Physical appearance and attractiveness consciously and subconsciously, affect patients’ quality of life. Traditionally, dentists were tasked with improving a patient’s smile, a central aspect of facial aesthetics and physical appearance. More recently, as the scope of practice of the aesthetic dentist has broadened to potentially include other components of facial cosmesis that go hand-in-hand with a patient’s smile, new options have emerged with which modern aesthetic dentists should familiarize themselves. As laws surrounding their use in dental offices continue to evolve, Botox and dermal fillers represent natural next steps in aesthetic dentistry.
Key points
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Physical beauty has long held an important place in society, because of biologic and psychological predispositions to treat those one deems attractive in more positive ways.
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Facial features change over time and often represent the first and most obvious evidence of physical aging.
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Veneers and crowns, along with invasive surgical procedures, have previously been the only tools available to alter a patient’s facial appearance and combat signs of aging.
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Today, aesthetic dentists have other means at their disposal, including Botox and dermal fillers, to greatly improve the appearance of their patients. These injectable products serve a complementary role to standard equipment in the dentist’s armamentarium.
The field of aesthetic dentistry evolves with each passing day. New practices, products, devices, and perspectives continue to emerge, and dentists are leading the charge to change lives through a tailored approach that combines these elements to suit the unique needs of each individual patient. Although some may consider “changing lives” hyperbolic coming from a dentist’s mouth, there is ample evidence indicating that a person’s appearance can heavily impact his or her life experiences, and that a healthy, beautiful smile alone may achieve this. Bearing this in mind, aesthetic dentists who dedicate themselves to improving patients’ smiles now have a unique opportunity to expand beyond the lower third of the face when addressing facial appearances. This opportunity comes in the form of such products as botulinum toxin (BTN) and fillers (eg, hyaluronic acid). Once limited to cosmetic surgeons’ practices, these products also can aid dentists in addressing the aesthetic goals of their clients.
When considering the future of aesthetic dentistry and how best to help patients navigate their journey to a more attractive physical appearance, it is vital to understand the underlying reasons for humans’ preoccupation with appearance and what is considered generally attractive. It is also necessary to question whether dentists are optimally using all tools and approaches at their disposal to support patients, and whether new and emerging treatments beyond the typical veneers and facial surgeries might offer a viable path forward. Dentists have a duty to improve not just their patients’ smiles, but also their quality of life. Understanding and assisting aesthetic dental patients in their pursuit of a more attractive appearance is central to this role.
Why are humans so preoccupied with perceived attractiveness?
The global beauty market is a billion-dollar business that is only expected to grow. The reason for this continued growth has ancient and modern roots.
Artists, such as Leonardo DaVinci, studied faces to discern ideal proportions, and the Roman poet Ovid wrote the first known manual of beauty advice for women. These creatives were studying attractiveness from a unique perspective and even today researchers continue to explore the concept of perceived attractiveness.
If history did not offer enough evidence to persuade one that humans are preoccupied with attractiveness, it should be noted that evolutionary theories, such as those regarding the survival of the fittest, also emphasize physical appearance. In fact, there is evidence that people look for symmetry or absence of gross asymmetry as a measure of health and fitness in a mate.
Furthermore, evolutionary psychology tells us that males are attracted to traits associated with estrogen, such as bigger eyes and fuller lips or a smaller chin and more diminutive nose. And research finds that males also favor high cheekbones in women to indicate childbearing maturity. It is not only males who evaluate perceived attractiveness with an evolutionarily modified lens. Females look for traits synonymous with the presence of testosterone, such as square chins, broad musculature, and heavy brows. ,
Aside from the general selection of a mate based on innate measures of perceived attractiveness, humans also make important decisions based on appearance. These decisions, research indicates, may mean that humans are predisposed to equate someone’s personality or trustworthiness with one’s perception of their facial aesthetic.
More visually pleasing or attractive faces may lead to different outcomes for those who have them and there is evidence that humans may consider attractive people morally superior, give them better grades in school, and even offer them a lighter punishment for crimes committed. ,
Those considered attractive often experience greater employment success and find themselves being higher paid. Moreover, those who find themselves to be beautiful also judge themselves more favorably. ,
Conversely, those with facial asymmetry or other atypical facial features may find themselves enduring a different set of social experiences. Those with facial asymmetry or facial features outside of the norm may be deemed untrustworthy, lazy, or less intelligent. Research indicates that these are not simply an indication of one’s “preferences” from moment to moment. Studies indicate that the brain is essentially hardwired to perceive attractiveness in this light.
Furthermore, there is evidence that humans view attractive faces differently, even from birth, and that this reaction is biologic and rapid. In fact, research indicates that infants respond to more attractive faces. When humans are viewing an attractive face the fusiform gyrus that handles facial recognition activates the nucleus accumbens, the brain’s reward center. It also stimulates activity in the amygdala where humans handle emotional responses. The frontal cortex, which is related to higher-order reasoning, is also impacted as is the orbitofrontal cortex, which handles decision making. Finally, activity is also present in the caudate nucleus, which formulates and activates repetitive or stereotyped behavioral responses when viewing attractive faces.
This chain of events indicates that the human body has an innate propensity to react to a face it perceives to be attractive by sending multiple rewarding signals to our brain. The brain receives these signals and begins a chain-reaction-like process of stimulation. As a result of this stimulation and that process, the brain can begin formulating and reinforcing stereotypes.
Those stereotypes, because of that reward system that is activated, become hardwired and cause humans to equate perceived attractiveness with positive emotions. There is also reason to believe that although the process is multifaceted, it occurs quickly: The brain can recognize and determine attractiveness in less than 13 milliseconds. ,
Attractiveness and beauty in the age of social media
With the advent of the Internet and the rise of social media, basic concepts of attractiveness have become heavily influenced by what is popular nationally and globally. Influencers, movie and television stars, pop culture icons, and the likes have all impacted what the general population considers attractive. The pervasive reach of the Internet has led to a propagation of norms of attractiveness, and those norms are now more easily recognizable than ever. The results of this phenomenon are a homogenization of beauty standards, because those on the receiving end seek to alter their own appearance to emulate that of their idols.
Although beauty norms are impacted by popular culture, there is still evidence that the general population leans on an evolutionarily predisposed ideal for attractiveness that includes facial symmetry, plump lips, and full cheeks. Finally, the obsession with youthfulness, which dates back to antiquity and is alive and well today, dictates a large part of today’s beauty standards. Thus, traits that betray the process of aging, such as wrinkles, marionette lines, or jowls, are considered undesirable. Dentists, who spend their professional lives working in and around the mouth and the face, are more than familiar with signs of extreme aging.
Signs of aging: the skeleton and fat pad atrophy
The human skeleton changes throughout its life via osteoblastic and osteoclastic activities. Patients in their twenties have skulls that are at their densest and as aging progresses, the skull morphs, leading to adjustments in one’s facial appearance. These ongoing skeletal changes impact the overlying soft tissue, the skeletal muscle attachments, and the ligaments ( Fig. 1 ).
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