Cosmetic dentistry: Facial aesthetic treatments and clinical and radiological implications

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Sir, cosmetic facial treatments are a rapidly developing area of clinical practice with increasing numbers of GDPs providing facial aesthetic treatments. As their popularity grows, more patients are now undertaking such procedures. We would, however, like to highlight the possible radiological implications of the use of certain aesthetic treatments, especially to our colleagues who provide these treatments for their patients.

A 49-year-old female was referred by her dental surgeon to the maxillofacial department with severe and worsening right-sided facial pain. Having undertaken a comprehensive clinical assessment and examination, relevant investigations were arranged, including an MRI scan. The use of MRI scans in the investigation and assessment of facial pain is well documented.¹

The resulting images were reviewed by a consultant radiologist and reported as showing 'unexplained bilateral subcutaneous malformations of possible vascular origin'.

At the following review appointment, it became evident that our patient had undertaken non-surgical cosmetic treatment with dermal fillers, which she had failed to mention.

Dermal fillers have long been used to mitigate the effects of ageing, with the aim of temporary replacement or augmentation of lost tissue volume.²

Several types of dermal filler are in current use by practitioners: these comprise short-term, medium-term (temporary) and long-term (permanent) fillers.

Whilst patients are inclined to provide a full history of all treatments to their aesthetic practitioner, they are less likely to disclose these cosmetic treatments to other healthcare providers and therefore this should be communicated by the clinician.

We would suggest that patients should disclose any history relating to their receiving aesthetic (facial) treatments. Colleagues performing these procedures, such as injecting dermal fillers, should also be aware of the possible radiological implications,³ as is evidenced with MRI scanning images (Fig. 1).

Figure 1

MRI scan indicating the subcutaneous areas identified by the radiologist as being of concern

Furthermore, chronic facial pain has been noted following injections in the region of the tear trough, leading to pain within the distribution of the infra orbital and zygomatico facial nerve territories. Whilst at present the exact mechanism for such pain is not understood, the use of permanent rather than temporary fillers may be more difficult to resolve⁴.