Australasian Dentist Issue 93

CATEGORY 78 AUSTRALASIAN DENTIST L ips are unique oral structures (as individual as fingerprints), anatomically and histologically distinct from the surrounding skin. They play important roles in mastication and deglutition; sound articulation; facial expression and physiological protection; as well as being tactile organs and erogenous zones. Lips, as part of thebroader smile, are also the central defining aesthetic feature of the lower third of the face, contributing significantly to our perceptions of health, beauty, vitality and how we interact with our environment. When teaching dentists and speaking globally on the topic of complete dento- facial rejuvenation procedures, one of the most common questions I am asked is about the approach I use to reliably achieve a natural, aesthetically pleasing lip enhancement. I think people are often shocked when the response is not as simple as, I just use a certain brand of dermal filler and some amazing whiz-bang technique. Lips, and lip enhancements, are far more complex and varied thanmost people realize, with patients, and practitioners alike, often being misled by social media to believe that all they need is some simple lip filler to plump, or some insta-fad technique like a “lip flip”. As with many conditions in dentistry, changes and deterioration in lip tissue either through age or neglect, vary greatly for each individual and are rarely the result of a single defining factor. This means that a single quick fix, shortcut approach is unlikely to provide long-term, natural-looking improvements in health and aesthetics. Only a complete assessment of each individual case and a multi-pronged treatment plan will avoid the over-inflated, trout-pouts that have become ubiquitous in the broader cosmetic industry. Rather than the use of dermal filler in lips being the frontline treatment of choice, very often it should be seen as last on the list. If dermal filler is the only approach to lips a dentist has in their toolkit, they will forever risk not achieving fully informed consent; underdelivering on results; and experiencing unnecessary complications. When it comes to rebuilding, restoring and improving the health and appearance of lips, practitioners shouldn’t have a haphazard, one-size-fits-all approach, but rather, they should have a systematic protocol for assessment, diagnosis, treatment planning and delivery, in exactly the same way we do inside the mouth – including imaging. I find that the easiest way for dentists to think about delivering great lip enhancements is that it is like placing a dental implant. The two procedures share many of the same basic considerations and should followastructured,well-defined, systematic approach, underpinned by comprehensive training and an appreciation of all available treatment options, to ensure practitioners achieve successful clinical outcomes for their patients. Flying blind, freewheeling with limited knowledge and only having one tool in your toolkit, will invariably lead to heartache for all involved. Let’s look at the three basic (implant like) steps I encourage dentists to think about, to achieve success with lip enhancement: Step 1: Prevention & maintenance are better than cure In line with our general philosophy as health practitioners, the primary focus when considering a lip enhancement must be on ensuring the lips are being cared for appropriately at home by the patient and that they attend the clinic for regular maintenance treatments, prior to more invasive therapies being considered. Just like a patient who’s implant treatment would be severely compromised if a dentist ignored the fact that they didn’t brush their teeth at all; had rampant periodontitis; never attended regular hygiene appointments; and was a heavy bruxer and smoker; so too will a lip enhancement fail if dentists don’t first address matters of general maintenance; instill good practices to maintain tissue health longer term; and reduce the impact of various insults causing daily damage to lip structures. Beyond just the natural deterioration we see with age, even more so than teeth, lips are vulnerable to a lack of care and exposure to environmental aggressors. 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. This compromised barrier means that lips are inherently prone to extreme dehydration, as well as pathology and conditions including all forms of cheilitis (lip inflammation), leading to dry, chapped lips, cracking, flaking, sores, bleeding and more. Furthermore, lips lack many of the protective elements seen in normal skin. Lips don’t have melanocytes to produce melanin and provide natural UV protection and they don’t have hair follicles, sebaceous or sweat glands, which would aid hydration and bring vital nutrients and antioxidants like Vitamin E to the lip surface. Due to this lackof the innateprotection, lips experience daily physiological stress and deterioration at a faster rate and to a greater degree than surrounding skin. Indeed, lip cancer represents the most common form of head LINICAL How a lip enhancement is like an implant! By Dr Myles Holt, BDS, LLM (Heath&Medical), MSc (Aesthetic Medicine), FIADFE, AADFA Director & Head Trainer Dr Myles Holt Fig.1: A successful lip enhancement involves greater consideration than just defaulting to the use of dermal filler. At home care, regular active maintenance and a multi-pronged treatment approach are needed to achieve great results.