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Why Should an Orthodontist Do Injectables?

On Dermal Fillers:

So what is an orthodontist, who is also a naturopathic physician, getting involved with facial esthetics anyway?  An orthodontist is considered an expert in facial esthetics and, due to the extensive training in head and neck anatomy,  understands the functional relationships of nerves and muscles of the face.  Not only is this training a key advantage of having a dental specialist provide dermal fillers, the procedures can be done with minimal discomfort due to targeted anesthesia making the procedure virtually painless.

For many people, orthodontic treatment is pursued for a better cosmetic look.  For others, the cosmetic outcome did not turn out too well, particularly if teeth were removed as part of the orthodontic process.  One of the most common complaints for these patients is insufficient lip support and an increase in the depth of the naso-labial folds.  Short of a surgical approach to move the upper jaw forward to restore lip support and reduce the depth of naso-labial folds, we use dermal fillers as a natural means (hyaluronic acid) for a rather immediate improvement in appearance.  Environmental damage and the natural aging process lead some to seek science-based options in the discipline of medical aesthetics as well.

What are fillers used to treat?

This depends somewhat on the filler, but the broad answer is lines and wrinkles. They can also be used to plump and define lips and fill hollow areas on the face. Here are some of the areas where they work best:

  • lines from the nose to the mouth (nasolabial fold)
  • lines from the mouth to the chin (melomental fold)
  • lines above the upper lip
  • frown lines (best combined with Botox Cosmetic)
  • in the lips for volume and definition
  • to restore volume to cheekbones or cheeks
  • in some situations, under the eyes

Dr. Dierkes is uniquely qualified in the field of facial esthetics as he was asked by the American Dental Association to write a landmark article of facial esthetics in the charter issue of Esthetic Dentistry.  The article was entitled The Beauty of the FaceAn Orthodontic Perspective.J Am Dent Assoc. 1987 Dec;Spec No:89E-95E.  An orthodontist is considered an expert in facial esthetics and due to the extensive training in head and neck anatomy understands the functional relationships of nerves and muscles of the face.  Not only is this training a key advantage of having a dental specialist provide dermal fillers, the procedures can be done with minimal discomfort due to targeted anesthesia making the procedure virtually painless.

How much do Juvederm or Restylane cost?

Restylane and Juvederm are usually priced by the syringe. For example, filling out the nasolabial folds (the lines from the nose to the mouth) will take one or two syringes usually. One syringe will range from $450 to $600. Perlane and Juvederm Ultra Plus (the thicker versions) generally cost about $500 to $750 per syringe.

The procedures are usually repeated every 6-9 months to maintain the esthetic advantage.  However, one can improve the longevity of this approach utilizing better cellular nutrition.  For example, supplementing with 3-5 thousand mg. of vitamin C will help improve collagen density.  Without sufficient vitamin C, the

chemical process of collagen formation cannot occur with any degree of density.  To arrive at a longer lasting  and better outcome, we recommend various nutritional supplements as well.  Juvederm Voluma is longer lasting; up to two years.

Another option is to use prp (platelet rich plasma) added to the dermal fill procedure.  Where Juvederm or Restalane is a more immediate improvement in appearance, the prp will actually regenerate the collagen due to the platelets effect on stem cell activity.  It takes about 3-4 weeks for this process to occur.  You have the immediate improvement in appearance from the dermal fillers coupled with a more lasting effect from the regenerative approach using prp.  Obviously, the combined procedures is more costly in the short-term, but less costly in the long run.  A newcomer to the line of dermal fillers is Juvederm Voluma, which promises longevity up to two years.

If delayed gratification is not an issue, keep the cost down and use the prp only for the outcome you are looking for.  PRP can be used to reduce the appearance of frown-lines, forehead wrinkles, crows feet, and loss of skin tonicity resulting in saggy skin (jowls).

Botox works by reducing the intensity of muscle contraction.  It helps to reduce the frown lines and crows feet in the upper face.  We also use it to reduce the intensity of muscle contraction in TMJ patients.  It will help reduce the pain as well as the destructive outcomes often associated with clenching.  If jaw dislocation is associated with the clenching, then is it recommended that a mouthpiece be used to distract the jaw joints as a means of identifying and treating any and all underlying factors that are either observed to be causative and/or perpetuating factors.

Dr. Dierkes uses the well-recognized brands of dermal fillers including Juvederm, Juvederm Ultra, and Juvederm Voluma as well as Botox.  The JUVÉDERM® family of dermal filler products; and physician-dispensed skin care products have long been recognized to be the most researched products available.  BOTOX® Cosmetic is a prescription medicine that is injected into muscles and used to improve the look of moderate to severe frown lines between the eyebrows (glabellar lines) in people 18 to 65 years of age for a short period of time (temporary).   As a world leader in medical aesthetics, Allergan is and will remain deeply committed to the Science of Rejuvenation™. This means providing medical specialists and patients with products and information backed by science so they can make the best-informed medical aesthetics choices possible based on their own individual needs and treatment goals.  Dr. Dierkes also uses other brand-name dermal fillers such as Restylane and Perlane.

Dr. Dierkes recommends an initial consultation to use as a planning session for patients considering fillers for the first time where a series of facial photographs are obtained and reviewed with the patient.  A medical history is obtained and an initial nutritional assessment made.   Better esthetic outcomes are obtained with adequate cellular nutrition to support the most optimal collagen density for longer lasting results.  Systemic factors are assessed as thyroid activity determines the level of soft tissue integrity as well.  As a naturopathic physician and orthodontist, Dr. Dierkes brings a uniquely fresh perspective to facial esthetics.