PART 1

ESTHETIC DIAGNOSIS

CONSIDERATIONS BEFORE PLANNING

OROFACIAL HARMONIZATION
PROCEDURES
© Dr Sonia R Bordin-aykroyd DDS MSc
 Content

● Esthetic diagnosis - considerations

● Aging Process
● Orofacial Harmonization - Facial recomposition
● Beauty concepts
● Golden ratio - Symmetries and proportions
● Role of the OFH doctor

© Dr Sonia Bordin-Aykroyd
 ESTHETIC DIAGNOSIS
Why is the patient seaking improvement of their facial features?
Include wellness assessment:

➢ Brief health evaluation within your professional scope

PHYSICAL HEALTH

How is their overall health?

➢ Does this patient smoke? too much sun exposure?

Photo by Anton from Pexels
Advise patient
© Dr Sonia Bordin-Aykroyd
 ESTHETIC DIAGNOSIS

Are they showing earlier signs of aging than their peers?

➢ Are there signs of premature aging, such as facial asymmetries or differences

from the norm that could be indicating an underlying medical issue?

Underdeveloped obstructive
jaws airway

Investigate airway or refer patient

© Dr Sonia Bordin-Aykroyd
 ESTHETIC DIAGNOSIS
FACIAL ANALYSIS Profile Evaluation
The more
centralized and
perpendicular the
lines, the more it
evokes the
sensation of
harmony

Images:
UNESP UNIVERSIDADE ESTADUAL PAULISTA “JÚ LIO DE MESQUITA FILHO” -FACULDADE DE
ODONTOLOGIA DE ARAÇATUBA
MARIANI VISSOTTO GARCIA

https://drnelsontakematsu.com.br/tratamentos/cirurgia-
ortognatica/ © Dr Sonia Bordin-Aykroyd
http://www.seer.ufu.br/index.php/horizontecientifico/article/viewFile/3799/2804
© Dr Sonia Bordin-Aykroyd
 Aging

Result of alterations of different structures:

Loss of structural tissues:

● Bone and fat pockets

Tissue alterations:
● Muscular hypotrophy Geometric changes of face
● Skin - reduction of production of
collagen and elastin - elasticity,
texture, colour © Dr Sonia Bordin-Aykroyd
 Aging Process
Geometric changes of face
Youth facial triangle: Inverted triangular
form found in young faces

Changes towards a more square facial shape

and a reversed triangle

https://www.cadernow.com.br/wp-content/uploads/2019/09/E7FDCC5D-D3AC-421F-AE21- © Dr Sonia Bordin-Aykroyd

3384D1A6EFEF.jpeg
https://conexoesfemininas.com/blog/harmonizacao-facial--dra-gisele-salgado--estetica.html
ESTHETIC DIAGNOSIS Aging Process
Factors accelerating facial aging features
Hormone imbalance
Free radicals/Increase oxidative stress level
Excess UV exposure
Air pollution
Tabaco
Alcohol
Stress
Hyperglycemia
https://njbh.com.br/2019/06/03/a-harmonizacao-facial-previne-e-trata-o-envelhecimento-facial/

Excess sugar intake

Diet
Repetitive facial expression
Underdeveloped jaws
tooth loss / Loss of vertical dimension
https://www.facebook.com/OdontoPontes/photos/pcb.2942514329187661/2942514249187669/ © Dr Sonia Bordin-Aykroyd
 ESTHETIC DIAGNOSIS

MENTAL HEALTH EVALUATION

Are they feeling their normal? Photo by Andre Moura from Pexels

➢ Are there any medical problems influencing their mental state that
must be addressed first?

Depression, lack of confidence

Refer? Team approach?
Facial dysmorphia
Eating disorder - Bulimia/Anorexia Do not over treat
© Dr Sonia Bordin-Aykroyd
Body dysmorphic disorder “the excessive and
disproportionate worry for a minimum or
imaginary defect in the physical appearance.”

Do not over treat

Sandoval O, García-Huidobro R., & Pérez-Cotapos S., (2009) © Dr Sonia Bordin-Aykroyd

 ESTHETIC DIAGNOSIS

VISUAL LANGUAGE / PERSONAL IMAGE EVALUATION

Visagismo Phillip Hallawell methodology

What are their visual language expressing? Photo by Andrea Piacquadio from Pexels

➢ Are their current facial lines and forms representing their

true personal archetype, temperament and desires?

© Dr Sonia Bordin-Aykroyd
 OROFACIAL HARMONIZATION

Treatment Plan - Facial / image recomposition

Objective: To work on the recomposition of the face, to

rejuvenate or enhance facial features, re-establishing lost facial
shape, contour, volume, skin texture and color, based on the
patient’s own facial characteristics without changing their
individual self-identity.

© Dr Sonia Bordin-Aykroyd
 Facial recomposition
Combination of techniques

● Re-establish patient’s lost structures: ● Facial rejuvenation

➢ Dental / occlusal rehabilitation ➢ Chemical peeling

➢ Maxillary expansion
➢ Orthognathic surgery
➢ Injectables
➢ Laser, PDT, IPL (intense pulsed
light) and other energy devices
➢ Neurotoxins and fillers
➢ PDOs - thread lift
➢ Collagen-inducing injectables

© Dr Sonia Bordin-Aykroyd
BEAUTY CONCEPTS
What is beauty?
© Dr Sonia R Bordin-aykroyd DDS MSc
What is beauty?

© Dr Sonia Bordin-Aykroyd
 The first association of the word
beautiful is with the face

Facial Beauty: ”Quality or combination of qualities (or

characteristics) in a face that evoke in the perceiver, a
combination of strong positive emotion and a high
degree of attraction”.
© Dr Sonia Bordin-Aykroyd
 How is beauty defined?

1.COLOR
2.TEXTURE
3.SIZE
4.FORM (SHAPE/LINES)

The more these four qualities

evoke the “Beauty Response”,
the more beautiful an object
will look.
© Dr Sonia Bordin-Aykroyd
 Many approaches to improve
visual image or enhance beauty
1.COLOR - Make-up, Lasers and energy devices
2.TEXTURE - Make-up, Lasers and energy
devices, Injectables
3.SIZE - Surgery, Injectables
4.FORM (SHAPE/LINES) - Accessories (glasses,
beard, mustache), Hair style, Surgery, Injectables

© Dr Sonia Bordin-Aykroyd
 Is beauty the same in every
culture?
No

© Dr Sonia Bordin-Aykroyd
 Average faces from different countries
How do you define beauty in your culture?

© Dr Sonia Bordin-Aykroyd
Models of beauty

© Dr Sonia Bordin-Aykroyd
When beauty is viewed as a
continuous spectrum, rather
than just beautiful of ugly, the
spectrum of beauty respects
changes, aging process, and
temperament, and in doing so,
better respects individual
personalities and represents
reality.

© Dr Sonia Bordin-Aykroyd
 Source: Phi atrix
© Dr Sonia Bordin-Aykroyd
© Dr Sonia Bordin-Aykroyd
Treating Asymmetries with injectables

© Dr Sonia Bordin-Aykroyd
The aim of the professional,
be it a plastic surgeon,
dermatologist, dentist,
image consultant, hair
styler, eyebrow designer or
make-up artist, is to
recompose a customized
personal image that truly
represents who your
customer is and it requires
mastering Visual Language.

© Dr Sonia Bordin-Aykroyd
Esthetic market demand

“One-size-fits-all”

Social media expectations.

© Dr Sonia Bordin-Aykroyd
Souce: Pexels
 Role - Orofacial harmonization

Role of OFH doctor is to analyse the patients’ concern and use the
best approach to manage their case and, after excluding any
medical issues, propose a treatment plan that is going to improve
upon their facial features through the recomposition of the facial
characteristics: shape, lines, texture and colour, that best
represents what temperament the patient wants to express, and
without changing their true persona.

© Dr Sonia Bordin-Aykroyd
 CONCLUSION

Understanding the etiology of facial asymmetry is

critical with regards to treatment planning,
management and long-term stability or your
treatment.

A better understanding of patient perspectives and

motivations and a sound knowledge of facial anatomy
can help optimize doctor-patient relations and the
delivery of care.

© Dr Sonia Bordin-Aykroyd