0:03 happy Wednesday again to everyone I had
0:05 to restart the video because the sound
0:07 got cut off but I will do a quick recap
0:10 now that I already thought about what I
0:11 want to say since my mind's a little
0:15 disorganized the gist of it is that uh
0:18 on Wednesdays I do consults and I see 40
0:20 to 50 patients try to educate them as
0:24 much as possible and every Wednesday I
0:25 learn a lot myself talking to patients
0:27 and you kind of understand what they see
0:29 what they're concerned about and that's
0:30 how you learn fast actually as a doctor
0:33 so it's helped me a lot listening to two
0:35 patients so what we're going to do is
0:37 something called lesson of the day
0:39 Wednesday and that's Wednesday after
0:41 hell day after seeing all these patients
0:44 we start we say hey guys it's Wednesday
0:47 let's do lesson of the day so today's
0:49 lesson of the day is talking about
0:50 facial imbalance and how patients
0:52 perceive it and where they can go wrong
0:54 because doctors don't see things right
0:57 all the time so one of those things is
0:59 I've had uh four patients come in today
1:01 saying that they wanted either a chin
1:04 implant or Buckle fat removal they've
1:06 felt like this because they had a slight
1:08 bit of jowling down over here a little
1:09 bits of depression and they felt that
1:12 the chin was recessed and realistically
1:15 I looked at all four of them and it felt
1:16 like a broken record it's kind of
1:17 embarrassing in front of my resident
1:20 from Monterrey hearing me say the same
1:22 thing four times because he thinks I'm
1:23 just like you know maybe brushing people
1:25 off but what it was was all four
1:29 patients had excess in Dental position
1:32 their Dental uh their teeth and their
1:34 maxilla was a little too prominent and
1:36 it made their chin look small
1:38 the other thing that it does is it
1:40 causes strain in the face because as we
1:42 close our mouth the mouth has to close
1:45 comfortably you close it relaxing let
1:47 gravity do most of the work if gravity
1:49 is not doing the work because the lip is
1:52 stuck up on a large maxilla or prominent
1:54 teeth it's stuck here try to close your
1:57 mouth and you see now this lower lip has
1:59 to work and if you watch it
2:02 chin goes up these muscles pull down and
2:05 it contracts this area so these patients
2:08 end up getting uh prominence here if
2:10 they have wide teeth even more
2:12 prominence if they have imbalance and
2:14 strain they end up getting masseteric
2:16 hypertrophy too and not in the back of
2:18 the masseter they get it in the front of
2:19 the masseter so they actually end up
2:21 with a bulge right here so they look
2:22 broad right there and they have drooping
2:24 right there and they want to do buccal
2:25 fat removal so what happens to this
2:27 patient if you do buccal fat removal
2:29 when they don't have excess Buckle fat
2:31 this thing collapses more this thing
2:34 deepens more permanently you can't get
2:36 it better so it's a big mistake what
2:37 happens if you do a chin implant on
2:39 somebody that looks like this from the
2:42 side you had big prominent teeth and now
2:44 you made a big prominent chin now
2:47 everything's coming forward so rather
2:49 than do that you educate the patient you
2:50 tell them listen it's just that your
2:51 teeth are prominent that's why you're
2:54 forming the resting face the RBF
2:56 where you kind of pull down that's why
2:57 you're forming these gels and they don't
2:59 get it sometimes because it doesn't make
3:01 sense they came to a plastic surgeon
3:03 they don't want to hear about teeth so
3:05 they have to understand that all these
3:07 things come into play when you're
3:08 talking about facial balance now if you
3:10 look at the side of the face we look at
3:11 the chin and we compare it to the
3:13 forehead you don't always compare it to
3:14 the nose and the mouth those are the
3:17 in-betweeners the forehead to the chin
3:20 should be kind of like a saucer and the
3:21 saucer should start and end in about the
3:23 same position so let's say we're looking
3:26 at a photo of me
3:29 not so fantastic looking but okay
3:32 there's me now let's say
3:35 um how does this guy work okay I have a
3:37 prominent mouth
3:39 and I bring my mouth forward because my
3:41 teeth are forward makes my chin look
3:44 small and some people would say hey
3:48 let's bring that chin forward well now
3:50 my chin forward and my mouth is forward
3:52 everything is drawn forward and that's
3:56 elongated so not fantastic but let's say
3:59 my mouth is forward
4:01 and then I say well let me bring that
4:03 mouth back now my chin looks a little
4:06 bit more normal size so that's the idea
4:09 of it so let's say again we bring that
4:12 chin forward what's going to happen or
4:13 sorry the mouth when the mouth goes
4:17 forward this goes up
4:19 that's what happens to people and if you
4:21 look around you'll notice that when
4:22 people try to close their mouths with
4:24 prominent teeth their chin sits up here
4:27 it doesn't sit down there and that
4:29 happens because the mentalis gets
4:30 stronger over time and every time you
4:33 close the mouth it stresses what also
4:36 happens is you get resting face
4:39 that thing falls down over there and
4:41 then on some people you get exaggeration
4:43 and jolly so they get this appearance
4:45 and you go to a doctor and they'll say
4:48 that's Buckle fat removal it is not
4:50 buccal fat removal here will cause a
4:52 collapse over here you'll get a
4:55 depression everything gets worse so what
4:56 do you do
4:58 boom you just put the teeth back in Shin
5:00 goes back down you can Botox it to help
5:03 take it back down and this starts to
5:05 relax and if there's any residual you do
5:07 profound a radio frequency treatment
5:11 that takes care of it while we're at it
5:16 let's do a little bit of that fantastic
5:18 maybe I should get a nose job
5:21 let's do a little bit of that oh that
5:23 looks nice parotid gland everybody
5:25 misses that big parotid gland
5:27 Fort Benjamin
5:30 you want to tuck that up that's what we
5:32 do during a weekend lift and a facelift
5:34 carotid land is large there you go so
5:35 people try to build that out
5:37 realistically you got to bring it in but
5:40 okay so as you can see
5:42 I've got image issues so
5:45 that is the lesson of the day is that
5:46 you have to look at the balance of the
5:48 face and realize these things that
5:49 sometimes it's the teeth it's not what
5:51 you went in for being the soft tissue
5:53 and if you leave those teeth alone
5:56 you're going to accelerate the facial
5:58 aging process Laura says I'm perfect
6:01 you're the best uh so you're going to
6:03 accelerate the Asian the facing face
6:06 facial aging and speech process and
6:07 you're going to accelerate resting
6:09 face so that's what happens with people
6:11 with prominent dentition if you have an
6:14 open bite where one side closes more
6:16 than the other now you're talking about
6:18 big strain lots of asymmetry you're
6:20 going to start twisting to one side and
6:21 you kind of look like that all the time
6:24 that can be fixed with orthodontic work
6:26 and we do have a podcast that was done
6:30 with Dr Octavio sintra de Brazil and he
6:33 explains and shows all those changes and
6:35 this is actually
6:37 all right so maybe I should do that
6:39 stuff but
6:41 um there's a good podcast that explains
6:43 about this facial aging and facial
6:45 strain but there's so much contribution
6:48 from the teeth onto the face it's a
6:50 shame that more facial plastic surgeons
6:52 and plastic surgeons aren't aware of it
6:53 because they end up doing the wrong
6:55 procedure all these patients are getting
6:57 chin implants they're getting facelifts
6:59 they're getting buccal fat reduction
7:01 when it doesn't really help and all they
7:03 really needed to do was send them to an
7:05 orthodontic specialist or an orthodontic
7:08 specialist like Dan grauer alright so
7:12 that's lesson of the day it is 6 p.m I
7:15 run to the gym between six and seven and
7:17 I come back up to work so I'll post this
7:20 and next week we'll see what pattern
7:22 presents itself
7:24 um that day and we'll just base it on
7:27 that and Doctor Ernesto he's the guy in
