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

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 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

The Art of the Consult

 

The cosmetic facial consult is probably the most important time spent during the entire cosmetic experience.  This time is not only important for the patient but also for the doctor and staff.  To appreciate the true nature of the communication the patient and the surgeon must understand each other’s role.  The patient should keep in mind that the surgeon and his or her staff do this all day every day and are used to discussing personal details with patients.  For this reason the patient should not be nervous.  It is not uncommon for patients to be somewhat nervous (or sometimes embarrassed) to discuss their esthetic shortcomings.  After all, no one likes telling someone else about the things that make them look old.  Frequently patients will actually be sweating during the consultation because they are nervous.  The problem with a nervous patient is that they will not be able to talk or listen as well as a relaxed patient, so my prime advice is to relax!  The main job of the patient is to talk, but it is up to the surgeon and staff to set the stage.  By the way, I am not a big fan of surgeons that do not personally participate in the consult.  If I am a patient and I go to a surgeon’s office for a cosmetic consult and I don’t speak personally with the surgeon or have an exam by the surgeon, a red light goes off.  If a surgeon is too busy or too important to do a consult, then I question how much he or she will participate in the remainder of the surgical experience.

The way I personally set the stage is to hand the patient a mirror and simply ask them “what would you like to change about your face and neck, Mrs. Smith?”  The wrong answer is “what do you think I need doctor?”  This is an incorrect response because the patient must take responsibility and participate in describing what actually bothers them.  If a patient cannot describe what they want improved then they have not put enough time and thought into the consideration of cosmetic facial surgery.  This is no time to be spoon fed as it is extremely important for the patient to actually list the exact things that they would like to change, in the order of their importance.  Now, this does not mean that the surgeon won’t supply guidance, but again, the patient must have a good idea of what they want improved.  Then, it is the job of the surgeon and staff to assist them in expressing the problems and provide a succinct explanation of what options exist.  The surgeon must first be a good listener, then a good advisor. 

For the doctor and staff participation, it is important to remember that we consult and operate on thousands of patients a year, but the patient in the exam chair may only do this once in their life and are not accustomed to the complicated words and many times what the surgery actually does.  I tell my staff that we must pretend that each patient is the only one we will operate on this year and to assume they don’t know anything about the procedures and we must educate them like they were family.  An example is a patient that comes to the office complaining about their eyelids and requesting cosmetic eyelid surgery.  The patient may not realize that their real problem is their sagging brows and forehead and that instead of upper eyelid surgery, they may actually need a brow lift.  There are many different combinations of procedures to treat a given problem and a good surgeon will take the time to explain the options to the patient.  Please don’t misinterpret that I am saying that the patients are dumb and don’t know what they want or need, as that is far from true.  In this day and age of the Internet, most patients are very sophisticated and already know a lot of information about their aging and the contemporary treatment.  The problem is that not all information out there is accurate and sometimes it takes some reeducation.  I think it is a great advantage for my patients to study my website prior to the consult as it makes the consultation much easier.  Knowledge is power, but it has to be the right knowledge!  By the way, if something you read or hear about sounds too good to be true, it probably is!  In terms of patient pre consult “homework” it really helps to write down your concerns is descending order of what bothers you the most.  Also relevant questions about the procedure, anesthesia, recovery, complications, etc. are beneficial.  Actually having a list prevents the patient form forgetting to ask about important questions.

When the surgeon examines the patient he or she will look, touch and question.  In my consults I also use pictures of actual patients with similar problems to further explain things to the patients.  I also use models of chin and cheek implants if relevant and provide written information about the various procedures.  At the end of the consult I like to have a list of the patient’s problems as they preceive them as well as a list of the problems as I see them (and how my staff perceive them,  as I value their judgment and experience).  Finally I have a third list which involves various treatment plans and finances.  This is based on the individual patient’s health status, available time off for recovery and finances.  It is not uncommon to have several treatment plans that revolve around health, recovery and finances.  Some patients prefer to have multiple procedures all at the same time while others (for reasons of health, recovery, and finances) prefer to have fewer procedures over an extended time period.  I frequently explain to patients that “it took a half of a century for the aging to occur, so it does not have to be corrected overnight!”  Some of my happiest patients had everything treated on the same day while I have hundreds of other patients that are happy by treating their aging in steps.  The most important thing is not what you do at one time but rather what is best tolerated by the patient.  Some patients are in poor health, some patients can’t get time off and some patients can only afford a limited amount of surgery.  Each patient is different and has different circumstances and each case must be customized and approached in a different manner.  In addition, it is important to not be stressed out for the procedure and recovery.  If the patient can’t get adequate time off or if the finances put the patient in significant debt, it just adds stress to the entire situation.  Since cosmetic facial surgery is stressful in itself, additional stress only makes things worse for the patient and surgeon.  Also important to remember is that a patient never “needs” cosmetic surgery.  It is a totally elective procedure and you should never be pressured to have a procedure or multiple procedures.  There is a lot of information to digest after the consult and any surgeon or office that is “pushy” about signing a patient up for surgery may be a red flag.  A patient should only do what makes sense to them, what fits their recovery window and what they can afford.  A discount “for signing up today” may be no bargain but rather reason for a second opinion.

Another misconception is that one consult is all that is necessary.  Since I do not charge for my consults, there is no problem coming back to the office for multiple discussions.  There are multiple advantages in multiple consults as there is truly a lot of information to cover, even for simple surgeries.  In addition, it is helpful to have the patient’s spouse or caregiver present at the consult to “coach” them and understand the surgery and especially the recovery.  I welcome all my patients to return for as many consultations as they feel are necessary to have their questions answered.  Many of them take me up on that offer.  In addition, I give all my patients my cell phone and email as I believe if a patient can’t reach their surgeon, they picked the wrong one.

I encourage my patients to go home and reexamine my web page after the consult as it will make more sense after our discussions.  They leave the office with an estimate of their surgical and anesthesia fees and other pertinent material.

In summary, the initial consult is the first day of the rest of your cosmetic life and should be an equal exchange of information between the surgeon and the patient.  It should set the stage for the prospective procedures and the patient should leave with adequate information to consider having surgery.  Rarely do patients return for surgery after a single consult and in my office we have a pre op appointment to go over everything one more time.  This includes further explanation of surgery and recovery as well as the usual paperwork such as informed consent, medical forms and prescriptions.

The best patients are those whom have a firm understanding of their diagnosis, treatment and recovery.  Elective cosmetic facial surgery can positively change a patient’s life in many ways and a cooperative and informed patient can make the surgeon’s job easier.  Finally, the initial consult gives both parties a chance to “feel each other out”.  If the patient does not get the “warm and fuzzies” from the surgeon and office they may want to seek alternate opinions.  If the surgeon does not feel comfortable with the patient then they may not be eager to take them on as it has to be a win-win situation on both sides.

For more information about Dr. Niamtu’s consultations see

http://www.lovethatface.com/cosmetic_facial_patient_information/consultation.html or for more information about cosmetic facial surgery see

http://www.lovethatface.com/

 

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia