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!