Ask the Experts

Posted Friday, September 14, 2007 to PROFILES > Plastic Surgery

Posted by The Original Anti-Aging & Cosmetic Surgery Magazine

Susan Goran, DDS

I am 36 years of age, have all of my own teeth, never had a filling but my teeth are worn down, crooked and discolored. Can you please tell me the approximate cost of caps. I would need at least 6 top and 4 bottom.

I'll try to answer your questions about your teeth even though I haven't had the pleasure of seeing them. If your teeth are "worn down, crooked, and discolored" and you have never had a filling I would try to dissuade you from "caps", i.e., porcelain crowns. Crowns are a way of improving your teeth but involve removing more tooth structure than is necessary for an aesthetically improved smile. More conservative cosmetic techniques include bonding or placing porcelain "facings" (or veneers) and/or minor orthodontic movement (for as little as 6 months) would ultimately be your best bet. You also should be aware that your teeth ideally should be bleached before any preparations are done. Costs of the various procedures depend on individual treatment plans.

With careful planning and guidance by a knowledgeable and experienced dentist, you can end up with a wonderful smile that is natural and you can be proud of.

Laurence Koplin, MD

I am a 20 year old male who is considering chin augmentation to enhance my looks as I have an undershot jaw. I have a few questions: firstly, am I just being too vain? Am I going to regret having this foreign object attached to my lower jaw? I also need braces for my crowded teeth, will having braces affect the surgery? Will people generally know that I've had surgery? Are there other alternatives available? I play both soccer and rugby, apart from the recovery time, can I still play these contact sports without having to worry too much?

You have some very astute observations. First of all, do not consider yourself overly vain for being interested in looking your best. In my opinion, good plastic surgery, performed appropriately, should make you look more normal, not more "separate" from the crowd. The reason for this is that the true goal of cosmetic surgery is to restore individuals to looking the way they should have looked all along. You were born with an undershot jaw which gave you a weak chin. The placement of an' implant should make you look as you always should have, with a good balance between your forehead, nose, teeth and chin. No more and no less.

The surgery is simple (less than an hour), the incision hidden under the chin where it is invisible, and the recovery less than a week. After several weeks, you should be able to pursue a totally normal, active life - including soccer and rugby - without the risk or worry of damaging the result.

If you need braces, they will not affect the result. Your surgeon will need to talk with your orthodontist so that together they can plan the amount of increased projection that would be ideal for you. The result, properly performed, should be absolutely undetectable both by appearance and by feel.

There are alternatives which are a bit more drastic. These involve actually cutting the chin bone and moving it forward, kind of like opening the bottom drawer of a dresser and sliding it out a bit. It needs to be "bolted" in place with tiny screws. In some people, particularly who have a very weak chin, this is an alternative which should at least be considered. Talk it over with your surgeon!

Wishing you good luck in your search for a balanced, ideal jawline. Be excited... the result should be well worth the journey!

Gary Lask, MD & Patrick Lee, MD

Can the Cool Touch Laser be used for facial rejuvenation?

Yes, the CoolTouch Laser can be used for facial rejuvenation; in fact, that is probably its ideal use. Cool Touch Laser is a nonablative laser,meaning it does not peel or damage the epidermis. Its intent is to target sun damaged collagen and elastin fibers in the upper dermis just beneath the epidermis; this treatment basically induces a dermal wound which generates a healing response and the production of new collagen. This new collagen would then give the skin greater turgor and lessen the extent of sun damage and wrinkling. Because it is nonablative and the new collagen formation takes time, immediate results may not be seen and the clinical improvement in the patient may be a gradual one. An individual patient's response over time may help determine how many treatments may be necessary.

Mau Rice Sherman, MD

I have a big nose for my tiny face and I would like to reduce the size. Can you tell whether there is any procedure that is safe and not obvious (my aunt had hers reduced and her nosejob is really obvious)?

Large noses can be formed either by an overgrowth of the bone and cartilage framework of the nose (which is the usual case), or can develop from an over thickening of the skin of the nose secondary to a proliferation of the grease glands underlying the skin. This latter condition (called adenoma sebaceum) can be readily and successfully treated with either dermabrasion or a laser peel of the nasal skin. I suspect that your large nose is inherited and is due to the overgrowth of bone and cartilaginous tissue. The treatment for aesthetic correction would be rhinoplasty surgery. The goal of this surgery is to produce a cosmetic and natural appearing nose. That is, a nose that does not have an operated-on or surgical look. This can be performed with newer surgical techniques safely and consistently, by adhering to principals of maintaining proper bony cartilaginous support to the nasal soft tissues. Sculpturing the cartilage and bone instead of over-resecting and removing this tissue should provide a safe, yet cosmetically appealing, nasal reshaping. Many cosmetic surgeons, when faced with this problem, will consider utilizing a newer "open" rhinoplasty approach where all of the tissues can be visualized and manipulated without fear of over-correction. The goal is a natural appearing nose that fits the other proportions of the face and is in balance with the rest of the facial features, without the telltale signs of surgery.

Grant Stevens, MD

How do I know whether or not I am a candidate for ultrasonic liposculpture?

Traditional tumescent liposuction has been very effective in young patients with mild to moderate amounts of fat. Ultrasonic liposuction expanded the number of patients suitable for body sculpting. This includes patients with larger amounts of fat and less elastic skin tone. It also allows us to treat areas not easily or effectively treated in the past. This would include fibrous areas such as the back, male breast and upper abdomen. A physical examination is required in order to verify whether you are a candidate for this procedure.

Gail Foster Zanville

What should I ask the doctor in the consultation?

One of the things I go over in my consultation is what questions you should ask the doctor. These include: which procedure would be most beneficial to your body type; what results you can expect given your skin's tone and elasticity; how long the procedure will take; what kind of aftercare will you need; how long is the recovery process? These are just some of the types of questions you need answered in a consultation.

Blair Kranson, MD

I have a tattoo on my wrist which I would like to have removed. What is the best method?

Over the years many procedures have been used to eliminate the unwanted tattoos. These include excision, dermabrasion and most recently laser surgery. Presently the best results for tattoo removal can be obtained with laser surgery: a variety of different lasers can be used. Some colors of tattoos respond better to certain lasers than others. With proper treatment a good result with little of no scarring can be achieved.

Laurence Rifken, DDS

I have a full upper denture and I would like to have implants but have been told I have no bone in my upper jaw for implants to be placed. Can anything be done, or do I have to have a denture for the rest of my life?

Yes, even though you say you do not have enough bone at present, bone can be added through various methods of bone harvesting and grafting to provide the anchorage necessary for dental implants to be placed.

There are many exciting methods to enhance bone support to provide implant placement.

Virtually anyone can benefit from the predictability of dental implants and the enormous support they provide for either fixed bridgework or implant supported dentures. Sometimes both bone and implants may be placed simultaneously to Simplify the surgical aspect of treatment.

A TEAM approach is the prudent and ideal way to maximize the treatments.

Your specific question is best answered by an implant surgeon which may be either an oral surgeon or a periodontal surgeon. These specialists should evaluate your anatomical situation by panoramic radiograph (x-ray)and CT scan (computerized tomography) of your maxilla (upper jaw) and skull.They can tell you whether bone grafting is needed and how best this be accomplished. The other most important member of the Team is the restorative dentist who should envision the final outcome or result of teeth that will be supported by the implants. He or she will predict the best prosthesis to achieve your desired goals.

Remember, the "TEAM" should be planning optimal function, comfort and facial esthetics. If you are missing both teeth and bone, your upper denture is replacing both with the artificial teeth and plastic base. The denture is designed to support the lip and affects your facial profile as well as the functional aspects of chewing with teeth.

Today's dentist and dental specialists are thinking about the entire face as well as the area around the smile zone. This is because we in dentistry can intercept and prevent so many developmental and reparative problems that can affect the entire face.

Be sure to ask your dentist about the TEAM, options for treatment, final facial esthetic results and even the impact upon phonetics and speech. If you are still uncertain, seek additional opinions.

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