When you have a tooth pulled, your face may look caved in: Here’s how to solve that
Q. I have a depression that has formed in my cheek because I’ve been having trouble with my teeth. I had to have a tooth pulled and now when I smile it looks like I have a depression. Is there anything I can do to fix that without having surgery?
A. This is not an unusual question. When a tooth is extracted and an implant is not placed, there is bone resorption, or loss of bone. The subsequent effect is that the soft tissue, which is the cheek, gets pushed in.
If you don’t have a raging infection, your dentist may recommend that you get bone grafting along with an implant. If you have an infection, you will have to wait and do this as a secondary procedure. One of the real wonders of plastic surgery is the new type of fillers that can last over a year.
I often have patients who have facial asymmetry secondary to bone and gum disease, both of which cause loss. In patients who have this condition, I like to use fillers that are hyaluronic acidbased. By building up the soft tissue in the area that has had the bone loss, the facial contour can be restored.
These injections can be done at any time once the infection has been treated. The beautiful part about this treatment is that it is easy and it can apply to most people. If done by a well-qualified injector, the treatment is generally painless and quick. Sometimes, patients need a re-treatment to individualize their treatment for the type of bone loss and or dental loss.
I often see patients who once they have had a treatment for an asymmetry, they will enhance the rest of the face with other non-surgical treatments.
Dr. Carlos Wolf is a partner in Miami Plastic Surgery and is board certified. Email questions to him at Cwolf@miamiplasticsurgery.com
I am 40 years old and while skiing last week, I injured my right shoulder. It was dislocated and it was put back in place in the emergency room. The ER physician said nothing was broken and the X-rays showed my shoulder was back in place.
I was given a sling to wear and I had an appointment with an orthopedic surgeon in Miami this week. He said to get an MRI and depending upon the result, I would likely need surgery. Does this sound right to you?
A. Patients under 35 who dislocate their shoulder usually injure a stabilizing structure called the labrum. The labrum is a cartilage that acts as a bumper to keep the ball part of your shoulder centered in the socket. The patient’s age, activity level and the degree of labral tear will help to determine the likelihood or repeat dislocations.
Older patients who dislocate their shoulder may injure their rotator cuff tendon. These tears tend to be large and if not fixed, can result in severe weakness in raising your arm as well as instability of the joint.
The MRI scan will help to determine which of these soft tissue structures are damaged as well as the possible need for surgery or rehabilitation.
Dr. Harlan Selesnick is team physician of the Miami Heat and director of Miami Sports Medicine Fellowship, Doctors Hospital. Send your questions to HarlanS@baptisthealth.net