blind approach to treatment provision was the only option practitioners had when performing skin rejuvenation therapies; like Botox, Dermal Filler, Fat-dissolving injections and facial Thread Lifting; across the head and neck region and it had become the accepted norm.

So, while dental practitioners would never dream of blindly placing an implant into complex anatomy without the aid of imaging; running the risk of not only a poor result but serious complication if inadvertently encroaching on adjacent nervous or vascular structures; those placing Botox, dermal filler, and the like, simply had no other option. This is in large part due to the nature of the tissues being treated. Traditional dentistry, largely, works with hard tissue for which dental x-ray has been around for more than 100 years, with technology developing significantly over time to provide imaging tools of better quality, lower cost, and improved ease of use chairside. Facial soft tissues have been much harder to image directly by treating clinicians with technologies like MRI and CT having only been developed over a much shorter period which, despite significant advances, are still expensive, cumbersome, and inconvenient.

Yet, a critical aspect to many facial rejuvenation procedures (as with traditional dentistry), is correct anatomical placement. Whether it is depositing dermal filler into a strategic tissue space; aligning thread lifts within specific tissue planes; injecting Botox into individual muscle layers; placing fat-dissolving solution into designated fat compartments; or even achieving the correct depth of micro-needling penetration into the dermis; a failure to achieve correct anatomical orientation will reduce the effectiveness of treatment. More importantly, poorly planned, imprecise, and ill-conceived procedures, when working within the complex and closely related anatomy of the face, have the potential to cause serious complication, ranging from aesthetic asymmetries and irregularities; functional defects, if Botox impacts unintended muscles; through to skin necrosis and blindness if dermal filler inadvertently encroaches on vascular supply.

While practitioners tried to mitigate these risks by ensuring they had a comprehensive anatomical knowledge and deployed “safer” materials and techniques, differences in individual patient anatomy and practitioner ability meant that this was far from fool-proof. Ultimately it had to be accepted that flying blind was the norm when performing facial procedures and that even when practitioners were trying to do everything right, complications and poor outcomes could readily occur.

This has been particularly difficult for those just starting out and trying to learn these procedures, as it required a substantial amount of blind faith, a steep learning curve and an inherent nervousness without the benefit and reassurance brought about by the kinds of accurate imaging and pre-screening they were accustomed to in traditional dentistry. Thankfully, this has recently changed with developments in Ultrasound (US) technology setting the new standard for care.

Above: Portable, wireless, hand-held, point-of-use Ultrasound technology, has set a new standard for patient care and practitioner education in dento-facial procedures.

Dentists lead the way

Through the pioneering work of the Australasian Academy of Dento-Facial Aesthetics (AADFA), the provision of facial rejuvenation treatments has become an accepted part of the practice of dentistry over the past decade. Additionally, Dentists are now recognised as among the very best practitioners to be offering these treatments to patients, with AADFA trained Dentists at the forefront of the industry, even contributing to the education of specialist plastic surgeons and dermatologists.

One of the main reasons for AADFA Dentists being able to readily move into this new area of practice and set the gold-standard for patient care in this field, is because of the clear parallels between the knowledge, skills and logistics needed to successfully deliver facial rejuvenation procedures with those required for traditional dental practice. The approaches seen in Dentistry, from high-level infection control and education, through to knowledge of material science and a focus on health-based responsible patient care, not cosmetic fads, have resulted in the bar being raised across the broader facial aesthetic community.

That trend now continues with AADFA becoming the first training organisation to incorporate the concept of active imaging, using the latest portable, wireless, hand-held, point-of-use US technology into patient assessment and treatment protocols for all facial rejuvenation therapies able to be performed by Dentists. The routine use of US has set the new standard for safety and efficacy when treating soft tissues, allowing Dentists to visualise precisely where target tissues lie; which areas to avoid; and to be guided in their treatment delivery.

This has not only set a new standard for patient care, providing comfort and reassurance to practitioners and patients alike, but it has set a new standard in the education of Dentists. Practitioners now learning dento-facial procedures can do so confidently, utilising the latest technology with AADFA’s clear parameters and clinical structure to flatten the learning curve and accelerate proficiency, all while increasing safety.

How is Ultrasound used?

Portable, point-of-use US technology utilises the same technology as all other ultrasound devices, with the advantage that it is low-cost, wireless, hand-held and can deliver real-time, high-quality diagnostic images direct to a tablet or smartphone, both quickly and painlessly, at chairside.

The US device emits a high-frequency sound wave which can penetrate several centimetres below the surface of the skin, where it is reflected differently by the various tissues being examined. This produces a live image of different densities on a grey-scale – bone appears different to muscle, which looks different to fat, which is distinguishable from the dermis and so on. Additionally, special settings allow for the colourful visualisation of not only the location of blood vessels, but also their size and velocity of flow.

Above: Hand-held, chairside Ultrasound allows practitioners to visualise vital structures in real-time, improving treatment safety and efficacy.

Clinical research has demonstrated repeatedly that these unique imaging features allow practitioners to set new standards for safety and efficacy in three key ways:

Pre-screening & Diagnosis

US can be used in much the same way as traditional dental x-rays are utilised in consultations to visualise individual anatomy, plan appropriate treatment, and identify areas of risk. US allows us to develop a clear understanding of the face we are working with, mapping out key structures in advance, to plan treatment delivery in a manner which achieves the best results while actively preventing adverse events. The position, orientation, size, and depth of features can all be noted in advance, allowing a plan to be developed to target specific tissue layers with the likes of threads; avoid critical blood vessels with dermal filler; inject only certain muscles strategically with Botox; and even measure exact skin thickness so micro-needles penetrate precisely into the desired level of the dermis for optimum collagen stimulation.

Guided Treatment Delivery

US enables the clinician to perform guided injections for treatments involving Botox, Dermal Filler, fat-dissolving injections, and even facial thread lifts. In real-time practitioners can visualise their needle penetrating through the different layers of tissue until the desired treatment area and depth is reached. They can watch as the treatment is administered deep within the face, all of which previously would have to be done blindly, by feel, while hoping for the best.

Identification & Management of Complications

US enables practitioners to closely examine areas treated previously that may have experienced complications, diagnose them properly and deliver the appropriate treatment. Prime examples of this are complications arising from the injection of dermal filler.

US examination will quickly and easily reveal exactly where filler has been placed in the past and it is even possible to tell what type of product has been used from its unique echo signature. It would be possible to see if the filler is blocking a blood vessel and precisely where that blockage has occurred, which without active and accurate treatment, may lead to skin necrosis.

Thankfully, the best modern day dermal filler products consist of a Hyaluronic Acid gel and are therefore dissolvable with hyaluronidase enzymes. This allows the emergency treatment of dermal filler complications by dissolving the gel deposit and can be applied to resolve areas of lumpiness, irregularity or overfill, or importantly, to dissolve areas of filler that are causing a blockage of blood flow to the skin. However, the reversal agent is not without its problems, as it does not discriminate between natural hyaluronic acid in the skin (which forms a vital component adding hydration, elasticity, and integrity), and the filler product injected by the practitioner.

The problem is that previously, flying blind, practitioners had no way of knowing exactly where a blood vessel was blocked or precisely where an irregularity was positioned within the tissues. This meant that, in order to dissolve dermal filler to treat a complication, the only option was to “flood” a wide area of skin with the hyaluronidase, in the hope that it would reach the site required, wherever that may have been. Commonly, while emergency complications may have been addressed using this saturation approach, the skin is left in a compromised state - dry, flaky and irritated - requiring further intervention to restore health and aesthetics.

With the use of US, in the same way as injections of dermal filler can be guided in the first instance, so too can injections of hyaluronidase, such that only small droplets of the drug are needed, precisely placed in the exact area of vascular blockage or excess filler placement, avoiding collateral damage to adjacent skin and structures.

Above: Ultrasound can be used in real-time to guide injections and manage complications.

Adopt the new standard

A substantial body of research has shown that the ability to now use US chairside has set a new standard for clinical care in dento-facial rejuvenation, improving results and increasing safety.

With the availability of this imaging technology, facial procedures have now been brought into line with the long-standing norms of traditional dentistry. This may mean that should a practitioner fail to adopt this new standard of care, continuing instead to fly blind, they may very well be exposed to regulatory action and litigation in the event of sub-optimal outcomes or complications.

Adopting this new standard of care early will continue to set Dentists as the gold-standard in the industry. In a world where patients are increasingly moving away from practitioners who focus on an out-dated approach of basic “Cosmetic Injecting” in favour of responsible practitioners focused on proper healthcare delivery, (see article in the previous edition of Australasian Dentist magazine), they are now willing to pay a premium to ensure they receive a higher level of care. The use of US guided treatment gives practitioners a powerful and marketable point of difference.

Dentists starting their education in dento-facial procedures with AADFA, benefit from the fact that US technology protocols are now incorporated into every training program as standard. Those practitioners who have trained previously in dento-facial procedures will need to ensure they move swiftly to build US protocols in their practice, with AADFA now offering a bridging course called “Phono” , designed to keep your practice at the forefront of modern dentistry.

LEARN MORE HERE

For more information regarding all aspects of facial rejuvenation in Dentistry, contact the industry pioneers at AADFA HERE

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Why "Cosmetic Injecting" is DANGEROUS!

Tue, 30 Nov 2021 01:20:25 GMT

Why the term "Cosmetic Injecting" is DANGEROUS!

Before Botox, patients used to be at risk of Dentists seeing them as just a walking set of teeth and gums. Now, more than a decade later, are patients at risk from those who see them as just a walking set of “wrinkles”, ripe for “cosmetic” exploitation?

The Dento-Facial Health & Aesthetic Concept

12 years ago, AADFA ( www.AADFA.net ) developed the term “Dento-Facial Health & Aesthetics”. This concept outlined how dentists and dental practices could expand their services beyond the oral cavity, stepping into a broader facial health screening, prevention, and maintenance role. A focus on health first, with aesthetic improvement being a natural consequence, allowed highly skilled Dentists to successfully offer patients a higher level care across the dento-facial region; setting themselves as the industry gold standard.

This concept, together with a ground-breaking training pathway which made it a reality, was not only new to the profession of Dentistry, but a revolutionary philosophy and approach compared to that of the existing facial “cosmetic” industry, mostly led by Nurses.

Since training of medical doctors and nurses had been [and still is], largely driven by the representatives of cosmetic product manufacturers, there was no commitment to providing a comprehensive, quality education, with most practitioners participating in just a few hours of rudimentary training, before being let loose on the unsuspecting public.

Possibly the biggest issue with such an approach is that the goal of a product manufacturer is not that of a responsible health practitioner. Focused purely on sales, the philosophy of getting practitioners to simply use more product, prioritizing revenues over quality, and utilizing direct-to-consumer marketing to tap into insecurities about appearance, certainly achieved its goal of building a multi-billion-dollar industry.

What, unsurprisingly, suffered though, was reputation and clinical outcomes. The “cosmetic” industry gained the reputation of being “cowboy country”, and it can still be, with many practitioners sticking to an antiquated and dangerous “cosmetic”; “anti-wrinkle”; “youth-restoring”; product driven approach. Seemingly every week professional reputations and that of an entire industry are torn to shreds in media headlines and what’s worse, images of poor patient outcomes haunt the internet. Yet rather than change their ways in the face of all this negativity, the “cosmetic” industry largely doubled down. Proving that often commonsense is no match for practitioners and companies' intent on making a quick buck by praying on insecurities around perceived beauty. It’s still common to see messaging around generating bigger, voluptuous (sometimes comical) lips, prioritized over achieving healthy, properly functioning lips that would then naturally look better.

AADFA recognized these problems in the broader “cosmetic” industry and developed a philosophy and comprehensive training pathway which positioned the attainment and maintenance of optimal health, centerstage. By focusing on improving the health and quality of the facial tissues as health practitioners, an aesthetic improvement will naturally follow. Even though the primary goal of some patients may be aesthetic improvement, long-lasting, optimal clinical outcomes, and the avoidance of complications, can only come from the establishment of good health as the primary focus.

The many thousands of Dentists, who have completed the AADFA Training Pathway, are aware of just how powerful and reassuring this philosophy is when incorporating extra-oral facial services, like Botox and Dermal Fillers, into practice and it has helped them stay ahead of the pack. In reality, it’s no different to what good Dentists do every day - you would never dream of placing a swath of veneers in a mouth that was fundamentally unhealthy. In the same way, you would never just learn to perform crowns and bridges and ignore every other aspect of patient need that should be incorporated into a complete treatment plan.

Yet that is what “Cosmetic Injecting” is all about and despite the well-documented issues, some new, inexperienced, and misguided Dentists seem set to repeat the mistakes of the past by following “Cosmetic Injectors” down the rabbit hole.

The new “Cosmetic Injecting” danger

AADFA’s health-based approach to dento-facial aesthetics, has proven so successful in overcoming the problems of the industry past, that AADFA is now called upon to teach it to doctors, nurses and plastic surgical specialists who are looking to press “re-set” and adopt a more responsible approach to patient care.

Yet while the broader industry is progressively moving away from a “cosmetic” and “anti-wrinkle” focus, recognizing that these services are health and medical treatments that just happen to have an aesthetic benefit, several rogue operators have emerged in the dental profession, which risk undermining this professional progress and threaten practitioner and patient safety.

AADFA has never advocated that Dentists stop being Dentists. In fact, skilled, regulated, responsible, conservative Dentists are among the only practitioners to be able to offer such a comprehensive approach to dento-facial health and aesthetics, with extra-oral services being treatment planned alongside traditional intra-oral treatments, in a truly holistic approach to care. Yet what has now emerged is a group of practitioners who are encouraging the profession to move into “Cosmetic Injecting”, using the lesser standards of beauty therapists and nurses as a guide.

We are even seeing Dentists being encouraged to call themselves “Cosmetic Injectors”, in a move solely designed to mislead patients into thinking these individuals possess some specialized qualification or ability when compared to other practitioners. This term is being used in much the same way as “Cosmetic Surgeon” is used by some GP doctors to mislead their patients into thinking they are akin to specialist Plastic Surgeons. Thankfully regulators are starting to notice such behavior and the unscrupulous targeting of weaknesses in a patients’ self-image.

A “Cosmetic Injecting” approach not only prays on the vulnerabilities of patients rather than educating them on how to make real health-based decisions; a serious issue with the rising prevalence of Body Dysmorphic Disorder; but a focus on purely cosmetic outcomes poses some very real dangers to practitioners and patients alike.

Chief among these is a limited set of tools and an over-reliance on “Cosmetic Injectables”, like Botox and Dermal Fillers. A knowledge of and ability to deliver facial injections was only ever a small part of what AADFA advocated and of what is required of practitioners to be able to develop a comprehensive, holistic treatment plan for patients to achieve safe and effective, long-term clinical results, without complication. In fact, injectable treatments like Botox and Dermal Filler should come a long way down the list and it has reached a point where if a practitioner is only promoting Botox and Dermal Filler for facial rejuvenation, they should STOP immediately!

If all you have is a hammer . . .

In much the same way as “dabbling” in implants and orthodontics has the potential for disaster for patients and practitioners, so too does simply trying to address the complex, multi-factorial nature of facial ageing and skin deterioration, with a limited array of “Cosmetic Injectables”. A failure to understand ALL of the available treatment options and the proper sequence of their use; limiting treatment to certain isolated areas of the lower face; and an over-reliance on a limited range of tools, leads to a multitude of problems, from a lack of informed consent, through to inappropriate treatment, clinical complications and poor aesthetic outcomes. When a single tool is being applied as a cure-all, problems soon follow, for as the “Law of Instrument” states - if the only tool you have is a hammer, you tend to see every problem as a nail.

For example, in the facial aesthetics realm, we see practitioners with limited education, skills and tools applying excessive amounts of dermal filler to lips and, classically, to the cheek region, resulting in an unaesthetic, over-inflated, thick mid-face, characterized by a drastically reduced ocular region or “squinty eyes”. It is also this excessive use of inappropriate products and services that exposes patients to serious clinical complications, beyond just looking strange and plastic.

The over inflated cheeks and squinty eyes, typical of a dangerous “cosmetic”

focus – if you see this in a “Cosmetic Injector” . . . RUN!

Successful Dento-Facial Aesthetics can NEVER just be about learning Botox and Dermal Filler injections. Dentists need to become knowledgeable in the full spectrum of facial rejuvenation, able to appropriately consult patients; diagnose and treatment plan utilizing an array of techniques, ranging from scientifically proven at-home skincare products and sunscreen, through to dissolving fat deposits and performing thread-lifts to address skin laxity.

A further issue for practitioners who follow a “Cosmetic Injecting” approach is the real risk of undermining credibility as a health professional. Especially when introducing dento-facial services to your long-standing patients, a purely cosmetic focus on wrinkles and voluptuous lips will invariably offend many and rather than being positioned as a health expert who understands the field in-depth, practitioners risk looking opportunistic, foolish and money-hungry. A “cosmetic”, “anti-wrinkle” focus for services like Botox also then makes it difficult to utilize them for the beneficial treatment of conditions like TMD.

The Education problem

The key to ensuring safe and successful practice, for practitioners and patients, is no secret and is the same when developing skills and techniques in all areas of Dentistry - comprehensive education coupled with a responsible approach to gain competency.

University degree courses for Dentists are thoroughly vetted to ensure an appropriate standard of education is being delivered, to produce the highest quality practitioners with the ultimate goal of protecting the wellbeing of patients. Yet many skills of a modern practitioner, including dento-facial aesthetics, are learnt and refined, only after graduation, through Continuing Professional Development (CPD) programs.

The issue is that CPD lacks the same level of oversight and in many facets of dentistry, has become the “Wild West”, directly impacting patient experiences down the line. From implants and full mouth rehabilitation, through to orthodontics and laser, it seems there is a growing pool of Dentists who think they are perfectly equipped to train others, with little more than the limited experience in their own clinic or the re-working of a course they took, which was developed by someone else. Now it’s not to say that many Dentists don’t have unique individual perspectives, skills, and knowledge to share, but that is a long way from being equipped and experienced enough to provide quality comprehensive CPD to keep patients and practitioners safe.

Simply put, there is a reason why treatments like implants, orthodontics and advanced restorative techniques now top the charts in terms of patient complaints and regulatory action. There is a clear correlation between this and a rise in random, short-term training courses in Dentistry, without any of these being vetted by an independent body.

The field of dento-facial aesthetics has not been immune from this. Inexperienced, opportunistic “educators” trying to sell practitioners on the idea of “Cosmetic Injecting”, have come (and gone); many without proper insurance coverage for participants and patients; offering “training” from the likes of suburban clinic waiting rooms; all leaving the profession worse off. One “Cosmetic Surgeon”, introduced through an orthodontic “mini-residency", was even struck off for clinical negligence!

Regulators seem unwilling to address the issue of declining CPD quality, seemingly preferring to act only after the horse has bolted and a patient complaint is experienced. Regulators state that it is up to the individual practitioner to ensure a CPD course is of a suitable standard, but this is really passing the buck on public protection, setting practitioners up to fail and is actually, far easier said than done.

It would be an expensive trial and error process for practitioners to have to continually undertake CPD programs first, only to find out the quality was not as hoped or needed. The recommendations of colleagues used to act as a guide but have become less reliable as many courses now provide incentives for positive reviews or “posts”. Even programs of so called “accreditation”, like the ADA CERP, don’t actually require the course content, structure, or presenter to undergo any form of independent appraisal or quality assessment to receive the, so-called, “accreditation”.

Highly qualified Dentists should be setting themselves as the gold standard in dento-facial aesthetics, not undermining their value by mimicking the misguided philosophy of lesser trained beauty therapists or “cosmetic injectors”.

To ensure you are set up for success; don’t risk your reputation, registration or the health and safety of your patients by misleading training and philosophy; follow these AADFA golden rules:

For more information on Dento-facial Aesthetics done the right way, contact AADFA

www.AADFA.net

E: a d m i n @ A A D F A . n e t admin@AADFA.net

COSMETIC DENTIST Magazine: Fierce Females in Dentistry Edition

Mon, 01 Nov 2021 05:24:36 GMT

The FIERCE FEMALES in DENTISTRY Edition is HERE, celebrating the women who are doing wonderful things in our industry

MAGAZINE

On the cover: Dr Jaclyn Wong

BY AADFA INTERNATIONAL

PHOTOGRAPHY BY GHE GROUP Media.

REA D BELOW

How dentists can help boost Australia's vaccination rates and fight COVID

director@aadfa.net (Myles Holt) — Fri, 03 Sep 2021 05:35:33 GMT

Every year millions of Australians get flu jabs and, all going well, many of us will be lining up to be vaccinated against the COVID-19 virus in the near future.

It's going to be a mammoth task to ensure everyone who wants to be vaccinated is able to. At the same time, we need to ensure vaccination rates for other diseases continue to remain high.

To meet the challenge, Australia needs to urgently expand delivery of its vaccination services.

In parts of the United States, dentists are permitted to vaccinate patients against diseases such as influenza and human papilloma virus, but not here.

Why is it that a patient can walk into a chemist and get a flu jab in Australia, but cannot receive the same service from their dentist?

It makes perfect sense for dentists in Australia to vaccinate and there is also strong support for such a move.

Our organisation represents more than 5000 dentists around Australia who are trained in both dental and cosmetic procedures.

When we asked them how they felt about being allowed to provide immunisation services to their patients, 85 per cent said they should be able.

Furthermore, 92 per cent said they were willing to undergo the necessary vaccination training.

Our members see their patients regularly, have widespread medicinal training and know how to carefully administer injections into the mouths of adults and children - an area far more sensitive than an arm.

They adhere to high levels of hygiene and infection control and they also routinely wear masks.

For patients, there's the convenience factor - if you can get vaccinated at a dental clinic, you don't have to make a separate appointment and travel to a different location.

Our survey also found 97 per cent of our members believe they should be able to have a conversation with their patients about vaccinations, while 84 per cent say they have previously discussed immunisation with patients.

COVID-19 has demonstrated to many of us the importance of vaccinations and I think most patients would welcome a friendly reminder about their annual flu jab or other shot, regardless of whether it's coming from their GP or dentist.

We're urging health authorities and those in government to let us vaccinate and we're asking others in our profession and patients to back us up.

Dr Myles Holt is the director of the Australasian Academy of Dento Facial Aesthetics.

Could This Minimally Invasive Procedure Be a Better Idea Than Lip Fillers?

Thu, 24 Jun 2021 05:22:54 GMT

Is “Lip Threading” The New Lip Filler?

The “Thread Lip Lift”

Dentists who understand all of the treatment options for rejuvenating the facial skin can provide a more comprehensive service to our patients, so that the work done intra-orally is supported by healthy extra-oral soft tissues. This vital interplay between extra- and intra-oral tissues and the success of various therapies, has never been more apparent than with another of AADFA’s new, world- leading techniques called the “Thread Lip Lift”.

As a part of the deflation and descent process we see in facial ageing, the upper lip becomes lax, creating a veil that lengthens to dramatically reduce the display of the maxillary anterior teeth as well as reducing the “pink” vermillion volume of the lip – which is often the complaint of the patient. Not only is this unaesthetic in itself, but the elongation of the upper lip with age can negatively impact the execution of any anterior dental veneers or dentures we are fabricating for the patient. When designing the optimal proportions of anterior restorations, unfortunately we have fallen in to the trap of taking our baseline reference from the lips – structures that change with the natural ageing process.

Traditional prosthodontics instructs us to ensure 2 mm of the maxillary central incisors are displayed at rest, with the remaining anterior teeth positioned aesthetically from this baseline. However, if the lip is naturally “long” or has lengthened with age, then following these guidelines will create unnatural lower face proportions. For example, when planning for anterior veneers, the aged lip would incorrectly steer the dentist to elongate the restorations to achieve the classic 2 mm of incisal display, leaving the patient with a dolichocephalic appearance and an altered occlusal scheme.

Furthermore, often patients with a lax upper lip will desire more lip vermillion volume. Most practitioners will attempt to add dermal filler, which may add volume to the lip, but it may also result in it drooping even further, leaving the patient looking unnatural.

To overcome the effects of ageing and achieve naturally aesthetic dental restorations it is possible to change the position of the lip during the initial treatment planning phase.

Lip lifting procedures have been around in plastic surgery for decades and usually involve surgically removing tissue from below the base of the nose to shorten the upper lip. The drawbacks of such an approach are obvious, including the pain and discomfort of surgery, together with the inevitable scarring left behind. Now, AADFA has overcome these issues by using Facial Threads to reposition the upper lip in a non-surgical, minimally invasive procedure that can be performed in just a few minutes under local anaesthesia.

The technique preserves normal function of the Orbicularis Oris muscle and results in the optimal amount of tooth display at rest, yet still allows the patient to close their lips normally. While lacking the longevity of its surgical counterpart, the “Facial Lip Lift” definitely achieves enhanced lip aesthetics, at a much lower cost than surgery, allowing for successful positioning of dental restorations. This technique can also be combined with the use of dermal filler to further ensure the lip proportions are optimised, without unduly weighing down the tissues.

Above. Results from Lip Lift procedure – increasing youthful maxillary tooth display and lip volume

Where Can I Learn More?

Utilising AADFA'S innovative, practical blended learning format, "FIBER" is AADFA's revolutionary program to combat Skin Laxity and skin deterioration.

"FIBER" is a world-leading, highly focused program, providing extensive mentoring and support to ensure you achieve mastery in some of the most cutting edge techniques in the field of Dento-facial rejuvenation; developing clinical competency and a safe, effective & successful practice.

Combining hours of vital online theoritical learning with robust "hands-on" practical training , FIBER introduces Dentists to the world of Polydioxanone (PDO) threads or sutures.

Complete "FIBER" in combination with "PHLEBOTOMY". AADFA's most unique program, "PHLEBOTOMY" teaches Dentists and dental teams to address intra and extra-oral problems using autologous blood concentrates.

Proving that AADFA are truly pioneers in the industry, there is no other course globally that teaches many of the protocols covered in this program. From fabricating an autologus dermal filler gel from the blood drawn from the patient, which can be used in the same manner as commercial filler products, only at a substantially reduced cost, through to the synergistic combination of blood concentrates and PDO threads to achieve unparalleled dento-facial health and rejuvenation. AADFA has developed a world-first clinical protocol which combines both therapies in a single session (called the “Concentrated Lift”), to synergistically achieve unparalleled dento-facial health and rejuvenation. There is no other course globally that teaches such a protocol and it’s just another example of how AADFA continues to innovate and lead the industry for the benefit of the dental profession.

AADFA training programs continue to innovate and lead the dental profession for the benefit of the public.

This highly specialised program, provides extensive mentoring and support to ensure you achieve mastery in some of the most progressive techniques in the field of Dento-facial rejuvenation; developing clinical competency and a safe, effective & successful practice.

LIPS: THE FORGOTTEN ORAL TISSUE

director@aadfa.net (Myles Holt) — Thu, 10 Jun 2021 05:19:16 GMT

LIPS: THE FORGOTTEN ORAL TISSUE

LIPS are defined as, “either of two fleshy folds that surround the mouth in humans and many other vertebrates and are organs of human speech essential to certain articulations”. 1

Lips are unique oral structures (as individual as fingerprints), which play important roles in mastication and deglutition; sound articulation; facial expression and physiological protection; as well as being tactile organs and erogenous zones. Lips are also the central defining aesthetic feature of the lower third of the face, being distinct from the surrounding skin, contributing significantly to our perceptions of healthy, beauty, vitality and how we interact with our environment.

But mention the word LIPS to most Dental Practitioners and their thoughts immediately turn to inconvenient bits of flaccid tissue covering the important stuff underneath, that just get in the way of us doing our job and that we wish were somehow detachable!

In fact, even those practitioners who do give greater thought to these oral soft tissues, do so, almost exclusively, from a perspective of screening for pathology or, perhaps in the case of an increasing number of practitioners who offer facial injectable treatments like dermal filler, from a perspective of correcting defects or age-related aesthetic changes, only once they have occurred. Very few dental practitioners acknowledge the importance and uniqueness of lips and include them in their practice as they do the teeth and gums, that is, by focusing on the maintenance health and prevention of disorder, so as to reduce the need for intervention at a later date.

This is in large part due to lips (and other facial soft tissues) not being given more than a cursory discussion (at best) during most traditional formal dental training around the world, where the major focus is on the dentition and periodontium. However, this is all set to change with the introduction of a revolutionary professional lip care treatment, (Lip-Tx, www.lip-tx.com) used by Hygienists, Dentists and Therapists, at every patient’s maintenance recall visit or indeed at the end of any dental appointment, designed to pay lips the service they are long overdue.

Lips need special treatment

The appearance of the lips not only has a major impact on the aesthetic perception of the face in general, but they can be indicators of general health and, as with other aspects of the orofacial complex, are exposed to pathology and deterioration in condition, due to the combined effects of the general ageing process (loss of supportive collagen, elastin & extracellular matrix components); abuse from the constant contraction of the underlying (Orbicularis Oris) muscle; environmental abuses (including exposure to smoking, dental visits/materials, UV radiation) and a lack of care. 2

Lips represent the transition between the mucosal membrane and the outer facial skin and, histologically, lips also sit at the crossroads between those tissues. Unlike facial skin, which has a thick, protective keratinized (stratum corneum) surface layer which is around 16 cells thick, lip tissue is comprised of non-keratinized epithelium, which is only around 3 cells thick, a histological difference which is easily recognized by simply looking at the color of the lips in comparison to normal skin (Fig.1.). The red/pink color is the result of the combined effects of a lack of thick keratinized surface, leading to translucence of the underlying capillary network, together with a lack of melanocytes (pigment producing cells found in the epidermis of normal skin and that afford UV protection). 3

But more important than causing a pinkish hue, the lack of a truly protective stratum corneum layer, means that lips have a poor barrier function, with low moisture capacity 4, leaving them prone to infection, pathology, desiccation and at the mercy of the abuses inflicted on a daily basis – everything from toothbrushing, lip-licking, mouthrinses, eating and UV exposure. Transepidermal Water Loss (TEWL) is the amount of water that passively evaporates through skin to the external environment, not through sweat, but due to water vapor pressure gradient on both sides of the skin barrier. The measurement of TEWL is a good indicator of the integrity of the skin barrier function, with an increase indicating impaired barrier function which correlates to skin ageing and deterioration. 5

Given the structure, it is not surprising to know that research has shown lips to experience significantly greater TEWL than the rest of the skin, with this compromised barrier playing a major role in many common dermatoses including all forms of cheilitis (lip inflammation), leading to dry, chapped lips, cracking, flaking, sores, bleeding and more (Fig.2).

Additionally, as Lips do not possess hair follicles, sebaceous or sweat glands like normal skin (which aid hydration and bring vital nutrients and antioxidants like Vitamin E to the skin surface), research has shown that, because of their vulnerable structure, lips lack the innate protection capacity of the surrounding facial skin and experience daily physiological stress and deterioration at a faster rate and to a greater degree. Indeed, lip cancer represents the most common form of head and neck cancer (greater in men than women), with 90 per cent of new cases being squamous cell carcinoma (SCC). SCC originating in the lip has been shown to carry a much higher risk of aggressive metastasis than when the same kind of cancer appears first on other parts of the skin. 6

Many people mistakenly think that lips are just like normal skin, that they can be maintained in the same way, or they don’t require regular care at all unless they become cracked, yet nothing could be farther from the truth – lips need special attention and regular professional maintenance to preserve their health and function and to avoid serious pathology.

The Best Lip Care

In the same way as when trying to determine the most appropriate ways to maintain the health and appearance of their teeth and gums, patients looking for information on how to best care for their lips are bombarded with a plethora of overwhelming and conflicting information. Much of the time a patient’s source of this important information is from manufacturers pushing marketing slogans; dubious social media influencers and celebrities with a vested interest; or they are confronted by poorly trained sales staff standing in front of walls of products on department store and supermarket shelves, all claiming to be the best and the brightest solution.

As learned and trusted experts in the oral tissues, one of the primary duties of dental practitioners is oral health promotion and guiding our patients on the best, proven oral hygiene practices. In a modern dental practice, that advice and product recommendation should also extend to how best to care for the health of their lips, to maintain their appearance and condition, while preventing pathology, because just like inside the mouth, an incorrect product choice can have dire consequences.

In addition to recommending products that contain ingredients which have been clinically proven to supplement the deficiencies inherent in lip tissue composition, such as various antioxidants, humectants and emollients, the consistency of the products are crucial, as is its ability to protect against damage from the sun. Specialist Dermatologists and skin cancer specialists from Harvard University have raised warnings in regard to lip care products, especially the rise in popularity of luxury branded, non-SPF based high-sheen, gloss products, which they say enhance the optical passage of ultraviolet rays, increasing their penetration into the already fragile skin of the lips and increasing the risk of lip cancer. 7 Even the tissue damage done which is short of true cancer, from using the wrong lip products, without professional formulation based on clinical research, can lead to painful and unsightly photo-ageing, including the premature formation of wrinkles, painful fissures and solar keratosis – nonmalignant yet unpleasant crusty nodules. Armed with this knowledge, it is unconscionable that at the completion of a dental visit (the micro-trauma from which could make the lips immediately more vulnerable), that responsible dental practitioners would simply allow their patients to leave the clinic, exposed to the sun, and left to their own devices to choose lip care products that may actually be doing more harm than good.

However, clinical studies have shown that the regular application of a professionally formulated, sequential multi-step lip-care treatment results in significant improvements in the health of the lips. 8 The use of the Lip-Tx Pro system (Fig.3), for just a few minutes at the end of each scheduled dental recall, hygiene visit or any treatment appointment, together with the daily use of the Lip-Tx Home product, has been shown to enhance the lip barrier function, reducing TEWL, protecting the tissue from environmental damage, including broad-spectrum SPF protection, thereby improving the general condition of the tissue, with reduced cracking, dryness and fine lines, as well as improving lip texture, colour and definition.

How does Lip-Tx work?

The most complete method for ensuring healthy lip tissue throughout life, works in much the same manner as promoting healthy teeth and gums – regular check-ups and maintenance treatments by a dental professional, together with the daily use of clinically proven products for home use. Lip-Tx pro is the world’s first, single patient-use, professional lip care system to protect and enhance lip health and aesthetics, designed in Australia by a group of global oral health experts, based on the latest clinical research in to lip barrier function optimization.

Utilized at the conclusion of any professional treatment of, or around, the lips, teeth & mouth (e.g., after dental treatment, dental cleaning, teeth whitening, lip filler or any other therapy which may compromise lip integrity), the powerful, synergistic, 3-step system consists of exfoliation, hydration and protection phases and takes less than 5 minutes to administer.

Step 1: Exfoliation (Fig.4)

Fig.4: Exfoliation (lip scrub) to gently cleanse the lips,

while enzymes promote skin renewal.

Step 2: Hydration (Fig.5)

Fig.5: Hydration (lip mask – second skin) to soothe and

deeply hydrate the lips, restoring vital moisture balance.

Step 3: Protect (Fig.6)

Fig.6: Protect (lip balm with SPF) to nourish,

replenish and protect the lips

At the same time, Dental Practitioners, faced with an increasingly competitive market, have been looking for ways to differentiate their practices and stand-out from the crowd. One of the most successful methods for doing so is to offer a more complete service to patients, with unique treatments, conveying the feeling of more comprehensive care.

The development of professional, in-chair lip care and take-home recommendations not only benefits the health and wellbeing of our patients and acknowledges the importance of the lips as a previously neglected oral tissue, but also benefits the future success of our practices.

References

1. https://www.merriam-webster.com/dictionary/lips
2. Klein AW. In search of the perfect lip: 2005. Dermatol Surg. 2005 Nov;31(11 Pt 2):1599-603.
3. Zugerman C. The lips: anatomy and differential diagnosis. Cutis. 1986 Aug;38(2):116-20.
4. Kobayashi H, Tagami H. Functional properties of the surface of the vermilion border of the lips are distinct from those of the facial skin.
Br J Dermatol. 2004 Mar;150(3):563-7.
5. Golara Honari, Howard Maibach, Applied Dermatotoxicology – Clinical Aspects Academic Press, 2014
6. M. MARUCCIA, M.G. ONESTI, P. PARISI, E. CIGNA, A. TROCCOLA, N. SCUDERI
Lip Cancer: A 10-Year Retrospective Epidemiological Study Anticancer Research Apr 2012, 32 (4) 1543-1546
7. https://abcnews.go.com/Health/BeautySecrets/story?id=4766632&page=1
8. Trookman NS, Rizer RL, Ford R, Mehta R, Gotz V.
Clinical assessment of a combination lip treatment to restore moisturization and fullness. J Clin Aesthet Dermatol. 2009 Dec;2(12):44-8.
9. Ganceviciene R, Liakou AI, Theodoridis A, Makrantonaki E, Zouboulis CC.Skin anti-aging strategies. Dermatoendocrinol. 2012;4(3):308-319.
10. Journal of Pharmacy and Pharmacology, September 2019, pages 1,353-1,369
11. Journal of Clinical Aesthetic Dermatology, 2013, issue 1, pages 16-26
12. https://www.forbes.com/sites/sarabliss/2021/03/01/why-doctor-formulated-skincare-brands-are-disrupting-the-85-billion-dollar-beauty-
industry/?sh=4384bf1ac556

Boom In Botoxing At AADFA Member Clinics

Wed, 09 Jun 2021 03:48:26 GMT

AADFA Member Clinics across AU & NZ have received a surge in inquiries for facial aesthetic and rejuvenation services since reopening
A Melbourne AADFA Member reported a 70 per cent spike in queries for cosmetic dental procedures
Since reopening in June many AADFA Members are witnessing massive jumps in queries
Because of smart diversification into Facial Aesthetic & Rejuvenation, AADFA Members were able to return to profitable practice sooner than traditional dental clinics during COVID-19
Now AADFA Members are experiencing a BOOM in Facial Aesthetic & Rejuvenation bookings

Dentists have received a surge in enquiries for cosmetic procedures since the lockdown, with workers desperate to look good on Zoom calls.

Botox, Dermal Filler, PDO Thread Lifts, Facial Fat Reduction, Rejuvenation Services and Teeth-Whitening are among some of the most sought-after procedures.

Dentists believe the jump in interest is linked to increasing pressure to look good on Zoom calls and an abundance of free time for high-flying executives.

AADFA Member Dr Reuben Sim witnessed a a 70 per cent spike in queries for cosmetic dental procedures at his Melbourne Dental Boutique.

He said the main clients he's seeing are white-collar workers who are typically preoccupied working long hours, but now have greater flexibility.

'We see a lot of bankers and lawyers, and because their lives are always go, go, go, they often haven't had the time, but since things have come to a halt it's provided them with that,' he told The Daily Telegraph.

AADFA Member Dr Deb Rea from Azura Dental in Adelaide, SA told Channel 7 News that she had experienced a rise in bookings for Facial Aesthetic & Rejuvenation Services post COVID-19 lockdown. "You know when these things happen in life people can feel very down and these procedures can give you just the perk you need. When my doors opened back up, they were the first patients on my door and why shouldn’t they be? We all deserve to look and feel our best" she told Channel 7.

Australia has the highest per capita spend on domestic cosmetic procedures in the world.

The recent demand for cosmetic procedures has been dubbed 'Zoom-Face-Envy' by the Australasian Academy of Dento-Facial Aesthetics.

S ince restrictions on cosmetic treatments were lifted in QLD Smile Studio Newstead has recieved an influx of bookings for what they call "feel good factor treatments ".

AADFA Member Dr Cate Gerber told Channel 10 News and The Project "Botox, Dermal Fillers and Teeth Whitening bookings majorly increased and she is still experiencing a boom in bookings and enquiries ".

The recent demand for cosmetic procedures has been dubbed 'Zoom-Face-Envy' by the Australasian Academy of Dento-Facial Aesthetics.

The Academy's Director, Dr Myles Holt said many people are seeking to change how they look after spending so long starting at themselves on video chat services during lockdown.

'Zoom-Face Envy has come about because many Australians are now confronting the reality of what they actually look like and comparing themselves with others as they sit through yet another work teleconference or virtual catch-up,' Dr Holt said.

'It seems many aren't happy with what they see and want to improve their appearance before returning to their workplaces and social gatherings, once all restrictions are fully lifted,' he said.

Botox may protect heart after surgery

Thu, 13 May 2021 04:17:01 GMT

New Title

It is thought that post-op injections of Botox might interrupt abnormal nerve signals to the heart.

‘BOTOX’ may prevent a common complication of heart surgery. Injections of botulinum toxin are being tested as a treatment for post-operative atrial fibrillation (AF), where the heart beats rapidly and irregularly, which is experienced by up to 40 per cent of patients after surgery – it’s thought as a result of inflammation.

Although the AF is temporary, it can result in heart failure or stroke. In an international trial at centres that include Derriford Hospital in Plymouth, heart surgery patients will have jabs of botulinum toxin around their hearts.

It’s thought the compound, which blocks signals passing between nerves and muscles, can help by interrupting abnormal nerve signals to the heart that cause it to misfire.

aadfa

Best Clinics Australia 📍Bribane Edition•

Best Clinics Australia ��Brisbane Edition•

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3 Lies Dentists are told about “Botox”

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Best Clinics Australia 📍Adelaide Edition

Best Clinics Australia ��Adelaide Edition•

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Private Training in BOTOX & Beyond, AADFA pioneers a new industry standard!

From July 1st , 2023, new rules around the use of facial injectable treatments took effect in Australia, coinciding with the introduction of new, industry-leading, private practical training by AADFA.

Private, 1-on-1 training as standard.

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Injecting credibility

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A changing audience

Dentists leading the way

In Your Face

In your f a c e

A decade ago Dr Myles Holt found himself at the centre of a major dentistry dispute concerning the future of facial injectables. Now he's having the last laugh. By Tracey Porter for Bite Magazine

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BOTOX Update:

New Laws, New Products, New Opportunity!

From July 1 st , 2023, new rules around the use of facial injectable treatments are set to take effect, coinciding with Australia receiving the first new Botox product in almost a decade. Dr Markus Weber discusses how these long-awaited developments present a BIG opportunity for Dentists.

NEW LAWS

1. Ongoing recognised education:

2. Botox and Dermal Filler are not enough:

3. Psychological Screening:

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Masseter Muscle Botox injections – the new clinical protocol

Masseter Muscle Botox injections – the new clinical protocol ﻿

1. An asymmetrical smile (Fig.2)

2. Xerostomia

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​LIPS: THE FORGOTTEN ORAL TISSUE

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Botox may protect heart after surgery

New Title

watch the episode

W ant to learn more?

Now he’s having the last laugh.

From July 1 ^st , 2023, new rules around the use of facial injectable treatments are set to take effect, coinciding with Australia receiving the first new Botox product in almost a decade. Dr Markus Weber discusses how these long-awaited developments present a BIG opportunity for Dentists.

Masseter Muscle Botox injections – the new clinical protocol

Dento-Facial injections

LIPS: THE FORGOTTEN ORAL TISSUE

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