Perioral Aesthetics: Aesthetic Medicine Techniques for Facial and Smile Treatment

Category: Surgery

Instructor(s): Ezio Costa

Course structure: Lessons: 31 lessons | Duration: 9 h 43 min

Course overview

Dr.

Ezio Costa welcomes you to Perioral Aesthetics - Aesthetic Medicine Techniques for Facial and Smile Treatment, the video course that will provide you with the necessary knowledge and skills to introduce perioral aesthetics into your daily clinical routine.

Modern dentistry is giving more and more importance to aesthetic facial treatments, going beyond the smile area.

Throughout theory lecture videos and clinical videos, Dr.

Costa will present a comprehensive overview of the characteristics and functions of hyaluronic acid and both superficial and deep injection techniques of different types of fillers in different areas of the face, providing practical skills that can be immediately replicated in your clinic.

Join Dr.

Costa, stay up-to-date, and learn everything you need to know about perioral aesthetics from one of the leading experts in this clinical field!

In particular, these topics will be treated in this course:
– Integration of dentistry and facial aesthetic medicine
– Hyaluronic acid: size, concentration, rheological and biomechanical properties
– Filler: rheological characteristics and the different options on the market
– Hyaluronic acid fillers: viscoelasticity, resistance to elastic deformation, volumizing effect, and preservation
– Both superficial and deep injection techniques, reference points
– Tissue biorevitalization techniques with needles and/or micro cannulas
At the end of this course, you’ll be able to:
– Adopt specific protocols for aesthetic facial treatment with botulinum toxin or hyaluronic acid filler
– Select the correct filler depending on the aesthetic area to be treated and the peculiarities of each clinical case
– Restore volumes and compensate for three-dimensional changes in structure
– Perform facial evaluations and mapping
– Treat the zygomatic-malar area, infra-orbital area, piriform space, chin, lips, and nose
– Have a professional knowledge of critical areas in support, aesthetics, and rejuvenation
– Assess the final outcome and plan for the need for possible refinement
Who is the course for?

To all practitioners who want to start performing facial aesthetic medicine treatments, as well as to those already involved in aesthetic medicine who want to receive a timely update about the latest full-face treatment protocols.

Curriculum

The aesthetics of perioral tissues

• Part of introductory lectures.

Preliminary phase and patient assessment

• Part of introductory lectures.

The characteristics of biological aging

• Part of introductory lectures.

The smile and facial aesthetics

• Part of introductory lectures.

The integrated approach to facial aesthetics in dentistry

• Part of introductory lectures.

Mapping and treatment

• Part of introductory lectures.

Hyaluronic Acid: a complete overview

• In this first video lecture, Dr. Costa will discuss in depth about the functionality, characteristics, and methods of use of hyaluronic acid in facial aesthetic medicine. In fact, hyaluronic acid is the gold standard for nonpermanent, nonsurgical procedures for facial aesthetic treatment. Participation in this video lecture will be preparatory to a full understanding of the techniques and protocols outlined in subsequent presentations.
• In particular, the following topics will be addressed:
• – Size, concentration, and biomechanical properties of hyaluronic acid
• – Biology and biotechnology of hyaluronic acid
• – Key steps from synthesis to degradation of hyaluronic acid

Hyaluronic acid fillers

• Continues the 360-degree presentation of hyaluronic acid by beginning to focus on how different companies produce different types of hyaluronic acid, rheological characteristics, and acid-tissue interaction processes. Different types of HA will be discussed: multi cross-linked, linear-free, cross-linked, and voluminizing.
• In particular, the following topics will be addressed:
• – How do industries produce different types of HA?
• – Which hyaluronic acid: characteristics and defects
• – The biostimulatory effects of HA
• – Linear-free hyaluronic acids VS cross-linked hyaluronic acids
• – High and low molecular weight: different functionalities

Introduction to facial aesthetics techniques

• Participants will learn how the goal of Dr. Costa's facial aesthetic treatments is to support the tissues by restoring their volumes to achieve a facial rejuvenation effect. The facial mapping process, a crucial step in treatment planning for which a major learning curve about the anatomy of the face is needed, will be shown.
• In particular, the following topics will be covered:
• – Preliminary assessment and face mapping techniques
• – Volume restoration to compensate for 3D variations in structure
• – Hints of facial anatomy: landmarks
• – Methods of using HA to support tissues
• – What factors to consider when mapping to plan rejuvenation treatments

The patient assessment

• In this presentation, participants will see the assessment of the patient's chief complaint and face to arrive at the production of a treatment plan based on HA and botulinum toxin with targeted and specially prepared timing.
• In particular, the following topics will be covered:
• – Understanding and knowing what the patient's chief complaint is
• – Mapping the face and delineating key areas for aging and tissue voluminization
• – Assessing degree of skin aging and any asymmetries
• – Assessment of the face: peculiarities and possibilities for intervention

Upper third of the face

• Through this and subsequent lectures, participants will receive guidelines for preparing effective treatment plans in certain key areas of the face.
• In particular, this presentation will focus on the area of the upper third of the face, paying special attention to the treatment of the skin and forehead depression.
• Protocols to align and make the forehead depression more harmonious with a direct needle or cannula technique will be discussed. Finally, clinical cases will be shown to illustrate the treatment of the temporal region, lateral canthus, glabella and eyebrow area.
• In particular, the following topics will be addressed:
• – Cognitive premises for treatment planning in the aesthetic area
• – Depressions of the forehead and temporal area
• – The eyebrow, lateral canthus and glabella area
• – Various types of treatment according to anatomical and ageing characteristics of the patient
• – The finishing of superficial and skin wrinkles
• – Temporal area depressions and eyebrow support with needle or cannula

Treatments in the zygomatic-malar region and infra-orbital area

• According to Dr. Costa, the two areas presented in this video lecture are the most important for facial rejuvenation and are the starting point from which to evaluate any aesthetic facial treatment plan. Participants will learn how to evaluate focal points at a strategic level such as the lateral zygomatic arch, the point of beautification, the mid-malar fat pad and the wing of the nose. In addition, the infra-orbital area where both deep needle and superficial cannula interventions can be performed will be discussed in depth.
• In particular, the following topics will be addressed:
• – The critical areas for facial rejuvenation
• – Direct deep injection on bone and superficial finishing by cannula
• – How to work on superficial fat to improve facial aesthetics
• – Tissue support in the zygomatic-malar area

The piriformis area and the lateral cheek

• The piriform space is an area lateral to the wing of the nose that can be treated with a deep needle directly on the bone. Dr. Costa will focus on analyzing some of the risk factors affecting the said area such as the facial artery, angular artery and chin foramen. Clinical clips will be shown in which revitalizing fillers based on liquid hyaluronic acid are used. The second part of the video lecture will comment on protocols useful in supporting the medial and lateral cheek region and the labio-mental fold.
• In particular, the following topics will be addressed:
• – The anatomy of the piriform space
• – The principles of aesthetic full-face treatment
• – The analysis of some very deep areas of risk in which to work only superficially with cannula

Mandibular margin and chin

• The mandibular border and chin are part of a region well known to dentists where one can intervene to support the ascending part of the mandible to improve facial aesthetics after working on the upper part of the face.

The lip area

• In this presentation, Dr. Costa will provide participants with guidance for a general patient assessment appropriate for understanding possible intervention options for improving patient aesthetics. The anatomy and composition of the lips will be discussed with particular reference to the skin, dry vermilion, intraoral mucosa, salivary glands, and subcutaneous fat. Participants will gain an understanding of how important the lips are in the facial rejuvenation process and how they can influence in improving smile dynamics in a progressive and harmonious manner.
• In particular, the following topics will be addressed:
• – The anatomy of the lips: inner and outer part, orbicularis muscle, labial mucosa, vermilion, border between red lip and white skin
• – How to treat the lips with superficial fillers but below the muscular plane
• – The use of revitalizers for lip support
• – How to improve smile dynamics using specific products at varying depths in different specific areas

The full-face treatment: step-by-step description of a clinical case

• Participants will observe the protocol for full-face treatment designed by Dr. Costa. This presentation will take place in step-by-step mode and the injection protocol will be shown in each area of interest, from the temple area to the zygomatic area via nose, piriform region, chin and lips.
• In particular, the following topics will be addressed:
• – Micro-injections for shaping the dorsum and tip of the nose
• – Retrograde VS anterograde technique
• – Linear-retrograde technique for projecting the lips differently to the left and right
• – Critical areas of support, in aesthetics and rejuvenation

Use of botulinum toxin in dentistry and aesthetic medicine

• This lecture will show botulinum toxin treatments in the lower, middle and upper third areas of the face.
• In particular, the following topics will be covered:
• – The frontal region of the face: harmony and support to the eyebrow
• – The anatomical limits of the frontal muscle

The dilution of botulinum toxin

• This presentation will discuss the preparation and dilution with sodium chloride solution of VISTABEX botulinum toxin and its subsequent storage.

Full-face treatment with botulinum toxin

• Botulinum toxin is a drug that reduces the strength of mimic and skeletal muscles; it is also used as a micro-botox to improve skin surface texture and activate fibroblasts. Dr. Costa will explain to participants how when using botulinum toxin in the face, one must first assess the facial mimicry and the strength of the muscles to be treated.

Peri-intra oral soft tissue management with botulinum toxin

• In this last theory lecture video, Dr. Costa will show how to accurately identify the main anatomical structures of interest and respect for perioral aesthetics treatments.

Clinical case: model on skull

• In this first clinical video, Dr. Costa will show what bone landmarks and landmarks to consider when performing deep injections on bone to redefine facial contour and to support the soft tissues of the middle and lower third of the face. The areas of the zygomatic arch, masseter muscle, lateral temple, temporalis muscle, facial artery of the mental foramen and infraorbital foramen will be analyzed in detail.

Clinical case: support and improvement of the perioral region

• In this clinical case we will look at the protocol of using the Fidia Ial-System DUO filler in the perioral region thus on the lips, vermilion, upper and lower lip skin, nasogenic and labial folds. Dr. Costa will describe the DUO filler as an interesting product because of its rheological characteristics; a low molecular weight cross-linked filler. The versatility of the Filler DUO product, capable of preserving proportions, volumizing tissues, and characterized by a high duration of stimulating effect on superficial and deep tissues, will be emphasized.
• In particular, the following topics will be addressed:
• – The viscoelasticity of cross-linked filler
• – The relationship between G' and G''
• – Choosing the correct material for the treatment of the lips and perioral area
• – Mapping for treatment of the lips and perioral area
• – Filler treatment of the lips to restore volume and contour definition (with cannula)
• – Filler treatment of the perioral area to improve the superficial appearance of the skin (with cannula)
• – Several very superficial techniques for finishing treatment

Clinical case: lip volume augmentation

• The area treated in this clinical case is the nasogenian folds where, in this specific case, there is a mental angioma that makes it impossible to treat the area superficially with a cannula. Dr. Costa's goal is to increase the volume of the labiomental area.
• In particular, the following topics will be addressed:
• – Tissue stimulation and rejuvenation
• – The needle voluminization of thinned lips
• – The versatility of both needle and cannula injectable DUO filler
• – Filler treatment of the nasolabial wrinkle, upper lip and labial fold
• – Treatment with filler of the labio-mental fold and chin contour (with cannula)

Clinical case: tissue support of the middle and lower third of the face

• This clinical video will discuss tissue support of the zygoma, premasseterine region, and parotid region. The 3 points at which to inject voluminizing product deeply into the bone will be shown and discussed: the zygomatic structure, the beautification point, and the deep pyriform space.
• In particular, the following topics will be addressed:
• – Face mapping and zygomatic arch design.
• – The comparison of 3D photos of the face pre- and post-treatment with fillers
• – The assessment of tissue displacement
• – Filler treatment for volume and support of the zygomatic area (with needle)
• – Treatment with fillers of the pre-masseter and parotid region for lateral cheek and mandibular border support (with cannula)
• – Treatment with filler for support of the lower lip area (with cannula)

Clinical Case : The support of the middle third of the face and slight correction of the nose

• An edentulous patient will be treated with a vial of DUO filler with the goal of supporting the upper lip despite no vestibular fringe support or alveolar bone. The protocol to increase support of the piriformis area, the nasal angle of the spine and also the cheekbone will be shown. At the end of the presentation, pre- and post-treatment images will be compared highlighting the fact that the entire medial, lateral, and zygomatic areas have been successfully supported.

Clinical Case: Voluminization of the zygomatic-malar region

• Dr. Costa will show how to strengthen the zygomatic-malar region on both the right and left sides through a soft, volumizing, active and intercalated product to ensure tissue rejuvenation and maintenance of lip turgidity.
• Specifically, the following topics will be addressed:
• – Nose filler treatment (needle and cannula)
• – Treatment with filler for projection of the tip of the chin (with needle)
• – Treatment with intercalated filler of the lips to give stimulation and hydration to the tissues and to soften the contour (with cannula)
• – Treatment with intercalated filler to improve the superficial skin appearance of the cheeks

Clinical Case: The resolution of a facial asymmetry with filler

• In this clinical video, a patient with facial asymmetry between the right and left sides is presented. Participants will notice how on the right side there is less support of the zygomatic arch, labial commissure, and mandibular border. Dr. Costa will show how to improve facial asymmetry by working deeply on the zygomatic arch.

Clinical case: harmonizing facial volumes in patient with total prosthesis on implant

• This short clinical video will show the treatment of reduced support of the zygomatic area and the injection protocol to relax and hydrate the cheek area.

Clinical Case: Facial mapping and correction of an asymmetry

• Participants will appreciate the face mapping from which the lack of lateral support and the presence of a diffuse depression in the right side of the face will emerge. The treatment plan will include supporting the lower part before the nasolabial fold, correcting the asymmetry and improving the appearance of the skin.

Clinical Case: reharmonization of the facial contour

• This clinical video will show reharmonization of the facial contour through injections in strategic areas: temple, cheekbone, cheek, jaw, and chin. Next, Dr. Costa will focus on the perioral, nasolabial, and lip regions by going to use different types of fillers at different G', either through needle or cannula with different injection techniques.

Clinical Case: Treatment of the zygomatic area

• In this last clinical video, the treatment of an under-supported cheekbone will be shown. A superficial injection of the product into the mental muscle will be performed, an injection into the piriformis area to support the nose wing and fill the depression, and then the depression arising at the nostril level will be reduced.