DR SAFA AL-NAHER

TEETH FIRST

DR SAFA AL-NAHER

Dr Safa Al-Naher is the director and principal dentist of Serene Dental and Facial Aesthetics. Her vision was to create a clinic where patients can experience a unique blend of dentistry and facial treatments. Dr Safa is passionate about education and training , teaching medical professionals to carry out treatments in an ethical and safe way.

One foundational part of the face remains frequently overlooked outside of dentistry: the teeth and the bite. Dentition provides internal scaffolding for the lips, influences facial height, affects the position of the chin, shapes the smile width, and even contributes to the way the mid-face appears to hollow or project. When dental structure shifts due to wear, misalignment, genetic patterns or natural ageing, the soft tissues respond in ways that strikingly mimics the presentation of ageing. Many concerns that patients seek to correct with injectables actually originate in the dental foundation.

THE STRUCTURAL HEIGHT OF THE LOWER FACE: UNDERSTANDING VERTICAL SUPPORT

One of the most influential, yet least understood dental contributions to facial appearance is the occlusal vertical dimension (OVD). Put simply, this refers to the height of the lower third of the face, determined by the distance between the upper and lower jaws when the teeth meet. It is the internal “pillar” that dictates how open, supported or compressed the lower face appears.

We often associate reduced OVD with older adults whose teeth have shortened through erosion or wear. But in reality, younger adults can also present with a shortened lower face when they have a deep bite or Class II skeletal or dental relationship. In these cases, the upper front teeth overlap the lower teeth excessively, or the lower jaw sits further back. This causes the mandible to rotate upward and inward, compressing the lower facial height, and this mimic premature ageing. Patients with this dental pattern often believe they need filler. Yet the volume deficiencies are the result of structural shortening, not soft-tissue loss. When vertical support is restored – through restorative dentistry, orthodontic bite correction, or full-mouth rehabilitation – the lower face naturally elongates and opens.

HOW TOOTH POSITION SHAPES THE LIPS AND PROFILE

Another essential but under-recognised factor is incisor inclination, or the forward/backward position of the front teeth. These teeth act as internal scaffolding for the lips, determining their support, curvature and projection. When upper incisors tilt backward, the lips lose their underlying structure, appearing flatter, thinner and less defined. Nasolabial folds seem deeper, and the philtrum lengthens.

Correcting the position of the teeth with clear aligners restores the natural forward curvature of the lips, allowing them to appear fuller and more youthful with significantly less injectable product.

This is one of the clearest examples of how modifying dental structure before performing injectables enhances the soft-tissue result, not by masking a deficit, but by resolving the underlying cause.

GUMMY SMILES: A MULTIFACTORIAL AESTHETIC PRESENTATION

While many gummy smiles are caused by a hyperactive elevator muscle – a case in which botulinum toxin is extremely effective – numerous gummy smiles are not muscular at all. They originate from structural issues such as altered passive eruption (where too much gum covers the teeth), vertical maxillary excess (where the upper jaw is too long), dentoalveolar extrusion (where teeth and gums have overerupted), or simply worn, short teeth.

In these situations, treating with toxin alone can reduce animation but does not address the underlying proportions. Patients may experience the best outcomes when the dental cause is managed first. Through gum recontouring, crown lengthening, intrusion of over-erupted teeth or restorative lengthening of worn teeth with botulinum toxin used as the final refinement. Understanding when a gummy smile is muscular and when it is structural is one of the most valuable diagnostic skills aesthetic practitioners can develop.

THE DEEP BITE AND ITS ROLE IN ACCELERATING LOWER-FACE AGEING

Deep bite, a condition in which the upper front teeth overlap the lower front teeth too far, produces a distinct pattern of perioral ageing. The muscles of the chin become overactive, the lower lip rolls inward, and the soft tissues around the mouth fold more sharply.

When the deep bite is corrected, the change in the perioral area can be profound. The chin relaxes, the lips appear more balanced, and the facial tissues sit in a more open, youthful configuration, even before any injectables are added.

SMILE WIDTH, ARCH FORM AND MID-FACE PROJECTION

Arguably one of the most visually impactful dental factors in facial aesthetics is the transverse width of the upper dental arch. Narrow arches create shadows at the corners of the mouth (known as buccal corridors), constrict the smile, and reduce the lateral support of the mid-face. This can make the nasolabial folds appear heavier and the mid-face seem flatter or more hollow than it truly is.

When the arch is widened using clear aligners or orthodontic expansion techniques, the smile broadens, the cheeks appear better supported, and the mid-face often looks subtly lifted. The nasolabial folds soften, not because filler has been added, but because the dental structure beneath has expanded to support the tissues.

This is facial rejuvenation driven not by volume, but by structure – a concept that lies at the heart of modern aesthetic medicine.

CLEAR ALIGNERS AS PART OF A FULL-FACE AESTHETIC PLAN

Clear aligners are often thought of as a cosmetic dental tool, but their impact extends far beyond straightening teeth. Through controlled tooth movement, they can improve lip support, widen the arch, increase tooth display, correct asymmetry, restore lower-facial height and improve smile dynamics.

When aligners are incorporated into an aesthetic treatment plan, they act as the foundational phase upon which injectables can be applied with greater precision and reduced volume. Patients frequently comment that their face looks fresher, because the underlying structure has been optimised.

RESTORATIVE DENTISTRY: THE FINAL LAYER OF REFINEMENT

Restorative treatments such as composite bonding and ceramic veneers play a crucial role in the aesthetic framework. By restoring tooth shape, length and symmetry, they refine the proportions of the smile and subtly enhance lip posture and perioral support.

When performed after alignment and bite correction, restorative dentistry becomes the final layer that completes the facial aesthetic picture. Injectables placed afterwards look gentler, more natural and more harmonious.

WHEN A DENTAL REFERRAL ELEVATES FACIAL AESTHETIC RESULTS

Collaboration between aesthetic dentists and injectors produces exceptional outcomes when patients present with:

• Lips that appear flat or unsupported despite filler

• Nasolabial or marionette folds that seem disproportionate to age

• A shortened or collapsed lower facial third

• A gummy smile with a likely structural cause

• A narrow smile or mid-face hollowing

• Significant tooth wear, deep bite or Class II profiles

• Facial asymmetry driven by occlusion Injectors need not diagnose the dental issue; they simply need to recognise when the structure may be influencing the result.

From there, interdisciplinary planning creates solutions that combine internal support with external refinement.

CONCLUSION

Facial ageing is not purely a superficial process. It is a structural one, and the teeth, bite and dental arches play a critical yet often unseen role in shaping the lower and mid-face. By incorporating dental understanding into aesthetic practice and by collaborating across disciplines, we can deliver results that are more natural, more stable, and more elegantly in harmony with the patient’s own anatomy.

Case Study

Before

BEFORE TREATMENT- YOU CAN SEE DEEP NASOLABIAL FOLDS AND THE LOWER LIP FOLDING INWARDS DUE TO LACK OF SUPPORT FROM THE TEETH IN THE LOWER ARCH AS A RESULT OF CROWDING AND A DEEP BITE. THE ACTIVITY OF THE MENTALIS MUSCLE ALSO APPEARS TO BE SIGNIFICANT.

After

AFTER CLEAR ALIGNER TREATMENT WHERE THE UPPER AND LOWER ARCHES WERE WIDENED, CROWDING AND TOOTH ROTATIONS CORRECTED AND THE DEEP BITE IMPROVED. THE NASOLABIAL FOLDS ARE SIGNIFICANTLY IMPROVED, LOWER FACE APPEARS MORE SUPPORTED AND THE CHIN MUSCLES RELAXED. THE SMILE APPEARS MORE NATURAL AND LESS FORCED.

After

AFTER COMPOSITE BONDING, ALLOWING MORE UPPER LIP SUPPORT.