A great smile is something that is often overlooked by cosmetic and plastic surgeons when it comes to facial aesthetics. While reconstructing a nose or enhancing an eyelid might be good for facial symmetry, to obtain true facial harmony it is sometimes the dentist that provides the total balance to a person’s face. In this interview with Aesthetic Insider™, Beverly Hills Cosmetic Dentist, Laurence Rifkin, DDS, discusses the importance of looking at the smile of each patient and addressing their dental needs along with their facial aesthetic treatments. This combined approach by aesthetic surgeons and cosmetic dentists can provide the patient with the true, balanced and harmonious appearance they have been seeking. To learn more about Laurence Rifkin, DDS visit www.drlaurencerifkin.com.
How does having a beautiful smile affect a person and those they interact with?
Having a beautiful smile really comes from the inside out. However, the way a person feels about themself is how they are perceived by the onlooker. As human beings we respond to what we see. For instance, if a person is missing a front tooth or they have a chipped or stained tooth, they tend not to smile and try to hide that perceived blemish so when they interact with others they don’t smile. Therefore, they are not perceived as friendly, likeable or as approachable as they would if they just smiled. A facial expression has a two-way neuropsychological effect upon our psyche, so our self-esteem is affected, and when a person cannot just smile it affects their relationships with the outside world. In business for instance, when a person is going for a job interview or interacting with clients or customers or even patients, if they cannot generate a warm, friendly, confident smile, it may lessen their chance of success. It can also affect personal and romantic relationships because it can make a person withdraw, or appear withdrawn. A smile doesn’t mean the person has to have perfect teeth, but a beautiful, natural looking healthy smile really is inviting because it’s the communication center between all of us.
When I speak for instance, people focus on what I’m saying and the facial expression that supports my spoken content. So, when a person hears words, they look directly at the mouth that creates these words, they are observing the lips, the teeth and gums, they are looking at the eyes (as humans we gaze back and forth and these are the two important facial features when we look at one’s face) and it gives us the perception of beauty, of honesty and integrity, and so they focus on that. This really comes back down to neuropsychological genetic studies. Dr. Konrad Lorenz won a Nobel Prize for understanding beauty. The concept of beauty itself is really interestingly and comes from our appreciation of our children, of our young. We perceive beauty as youthfulness. Also evolutionary it has been proven that general body symmetries, left and right symmetries, support health, so an animal or a creature that has a physiological or anatomical asymmetry sometimes is not as healthy as one that is symmetrical. Let’s say you have one leg shorter than the other, you probably can’t run as fast or perform whatever functions you need to do. When doctors examine patients and find a lump on one side of the body and it’s not on the other, they have to investigate it. It may be nothing but it could be an indication of some health issue. So, symmetry and youthfulness is a form of beauty, and when we look at one another or when we look at ourselves, if we see some blemish in some way, shape or form, we lose that positive confidence in how we look at ourselves, our self-esteem and how others perceive us, as well as how we perceive others. Therefore, having a beautiful, natural smile and using it when we interact with others, can have a very positive impact on all of our relationships.
What are the principle factors you consider when creating a beautiful smile?
As a cosmetic dentist, patients usually come to me to improve their smile through cosmetic dental treatments such as veneers, tooth whitening, etc., rather than for their general dental health which is a very important foundation that should never be ignored just for cosmetics. We always have to start with the foundational health. But when I look at someone who wants to improve their smile, I have to look at why they’re coming to me in the first place. If a person wants to improve their smile, they generally want to look their best and know that their teeth are just one aspect of their overall appearance. However, because I am a dentist they don’t always realize that I may or may not have the knowledge to consider other areas of their facial aesthetics, such as their nose, eyes or neck, that can be improved. My background lecturing at the AACS (American Academy of Cosmetic Surgery) and at LA-MCA (Los Angeles Multi-Specialty Cosmetic Academy) and professional relationships I have developed over the past thirty years with many plastic surgeons, facial plastic surgeons and dermatologists, has broadened my knowledge of facial aesthetics that I can share with my patients whom I often refer to my colleagues for other procedures. The principle factors I consider when creating a beautiful smile is a matter of balance, an artistic balance. I look for balance, symmetry and harmony and not just in the teeth and lips, but also in their personal features. I look at their eyes, nose, cheekbones, chin, etc., in relation to their smile and consider their full profile. By analyzing the face from the front and from three-quarter profiles, I can see how the lips, gums and teeth appear in relation to the attributes of the face and its structure and from there I can plan how to build the best and most beautiful smile that I can.
How often do you refer patients to colleagues in plastic and facial plastic surgery?
Quite often actually. I developed the Rifkin Method which is my system of interviewing a patient to determine whether or not they are also interested in other aesthetic procedures besides their teeth. Over the years what I found is that dentists have been isolated by the patient (which is understandable), and the plastic surgeon has been isolated by their patients also. Therefore, through the Rifkin Method I have developed a network of super-specialists that work with the patient and puts them in charge of their overall facial aesthetics. This way the patient can choose what they believe is the best strategy to get them the smile and appearance they truly want.
Does overall facial aesthetics require a team approach?
I believe that we have to work as a team. I work with surgeons, I work with orthodontists and in some cases, I even work with makeup artists and hair stylists to help the patient put together the most ideal, pleasing features for them. Of course my focus and expertise lies in improvement of the teeth, mouth and smile, but the other aspects of facial and physical harmony that the patient is seeking has to be very personalized to each patient. Every face is unique like a fingerprint and you have to put together those facial elements in a harmonious fashion and it takes a variety of specialists and experts to do that.
Why did you develop the Rifkin Method?
Over my thirty plus years in practice I have developed a great deal of trust among my patients who come from all walks of life and who often asked me what else could be done to help them look younger, or more vibrant. They would tell me that they had been referred to a plastic or cosmetic surgeon by a friend, or they had seen somebody on a TV news show or digitally on the Internet and they were not sure if that person was qualified or not. So it occurred to me that for those patients I could ask a series of questions and then put them in touch with the other expert team members I have developed relationships with over the years and they could make their own selection in terms of which specialists they want to work with who understand the full concept and integrated, comprehensive approach to facial beauty.
What steps to you take in your patient analysis to determine their course of treatment?
To begin with, I look at the patient’s goals. I talk to them from a heart-to-heart standpoint of what it is they want to achieve. Not everyone is concerned about whether their face is symmetrical or not which is fine, and not everyone needs or wants a lot of cosmetic dental or cosmetic surgery work either. I’m a believer that if a procedure is not indicated, or the patient does not want other enhancements because they are secure in themselves and with their own appearance, then great. Their inner confidence is going to present a great, warm and friendly smile and to me that is what is most important. During the initial exam, I look at what their goals are and I take two and three dimensional photographs from multiple views, as well as three dimensional radiographs or x-rays such as CT scans (which have incredibly low radiation) to look at the internal skeletal structure and I put together a personalized power point presentation that the patient and I review together. This way they can see their face, their mouth, their teeth and every aspect possible. After discussing their dental needs and next steps in terms of what (or if) cosmetic dental or other enhancement is required, I will address any other blemish they might want corrected and, if there’s an indication, I will communicate and work closely with the preferred plastic/cosmetic surgeon or dermatologist to provide further improvement.
How does cosmetic dentistry provide the patient with a more harmonious and balanced appearance and what elements do you apply when working with plastic and cosmetic surgeons to help patients attain their desired end result?
The sub-specialties in facial aesthetics each work on a different area of the face, i.e., the oculoplastic surgeons provide improvement to the eye and forehead area, the plastic/cosmetic/facial plastic surgeon provide improvement to the face, neck, cheekbones, chin, eyes, etc., and the dermatologist provides improvement to the skin and so on. The cosmetic dentist, of course, provides improvement to the teeth. What is important to understand is that the underlying structure, whether it is cheekbone or tooth is very important to the end result. Let’s take, as an example, a patient that has poor lip support. Their teeth are either small or they’re tilted inward and they have a change in their profile from the nose to the lip which we call insufficient lip support. That same patient wants to have fuller lips and goes to a plastic/cosmetic surgeon for lip enhancement. After injection, however, they look like they have fat lips that completely hide the teeth and make the teeth look even smaller in appearance. My approach would be to bring the teeth forward whether by orthodontics or cosmetic dental enhancement first, and then have the plastic/cosmetic surgeon provide lip fillers to create a perfect, balanced smile. If the plastic/cosmetic surgeon does the lip enhancement without understanding how the teeth might become hidden by the increased lip volume, the patient will then come to me asking for bigger teeth which would not give them a harmonious, balanced appearance as the teeth would be too large for the face. The same considerations can be applied to chin and cheek augmentations, as well as rhinoplasty. In the case of a deficient chin, a plastic/cosmetic surgeon might put in a chin implant, or inject a filler along the jawline to create a stronger definition. However, I would first look inside the patient’s mouth to see if their bite is incorrect and is causing a weak chin or an asymmetrical jawline, and correct that before suggesting a surgical or filler procedure. The goal of doctors and dentists is to provide a balance, symmetrical appearance to the patients face and this can be achieved better when we work together.
Are orthodontics popular with older patients?
Yes. In more recent years we have seen an increase in both patient interest in orthodontics and in dental improvements with features such as Invisalign and other tooth straightening devices. Of course, it’s better to start orthodontics at a younger developmental stage when we have more control of facial growth, jaw formation and jaw bone size. When we get older, we can move teeth to some limited degree, and teeth do wear and shorten overtime so orthodontics or reconstructive dentistry can impact and correct that. Some of my patients always wished they had worn braces as a child to correct crooked teeth, and as an adult tooth straightening becomes important to them.
What other aspects of cosmetic dentistry improve overall facial aesthetics?
I like to do the minimal amount of tooth modification with veneers or crowns if we can avoid it, and sometimes orthodontics can do that. Tooth whitening and, of course, veneers. Veneers have come such a long way in recent years in terms of color, shading, texture, etc. Most veneers I perform these days look completely natural and suit the patient’s skin color, and facial shape. My goal is to refine everything that I do and that includes the step-by-step approach I have to creating a great smile including doing wax sculptures of teeth and provisionals (temporary teeth) so that my patients can try on their new smile first to make sure they are happy with the result before finalizing it. Plus the new ceramics we use are wonderful and look completely natural.
How can plastic/cosmetic surgeons work better with cosmetic dentists for overall patient improvement?
The new LA-MCA aesthetic meeting that was recently held in Beverly Hills, CA, was a great start to truly bring together all the specialties involved in patient aesthetics, head to toe. I have spent many years attending and lecturing at aesthetic meetings such as those held by the AACS and more recently LA-MCA as I have wanted to improve my understanding of cosmetic surgery so I can be better prepared for my patients. I think the more understanding that plastic/cosmetic surgeons gain of the importance of teeth to the underlying, and overlying facial structures, the better results their patients will achieve overall.
Dr. Rifkin displays a relentless passion for excellence in periodontal health, function and dento-facial aesthetics. He creates synergy between science, technology and fine arts. He also believes in a team approach to achieving optimal results for his patients, collaborating with both dental and medical specialists he’s personally hand-selected for their skill and integrity.
READ MORE ABOUT DR. LAURENCE RIFKIN IN THE ARTICLES BELOW.