Do’s and don’ts in the realm of lip and oral facial augmentation

by Robert Gordon, DDS

Can I perform lip and perioral augmentation with dermal fillers and Botox®?

According to the Dental Practice Act, dentists are the experts of the orofacial area. Some states incorporate into their state legislation the exact verbiage that governs the use of injectable fillers and botulinum neurotoxin (Botox) at a dental practice while other states are in the process of establishing these guidelines. Other states have not taken an official stance in regard to the use of dermal fillers and Botox. At least one state (California) has adopted rules that are so restrictive that they effectively prohibit dentists from performing these augmentation procedures.

These three standpoints are a result of three typical behaviors humans project when presented with something new – avoid (provide no guidelines for doctors), deny (restrict doctors from performing augmentation), and, finally, accept (provide doctors with guidelines for augmentation).

What can I do?

• Educate yourself, your dental board, and community – Education paves the road of sound decisions. Invest in literature and attend educational seminars that include hands-on training.
• Organize – Become active in dental study groups, organizations, and state legislation. Activity in this new and developing area is paramount in paving its way into our realm.
• Record – With the increase of the various filler substances placed in the lip and perioral area, dentists must become aware of the clinical manifestations with which they may be presented. Various fillers all have unique clinical appearances and feel to the lip and perioral area. Botulinum toxin such as Botox also may present with some distinct clinical features. As the orofacial expert, dental practitioners must be able to identify the manifestations that result from various fillers and Botox.

What can’t I do?

• Deviate beyond your area of expertise – This may be the most critical component in ushering the use of dermal fillers and Botox into dentistry. Although dermal fillers and Botox may be used in other areas of the face, it is not the area of expertise of dentists. An example is when a dentist injects a dermal filler or Botox into the forehead. In my experience, most physicians do not object to dentists performing augmentation in the orofacial area. On the contrary, they know this is our area of specialty and they accept it. One can even develop a great referral practice with other local physicians, by referring out areas other than the lips and perioral. Remember, dentists are able to present a full differential diagnosis of the oral facial area. This would include orthodontic, orthonathic, soft tissue, and dental treatment modalities for a superior cosmetic result.
• Practice what you are not licensed to do. That is, if you are in a state that prohibits dermal filler usage by dentists then obviously one must abide by the law. This does not mean you may never be able to practice lip and perioral augmentation in your state. The onus rests on the dental community to work with the state boards to establish guidelines and standards for these procedures. I have found all too often that boards that have made prohibitive decisions regarding dentists performing lip and perioral augmentation procedures have done so because of:
  1. The lack of an organized dental body (community) endorsing lip and perioral augmentation.
  2. The absence of significant educational information to decide about lip and perioral augmentation by dentists.
  3. The lack of organized educational programs that we (the dental profession) can regulate and monitor to assure optimal training for dentists in lip and perioral augmentation.
• Remain dormant – An age-old adage says people never miss something that is taken away if they never knew they had it. For dentistry, most states either allow the use of dermal fillers and Botox, some are still on the fence, and there are a few who aggressively restrict it. We as the dental profession are responsible for self-regulation but if we do not take that responsibility, others will. Become active.

Dr. Robert W. Gordon has a passion for art and facial esthetics. With a background in fine arts, he lectures to oral/facial augmenters on his classification, diagnostic and reconstructive lip and perioral augmentation techniques. Dr. Gordon also maintains two private practices in St. Petersburg, Fla., that concentrate on cosmetic lip and perioral augmentation. While practicing predominantly cosmetic dentistry, he became aware of the intimate correlation of dentistry and cosmetic and perioral augmentation. This led him to author, “Vermilion Dollar Lips,” a textbook that addresses the science and art of lip and perioral augmentation. For additional information, visit VermilionDollarLips.com or send an e-mail to Dr. Gordon at [email protected].