Letters to the editor

Facial gold thread rejuvenation: challenges in history taking and radiographic interpretation.

A 47-year-old female patient presented to the primary care clinic for routine dental check-up. Following intra-oral examination, generalized periodontitis and missing teeth were observed. Orthopantomography (OPG) was advised for evaluation of the periodontal status and for further treatment planning. OPG revealed multiple thread-like, irregular, crisscross radiopacities measuring a few millimetres to 2 cm distributed bilaterally across the premolar and molar regions of both jaws, maxillary sinuses, and lateral orbital surfaces (Figure 1). Identification of proximal caries around maxillary left third molar was difficult owing to the overlapping of these radiopacities (yellow arrow indicating proximal caries). The supporting structures of the tooth such as periodontal ligament space, lamina dura, and interdental bone were obscured around the premolar-molar area leading to difficulty in accurate interpretation. Upon inquiry, the patient disclosed undergoing facial rejuvenation with gold threads 4 years previously. Gold facial rejuvenation involves inserting 3–5-mm 24-carat gold threads into subdermal soft tissues to enhance skin tone, elasticity and reduce wrinkles.¹

OPG is one the most commonly used extra-oral radiograph for detection of multiple caries, vital structures, interdental bone, pathological lesions and fractures.² However, in this case interpreting the areas around multirooted teeth was challenging owing these radiopacities. Therefore, additional radiographs with different angulations were required for accurate diagnosis, thus exposing the patient to additional X-ray radiation.

Patient was satisfied with the cosmetic outcome of the procedure; however, she refused to provide further details. The reasons for patients’ refusal could be speculated as being due to the hesitancy of an aesthetically conscious female patient,³ the incidental findings being unrelated to her chief complaint and the cosmetic procedures were performed at her residence by a ‘trained cosmetic doctor’ at a relatively lower cost compared to similar procedures offered by a qualified plastic surgeon. The procedures performed at her residence also raise concerns regarding compliance with sterile working conditions in the vascular region of the face, a point previously not discussed.² The patient intended to undergo a second session of gold facial rejuvenation in the near future, as recommended by her ‘trained cosmetic doctor.’ This procedure may result in the addition of more radiopacities in the OPG further obscuring the vital strutures. Cases of thread-like radiopacities due to gold rejuvenation has been documented in few case reports previously.^1,2,4 However, with the rising popularity of gold thread rejuvenation procedures, such cases may be reported with increasing frequency. Oral healthcare professionals should be aware of the increasing use of radiopaque materials in facial cosmetic procedures to avoid being perplexed with such findings.