Unfortunately, dentists often don’t know the full capabilities of cosmetology. Accordingly, aesthetic medicine physicians are not always aware of the possibilities of dentists. The question of combining various specialists — plastic surgeons, dentists and beauticians — was under discussion at the First International Conference «Three-discipline planning of the face and neck correction of a difficult patient», held in Kyiv in spring 2016.
The main organizer of the event was «Esthete Center Dr. Borodko». That is why Olexander V. Borodko — plastic surgeon, surgeon of the highest category, a member of the Association of Plastic, Reconstructive and Aesthetic Surgery — is our interviewee now in Live talk.
On behalf of the H-Clinic with Olexander spokes Olena Venger — dentist of IRIS DENT CLINIC member of the Ukrainian Society of Periodontists and the Ukraine Association of Orthodontists.
h.: Olexander, how did the idea of cooperation between estists and dentists arise? We know, that this idea originated from you and you embody it now at conferences and workshops.
O. B.: Once I heard that this kind of association already exists in Europe. Maybe it is not association but cooperation. So we decided to launch it here. The idea of the conference belongs to my wife Inna. This event was the first impetus to the understanding that these professionals need. We want to ensure that the joint work of experts able to provide patients the best aesthetic, more long-term and predictable outcome.
h.: Why do you think this question is important now?
O. B.: Aesthetic medicine market is developing frantic pace. The world is replete with proposals to restore the health and beauty of the face. People very often get confused, not knowing how to start. Each expert recommends starting with what concerns his specialization. Our goal is- to coordinate actions the way that helps harmoniously correct face, restore volume and lost ratio.
We need to go beyond our specialized study and experience the full assistance provided to a patient who had an aesthetic problem. Only our joint work can improve the patients’ quality of life.
h.: Why do you think it is so important to combine specialists?
O. B.: It is a full service for patient. If subcutaneous structure is unbalanced, the correction results and complications of premature aging are very unstable. Still need to work not only with the skin but consider many other nuances. An integrated approach is the safest, most appropriate and long-term. It has long been necessary for us.
Of course, loss of teeth as a result of caries and its complications or periodontal disease burdens cosmetologist job. Comprehensive approach will be useful: dentist solves this problem by compensating lost teeth by prosthesis, restoring the structure and function of the masticatory system.
It is the fact that the patient does not always understand why he is not satisfied with their own appearance. For example, most people are concerned only smile aesthetics area, and they are absolutely not concerned chewing teeth.: These patients do not realize that in the absence of complete denture adjustment they can’t get changes in the aesthetics of the whole face.
h.: So you do not consider plastic surgery self-sufficient, do you?
O. B.: I clearly understand that when I as a plastic surgeon engage in the patient by myself, it will not be equivalent aid. And dentist’s help also can’t be self-sufficient. For example, if the doctor only align the dentition, the corners of lips remain down. Cheeks, wrinkles — all remain. The main result of our collaboration is a full service. The patients should feel satisfaction from their appearance and harmony within. Passing from one specialist to another, the patient often feels a certain lack of work of doctors.
h.: We are talking about plastic surgery, Olexander, so what led you for this? You are one of the first plastic surgeons in Ukraine.
O. B.: First I got into operating to Olexander Sergienko, children’s orthopedic surgeon. I saw his work, and it made a strong impression on me. Assisting him, I realized that I was not interested in anything other than surgery. Serhiyenko impose cosmetic seams adolescents with injuries so that there was no visible scar. He began to teach me to do cosmetic seams. There is a lot of plastic in pediatric orthopedics, so all started from it. Later, I was invited to Kyiv to work in a private clinic and be a top doctor. It was aesthetic medicine, which Ukraine had just started to develop.
Then it was acquaintance and work with Vasily Pinchuk — hand micro surgeon, with Roma Lisovets — orthopedic surgeon. My story started like this. I have experience in plastic surgery for over 20 years.
h.: Sometimes we have planned and coordinated treatment plan and the patient, not to mention it decides to make lips correction. The result is a kind of inharmonious. What to do in this situation?
O. B.: It is better to prevent it than to correct the situation. Of course, the beautician can deploy the corners of the mouth with the injection method.
Therefore, during the history of the anamnesis, additional questions should be asked. You need to find out what exactly worries the patient in his own appearance. You must explain that the help of other specialists is also necessary, if dental treatment is a priority. In an ideal situation the dentist and the beautician agree on a treatment plan and future surgical interventions with each other.
h.: What exactly dentists must learn to most effective cooperate with aesthetists?
O. B.: I would not be so categorical. I think, and we have much to learn. It was the discovery for me that dental wax modelling helps plastic surgeon provide how the dentition will look after the restoration. We must realize that changes in the face are associated with both cosmetology and dentistry.
Be sure to conduct advanced patient dental photography, which includes portrait photos with specific requirements. For example, below the shoulder girdle to consider the posture, position of the head of the patient before, during and after treatment. But it is important to understand clearly differentiate when orthodontist, a plastic surgeon can handle, and when orthognathic surgery is necessary.
In the case of joint management of the patient we should clearly understand the sequence — who starts first. This sequence we set individually during the initial consultation. From the first consultation the doctor as a psychologist should understand the problem and feel the pain points of his patient, which will work with in the future.
h.: The conference dealt with the difficult patients. What exactly do you mean by this concept?
O. B.: Calling the patient «difficult», I mean that doctors — cosmetologists, plastic surgeons — have not considered in their offices to consult the dynamic changes in the profile. We never mention about the features of the head and neck posture regarding the shoulder girdle.
With age, the head position changes. А small child holds his head straight and slightly back and walks bulging out his belly then aged man increasingly tilts his head forward. It is from this there are problems such as sloping chin changes and changes in bite. Everything is more complicated than we think. As any specialist, I see some signs, which determines that the patient is «mine» and immediately evaluate options to help I can provide. These are injectables; modelling face with fillers; peels that change the structure of the skin, improving it; spinning lift, which can delay time-surgical lifting and, eventually, the actual surgery.
h.: Does it basically come to age-related changes, because that age is changing bite?
O. B.: Yes, usually it happens gradually and physiologically, but sometimes pathological changes take place when abrasion is excessive and bite height decreases in the short term. Accordingly, the nasolabial fold deepens, there are problems with drooping corners of the mouth, fullness of lips, soft tissue maintenance. In the case of total or partial adentiyi resorption of facial bones accelerates, causing premature aging. Because of this appearance and aesthetic perception of the patient’s change. Unfortunately, patients usually do not see the connection between the integrity of the teeth and their appearance.
h.: When a patient comes to you, which is the key to keep him under your care?
O. B.: This is solved once on initial consultation. I do not evaluate financial possibilities of the patient, but his adequacy, reality of his desires.
h.: What result do you expect from cooperation with dentists?
O. B.: We need to create an anamnesis collection algorithm. The patient can come to consult a beautician, plastic surgeon, dentist, and each one has to understand how he can help not only by his profession, but also to attract related professionals.
h.: What has changed in your personal work after the conference? What are you paying more attention now?
O. B.: I’ve seen the possibilities of dentistry. I also have dental problems and, since then, I see patients with dental problems. I assign them 3D diagnostics. My promises to patients depend on its results.
I think it is important for cosmetologist to understand that dental health provides a range of preventive measures, I think it is important for cosmetologist to understand that dental health provides a range of preventive measures,from treatment of caries to orthodontic treatment.
We have to orient in each other’s services. Cosmetologist, aesthetists should know first what dentists call centers of a chronic infection, apical periodontitis, radicular and follicular cysts, periodontal disease tissue. And what could be the consequences of these problems.
To clarify the diseases of the oral cavity the doctor-cosmetologist needs to ask the patient a few questions. Namely: «When was the last time you visited a dentist? How regularly do you do this? Do you suffer from periodontal disease? The doctor-cosmetologist, to clarify the diseases of the oral cavity, you need to ask the patient a few questions. Namely: «When was the last time you visited a dentist? How regularly do you do this? Do you suffer from periodontal disease? Are you worried about puffiness of the gums, bleeding?»
h.: What recommendations can you give dentists?
O. B.: The attachment of all the forces only in the dental treatment will not solve the problem radically. Grinding can improve the texture of the skin, the volume of the face can be restored using the aesthetic contour of plastic and plastic surgery.
You can tell patient: «You brought me something that has now come to the fore. But there are things of the second, third-order importance that are “covered” by the fore.»
The dentist should see aesthetic problems: asymmetry, premature aging, nose, flabbiness of the skin. Before carrying out manipulations, you need to ask the patient, he did not visit recently a cosmetician, a plastic surgeon, did not perform any procedures. These questions are not present in standard questionnaires of stomatologists for an anamnesis, but I think that it is necessary to work actively in this direction.
h.: Do you plan to involve doctors of other profiles?
O. B.: Now about the joint work of several specialists. These are a plastic surgeon, a cosmetician, a dentist, as well as specialists in rehabilitation cosmetology, who work to restore the dynamics of the correlation of details of the face, neck, and shoulder girdle.
This cooperation is absolutely necessary! If colleagues deem it necessary, let them complete it. I’m open!
