This content emphasizes that apparent facial aesthetic concerns like jowling, recessed chin, or facial imbalance are often misdiagnosed and mistreated, with the underlying cause frequently being dental and orthodontic issues rather than excess soft tissue.
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happy Wednesday again to everyone I had
to restart the video because the sound
got cut off but I will do a quick recap
now that I already thought about what I
want to say since my mind's a little
disorganized the gist of it is that uh
on Wednesdays I do consults and I see 40
to 50 patients try to educate them as
much as possible and every Wednesday I
learn a lot myself talking to patients
and you kind of understand what they see
what they're concerned about and that's
how you learn fast actually as a doctor
so it's helped me a lot listening to two
patients so what we're going to do is
something called lesson of the day
Wednesday and that's Wednesday after
hell day after seeing all these patients
we start we say hey guys it's Wednesday
let's do lesson of the day so today's
lesson of the day is talking about
facial imbalance and how patients
perceive it and where they can go wrong
because doctors don't see things right
all the time so one of those things is
I've had uh four patients come in today
saying that they wanted either a chin
implant or Buckle fat removal they've
felt like this because they had a slight
bit of jowling down over here a little
bits of depression and they felt that
the chin was recessed and realistically
I looked at all four of them and it felt
like a broken record it's kind of
embarrassing in front of my resident
from Monterrey hearing me say the same
thing four times because he thinks I'm
just like you know maybe brushing people
off but what it was was all four
patients had excess in Dental position
their Dental uh their teeth and their
maxilla was a little too prominent and
it made their chin look small
the other thing that it does is it
causes strain in the face because as we
close our mouth the mouth has to close
comfortably you close it relaxing let
gravity do most of the work if gravity
is not doing the work because the lip is
stuck up on a large maxilla or prominent
teeth it's stuck here try to close your
mouth and you see now this lower lip has
to work and if you watch it
chin goes up these muscles pull down and
it contracts this area so these patients
end up getting uh prominence here if
they have wide teeth even more
prominence if they have imbalance and
strain they end up getting masseteric
hypertrophy too and not in the back of
the masseter they get it in the front of
the masseter so they actually end up
with a bulge right here so they look
broad right there and they have drooping
right there and they want to do buccal
fat removal so what happens to this
patient if you do buccal fat removal
when they don't have excess Buckle fat
this thing collapses more this thing
deepens more permanently you can't get
it better so it's a big mistake what
happens if you do a chin implant on
somebody that looks like this from the
side you had big prominent teeth and now
you made a big prominent chin now
everything's coming forward so rather
than do that you educate the patient you
tell them listen it's just that your
teeth are prominent that's why you're
forming the resting face the RBF
where you kind of pull down that's why
you're forming these gels and they don't
get it sometimes because it doesn't make
sense they came to a plastic surgeon
they don't want to hear about teeth so
they have to understand that all these
things come into play when you're
talking about facial balance now if you
look at the side of the face we look at
the chin and we compare it to the
forehead you don't always compare it to
the nose and the mouth those are the
in-betweeners the forehead to the chin
should be kind of like a saucer and the
saucer should start and end in about the
same position so let's say we're looking
at a photo of me
not so fantastic looking but okay
there's me now let's say
um how does this guy work okay I have a
prominent mouth
and I bring my mouth forward because my
teeth are forward makes my chin look
small and some people would say hey
let's bring that chin forward well now
my chin forward and my mouth is forward
everything is drawn forward and that's
elongated so not fantastic but let's say
my mouth is forward
and then I say well let me bring that
mouth back now my chin looks a little
bit more normal size so that's the idea
of it so let's say again we bring that
chin forward what's going to happen or
sorry the mouth when the mouth goes
forward this goes up
that's what happens to people and if you
look around you'll notice that when
people try to close their mouths with
prominent teeth their chin sits up here
it doesn't sit down there and that
happens because the mentalis gets
stronger over time and every time you
close the mouth it stresses what also
happens is you get resting face
that thing falls down over there and
then on some people you get exaggeration
and jolly so they get this appearance
and you go to a doctor and they'll say
that's Buckle fat removal it is not
buccal fat removal here will cause a
collapse over here you'll get a
depression everything gets worse so what
do you do
boom you just put the teeth back in Shin
goes back down you can Botox it to help
take it back down and this starts to
relax and if there's any residual you do
profound a radio frequency treatment
that takes care of it while we're at it
let's do a little bit of that fantastic
maybe I should get a nose job
let's do a little bit of that oh that
looks nice parotid gland everybody
misses that big parotid gland
Fort Benjamin
you want to tuck that up that's what we
do during a weekend lift and a facelift
carotid land is large there you go so
people try to build that out
realistically you got to bring it in but
okay so as you can see
I've got image issues so
that is the lesson of the day is that
you have to look at the balance of the
face and realize these things that
sometimes it's the teeth it's not what
you went in for being the soft tissue
and if you leave those teeth alone
you're going to accelerate the facial
aging process Laura says I'm perfect
you're the best uh so you're going to
accelerate the Asian the facing face
facial aging and speech process and
you're going to accelerate resting
face so that's what happens with people
with prominent dentition if you have an
open bite where one side closes more
than the other now you're talking about
big strain lots of asymmetry you're
going to start twisting to one side and
you kind of look like that all the time
that can be fixed with orthodontic work
and we do have a podcast that was done
with Dr Octavio sintra de Brazil and he
explains and shows all those changes and
this is actually
all right so maybe I should do that
stuff but
um there's a good podcast that explains
about this facial aging and facial
strain but there's so much contribution
from the teeth onto the face it's a
shame that more facial plastic surgeons
and plastic surgeons aren't aware of it
because they end up doing the wrong
procedure all these patients are getting
chin implants they're getting facelifts
they're getting buccal fat reduction
when it doesn't really help and all they
really needed to do was send them to an
orthodontic specialist or an orthodontic
specialist like Dan grauer alright so
that's lesson of the day it is 6 p.m I
run to the gym between six and seven and
I come back up to work so I'll post this
and next week we'll see what pattern
presents itself
um that day and we'll just base it on
that and Doctor Ernesto he's the guy in
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