The Liquid Facelift: there’s a sucker born every minute!

 

P.T. Barnum, the great circus promoter is frequently quoted as saying “there is a sucker born every minute”.  I am sure he would be quite amused by the new amazing miraculous “Liquid Facelift”!

In this day and age, the best way to promote one’s agenda is to “invent” a really sexy sounding facelift.  First you need an unusual name so the media can key in on it and it will make patients think it is new.  Next, you need to make it sound like it is some new “miracle” that has displaced previous technology.  Finally, you need to make it sound really desirable.  The best way to do this is to tell people that it is non surgical and has little or no recovery.  If someone can put these three things together and find someone in the media to promote it, they will frequently get their 15 minutes of fame.  In the best case scenario the entire hype concept will really take off and the “miracle procedure” will fill the appointment book of the promoting doctor and he or she will frequently franchise their technique to teach other doctors this gift to humanity.  It all goes great guns……………..until…………..well until the other doctors, the public and the media find out four things.

1.  It is really not a new technique, only a hyped repackaged version of procedures that have been around for decades.
2. It is very expensive; it has more recovery that promoted.
3. It is really not a facelift and the results in the average patient are disappointing
4. It doesn’t work.

When all of these factors fall into place, and they always do, many patients are left disappointed and with skinny wallets in the wake of disappointment. 

We have seen this many, many times!  Do names like the Contour Thread Lift, Thermage, The Life Style Lift sound familiar?  I am not sure which is sadder, the fact that so many doctors try to make something out of nothing for personal gain or publicity or the fact that the poor public is so gullible and easily parted from their hard earned cash.  To me, this is much like the weight loss or diet industry.  It is a well established fact based on science and physiology that if you restrict caloric input and exercise you will lose weight.  That simple, no magic!  Yet as I was typing this blog, a commercial came across about the Cookie Diet.   All you have to do is eat these yummy cookies and the weight will fall off!  Please! This should be illegal, but I am sure thousands of gullible people will try the cookie diet and that it will soon fade into obscurity that the thousand diets before.  Will the public ever learn?  If it sounds too good to be true, is it true?

Back to the liquid facelift.  What this procedure really is, is filler injection.  Yep, filler injection, Restylane, Juvederm, the same stuff that thousands of docs do every day.  The liquid facelift is nothing more than a mega filler injection session.  Instead of just filler in the lips or smile lines, it goes in the midface, the jowls, and other place.  Nothing new as most of us that inject filler inject it in these areas when requested.  So, please consider several things.

1. The liquid facelift is not a facelift.
2. The liquid facelift is filler injection.
3. Fillers laser up to a year in the best scenario.
4. Fillers are extremely expensive and a liquid facelift can use up $5-8,000 of filler in 20 minutes.
5. Most people that need a facelift have excess skin and loose muscle.  The liquid facelift does not tighten the skin or muscle; it just fills up hollow spaces.  This is fine, but is it worth it for a year of looking better.
6. A facelift can last 10-20 years, and yes, it required surgery and 2 weeks of recovery.  So what, if you want a real facelift with real facelift results, have a real facelift.
7. All the filler in the world won’t tighten up turkey gobbler skin on the under the chin and under the neck.

 

Is there anything good about the liquid facelift?  Sure, fillers are great and even though I do almost 100 facelifts a year, I am one of the busiest filler injectors in my state.  Fillers are great, but they are not a facelift and should never be used in conjunction with the word “facelift”.

If P.T. Barnum were still alive and if he was a doctor, I bet he would be a big proponent of the liquid facelift.

To find out more about Dr. Niamtu or cosmetic facial surgery in Richmond, Virginia, visit www.lovethatface.com.

 

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

www.lovethatface.com

Laser Treatment of Burn Scars on the Today Show: Miracle or Not?

On May 28^th the Today Show ran a very interesting segment about a very touching story of very pretty triplets that were badly burned in infancy and were treated with a new laser treatment to improve their burn scars.  The laser was the Lumenis Encore laser and the Deep FX laser, also made by Lumenis.

I have received many phone calls from excited patients who have burn scars or have relatives with burn scars, requesting the “new miracle laser that cures burn scars on the face and body”.  I want to say that I have the very laser that was featured and I am a huge fan of Lumenis lasers.  I also want to say that I am a bit disappointed that the general public may have come away from this feature with the idea that a huge breakthrough in burn treatment has been discovered. 

Without sounding like a naysayer I am skeptical about how effective this treatment will be or how it was presented.  I truly hope that it will advance the treatment of burn scars because that would truly be a huge advancement for humanity and the people that suffer from burn scars.  As a father of two severely disabled young sons, I personally know a parents heartache of seeing a disfigured child.

One problem of the media taking hold of a “new” treatment is that it is frequently presented as a huge worldwide breakthrough in medical advancements.  Sometimes it may be, but most frequently, these stories sensationalize these treatments and put the cart before the horse.  The problem is that viewers get the idea that this is world changing technology.  If a treatment is available that could truly and radically improve burn scars, it would be Noble Prize worthy, not just Today Show worthy.  We have seen the Today Show (and Oprah and other shows) present such “huge surgical advances” as the Thread Lift, The Fraxel laser, the Liquid Facelift and many other procedures that sounded sensational, but proved to be almost useless, let alone a breakthrough.  The key phrase with so many of these treatments is that “the results exceed the expectations”.

I believe that the doctor that was featured on the show is a very legitimate and conscientious practitioner that is truly interested in finding an improvement for these unfortunate patients and imply absolutely no negativity about her work.  I believe that it is in the really early stages of usage and that much more long term follow up must be done.  A study by a university burn center with long term follow up would be news worthy.  Single treatments with admittedly minor improvement (the video I saw showed one of the triplets stating that she thinks that she and her boyfriend can see a little improvement is not testimony for a medical breakthrough.  I say this realizing that she has only had a single treatment and perhaps more improvement will be observable with additional treatments.  I hope this is the case because Lumenis is a credible company that would love to be part of such a break through.  I do think, however, that this story is premature and has been presented in too much of a sensational way.  The only bad thing about this is that it can lead the tens of thousands of burn patients to think that something has arrived to change their life.  I wish it were true, but I personally don’t think it is.  I really want it to be true.

Too often the media sensationalizes medical treatments and the public gets misled.  I am not expecting this treatment to be as sensational as presented and it is my fear that like the numerous patients that have contacted me that thousands of others around the country may be given false hope.

To find out more about cosmetic facial surgery visit www.lovethatface.com

 

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virgina

How to Choose the Right Cosmetic Surgeon

A  national magazine called me to interview me on the subjecting of “Choosing Dr. Right”or how to pick a cosmetic surgeon.  During the interview, I wrote down some thoughts and here they are!

 

In reality there are no absolute criteria for selecting a surgeon and some of the surgeons that have the best qualifications do poor work and some simple, unknown, humble surgeons are true artists.  In our society we set standards for picking any service whether it is automotive repair, a school for your children, the place where you purchase your groceries or healthcare. What people look for is a qualified provider.  With consumer goods it may be the seal of approval from the Better Business Bureau, with surgery it is board certification. This does not guarantee proficiency, but is a universal standard for training.

 

As with consumer goods, the quality of work provided can translate to cosmetic surgery outcomes.  You may favor a certain restaurant because of a clean environment and consistently excellent food.  Surgeons that have consistently pleasing outcomes probably know what they are doing.  Generally the public appreciates this and a reputation for good surgical care and outcome brings a busy practice.  These surgeons are usually “superspecialists” and concentrate on a given procedure, i.e face, breasts, liposuction.  In addition, in my experience, the cosmetic surgeons that are the best, limit their practice to cosmetic surgery.  Not to say that performing other procedures makes a poor surgeon, but if all a surgeon does is cosmetic procedures, he or she would probably have more experience than a surgeon that “dabbles” in facelift surgery.  A surgeon that only does faces may be a better facelift choice than another who does surgery all over the body.  This is not a steadfast rule, but it is hard to be great at everything.

 

All of us use various service providers because we get treated incredibly well.  Special service is a hallmark of quality.  There is a huge difference in checking into a “W” hotel and a Motel 6.  Concierge service can also occur in the cosmetic surgery office and generally offices that know how to provide the best patient service and communication have quality all the way through the practice.  None of us want to be brushed off when we have a problem or need information and it is a very bad feeling to have a problem after surgery and not be able to readily speak to the surgeon.  Look for excellent patient service and care, the ability to easily reach the surgeon and staff and a clean and contemporary facility are usually good indicators about the quality of a practice.  On this vane, having an accredited facility is another indicator that the office and surgeon are interested in excellence.  Full accreditation can be a task of awesome proportion and is another positive factor in the patient’s decision making process.

 

Bedside manner is a classical means of rating surgeons.  We all know of excellent surgeons that have personalities like sour milk and we all know very personable surgeons that perform mediocre surgery.  Looking for a surgeon that the patient personally can communicate is very important.  “If you can’t speak to your surgeon, you may have the wrong surgeon” has always been one of my mantras.  If you have a rude, distracted or unfriendly surgeon when you are at the consult process, how will he or she act when the going gets tough?  Astute surgeons realize that a cosmetic surgery consult is actually a job interview for their services.  In addition, being able to reach your surgeon easily is paramount.  When I give my cell phone number to patients they are usually blown away as few surgeons exhibit that level of sincerity. 

 

Outcome is probably the most important buzz word in this discussion.  Show me any business that produces consistent quality outcome and you will see a successful business.  Providing a consumer with more than they expected is the hallmark of building a business.  Most busy, competent surgeons have a significant volume of cases that are testament to their work.  This is usually very self perpetuating and nothing succeeds like success.  Generally a busy surgeon with good outcomes will be popular by word of mouth.  Also, an experienced surgeon should be able to show prospective patient examples of his or her work.  If a surgeon can’t show you 50 before and after facelift pictures, something is not right.  Obviously, it may be a young surgeon with less experience and may do good work, but seasoned surgeons should have voluminous amounts of their work to help guide patients in the decision process.  Also remember that ever the best surgeons have occasional outcomes that are less than expected, but it is the general “gestalt” of a surgeon’s work that is important to the patient who is shopping for the correct surgeon.

 

Backing up one’s work is also a huge thing to look for with any consumer service.  If I pay thousands of dollars for a big screen TV and it does not work correctly, I expect the seller to stand behind their product.  Although cosmetic is not as simple as an appliance warranty, there are daily occurrences where a superlative surgeon will “back up what they do”.  The patient is always right should be a way of life and compromising for the effects on patient relations is something that is viewed with a very positive note.  It is impossible to guarantee a surgical result, but meeting reasonable patients half way when problems occur is positive marketing that money can’t buy.

 

 

Practice or Passion?  Another means of judging a surgeon is to evaluate their total involvement in their profession.  Like anything else, show me a person with a passion for what they do for a living and I will generally show you some that is good at what they do.  Doctors that publish, lecture, give courses and teach other doctors, have university appointments and are active in community service generally love what they do or they would not be so involved and these surgeons are generally “a cut above”.  No pun.

 

 

Things to avoid?  Beware of a surgeon who speaks negatively against their competition.  Remember that a surgeon that slanders his competition may also talk negatively about you as a patient.  Also, in most cases, surgeons that discredit their competition are usually hurting or jealous of the person they defame.  This is an unfortunate quality of many humans, to try to look good by making someone else look bad. This is especially true for those surgeons that attempt to mislead the public by saying only “their” specialty is qualified or better trained to perform cosmetic procedures.  This is like Ford saying that their car is the only choice and that all other cars are inferior and unsafe.  We all realize that turf wars exist between sports fans, restaurants, politics, religions and yes, surgeons.  The competent surgeon and savvy patient should never get caught up in these petty indifferences.

 

In conclusion, the above points, each taken separately, can serve as concrete facts when selecting a competent surgeon.  Collectively, the more of the above attributes that a given surgeon has the better a patient should feel when making a decision.  Show me an enthusiastic, board certified surgeon, who has many successful cosmetic cases from their accredited facility that is easy to communicate with and that backs up their work, and I will generally show you Mr. or Mrs. Right.

 

For more information on cosmetic facial surgery in Richmond, Virginia go to www.lovethatface.com.

 

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

www.lovethatface.com

The Day My Computer Broke!

My trusty and faithful laptop has been acting up ( I curse Windows Vista) for several months and it has been getting slower and slower. I finally could not take it anymore and decided to format the hard drive reload everything and start all over. I must admit that a big part of me simply wanted to drive over the Apple store and by a new Mac, but I am not sure I am ready to make that jump after 20 years on the P.C.

So…..I was up till the wee hours of the AM, reloading all my programs and trying to get my email program up (you all know we can’t live without email). Everything was loaded and I had to get up early (before my usually gym workout) and make some minor tweaks, then off to work.

When I got to my office my computer gave me bad news. I would not load the Windows Vista update and keep turning on an off and was in a cycle of death. To cut to the chase I handed it off to a computer professional and went back to my world without a computer.

First, I felt naked. I kept going to my monitor and mouse, out of habit but there was not computer, so I began doing other things. I was quite figedty as I was without email, and that haunted be all day, but…………

I had tons of time as I was not stuck to the giant magnet on my desk. So, I cleaned my desk off, and began going through the piles of journal articles that I had accumulated in the “someday I’ll” pile. The “someday I’ll” thing is that we all tend to collect things with the best of intentions, kind of knowing that we will probably never get to them. Someday I’ll…..read this book, read these journals, clean out this desk, return these calls, clean out my picture files, etc. The problem with “someday I’ll” is that someday never comes. So, anyhow, I finally got around to the list. What a great day, I had all this time because I wasn’t on the computer. Still felt guilty about all those important junk email awaiting me, but I plowed through 8-10 journal articles and I really learned a lot. I couldn’t can them to PDF files and I could not add notes to my Outlook notes, but nonetheless, I learned a lot. I cleaned out my desk. Found two gift cards and some old messages that somehow got stuck in the drawer.

I got all of this done and still had time, so I went over and had a conversation with my partner whom I generally never speak with because we were both busy. Then, I still had free time between patients, because I wasn’t on my computer, so I did something I never do, I went to lunch! I usually catch up on work or try to sneak to the gym, but today I had time. At the bottom of the file were some of my office forms that I have been meaning to update so I did that and redesigned my office cosmetic brochure…..with a pencil of all things. (was really missing my computer now). I have a TV in my office and sort of listen to news programs in the background. I heard that the Pope was asking the faithful for high tech fasting for Lent. That means giving up the Internet, or the iPod, etc. Lucky I am not that religious as just one day without the computer was killing me!

In conclusion, without a computer, I had a lot more free time. The downside is that I was cut off from the outside world. The other downside was that I could not do anything real creative because I could not access my patient pictures or Photoshop. I also could not work on my textbook that I am writing which has consumed much of my life over the past month and will continue to do so until its completion. What I did have was a “time enema” of sorts. I simply seemed to have much more of it. It made me think about how much time we all waste keeping up with friends, deleting junk emails, watching funny videos and yes, sometimes doing work. It also made me think that perhaps I should simply shut the computer down for an hour in the AM and an hour in the PM and do some of that menial “someday I’ll” work.

I tried to imagine how I got along without a computer for the first 80% my life and I can’t remember how it used to be. I really missed my trusty laptop, but tonight my wife and I are going out to eat and I won’t be working on my textbook tonight. Ahhh…the good old days.

I must admit that after work I borrowed my nurse’s notebook to write this blog. Withdrawl is hell!

To learn about cosmetic facial surgery in Richmond, Virginia by Dr. Joe Niamtu, visit www.lovethatface.com

Joe Niamtu, III DMD
Cosmetic Facial Surgery
Richmond, Virginia
www.lovethatface.com

Can Retin A Kill You?

Sounds like a headline from the National Enquirer!  After decades of safety of use in millions of patients (including this author!), a recent report has raised some eyebrow when a recent study made some alarming claims.  Relax, you are not going to die, but read on to learn some interesting facts that could affect your health.

Retin A (generically known as tretinoin), a Vitamin A analogue that is a popular acne medication and has been used by physicians to prevent skin cancers, treat wrinkles, and prevent skin aging, has been criticized in a recent study for increasing the risk of death in some patients.

Even though these products have been used safely and effectively for many years, a recent study by Weinstock MA et al, published in the Archives of Dermatology, showed that patients treated in a VA hospital with 0.1% tretinoin topically to prevent skin cancer had a higher risk of death than those not using tretinoin. The veterans in this study were predominately elderly men.

The researchers looked at various factors in the study to try to determine the explanation for the increased number of deaths among tretinoin users. It is difficult to know for sure because the study was not designed to look for risk of death, but it seems that it is smokers who are at greater risk.

This finding goes along with a study looking at an oral form of Vitamin A called isotretinoin that showed that isotretinoin may be harmful to current smokers.

It is important to realize that this is the first sign of a risk of harm from using tretinoin after decades on the market, so this study’s results may not hold up when more testing is done. However, it is prudent to take this advice: If you use tretinoin (retinol, adapalene, tazarotene) or take Vitamin A or beta carotene supplements, please do not smoke. Smoking is known to age your skin prematurely and to cause lung disease and heart disease. It now looks as if using popular anti-aging products in addition to smoking may increase your risk of death.

To find out more about cosmetic facial surgery in Richmond, Virginia click on www.lovethatface.com.

 

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

Evolence: A New Breed of Fillers

Recently, new wrinkle filler called Evolence has been getting a lot of attention, especially after Demi Moore and other Hollywood types have admitted using it.

This is an exciting time in cosmetic surgery as many new and effective products have become available.  As the minimally invasive revolution continues, patients find it difficult to take precious time away from work or play and want significant lasting results with minor recovery.  Enter Evolence!

Evolence is new to the United States after recent FDA approval, but is the number one filler in Israel and has been used outside of the US for ten years.

What sets Evolence apart from other wrinkle fillers is its unique collagen composition.  While most of the other popular fillers are made of synthetic substances, Evolence is the first all natural filler.  It is made from porcine tendon which has the closest structure to human collagen and has been used for decades in heart valves, skin grafts and other medical and surgical products.  Although collagen fillers are not new, they fell out of favor due to two things.  One was that patients were allergic to the older bovine collagen fillers.  Evolence has a unique proprietary process of removing the allergic components of collagen and no allergy testing is required!  This is a huge and new step for injectable collagen fillers.  The other drawback of previous collagen fillers was that although they did a good job, they simply did not last.  Evolence has a patented Glymatrix technology which is a sophisticated cross linking process that extends the length of the filler for up to or over a year.  I can speak personally to this filler.  I was chosen to be one of the teaching staff for Evolence and attended an injection training session in January of 2008 in the Cayman Islands.  The meeting was off shore as new fillers that are not FDA approved cannot be injected on US soil.  The instructors were offered free filler, so I had my smile lines injected.  As I type this blog entry it is exactly one year later and my filler is still present.

The main difference between Evolence (the new collagen) and other fillers is that Evolence actually becomes part of your tissue.  It is collagen and is designed to replace the collagen we lose due to aging.  When injected, instead of being recognized as a foreign body (like most fillers) it is recognized as collagen and the body integrates it into the natural surrounding tissue and even grows blood vessels into it.  It also causes the body to produce some new collagen which can add to the result.  Pretty cool.

Perhaps the biggest advantages of Evolence is the fact that since collagen has many special properties, there is less swelling, pain and bruising with Evolence.  It is great for the patient who wants treated but has a big party in several days.

Right now Evolence is only FDA approved for the nasolabial folds (smile lines) but an new product called Evolence Breeze will be available for lip injections and is used very successfully in other countries.

Since new fillers seem to come and go every month (Artefil went out of business last in December 2008 ) it is critical for surgeons and patients to critically evaluate all new products before recommending them to patients.  Having had Evolence treatment on my own smile lines as well as using it on my patients, I can say that this product is a welcome addition to the armamentarium of cosmetic surgery providers that utilize injectable wrinkle fillers on their patients.  To find out more about Evolence visit www.evolence.com and for more information about cosmetic facial surgery by Dr. Niamtu in Richmond, Virginia visit www.lovethatface.com

 

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

www.lovethatface.com

Dysport: the new “Botox”

If Allergan’s Botox is Goliath, then Medicis and their new neurotoxin is David.  No one can argue that Botox has enjoyed a monopoly in the United States for past 15 years.  After all, Botox was a true paradigm shift in cosmetic surgery.  Never before, without surgery, could a patient have wrinkles disappear.  The introduction of Botox was something so different and so easy that it truly heralded in a new era known as minimally invasive surgery.  What began as a “pretty poison” has grown into “cosmetic maintenance” and now women and men get regular Botox injections with the same regularity that they get their hair colored or teeth cleaned.  Botox has not only continued to be safe and effective, but has gone on to treat many conditions from headaches to hemorrhoids.

Botox has gone largely unchallenged and Allergan has become a corporate giant due to its sales.  Second to Viagra it is the largest selling drug.  A brief challenge came in the “at the turn of the last century” with Myoblock, a similar product but chemically different.  Unfortunately for Myoblock, it did not live up to the effectiveness of Botox, and its popularity was short lived.  It is still used for the few patients that have a resistance to Botox, but is a small player.

Dysport is chemically very similar to Botox and has been used in the United Kingdom for 15 years.  It varies from Botox in its biochemistry and protein structure but basically does the exact same thing.  This drug has recently received FDA acceptance and will be sold in the United States under the same name.  Dysport will make a big bang with the media upon it final FDA acceptance and rumors will fly.  The Dysport FDA trials showed that Dysport took effect somewhat faster than Botox and basically lasted the same amount of time, about three months.  Why challenge the king of neurotoxins (more politically correctly called neuromodulators) with a drug that basically does the same thing.  I call it Coke versus Pepsi marketing.  Consumers and surgeons desire choices in everything from clothes, to cars to, carpet and want choices.  There is also some bragging rights from being the “new kid on the block” (just ask Red Bull).  Cosmetic consumers and media are fascinated by “new” technology and if it is new then it must be better.  Frequently this does not pan out, but a well marketed and effective competitor can certainly gain market share.  When all the US automakers were getting bailed out by the Federal government, Toyota (who was a newcomer to this country) remained strong.

To cut to the chase, Dysport is exciting because it is new and is also taking on heavyweight Botox.  It is likely to become a popular competitor.  What remains to be seen, and could make the difference in the wrinkle wars, is how Dysport is priced in comparison with Botox.  If Medicis significantly undercuts Allergan, Dysport could potentially displace the king.  I doubt that this will happen as corporate America is not fond of less profit.  A similar scenario occurred with Restylane, the revolutionary lip and wrinkle filler from Medicis.  This was the first new filler that was FDA approved and made a meteoric rise to the top of facial injectables.  There was no significant competition for about 4 -5 years until Allergan obtained FDA approval for Juvederm.  In the pre release period, much speculation occurred as to whether Allergan would significantly undercut the pricing of Restylane.  Guess what?  They did not.  Their pricing was almost identical and Juvederm no doubt took a chunk out of the filler sales dominated by Allergan.  Competition is generally a good thing as it offers the public more choices and can sometimes drive down prices, but don’t look for this with aesthetic companies.  They figure if patients will spend $500 for X, then they will spend it for Y.  Time will tell.

To find out more about Botox, Dysport and other cosmetic facial surgery procedures, visit www.lovethatface.com.

 

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

www.lovethatface.com

The First Face Transplant in the USA

Dr. Niamtu with Dr. Maria Siemionow 

There are a lot of disadvantages of lecturing all over the world in terms of travel, inconvenience and time away from home, but this is greatly outweighed by the advantages of making friends with special people.  While serving as the co-chair of the American Academy of Cosmetic Surgery meeting in Phoenix in 2007 one of my duties was to procure world class experts to discuss topics of interest for cosmetic surgery.  This had been right around the time of the French performing the world’s first face transplant.  I became aware of Dr. Maria Siemionow, a transplant surgeon from the Cleveland Clinic.  I was thrilled when Maria agreed to be the featured speaker for our meeting which led to a friendship.  This was several years ago and she detailed her work with animal models in preparation for the first U.S. transplant.  It was pretty fascinating as an incredible amount of work from all walks of medicine are needed to coordinate such an undertaking.  On the surgical side there are transplant, vascular, plastic, ENT, maxillofacial, craniofacial and other surgeons.  On the medical side there are numerous specialties that deal with the host and donor rejection issues and there are psychologists that counsel the patient, families, etc.  More work than you would ever imagine.  Most people think that the work is what happens in the operating room for 20 plus hours of surgery, but that may be the easy part.

This is a very emotional issue with incredible medical ethical implications.  There is much less emotion when transplanting tendons in the knee, corneas in eye or even heart transplants, as these organs are hidden and do not express emotion.  Ethicists do not accept this type of surgery for cosmetic reasons, but rather as last ditch efforts to correct deformities so horrific that the patient has no chance of a normal life in their current state.  The lady in France was mauled by dogs, the patient in Cleveland was a victim of severe trauma.  These unfortunate patients are disfigured to the point of being unable to cope with the isolation of not being able to leave their home.

Think about the psychological ramifications of this type of surgery.  The recipient patient may resemble the deceased donor.  What about the relatives of the donor possibly seeing someone with a new face that resembles their deceased loved ones?  What about the recipient patient knowing that their face is part of someone who is not living?  None of this is to be taken lightly.  Many problems exist with tissue rejection as human immune systems vigorously reject foreign tissue and patients must undergo extensive pharmacologic treatment including massive steroid doses.  The treatment can be worse than the cure.  This is not a procedure where you simply go have an operation and simply heal.  This is not a facelift, this is a face transplant.  There are good possibilities that many of the functions of the transplanted face will not work.  The muscles may not move, the new face may be expressionless.  No taste, no smell, no feeling.  In effect the new face may be a living mask, but to the recipient it may be the only possible option to appear human, just as a donor heart may be the only chance a patient with heart disease has to live. 

Also the fact exists that the entire transplant may fail and the patient could be more disfigured than they were before the surgery, or they could become so sick from the medical treatment they could die.  Again, there are many considerations with this type of surgery.

What will the future hold?  If we can work out the rejection problems, it could be possible that these procedures could be predictable.  If that happens, replacing missing facial anatomy may be a possibility.  On the other hand, as cloning and stem cell research develop, we may be able to “grow” new anatomy and the entire transplant situation may go down in history as weird science.  In any event, it is a very situation that challenges all aspects of medical and human ethics.  In the movie “Face Off” John Travolta and Nicholas Cage exchanged faces seemingly as simple as putting on a Halloween mask.  This technology may never happen but if it does where does it stop?  Assuming it became an extremely predictable, would an older patient ethically be able to have a younger face transplanted?

All of this makes for deep thinking and undoubtedly will be the plot of more movies and books.  Maria Siemionow and her team deserve the greatest respect for their unfaltering research and work leading to this historic event.  I am honored to have her as a friend.  Time will tell how society views the process.

To find out about cosmetic facial surgery in Richmond, Virginia visit  www.lovethatface.com

 

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

www.lovethatface.com

Latisse & Lovely Long Lashes

Latisse is here!

…..and Dr. Niamtu is the first office in richmond to have it!

 

 

 

Grow thick eyelashes and eyebrows in weeks with this amazing new, effective and safe product. Latisse can only be purchased from a licensed doctor and cannot be bought in stores. Dr. Niamtu will offer a $20 discount (normal price $120) for the next 60 days to introduce patients to the best kept secret in Hollywood.

 

Actual Patient of Dr. Joe Niamtu after using Latisse for 90 days

 

Every once in a while something really cool comes along in cosmetic surgery.  Something that is affordable, is safe, works well and has no recovery.  Latisse for eyelash enhancement is an example of a cool new procedure.  Latisse(bimatoprost ophthalmic 0.3%) is an eye drop medication produced by Allergan Inc. (the makers of Botox) used to treat glaucoma by lowering intraocular pressure.  Latisse was FDA approved for that purpose in 1996 and has been proven safe in hundreds of peer reviewed articles. Allergan has now obtained FDA approval and Latisse is here.  A clinical trial at Miami University, in which the drug was given to subjects to use in one eye and a placebo in the other, confirmed the findings. Eyelashes treated with Lumigan grew 2 millimeters in 6 weeks, which was twice as quickly as placebos.

 

 

The cost of Latisse is $120 but Dr Niamtu will offer it to to patients for $100 for the first 60 days.  The 2.5 milliliter bottle will last for months.    For lash lengthening one drop is applied to a clean eyeliner brush and brushed through the lashes.  One drop is used for each upper and or lower lash and patients should wait at least 15 minutes before wearing contact lenses.  Latisse will also make the eyebrows grow and this drug has been used to treat eyebrows and lashes that have been lost to chemotherapy or other reasons.  In order for Latisse to work the patient must have active hair follicles in the lashes or brows. Latisse works at the bases of the eyelashes and when the follicles are in the growth phase (anagen) it stimulates the hair growth. The results are apparent in 1 to 4 weeks and sometimes works in as fast as 2 days.  The medication (a prostaglandin analogue) stimulates follicles in the resting stage (telogen) to transition to the growth phase as well as keep the follicles in the growth phase longer.  It also makes the follicles hypertrophic which causes thicker lashes.

 

No serious effects have been reported.  Temporary side effects can include inflammation (hyperemia) resulting in redness of the white of the eye (15-45% of patients) and 15% of patients report itching.  Latisse is not to be used in patients with chronic eye inflammation or patients who have very recently had eye surgery.  Patients who have had complicated cataract surgery should not use Latisse.  Latisse also stimulates melanocytes (pigment cells) which causes the lashes to become darker as well as longer and thicker.  Due to the stimulation of pigment cells Latisse can darken the iris (center of the eye around the pupil) in some patients.  This occurs mostly in patients with hazel colored eyes.  If Latisse contacts the eyelid skin or cheek, it can also darken the skin, which can be treated with bleaching cream.  It is important to only put the drug on the base of the eyelashes and not in the eye or on the skin.  The darkening of the iris has been seen mostly in patients that use the drops in the eye, and not the more conservative method of applying with an eyeliner brush.  If the drug is stopped, the iris does not continue to darken, but will not reverse to normal color.

 

The effects of Latisse only last as long as the drops are being used.  If the drops are stopped abruptly, many of the lashes will phase out simultaneously and the lengthening result will be lost, so it is recommended to wean off the drops slowly so the lashes will be in different phases of the nongrowth phase (catagen).

Women put a lot of energy into their eyelashes using mascara, curling devices, false lashes and over the counter “enhancers”.  Long eyelashes have historically been favored by women and this new use of an safe and effective medication is sure to become a very popular cosmetic treatment.  Patients I have witnessed using Latisse simply love it and some of them have had to actually trim their lashes because of the impressive growth.

 

Wonder what will be next!

 

To find more about cosmetic facial surgery procedures by Dr. Niamtu in Richmond, Virginia visit www.lovethatface.com.

 

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

“On Being on a Magazine Cover”

 

I recently had the honor of being featured on the cover of Plastic Surgery Practice magazine.  Usually people get on magazine covers if they do something really good or something really bad.  In this case it was the former.  This magazine profiles leaders in plastic and cosmetic surgery and has featured some of the best known surgeons in the country.  Obviously, it was a huge honor for me.

When I reflect on what it took to get there the thought takes me back over a decade ago when I first became interested in cosmetic facial surgery.  At the end of 1996 I noticed a trend that cosmetic surgery was really starting to blossom and permeate numerous specialties besides Plastic Surgery.  Many programs including ENT, Oral and Maxillofacial Surgery, Ophthalmology and Dermatology were teaching cosmetic surgery procedures to their residents.   In my specialty, Oral and Maxillofacial Surgery, cosmetic facial surgery became part of our board exam and was covered by our malpractice insurance.  Having seen all of these changes and always enjoying the cosmetic aspects of Oral and Maxillofacial Surgery, I began to seek more knowledge about cosmetic procedures.  I soon became aware of a group called the American Academy of Cosmetic Surgery.  This was a somewhat unusual group as it was made up of members from virtually every specialty that wanted to share their knowledge about cosmetic surgery.  This does not sound that unusual now, but in 1996, many surgeons and specialties operated in stealth, not willing to share knowledge with colleagues.  All of my life I have become obsessed with my passions and it quickly became obvious that I was about to become obsessed with cosmetic facial surgery.  Prior to this time, I had a very successful and enjoyable time practicing routine maxillofacial surgery.  I began a solo practice and with the help of awesome partners, grew it to an 8 man, 6 office machine with 75 employees. As much as I enjoyed what I did for a living, there was something missing.  I felt withdrawn from academics, as many practitioners do after a decade or so of practice.  I was looking for some mental and surgical stimulation and cosmetic facial surgery filled that need.

It did not start out as an easy ride.  As my cosmetic surgery acumen grew, I began marketing my cosmetic services and that ruffled the feathers of some local competing specialists.  A number of detractors attempted to keep me and others from performing cosmetic facial surgery, mostly by deception with other doctors, patients and politicians.  A driven person will not accept defeat at any cost and I was determined to pursue my practice in a cosmetic direction.  As my experience grew so did my patient volume and producing good results with happy patients will trump adversaries over the long run. 

Around 2003, I decided that I enjoyed cosmetic facial surgery so much that I would limit practice to that discipline.  It was a big decision as it is difficult to maintain a practice on cosmetic surgery only, especially a head and neck cosmetic practice.  Surgeons performing full body surgery have more to choose from.  Cosmetic facial surgeons are limited to that area and there is only one other surgeon in my city besides me who limits his practice to cosmetic facial surgery.  Many Plastic Surgeons dabble in cosmetic surgery and fall back on reconstructive surgery to fill the voids but having a dedicated cosmetic practice is much more difficult.

From the onset of my cosmetic surgery experience I meticulously documented my learning and surgical techniques.  I began using this information to publish and teach.  I have always enjoyed writing and used my free time to publish articles on cosmetic facial surgery.  To date, I have published over 200.  I have also always enjoyed teaching and seriously considered a career in academics when I finished my residency.  In 1997 I gave my first cosmetic surgery lecture at a surgical meeting.  As I progressed, I submitted abstracts to more and more meetings from various specialties and organizations.  This is a very time consuming process as it requires unbelievable time and effort to lecture.  I think I spend more time using PowerPoint than anyone on the planet!  Also, a teacher must remain at the cutting edge of what is happening, so it is a significant commitment.  Over the past decade, my ability to teach and lecture became appreciated by various societies and specialties and in 2008 I lectured nationally and internationally 27 out of 52 weekends.  There have been many drawbacks from this; time away from home, work and family, missing hobbies such as bow hunting and fishing and spending countless hours in airports.  There have also been many rewards.  I have met thousands of cosmetic surgeons from all specialties, all over the world.  Some of my best friends have been made on the road and I cherish this family of cosmetic surgeons.  With this experience came committees and board appointments with the American Academy of Cosmetic Surgery.  I have served on numerous committees, was on the board of directors of the Cosmetic Surgery Foundation and have served as a co-chair for two annual meetings.  Also with experience comes other honors and I have been appointed to editorial boards of such publications as Cosmetic Dermatology, Aesthetic Surgery and Medicine and Cosmetic Surgery Times.  Finally, I have been asked by Elsevier, one of the leading companies in medical publishing, to write a textbook on cosmetic facial surgery.  This is a supreme honor and my chance to leave something behind.

I feel very lucky to love my job and I am excited to move into our new cosmetic facial surgery office and surgery center which is a state of the art facility here in Richmond, Virginia.  This magazine cover comes on the same week that we move into our new facility and serves to make me feel good about all the countless hours I have invested in cosmetic facial surgery.  As many of my friends that I trained with ponder retirement, it is my hope that I can work another 20 years, because I love what I do.  I also feel great about the fact that I have given back to the community by treating many patients that were unable to pay.  There is no better feeling that helping someone who has no other place to turn, especially children.

So, I spend my days performing cosmetic facial surgery and my evenings making before and after pictures, updating my web site, working on my text book and writing on my blog.  I sometimes feel overwhelmed and wonder what keeps me going.  It is simply that I have a passion for what I do. 

So what does it take to get on a magazine cover?  It takes passion!

To find out more about Dr. Niamtu or cosmetic facial surgery in Richmond, Virginia visit www.lovethatface.com

 

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia