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COSMETIC LASER CENTER OF MANHATTAN ~ NEW YORK CITY
120 Central Park South
59th Street between 6th & 7th Avenue
Manhattan, New York 10019
212.262.0950
E-mail address
lazersmile@aol.com

Esthetic Plastic Surgery ~ Esthetic Dentistry
The Right Combination for Those Who Desire a Total Look

David Gaudino M.D, MS ~ Esthetic Plastic Surgeon


Cosmetic Plastic Surgery Combined with Esthetic Dentistry - the best approach is skillful blending of the essential structure and function of the face, the smile and teeth with subtly augmenting plastic surgery procedures, such as the use of Botox and Collagen injections for the elimination of unsightly wrinkles and lines. This will afford a major transformation of the face without a face-lift. Too often the public is sold on procedures that require major cutting and suturing. However, an instant face-lift is possible by regaining the original vertical dimension (height of the teeth) that has been lost by eating, chewing, grinding, and clenching. The eyes and the smile possess the beauty of the person; enhancing these we enhance the beauty of the individual.

Aesthetic Smile Design

  • Rejuvenates the face and the smile
  • Enhances dental beauty and proportion of face and teeth
  • Enhances function and structure of the bite
  • Eliminates structural defects of teeth
  • Optimizes color, shade and shape of teeth
  • Builds confidence and self-esteem


The Dental Face Lift
The collapse of the bite is one of the major contributors of facial aging. There are numerous muscles that are attached and involved in the maintaining of the bite, not only in smiling but also in the elastic proportion of the face while at rest and in motion. As the teeth lose vertical dimension or height, the muscles of the lower and upper jaw collapse, giving an aged, compressed and tired look that many patients attempt to eliminate via a face-lift. The problem however, is not enduringly eliminated if the vertical height of the bite is not adjusted in a permanent way, no matter how magnificent the face-lift. Often times a face-lift may be postponed for years if the vertical dimension of the posterior and the anterior teeth are adjusted to a functional, structural and esthetic height. By increasing the height of the posterior and anterior teeth, muscles that are involved with these teeth will then as a natural consequence also lift. When these are lifted the skin, ligaments and tendons of the face are lifted simultaneously; giving an actual internal face-lift without the pulling, cutting and tucking of plastic surgery.

The Golden Proportion
Facial symmetry is one of the most important elements of dental and facial beauty, without it the most beautiful smile may appear askew and out of alignment. Harmonizing the smile may be as simple as synchronizing the facial and dental midlines. The facial midline is the imaginary line running central from the forehead to the nose and down to the chin. The dental midline is the line between the upper two anterior incisors and in a helping capacity by the line between the lower anterior incisors. Sometimes the facial midline may naturally be askew and the interpupillary (essentially the midpoints of each pupil) aspects of the eyes will by necessity be used as the centralizing aspect of the face. Symmetry is a natural component pervading nature and environment in multiple ways. Although there is no such thing as perfect symmetry, there are appropriate levels that will bring harmony and balance to the face and dentition.


The Whitening of Teeth
Youth is always associated with beautiful bright white teeth, however as we age our teeth tend to yellow and darken organically. Laser bleaching is a gentle, expeditious way of lightening the teeth without waiting weeks or months for teeth to lighten, as this is an in-office procedure. What has taken a lifetime to darken will whiten within two hours without pain or discomfort. Maintenance of laser-whitened teeth can be continued indefinitely with the use of a home bleaching system once a month. Lighter teeth can give the added confidence needed in smiling and talking and will enhance the effects of plastic surgery.


Augmentation of the Lips
Permanent augmentation of the lips is easily achieved via cosmetic dentistry. Often times the lips appear flat and thin because of the teeth, and not as a result of a deficit on the part of the lips. Because the teeth make up the surface upon which the lips lay and in which they gain their thickness and protrusive appearance. If the teeth are too small, irregular or flat, the lips shall appear flat, thin and life-less. Enhancing the smile with porcelain veneers is the perfect modality in altering the way the lips embrace the teeth giving a sexy and thick appearance. The lips will be yours without implants that harden with time and often fail with time. The use of excessive collagen and implants may give the lips an unaesthetic appearance, as the lips may appear uneven, irregular and unnatural. If the lips require a little more augmenting, small amounts of collagen can be used to enhance the effect of the dental work.


Our plastic surgeon is a permanent staff member whose main concern is helping in the conservative design and appearance of the client's face and smile. There can be no mistakes in plastic surgery for once it is performed it is essentially irreversible. Taking into account that it is the enhancing and transformation of the individual via what is available to the individual that can make plastic surgery so successful. Conservative plastic surgery is gentle and not overly aggressive, allowing for natural and progressive enhancement of the body and face in a logical and sequential fashion.

Two theories of aging help explain the limitations of aggressive surgery. Protein cross-linking is one theory that explains the loss of the subcutaneous tissue of the face, neck and body. As we age due to life-style adaptations and toxin intake the collagenous tissue of our body begins to degrade and thin out. This is due to cross-linking of the protein cells of which collagen is made. Protein cross-linking believed to be due to breakdown of regulatory systems in the body, causes protein chains to lose cohesiveness and organization. The face-lift may tighten the skin; however the underlying tissue will progressively waste away, because it is a functional and structural change. This will stretch the skin but it won't fill in the underlying tissue that gives a youthful look. Hence the face shall appear taught but clenched, shrunken, bony and over-emphasized. Another theory, damage from free radicals, asserts that the body again from toxins, pollution and life-style will suffer and begin to degrade because of free-radical attack. Essentially the underlying fascia will waste away.

Redesigning the smile, which involves the structural and functional alteration of the teeth, will affect the tendons, ligaments, muscles and bones of the face, head and neck. Elongating the collagenous fascia, allowing for oxygen and nutrients to reach and feed the underlying structure that supports the skin. This will also affect the posture of the body, hips, waist, neck, back, legs and including how the breasts are positioned in space with the rest of the body.

Once the face has been optimally aligned structurally and functionally the process of adding density with collagen or making repetitive facial muscles immobile with Botox can begin. This can be likened to the stretching of canvass on frames, if the frames are mal-adjusted or not balanced, no amount of stretching the material will make them balanced or straight. In fact if you stretch too much the material will cave in on itself and may even tear. The face is like a canvass, the structure must be made right, then the artist may add color, depth, fullness and texture, without structural qualification the canvass is only half finished.

In order to aid in the process of aging and combat protein cross-linking and free-radical destruction vitamin creams and vitamins are a necessary protocol in the regeneration of collagenization and the unlinking of non-cohesive protein links. Anti-oxidant therapy is presently accepted and practiced as a major combatant of aging and disease process. These powerful nutrients work synergistically to provide the body natural-defense against internal aging toxins that wreak havoc upon the collagen fascia that is the pre-eminent youth factor of our bodies. Even with a face-lift, without the underlying collagen fascia, the individual shall appear aged, tired and worn, as the youthful fullness of the skin will be missing. Artificial attempts to fill the face with collagen and fats can lead to disastrous results and are temporary, as the body consumes these products within a matter of months. Leaving the individual no choice but to be re-injected with these products again; this in the end is traumatic to the system and face.

We have found that a vitamin regimen of anti-oxidants, a healthy life-style and Lunasol facial cream, a natural anti-oxidant quality cream, can help the body and especially the face regain a youthful vigor. This in combination with the dental face-lift and slight enhancing plastic surgery will give a natural and long lasting result to the face. Altering the structure and function of the teeth will open-up reduced and flattened facial muscles and attending structures, lifting the neck, the cheeks and the face. The canvass of the face shall be aligned and taut allowing for natural vigor to pull and stretch the skin without compression and lack of collagenous substructure.


Esthetic Plastic Surgery Services

  • Collagen
  • Botox
  • Chemical peel and dermabrasion of facial skin
  • Eyelid Surgery ~ Blepharoplasty
  • Liposuction of buccal fat for enhancement of the cheeks
  • Liposuction of the face and neck
  • Miniature face lift
  • Forehead lift
  • Precise surgical removal of moles, cysts, lesions and skin cancer
  • Laser removal of tattoos
  • Lacerations
  • Scar treatment and removal
  • Hand surgery and reconstruction
  • Cuts, lacerations and cosmetic birth defects in children


Extract from "Smile Psychology":
By Martha Cortes DDS & David Gaudino MD, MS
(Published in Current Opinion in Cosmetic Dentistry 1994: 134-138)

In 1872, Darwin was one of the first to suggest that facial expression was a universal language… Darwin hypothesized that facial expressions performed useful or instinctive functions.

Smiling, in relation to achievement or task-related events, has most frequently been studied in children by the psychologists Stipek et al. In one study, children between 1 and 5 years of age were evaluated for developmental changes in reaction to achievement-related outcomes. The children responded to successful positive outcomes by smiling. On the other hand, failure elicited avoidance-type reactions in the same children, who looked away and did not smile.

Smiling is an important means of communication. A smile or a lack thereof can be interpreted to be a perceptive response to a present or former set of circumstances. Decreased smiling often occurs in patients who have avoided dentistry for extended periods of time and who require general and cosmetic treatment for fractured, decayed, or abscessed teeth.

Anatomically, a smile is the combined action of two major facial muscles: the zygomaticus major and the orbicularis oculi. The smile is a combination of voluntary and involuntary muscle contractions. During smiling, the upper lip is elevated superiorly and posteriorly by the zygomaticus major, the nasolabial fold deepens, and the cheeks are elevated. The smile is followed by the involuntary contraction of the orbicularis oculi, resulting in narrowing and wrinkling around the orbital area. In 1862, the French anatomist Duchenne noted that the orbicularis oculi muscle surrounding the eye is retracted in smiles that occur spontaneously. The orbicularis oculi is an involuntary muscle action around the orbital area that accompanies smiles as well as laughter.

Studies now show that smiling, like laughter, can produce physiologic processes that catalyze a series of sensations and psychologic reactions that are commonly associated with happiness. It has been shown by Frank et al, and Adelman and Zajonc that the act of smiling can alter cerebral blood flow, body temperature, and chemical dynamics. As the cheek muscles contract into a grin, blood flow patterns are altered. Cerebral vascular temperature is lowered, contributing to the onset of positive emotional states. There are currently investigations being conducted involving the relationship of emotive responses to specific stimuli of the autonomic nervous system.

Smiles transform personal presence and image via demonstration of warmth and affection and the enhancement of attractiveness. According to the study by Frank et al. Smiling is thought to have become part of the female persona; women who did not smile were perceived as less attractive and unapproachable.

Cosmetics play a special role as primary restorer of health and the natural smile. Smiling is involved in human development, achievement-related outcomes, and social perceptions. The study suggests that gender differences influence smiling frequency and self-image.