“Botax”: The Proposed Tax on Cosmetic Surgery

Ahhhh, the federal government has found another unturned stone to tax a small portion of the American public, the cosmetic surgery tax.

This source of revenue is considered unfair and excessive by most individuals.  All cosmetic surgery procedures would include a 10% tax.  This sounds good for the Feds, but bad for the consumers.  Now, of course, the readers of this blog will say “of course he does not want a cosmetic surgery tax, it will affect his income”!  Well you are correct on that, but there is actually a bigger picture of unfairness.

First of all, the Federal Government (or State Governments) do not participate in any insurance with these procedures because cosmetic surgery is elective.  Patients are already paying for this with after tax dollars, so now they have to pay tax on taxed income.  Also, as seen in other states that have initiated a cosmetic surgery tax, patients simply go to another state to have their surgery.  This does nothing to support local economies and takes business away from the surgeons in that state.  An additional negative about this tax is that it discriminates against females as they are the largest consumers of cosmetic surgery. Other consumers, regardless of gender, save hard for cosmetic procedures and may be priced out of the market.

Another possibility of this type of tax is that it can encourage “back room” surgical procedures.  This is one of the arguments for legal abortion.  When it is illegal, patients have had fatal or damaging outcomes by using “back room” not qualified medical personnel for treatments.  A further tax on cosmetic surgery or any surgery for that matter can encourage non qualified medical treatment.

When the Fed decides to tax a luxury, where does it stop?  Should there be an additional tax on high quality running shoes, top shelf alcoholic beverages, the best lawnmowers, etc?

Patients pay tax on the money they use for cosmetic surgery and the surgeon pays tax on the income he or she makes from the surgery.  That would seem to be enough.

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

Joe Niamtu, III DMD, FAACS

Cosmetic Facial Surgery

Richmond, Virginia

The Diva Lift: Facelift for Full Figured Females

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In this day and age, it is a bit disgusting that some surgeons go out and makes a minor change to a procedure that has been around for a century and “invents” some new miracle procedure.  There are bunches of these types of docs out there.

I recently detailed some of my work that involved modifications of traditional facelifts in patients with high body mass index (BMI) in an article in Cosmetic Surgery Times.  The Body Mass Index is a formula that gives a number based on the height and weight of the patient.  Overweight patients (full figured) present many differences when compared to the average facelift patient.  This magazine goes out to cosmetic surgeons from multiple specialties and frequently details new or innovative approaches to cosmetic surgery.  The editor, Teresa McNulty, and I discussed a modified facelift that I was performing on full figured women with great results.  She was impressed with my surgical results and suggested the name of the article be the “Diva Lift”.  So there, that is how the name came about and not as a self anointed marketing ploy on my behalf.

What is the “Diva Lift”?

First of all, the word Diva, until the past decade when it became descriptive of any star female singer, was commonly used to describe full figured opera singers.  Facelift surgery is a very large part of my cosmetic facial surgery practice and one of my favorite procedures.  I enjoy facelift surgery because I think it is the most dramatic cosmetic surgery procedure that exists for several reasons.  First of all, you can hide mediocre surgery on boobs, bellies and buts, but you can’t hide facial surgery.  Secondly, as we age, big changes occur in our cheeks, face and neck that cannot be disguised with clothing.  Another important thing about facelift surgery is it is probably the most noticed surgery as patients look at their face daily more than any other body part and those we interact with see our face more than other parts of our body.  Facelift is the ultimate rejuvenation procedure.  Patients simply feel bad when their face ages and feel better when it is firm and tight.

 Facelift patients come in all size, shapes and genders and unlike some operations, no two are the same.  Also many surgeons perform different variations of facelift surgery.  Like anything else, there is a right way and wrong way to perform facelift surgery.  Many surgeons perform time tested “textbook facelift surgery” while others get lazy and adopt shortcuts that affect the results and longevity.  Worst is the current rage of “minimally invasive facelifts” that are merely marketing ploys of corporate franchises.  These lifts claim to be revolutionary or miraculous and lure patients with promises of maximum results with minimum downtime and cost.  Note to consumers!  You get what you pay for.  I don’t mean this only in terms of cost (because some of these miracle lifts cost more than my larger lifts) but in terms of recovery.  If a patient over 40 years desires comprehensive facial rejuvenation that will last over 10 years, then they need a longer recovery.  Two weeks of recovery is not too much to endure to reverse decades of aging and skin sagging.  To truly address the deep tissues of the front of the neck and cheeks, incisions must be made under the chin and in front of and behind the ears.  These incisions are well hidden and almost unnoticeable when performed by experienced surgeons.  These trendy “minimally invasive” facelifts only use a smaller incision in front of the ear and this severely limits the effect of the lift.  When you perform facelift surgery correctly and comprehensively, it requires tightening of the neck muscles under the chin (called the platysma muscle).  It also requires tightening of the deep layers of the cheeks (known as the SMAS which stands for superficial musculoaponeurotic system) with numerous sutures for a secure and lasting result.  Finally, the incision behind the ear (which is hidden in the hair) is absolutely imperative to truly address the excess skin of the chin, face and neck.  When a surgeon shortcuts any of these incisions or approaches, the patient gets short changed.  The result will simply be less dramatic and for sure will be less long lasting.  A three to five day recovery may sound like a great thing, but it is a short cut.  To address all the important structures, a recovery closer to two weeks is necessary.  Most facelifts with short recoveries will unfortunately also have short results and will begin to relapse within the first 2 years.

The “Diva Lift” (and I must admit that I hate to “name” a facelift is far from a short cut.  In fact, it is a more aggressive facelift because these overweight patients have more fat and skin and need more surgery to obtain a natural and long lasting result.

 

How is the “Diva Lift” different from conventional facelifts?

 

The main differences of the “Diva Lift” are modifications of traditional facelifts to address the excess fat and skin.  The first difference is that these procedures require a higher level of liposuction of the superficial and deep fat when compared to a normal weight patient.  Also, deep fat accumulations are addressed under the chin and the front of the neck.  By reducing or sculpting this deep neck fat, the surgeon can obtain a much more defined neck after the facelift compared to facelifts that don’t involve this deep fat. After the superficial and deep fat are reduced or removed, the neck muscles in the front of the neck (platysma) are tightened.  The “Diva Lift” also involves a higher level of “liposculpture” where instead of just removing the fat under the skin; it is sculpted to provide youthful contours of the jaw line, jowls and neck.  Full figure patients also have much more fat in their cheeks and neck and the “Diva Lift” specifically address this to a greater level than the conventional facelift.

Besides the deep fat in the neck, the way that the deep tissues of the cheeks are managed is critical in larger patients.  In many patients, a common surgical technique called “plication” involves tightening the deep fat and tissues in the cheeks by folding them over.  In a thinner patient this technique may be desirable as it add some facial volume, whereas in the full figure patient the goal is to reduce some of the cheek volume.  With this in mind, the “Diva Lift” involves a more comprehensive method of treating the deep tissues in the cheeks called “SMASectomy”.  Instead of folding the tissue over on itself like plication surgery, some of the deep tissue is actually removed which not only tightens but slims the face, which is very important in this type of patient.  In the “Diva Lift”, much more time is spent dealing with fat excess than in the conventional facelift.  Also important in this type of lift is the tightening of the backside of the neck muscles (posterior platysma).  Many surgeons omit this step and again, it improves the result and longevity of the lift.  Why doesn’t every surgeon do all of this?  The answer is simple.  It takes time and expertise to competently perform these procedures and some surgeons don’t want to devote the time or do not have the surgical expertise.  The “Diva Lift” is not a facelift for beginning or inexperienced surgeons.

The last step of the “Diva Lift” that varies from conventional facelifts is the excess skin management and incision patterns.  Since the full figured patient has more skin than the average patient, incisions must be slightly larger (but still well hidden) and performed in a certain manner so there is no bunching of the tissue.  These incisions are specially designed as not to be noticeable or make big changes in the patient’s hairline, specifically the sideburn region and the hairline behind the ear.

So, the “Diva Lift” is not a smaller, but rather a larger type of facelift.  It embodies a little more aggressive treatment at each step of the facelift when compared to the average facelift.  It definitely requires more work on the part of the surgeon and perhaps a few more days of recovery for the patient, but the results are worth it.

Some surgeons may read this and say “this is nothing new and Dr. Niamtu is merely doing a larger facelift”.  In some ways they are correct, but it is not simply a larger facelift.  It is a combination of procedures that must be addressed in a specific way with careful attention to details as the full figured facelift patient requires a different type of surgery.  I am the first to admit that I have not invented or discovered anything new.  I have merely modified common facelift techniques to better serve the full figured patient and have obtained impressive results with this technique that have been natural appearing and long lasting.

There may be nothing new under the sun, but there are surely ways to innovate existing procedures to better benefit selected patient populations.

To find out more about facelift surgery by Dr. Niamtu in Richmond, Virginia visit www.lovethatface.com

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

www.lovethatface.com

How We Feel After Cosmetic Surgery: Dr. Niamtu’s Tips for a Healthy Recovery

The recovery period after surgery varies from person to person, and of course, depends on the procedure you’re having and whether multiple procedures are being performed at the same time. The following graphics have been modified by me based on information that has been around for a while and I am not sure who originally put them toghether, but my goal was to and to and publish this in a format that is better suited to the patient so they can have a better understanding of how different patients react to surgery. Some patients literally breeze through the recovery process and others have a more difficult time. Some patients get a bit depressed and wonder if they did the right thing in having cosmetic surgery. The following charts will provide insight into the recovery process and hopefully put patients at ease when they have a more thorough understanding of the surgical healing and physical and psychological changes involved the first month after surgery.

 

 Regardless of the procedure there will be both physical and emotional issues to consider during recovery. It’s important to remember not to rush the healing process. Here are some helpful hints for a healthy recovery:

• Reduce swelling following facial surgery by applying ice. Even if your surgeon has applied bandages to reduce swelling you may need to apply ice periodically. Ask your surgeon how long you should continue this.
•  Plan your recovery time smartly. Depending upon the surgery, recovery time could range from a few days to a few weeks. Keep this in mind as it affects your work, family, and social schedules after surgery.
• Be realistic in your expectations. Let’s face it, you’re going to look worse before getting better. Just about all types of cosmetic surgery procedures involve bruising and swelling. Your real results won’t reveal themselves for a few days (or longer) so don’t panic! Let the natural healing process take place. If you suspect a problem see your surgeon.
• Follow your surgeon’s guidelines. Whether it’s taking prescribed medication or when to resume regular exercise, or hygiene instructions, your surgeon can provide the best advice for a safe and healthy recovery.
• Arrange for care for the initial 48 to 72 hours after surgery. Even though you may believe you can resume your normal routines, having someone there to assist you will bring peace of mind and allow the healing process to occur normally and with less disruption.
•  Rehydrate your body often. Surgery of any kind can reduce fluids in your body. Drinking water frequently will help replenish these lost body fluids. Also, eat lightly for the first few days and only food that is easy to swallow and digest.
•  If you’ve had surgery on your head or neck, keep them elevated for a few days. This will reduce swelling and speed the recovery process without compromising the results.
•  Avoid exposure to direct sunlight. Use sun block with proper UV protection to protect your skin.
•  Don’t take aspirin or anti-inflammatory medications. These might interfere with medications prescribed by your doctor. Be sure to check with your doctor about which over-the-counter and prescription medicines you should avoid during recovery.

For more information about cosmetic facial surgery visit www.lovethatface.com

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

What goes around…..comes around.

I had an interesting experience at the office today.  Not my first of this type, but a good one.  I went to a treatment room to see a patient that I have treated many times for Botox and small procedures.  I noticed that she would not make eye contact with me and thought that was odd. I asked her how her summer was and she said “terrible”, again while staring at the floor.  When I asked her why, she said she made a terrible mistake.  She went on to explain that she had consulted me months ago about a facelift, but on the recommendation of a friend, went to another surgeon and the result was a disaster.  I held her hand and reassured her that I am not offended and this happens to all doctors but I was sorry about her result.  Upon examination, she was correct, she had a poor surgical result.  Her incisions were improperly placed and noticeable, her neck still had much laxity, she had lost areas of tissue that healed with scars and had folds on her neck and chin from improper technique, to name the major problems.  She began crying and said she wanted to sue the other doctor.  I asked her who the other surgeon was and she told me.  She also told me that she should have know better than to go to him because when she told him that she had also consulted me, he “went off”.  She said this surgeon went into an embarrassing 5 minute diatribe about how I am unqualified to perform her facelift and many other degrading things about me.  She said that she already had paid a deposit and signed some papers so against her feelings she went ahead with the surgery.  She explained how disappointed she was and how much she suffered and how it ruined her entire summer.  She also reminded me that she asked me one time about this surgeon and I did not say anything negative about him and after his assault on me, she now sees the value of being a bigger person.  She stated “wow, you must really have taken a lot of this surgeons business for him to be that jealous, I am so sorry I did not choose you to begin with.” This was a good reminder of how astute patients really are. 

I again told her not to feel bad and that her actions were in the past and she can’t change that.  She spoke about suing the other surgeon which I totally discouraged, knowing that if the shoe was on the other foot, he would have relished in the process.  We began working on the scars and made a treatment plan to deal with the other problems and upon leaving, she gave me a hug.  I hope a lot of younger surgeons see this blog as there are a multitude of lessons to be learned in a case like this.  First of all, always speak with purpose and never lower yourself to the level of negative, insecure people.  You will always look bigger and patients can see right through an insecure surgeon.  Secondly, many doctors are victims of “competitive insecure bashing” and they should never let that bother them.  If a surgeon treats his or her patients like family and does good work, it will all catch up with the good doc and take away from the bad doc.  A Chinese proverb says “if you sit by the river bank long enough, you will eventually see the bodies of your enemies float by”.  It’s true.  Most doctors that talk trash are identifying themselves to that patient as insecure and intimidated by their competition.  If you can’t say something positive, then simply say “I don’t know anything about him”.  So today I wanted to thank Dr. X for his kind referral of this patient and all her friends.  I actually received patients without any marketing.  What goes around comes around.

To learn more about cosmetic facial surgery in Richmond, Virginia visit www.lovethatface.com

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

……on writing my textbook

In an earlier post, I described the work involved with writing a major cosmetic facial surgery text.  I literally spent 3-4 hours a day (and sometimes up to 11 hours) writing chapters on common topics of cosmetic facial surgery.  Being a major text from one of the best known medical publishers (Elsevier Saunders) there is no room for short cuts or nonfactual information.  Undoubtedly, young surgeons will use this text (and others) to learn how to do cosmetic facial surgery.  This means that everything has to be correct and referenced.  For the past quarter of a century, I have been a photography addict and it has paid off.  My text will contain several thousand images in a “step by step, how to do it” format.  Currently I am reviewing proofs (see picture) of all the pictures in each chapter.  Each image has to be rechecked for accuracy, clarity and to check that the captions are correct.

I am also knee deep in videos.  Contemporary textbooks contain DVD’s in the back cover that provide multimedia instruction on the various procedures.  Again, no room for amateurish movies.  I purchased a high end, high definition digital camcorder and although I already have movies of all my surgical procedures, I am remaking them in high definition to compliment this detailed book.  This is a task of awesome proportions.  Doing surgery and doing surgery for a movie is very different.  I have to narrate each step during the procedure and make sure that bloody gauze, drapes and instruments remain clean.  The videographer must focus on the key aspects of the procedure.  It is a lot of work but just the beginning.  The next step falls on my shoulders.  I must take all the raw video clips and assembly them into a movie.  This takes significant editing to makes sure that the movie flows properly, has transitions between scenes and the audio is acceptable.  Once this is put together, the movie must be rendered, or formatted to work on the average DVD player.  This editing process takes many hours but when I view the final product it is a warm and fuzzy feeling.

Having done most of the heavy lifting for this book, the next task will be to review all the text that I wrote and I hate that part.  It is hard for an author to go back and reread hundreds of pages (probably over a thousand) that he or she already wrote.  I am told by the publisher that the book should be available by July 2010.  Too long for me, but because the unusually large amount of color pictures, the book must be prepared overseas and shipped back and forth during production.  I am really excited to get that first copy as this project reperesents the most comprehensive and intense project that I will ever embark upon.

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

Joe Niamtu, III DMD

Cosmetic Facial Surgery

www.lovethatface.com

Botox without Needles?

For over 100 years, doctors have been administering medications with needles.  I can’t think of any single factor that patients of all ages hate about seeing the doctor that is worse than the fear of needles.  Besides scaring patients, many health care workers are injured or infected from accidental needle sticks.  There is nothing fun about needles!

There are hundreds of scientists and researchers constantly working on alternate medication delivery systems to get medications in the body without using needles.  We have made good progress with numerous medications.  Patients with chronic pain are able to get pain medication from patches applied to the skin and numerous other medications can be administered in this manner.  I predict that in the future, we will even be able to provide general anesthesia without needles or tubes in ones throat.

A topical, non injectable form of Botox (botulinum toxin A) is impressing researchers and is in phase II clinical trials. Revance Therapeutics is a private company in Mountain View, California that has developed a gel that is mixed with the Botox or Dysport that allows large macromolecules to cross the skin and provide local and targeted treatment of the muscle that causes “crow’s feet” wrinkles.  The company calls this technology TransMTS (macromolecule transport technology) and this technology is based on a single, straight-chain peptide that allows the skin to accept the medication instead of preventing absorption.  To get a bit more technical, adding a peptide as a separate component to the neurotoxin allows the medication to cross the skin. The peptide is said to form an ionic bond with the toxin and the peptide also has a protein transduction domain (PTD) which allows the medication to penetrate the skin.  The protein carrier featuring (PTD) holds on to the cell membrane and allows larger molecules to pass.   Currently, there have been over 600 crow’s feet regions treated with this technology with impressive clinical results and without complications.  Studies are also in place to use this topical application to the under arms for control of sweating.

No mention has been made of how long the treatment takes or how long it lasts and there will certainly be variables that effect results in given patients.  In any event this new technology is very exciting and representative of what the future holds for painless application of medicines.  This would be a very welcome addition in the cosmetic facial surgery arena.

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

 

Joe Niamtu, III DMD

Cosmetic Facial Surgery

www.lovethatface.com

Sunscreens: don’t get burnt!

Although sunscreens are important all year round, they are especially important in the summer months to protect your skin from aging and cancers.

Consumer Reports reviewed 10 well known sunscreens in July 2009 and assessed UVA and UVB protection and their waterproof effectivness and had some interesting findings.  To clear up some definitions:

• UVA rays are penetrating rays that can cause sunburn, wrinkles, pigmentation disorders and skin cancers.
• UVB rays cause sunburn and other sink damage and also contribute to skin cancer.  The UVB rays are most responsible for sunburn. 
• SPF is sun protection factor and measures the UVB sunburn protection on treated skin as compared to skin with no sunscreen.  The way this is calculates is as follows.  Untreated skin normally takes 10 minutes to turn red.  An SPF of 30 lengthens that time to about 300 minutes. 
• Broad Spectrum implies that the product blocks both UVA and UVB rays (but does not indicate how effective the product is at each).
• PABA-Free means that the product contains no esters of para-aminobenzoic acid.  Older products with PABA can cause skin reactions, but are rare in products made in the USA.
• Water Resistant means that the product maintains the stated SPF for 40 minutes in the water.
• Vary Water Resistant means that the product maintains the stated SPF for 80 minutes in the water.
• Total Sun block are those with pigments such as zinc oxide that do not allow any sun rays to penetrate.  These are often worn on the nose or lips of sun sensitive individuals.
• Nanoparticles are particles different chemical or physical characteristics from normal sized particles.  These are often used with zinc oxide or other pigments that totally block the sun rays.  My using nanoparticles, the material looks clearer on the skin. There is some concern about the safety of nanoparticles on human health.  For more info go to www.consumerreportshealth.org and search for nanotechnology.

When shopping for sunscreens, purchase a product labeled “very water resistant” or “waterproof” with an SPF of at least 30 which is plenty for most people.  An SPF of 30 is an easy number to remember and in fact, the FDA is has announced plans to limit SPF numbers at 50.  With this change, sunscreens that provide more than protection than 50 will be labeled 50+.

The highest rated sunscreens by Consumer Reports were:

1. Aveeno Continuous Protection Spray SPF 45. Cost $2.43

2.  Target Sport Continuous Spray SPF 30. Cost $.87

3.  CVS Sunblock with Zinc Oxide for Face, Nose & Ears lotion. SPF 45. Cost $2.33

The Consumer Reports Best Buy were:

1. Walgreen’s Continuous Spray Sport SPF 50. Cost $1.33

2.  Coppertone Water Babies SPF 50 Lotion. Cost $1.14

3.  Target Sport Continuous Spray SPF 30. Cost $.87

You can see that you don’t have to spend a lot to get good sun protection and in fact many people waste money on exotic sounding labels that may provide less protection.  There are some important facts to remember before going into the sun.

• Apply sunscreen 15-30 minutes before going out in the sun to allow for the absorption and coverage.
• Apply at least 2-3 table spoons of sunscreen for the average adult.  This is a lot of sunscreen!  Most people apply way too little product.
• Reapply every 2 hours or after swimming or heavy sweating.  This is very important
• Wash your clothes after a day at the beach as all of the products can cause stains when left on clothes.
• Discard sunscreens that are more than 2 years old as they lose potency.  Since there is no expiration date on the bottle, mark the purchase date with a magic marker!
• Don’t rely solely on sunscreen to prevent aging and cancer.  Protect you skin with clothing, hats and sunglasses.  This is especially important for people with light skin, hair and eye color.
• Avoid direct sunlight during the hottest times from 10AM-2PM.

There is no doubt that sun exposure accelerates skin aging and the incidence of skin cancer.  Every patient should have a full body mole exam on a yearly basis.  The excessively tanned look is a thing of the past and very few patients are going to avoid the sun completely, so use your head, use moderation and use sunscreen to stay younger longer.

Much sun damage is invisible to the naked eye and Dr. Niamtu offers complimentary skin scanning with the Canfield Reveal Skin Scanner.  You can see in the picture below that in normal light a patient shows little skin damage but with the scanner, there is no doubt about the extent of the damage.  Most patients are shocked to see the degree of sun damage they have.

 This image shows a patient in normal light and in the Reveal Skin Scanner.

To keep your skin younger it is important to use Retin-A and some form of bleaching cream.  The Obagi Nu Derm systemis an excellent means of maintaining young and healthy skin.  For patients that desire to reverse sun damage and improve wrinkles and sunspots as well as tighten the skin, Dr. Niamtu offers many treatments including CO2 laser resurfacing, Fraxel Laser, Active FX laser and Deep FX laser as well as Vascular Lasers for spider vein treatment.  Chemical peels are also effective for reversing sun damage and Dr. Niamtu provides numerous types of chemical face peels.

 

The above image shows a patient before and after CO2 laser skin resurfacing to improve wrinkles,sun damage and sun spots.

Visit http://www.lovethatface.com to find out more about reversing sun damage and keeping healthy skin as well as other cosmetic facial surgery topics.

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

Writing a Textbook: the hardest thing I have ever done.

Over the years I have written several hundred cosmetic surgery journal articles, text book chapters and general publication articles.  Over this time I have edited three textbooks and contributed 18 chapters to other author’s textbooks.
Last September, I was asked to write a textbook on cosmetic facial surgery by Elsevier which is one of the largest publishers of medical textbooks in the world.  This was quite an honor and I explained that I know some of the best surgeons in the world to contribute chapters.  To my amazement and honor, Elsevier informed me that they wanted a single author textbook.  Ouch!  Again, a great honor, but I knew that this would be a task of awesome proportion.  And it was!
Last October I started writing a comprehensive textbook that would encompass the most contemporary cosmetic facial procedures.  My goal was to write an “atlas” type text that would describe each procedure in step by step detail accompanied by actual intraoperative photographs.  I wanted this text to be not only an instructional book, but also be able to guide surgeons through the step by step of each procedure.  My average chapter is ten thousand words and one hundred pictures, but some of the larger chapters like facelift and laser grew to 55,000 words and 250 images.  I was given a July deadline and finished at 11:48 on June 30th!  This was the hardest thing I ever did for numerous reasons.  First of all, I wrote every word off the top of my head.  When you write an instructional text, there is no room for error or missteps, so everything has to be accurate.  I wrote several hours every day.  On several days I wrote over 11 hours and one Sunday I typed for 13 hours with several breaks.  I wrote on airplanes, on trips where I was a passenger in the car, on my father’s couch at Christmas, and even typed two chapters on my iPhone while at a beach vacation.  I simply wrote and wrote and wrote every day.  My wife has been a “text widow” for the last 9 months, but has been unbelievably supportive.  Having completed 16 chapters and thousands of photographs, I am now editing video for the DVD that accompanies the textbook.  This has been another load of work.
I truly want this book to be my “Opus” and want to leave behind something that not only documented my cumulative cosmetic surgery experience, but something that could serve to teach other surgeons how to perform these wonderful cosmetic operations.  I wanted to be able to save novice surgeons some of the hard learned lessons of cosmetic surgery and to distill the knowledge to a very understandable level.  To that end, I believe I have accomplished my goal.
There is still a lot of work to be done finishing the videos and then there will be the proofing all the chapters which is very difficult.  It is very hard to have to go back and reread all the material that you write!  My fingers are sore from typing, and I have to really be conscious about my posture as hunching over a computer all this time can make someone a hunchback.  I feel that I have accomplished something that only a handful of surgeons ever get to do.  The book started out as 600 pages then went to 800 pages and I am hoping the publisher will allow a lot more than that because I have sent them much more.  I am not sure if it will all fit in a single volume.  May take two.
Writing this textbook is the hardest thing I have ever done!

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

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.  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”.

Dr. Jill Weibel is a friend of mine and she is one of the nicest and most compassionate doctors I have met and a leader in laser technology.  I believe this type of laser treatment for burns 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 the “miracle” hype on 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.  My phone rand many times after this story ran and I too have used the Deep FX technology on scars.  The thought of improvement with the new is exciting but it is too early to brand it as a “miracle”.  As academic surgeons like Dr. Weibel and others continue to blaze new trails with this type of fractional laser, the cosmetic treatment of burn scars may become a reality.

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

 

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virgina