Cosmetic Surgery for Men

 

Males and minorities are the fastest growing demographic in cosmetic facial surgery.  Although my cosmetic facial surgery practice is about 90% female, males continue to be a growing group.  There are many reasons for this.  First of all, many more people are openly having cosmetic surgery than in the past as it has become an accepted practice.  So as there are more females seeking cosmetic surgery, there also more males.  In previous generations, cosmetic surgery was a close guarded secret of the upper and middle class patients.  Patients would wait till they looked older before having surgery and would often secretly sneak off and have a drastic procedure that oftentimes looked unnatural.  Today’s patients do not want to wait to get old to look young!  Therefore they are seeking smaller procedures at a younger age to stay young and avoid the overhaul their parents had.  Whereas cosmetic surgery was a stigma in the past, people (including celebrities) are much more open about it now.

Males present different challenges for cosmetic surgeons.  They are sometimes a little embarrassed to talk about their cosmetic deficiencies and don’t want their friends to know what they are thinking or doing.  They also present a different surgical challenge.  Men have thicker and bearded skin and do not have the long hair that many women have to hide incisions.  Men also do not wear makeup so their recovery may be somewhat longer that a female who can cover bruising, etc.  They are also more resistant to “lying around the house” for a week to recover , and will frequently try to return to exercise, sports and work prematurely.  Finally (and sorry guys) they are more resistant to closely following post operative instructions than women.

The biggest growth I have seen in males concerns minimally invasive cosmetic procedures such as Botox and wrinkle fillers.  These simple and effective treatments can provide relatively dramatic results with little or no down time.  Male patients are also good candidates for smaller surgical procedures such as cheek and chin implants and chemical peels and lasers.  Cheek and chin implants are an attractive option for males as they can not only restore volume to make a patient look younger, but can also give a man a more masculine appearance with relatively simple procedures.  My most common surgical procedures in males include eyelid surgery and facelift.  This is a common combination in males wishing to rejuvenate their upper face and tighten their neck.

Skin care has also proven to be of increasing interest in male patients.  Most guys are not interested in a collection of potions and lotions that require morning and evening use, but tend to do really well with simple creams of Retin A and bleaching medication such as Triluma.  There is so much science proving the ability of these simple prescription care products to keep patients looking younger, it is hard to dispute their effect.  Due to this, men as well as women can get good results by using some simple skin care and sunblock.

In previous generations, cosmetic facial surgery may have been for “sissies”, but today’s men want to look as young as they feel and the stigma is gone.  For more information about cosmetic surgery in males or other cosmetic facial surgery procedures, see www.lovethatface.com.

 

Joe Niamtu, III DMD

Cosmetic Facial Surgery

www.lovethatface.com

Medical Tourism: Is this an oxymoron?

 

With the extreme interest in cosmetic surgery many new avenues have appeared to mix surgery and recovery and medical tourism is one of them.  Medical tourism is the idea of having cosmetic surgery and recovering at a remote destination, usually a luxurious one.  On the surface, this may sound cool, but in reality, who really wants to spend their vacation with swelling, bruising, stitches and bandages.  I guess one could make an argument that the patient could go to the vacation spot a week early and enjoy the vacation, then have surgery and recover the second week.  This way, one can combine vacation and recovery…………….but why?  Personally, I can’t fathom combining the two.  I work hard and when I go on vacation, I want to enjoy it.  I don’t want to spend it in bed, especially in a recovery bed.  Another thing to consider is what type of medical facilities are available at the luxury destination.  I have been to some really beautiful places in my life, mountains, islands, wonders of the world, etc.  Few of any of these localities are known for their medical facilities any more than Cleveland Clinic is known for a vacation Mecca.  The news is replete with horror stories of patients that went to Mexico or South America for a “bargain” surgery and vacation and lived to regret it.  When I go on holiday, I want the best chefs, bartenders, and tour guides, when I have surgery I want the best facilities, medical staff and emergency equipment.  I think it is rare to find the combination of all of the above.  Not impossible, but uncommon.  Sunscreen or penicillin? Pina colada or pain pill?  Not the choice for me.  Hey, I was just saying……………………….

 

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

www.lovethatface.com

 

Cosmetic Surgery Addiction

The first question of this article is “can a patient become addicted to cosmetic surgery?”  The first answer is absolutely!

Cosmetic surgery is a means of artificially enhancing or reversing the aging process.  First and foremost is the fact that “no one needs cosmetic surgery, it is totally elective.”  So, here we have an entire specialty built around procedures that no one really needs!  We are not saving lives or healing (with the notable exception of reconstruction, and the like) but rather adorning ourselves to look better or younger in our eyes or in the eyes of others.  Pretty vain when you truly consider it.  Being a cosmetic surgeon, I am obviously a proponent of cosmetic facial surgery but like anything else in life it needs to be performed with a balance.  You don’t have to travel far to see patients whose faces and bodies scream “I am addicted to cosmetic surgery!  I have seen this in New York City, Canton, Ohio, Dubai, Venice and Athens.  Some people smoke too much, some people drink too much, some people gamble too much and some people have too much cosmetic surgery. 

I can write an entire text on the changes that the Internet has brought to cosmetic surgery.  Most of them are very positive but it has also brought some negatives.  One of the positives has been patients from out of town or out of the country.  In my practice I now operate on many patients from out of town and out of the country.  It is a joy and an honor and I have made friends from all over the world.  On the other hand I have evaluated many patients that seek surgery outside their domicile because no local surgeons will operate on them or already have.  Many of these patients have unrealistic expectations and are bothered by small physical flaws that are actually manifestations of a larger psychological disease.  A small percentage of these patients are not happy, have not been happy and will never be happy with their physical self.  Their quest is to change their life by having the next cosmetic procedure, in the same vein that a compulsive gambler puts his or her last dollar into a slot machine in the remote hope of a big payoff that may change their life.  Don’t get me wrong, as the vast majority of my out of town patients are very realistic in their wants and desires, but having a high profile practice also brings its share of unreality.  To operate on a realistic patient is a joy; to operate on an unrealistic patient only makes you the next surgeon that “didn’t do it correctly.”  When I lecture to young surgeons (as I frequently do) I tell them that one of the main ways to be successful is to operate on the “right” patients.  By this, I mean that the correct procedure on the correct patient is a reward for both the doctor and the patient and the inverse of this can spell disaster for both.  Unfortunately, there is no means to measure the psychological stability of a prospective patient and due to this sometimes the surgeon and staff are fooled.  The patient can get a good idea of the skill of a surgeon by looking at their credentials, before and after pictures, talking to other patients, etc., but it is pretty hard for a surgeon to garner the status of a new patient.  Most surgeons learn this the hard way by a series of misadventures throughout their early career.  “I will never operate again on a patient like that” is a common mantra among seasoned surgeons.  Each time that a surgeon experiences such a patient (or hears a story from a colleague) they pick up on the “red flag”.  After getting a little grey in the temples, these red flags become more easily recognizable and hence avoidable.  A good surgeon says “no” frequently and will not operate on any patient that comes through the door.  The doctor and staff become more adept with experience in picking up on these “red flags” and avoiding the wrong procedure on the wrong patient.

I do want to say that there are also “red flag” surgeons of which patients must beware.  These include surgeons that over promise, promote “miracle” treatments, do not offer their availability, and cannot produce substantiation of their results.  Doctors are not exempt from reality.

A patient that wants breast implants, a hair transplant or a facelift to look and feel better is a great thing.  A patient that wants one of these procedures to change their life or make up for personality defects or other psychological issues is not a good thing.  Some people crave attention.  They have ungodly loud stereo systems in their cars that scream “notice me, please”.  Some people do the same with their homes by decorating them ostentatiously and some people do it with their body by trying to look like something they are not.  These patients stick out like a sore thumb and are not a good testament to cosmetic surgery or advertisement for that surgeon.  It is said that quality cosmetic surgery should “whisper, not scream”.  In the quest to look natural, some patients become more unnatural.  For a surgeon, happiness comes in operating and it is difficult to turn down a patient who presents with that ability.  Every surgeon has had the situation where they say “I am so sorry that I operated on that patient.”  It is not a fun situation to be in and you become an additional cog in the wheel of unhappy experiences for that patient.  Sometimes it is even rewarding to say no.  When you see a patient in your chair with breast too big, lips to big, skin too tight, a perfect tan and make up too excessive you feel you are doing a favor to them and to your reputation by denying further surgery as they are addicted and you are enabling their disease.  By not operating on them, you may be actually helping them.  Every cosmetic surgeon is a part time psychologist and must be to be competent.  A surgeon must truly listen to what the patient is saying and council them on their decision process.  Once in a while, these patients simply need someone to listen to or bounce ideas off of about their physical appearance.  I have told many a patient to appreciate their inner beauty and focus less on their acne scars, lose skin or other physical appearance.  I have told them about other patients who are much more ravaged or afflicted and how happy those patients would be to look like the patient sitting in my chair at this moment.  I believe that sometimes they leave my office relived that they don’t need a cosmetic procedure, feeling better about themselves and thankful for the candid insight.  Other times I see that they have talked a surgeon down the street into the procedure and after having it, are still unhappy.

Again, there is no more rewarding feeling for a cosmetic surgeon than performing a successful procedure on a happy patient.  It is the essence of what we do and how it should be.  Hopefully most encounters will be like this, but we don’t live in a perfect world.  One way to make it better is to appreciate the fact that some patients are and can be addicted to cosmetic surgery and avoiding operating on these patients can enhance your practice and their life.

 

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

 

Cosmetic Surgery Bulletin Boards: Can you believe everything you read?

 

One of the true joys of being alive in this day and age is the Internet.  For those of us that are older than 20 years of age it is hard to imagine life without it.  The Internet has empowered us and made encyclopedias and dictionaries obsolete.  It seems that you can find out anything with just a few clicks.  To Google has become a common verb!

Information is definitely power, but if that is true, misinformation is then weakness.  The decision to have cosmetic facial surgery and the ramifications that go along with it can be tasks of awesome proportion.  There are many surgeons to choose from, many procedures to have done, there are also considerations of patient health, recovery and budget.  When you think of all of this at one time (as most patients do when walking blindly into a consult) it is a miracle that a decision can be made.  So much information, so little time!

Bulletin Boards have become common and popular forums for humans to share information….or misinformation.  I have picked up some great tips on various bulletin boards like how to repair my 1965 Jaguar, how to tune my boat engine, what fishing lures to use on the James River, the best abdominal exercises, etc, etc.  Sometimes I have to wade through some incorrect or opinionated data and it can vary from confusing to dangerous.  With the Internet you have to take the good with the bad.  Cosmetic surgery bulletin boards are numerous, frequently factual, sometimes entertaining and frequently misleading.  On a positive note, these bulletin boards allow patients to discuss and compare data and experiences on various procedures, products and surgeons.  I have seen a lot of very good comments, ideas and advice on these bulletin boards, but I have also seen downright false, mean spirited, confusing and doubtful information as well.  Cosmetic facial surgery is not only my job, but it is my passion, so I am basically consumed with it during my waking hours.  It is my profession and my hobby.  At work, I see patients and operate, at home I work on my website and blog and for leisure I read cosmetic journals and text books.  For fun, I write journal articles and textbook chapters.  My wife thinks I am crazy, but she understands a man driven.

It was my honor to find out that I came highly recommended on several of these bulletin boards.  It is downright flattering to have your passion reflected by nice comments and appreciation of your work.  Sooner or later, however, I (like many compassionate surgeons) may be maligned by an unhappy patient with an ax to grind.  No one likes to hear negative comments about themselves, if they are serious about what they do for a living.  I have one friend who is truly a world class surgeon and is very good at what he does.  He had an unhappy patient (as all doctors will from time to time) that made it their hobby to assassinate this surgeon on virtually every forum that would accept a post.  Due to this, this surgeon has been very discredited for what was not really his fault.  To his defense, he did not deserve it.  There may be others that do.  Some doctors are complacent and are not patient oriented.  They may have consistent poor outcomes and unhappy patients.  A person like this may warrant the bad publicity, but we should all stop and take a deep breath before we discredit someone.  We have all gone to a great restaurant and had a bad meal, or gone to a famous vacation destination and had poor service, etc.  The same can happen with cosmetic surgery.  Because one patient had a bad experience or outcome may not mean that all patients would have the same.  A complication may be the surgeon’s fault (we are human too) or it may have been the patient’s fault.  Some patients refuse to follow pre or post op instructions, others use medications they are warned not to.  Some patients smoke and lie about it and some patients just had bad luck. 

I have been very fortunate that I have been able to have positive dialogue with 99.9% of my patients from the time I meet them.  I always try to personally answer emails on a timely basis, I give all my patients my cell phone number and I am surrounded by a great compassionate and caring staff.  It is not that we never have problems because if you have a very successful and busy practice, you will have problems from time to time.  The most critical thing is how they are handled.  Sometimes it is merely the fact that the patient does not understand, or they are anxious and communication, hand holding and compassion go a long way.  Sometimes, they feel that the surgeon is not responsive or has done something wrong.  Sometime it as simple as the surgeon saying “I am sorry”.  Sometimes the patient is totally unreasonable and sometimes the doctor may be unreasonable.  Fortunately, most successful surgeons have good people skills and are able to smooth out the things that happen.  Sometimes a good surgeon gets a bad patient and vice versa.  Successful surgeons become good at “picking” the right patients.  Over the years, the surgeon and staff develop a sixth sense about patients that may be problematic.  These include patients that are know it alls, patients that don’t listen, patients that talk bad about previous surgeons and patients that are not dependable.  Many patients also have a sixth sense about surgeons, offices and staffs and can tell a genuine proficient and caring surgeon from someone who is faking it.  Having said all of this, usually the patients choose the correct surgeons and the surgeons choose the correct patients.  Everything works out well.  When it does not, it takes responsible communication from both sides to try to make things better.  The problem with some bulletin board postings is that they only tell one side of the story.  If I said that one specific hospital had a high mortality rate, it may cause many people to speak badly about it.  If I said in the next sentence that it was a hospital that only treats terminal cancer patients, you hear the other side of the story.  Some patients will never be happy no matter whom they see because they are not happy with themselves.  Cosmetic surgery requires a stable, rational and psychologically secure patient for the best outcomes.  Some patients have psychological and or image problems and have no business having cosmetic surgery.  The surgeon that operated on them has made a mistake before the first scalpel cut.  Don’t get me wrong, there are surgeons with these issues as well, most of them aren’t busy or popular.  The more good work you do, the more good press you get.  Unfortunately, it only takes one bad apple to spoil the whole bunch and we all should keep that in mind when things get sticky.  Doctors should not talk bad about other doctors or patients, that is a matter of ethics (by the way, doctors that talk bad about other doctors probably talk bad about their patients and that should be a warning sign).  Patients should not go out of their way to demonize a well meaning surgeon who may have been a victim of circumstance.  There are no official ethics here, just the Golden Rule…”Do unto others”.  Just great words for which to live ones life.

I see many patients each day and those whom have visited my website (or other sites and bulletin boards) usually have an advantage of education about what we do and how we do it.  Occasionally, I see a patient that has been brainwashed with misinformation to the point that they feel they know more about the technique than I do.  Obviously that would be a poor choice to operate on that patient.  A know it all or a patient that tells a surgeon how to do a procedure is a gamble and a set up for problems.  It is fine to ask about a given technique or discuss options, but it should be the surgeon that directs the care.  I may present the patient with 4-5 options (filler vs laser vs facelift, etc) and by providing them information such as before and after pictures, patient references, brochures, etc. they can make and informed decision.  I have heard many patients discuss things that they saw on a bulletin board and were not true, or at least not true the way I practice.  Discussion should be two way. The patient and surgeon should both talk and listen.  A bullheaded patient (or doctor) is hard to deal with. The beauty of it all is that no one “has to have” cosmetic surgery, it is totally elective.  If they don’t have a good feeling about a surgeon, they should find another one.  Same for the doctor.  If a certain patient has personality traits that do not blend in with the way you practice, then they should not operate on that patient.  One thing every patient and surgeon should evaluate between each other is “how will he or she act if there is a problem”.  That goes for surgeons and patients.

Education and bulletin boards are great things when they are factual.  You can’t believe everything you read or hear.  Remember, there are Liberian Bank schemes, people trying to steal your identity and a host of other examples of misinformation on the Web.  Be rational, fair, consider the source, hear both sides and most importantly, as you parents told you…………….if you can’t say someting nice………

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

Keloid Scars of the Face and Neck

Cosmetic facial surgeons frequently see patients with keloid scars.  There are many types of scars.  Hypertrophic scars are those which enlarge within the boundaries of the original scar and keloid scars are those that enlarge outside the boundary of the original scar.  Due to this, keloids can become quite large and disfiguring.  Although any race can develop keloids, they are most common in darker skin types.  The actual cause of keloids remains unknown but they frequently develop as a response to irritation, such as ear piercings, traumatic lacerations or surgical incisions.  Some areas of the body are notorious for forming keloids such as the earlobes or the sternum (breast bone) in open heart surgery incisions.

Over the years there have been many different treatments for keloid scars.  Although it is tempting to merely excise them, they will most often return with a vengeance, growing larger than the original keloid.

One of the most simple and frequently effective treatments for keloids is injection with an anti inflammatory steroid such as Kenalog (triamcinalone).  This causes the keloid to shrink and repeated injections can be quite effective in softening and reducing the size of the keloid.  A chemotherapy drug called 5 flourouracil can also be mixed with the Kenalog for even more scar dissolving power.  Sometimes injectable steroids are quite effective and can dissolve the entire keloid.

 

The patient above was treated with Kenalog injection only.

Another method of treating keloids is to surgically excise the keloid and begin immediate injection of Kenalog.  I have used this technique on smaller keloids with good success.

The most effective method for treating larger keloids is to surgically excise the keloid, then proceed immediately to the hospital for a single radiation to the area.  This has been my most successful treatment for very large keloids.  Although it is impossible to guarantee the the keloid will not reoccur, the combination of surgical excision and single dose radiation has been a very positive treatment in my practice.

   

The above keloids was treated with surgical incision and immediate single dose radiation.  This treatment is frequently covered by insurance.

For more information on the cosmetic treatment of head and neck scars and other cosmetic facial surgery procedures, see

www.lovethatface.com

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, VIrginia