CATEGORY 42 AUSTRALASIAN DENTIST Patients rarely present asking for facial harmony. Instead, they point to an isolated feature – a forehead line, a thin lip or a deep nasolabial fold – and ask for it to be treated. It is tempting, particularly for less experienced injectors, to focus on the concern directly in front of them. Yet doing so often overlooks the very reason the concern exists. As dentists, we instinctively know that successful treatment begins long before we pick up an instrument. A patient requesting a veneer may actually require orthodontics. A worn incisal edge may be the consequence of parafunction rather than simply tooth wear. Restoring the visible problem without understanding the underlying diagnosis rarely produces predictable, long-term success. The same philosophy applies to cosmetic medicine. Injectables are treatment tools, not treatment plans. Before deciding where to inject – or indeed whether to inject at all – we must first understand the patient's facial proportions, skeletal support, muscular balance and the relationships between individual facial structures. Only then can we develop a treatment plan that enhances the face rather than simply treating isolated features. The best cosmetic results rarely come from treating wrinkles. They come from understanding why those wrinkles developed in the first place. Dentists already understand facial harmony Cosmetic dentists spend years developing an appreciation for balance and proportion. Every smile design requires consideration of tooth width, gingival display, lip dynamics, facial symmetry and the relationship between the dentition and the face. Very few clinicians would design ten beautiful veneers without first stepping back to assess the patient's overall smile. The same principle should guide cosmetic injecting. Very few clinicians would design ten beautiful veneers without first stepping back to assess the patient's overall smile. The same principle should guide cosmetic injecting. A beautifully treated lip may still appear unnatural if the chin lacks projection. A perfectly relaxed forehead may look heavy if brow position has not been considered. Softening the masseter may create facial imbalance if the patient already has a narrow lower third. In other words, every facial structure exists within a much larger aesthetic framework. But what about our scope? Many dentists continue to question whether cosmetic injectable treatments fall within their professional scope of practice. This concern is understandable, particularly given the evolving regulatory landscape, but it should not discourage appropriately trained clinicians. AHPRA's Registration Standard: Scope of Practice recognises that practitioners may expand their scope provided they have the education, competence and ongoing professional development necessary to deliver safe patient care. The Dental Board of Australia's Guidelines on Scope of Practice also acknowledge that dentists may perform cosmetic procedures involving the face when they have the appropriate knowledge, skills and training. As oral health practitioners, we are already responsible for assessing the entire orofacial complex, discussing treatment options and helping patients make informed decisions about their care. Cosmetic medicine simply extends this responsibility beyond the dentition. Cosmetic medicine should not be viewed as a departure from dentistry, but rather as an extension of our understanding of facial anatomy, function and aesthetics. When practitioners undertake appropriate education, maintain regular continuing professional development and practise within the limits of their competence, treating the face sits comfortably alongside many of the skills dentists already apply every day. The principles that underpin excellent cosmetic dentistry – careful diagnosis, treatment planning and an appreciation of facial harmony – are exactly the same principles that underpin excellent aesthetic medicine. The difference is simply that our canvas becomes larger. Rather than focusing solely on the smile, we consider how the lips, chin, nose, cheeks and surrounding facial structures work together to create balance, expression and natural beauty. Beyond the Golden Ratio For centuries, mathematicians, artists and anatomists have searched for objective measures of beauty. Perhaps the most famous is the Golden Ratio (approximately 1:1.618), first described in Ancient Greece and later embraced by Renaissance artists including Leonardo da Vinci. The concept proposes that certain proportional relationships are inherently pleasing to the human eye, and numerous attempts have been made to apply these principles to facial aesthetics. Facial attractiveness is influenced by multiple interacting variables, including symmetry, skin quality, facial movement, skeletal architecture, cultural influences and individual preference. Although some attractive faces approximate aspects of the Golden Ratio, equally attractive faces often do not. The danger arises when clinicians attempt to force patients towards predetermined proportions. Chasing numerical perfection risks removing individuality and may produce outcomes that appear technically correct but aesthetically disappointing. Patients do not want identical faces. They want to look like the best version of themselves. Facial proportions: The missing step before every injection Why every cosmetic treatment should begin with diagnosis, not the drill or syringe CLINICAL Dr Giulia D’Anna By Dr Giulia D’Anna Founder, Dermal Distinction Academy. Aesthetic Medical Emergency Team (AMET) Complications Expert
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