Beauty is only skin deep, but that’s the part everyone sees. Like it or not, we’re often judged by our appearance, at least initially—and first impressions count.

“As human beings, we can’t help but react to the way others respond to our appearance,” says Dr. Robert O’Brien of Kehrs Mill Family Dental Care. “Women can be particularly sensitive to the messages they get from others, although I see this happen to men, too.” People who sit in O’Brien’s chair often seem withdrawn, depressed, or even hostile at first, he notes, because they are self-conscious or even ashamed of their teeth.

“Some of them feel so bad that they’ve more or less given up on socializing with others,” O’Brien says. “So much energy goes into covering up their teeth, it’s almost as if they don’t have enough left to interact with others. They often get a pinched, squinty-eyed look on their face, because it takes so much effort to keep their teeth hidden while they talk. It’s a vicious cycle, because the more grim they look, the less friendly they seem, and the less others approach them.”

Missing, stained or misaligned teeth can make people look much older, O’Brien points out. “Missing teeth, for example, cause facial muscles to sag and atrophy, resulting in that gaunt, sunken look associated with aging,” he says. The rest of the body is affected, too: “When you feel bad about your appearance, it influences your posture and gait,” he says.

Skillful cosmetic dentistry can make a difference even to those who have suffered from a poor self-image for many years. “There’s an immediate difference in their attitude, especially with women patients,” O’Brien says. “They start taking more interest in their appearance and usually come in with a new hairstyle and more stylish clothes next time I see them. When you give them a beautiful smile, whether it’s through cosmetic or restorative procedures such as dental implants, porcelain veneers, etc., they’re ready to welcome the world. I tell them, ‘I want you to stop at every mirror you pass today and smile at yourself. Take a look at the real you!”

Facial plastic surgery can be another way to boost a battered self-image, says Dr. L. Mike Nayak of Nayak Plastic Surgery and Skin Enhancement Center. “I’ve seen so many painfully shy people come out of their shell as a result of a facial improvement, especially when it’s a feature that has been out of line with the rest of their face, usually an odd-shaped nose or prominent ears,” he says. “One 16-year-old girl who had rhinoplasty became talkative and animated almost from the moment she saw her new nose in the mirror. It was so gratifying.”

Teenagers are often painfully self-conscious about what they perceive as facial flaws, but Nayak has seen amazing self-image shifts in older patients, too. “The aging process can damage self-image when people feel that the face in the mirror no longer belongs to them,” he says. He recently performed a face-, eye- and brow-lift on a woman in her 50s. “She was very quiet to begin with; now she has a Harley and a tattoo!” he says. “It’s not so much that she’s a whole new person. It’s more that now she feels confident to be who she really is.”

Nayak does a fair amount of cancer reconstruction, as well. “It’s about a third of my practice,” he says. “It’s great when we can help someone who may have been disfigured pass what we call the Walmart test—in other words, we give them the ability to blend into the crowd.” He also volunteers with Face to Face, a surgical mission program, and has treated patients and educated local doctors in Vietnam. “It’s so satisfying to build continuing relationships and international goodwill,” he says.

Nayak is guided by a single rule: “Never operate on anyone with the implied promise that surgery will change their lives,” he says. “Yes, it’s true that your quality of life might very well improve if you feel more confident about your appearance, but there are no miracles.”