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

Anesthesia and Cosmetic Surgery

 

One of the biggest humanitarian innovations in the history of civilization was the discovery of anesthesia.  Prior to the discovery of ether anesthesia in the 1840’s, people were pretty much tortured during surgical procedures and “bitting the bullet” had a very literal meaning.  The best Civil War battlefield surgeons were those who could most rapidly remove a limb.  Fast surgery was very important at one time.  The first part of the 20^th Century ushered in the discovery of local anesthetics with Novacaine being the first agent.  This was another huge advance as it made anesthesia “portable” safer and provided patients with another surgical anesthetic option.  Prior to this, having a mole removed or a tooth worked on was a tough deal!

We are lucky to live in an era of multiple anesthetic options for cosmetic surgery.  General anesthesia is the deepest form of surgical anesthesia.  This technique is defined by an unresponsive patient that cannot follow commands and requires assistance with life support.  Although the lighter anesthetic procedures allow the patient to breath on their own, the deeper techniques “breath for the patient” by using a ventilator on the anesthesia machine.  A breathing tube is frequently placed through the mouth or nose and through the vocal cords to enable the oxygen and anesthetic gases to enter and the carbon dioxide to be exhaled.  Although some cosmetic procedures are better performed with general anesthesia, there has been a giant trend to not use such deep anesthetic techniques.  Many surgeons feel that general anesthesia adds additional risks with cosmetic surgery.

The second type and most common anesthetic technique is IV sedation or M.A.C. (monitored anesthetic care) anesthesia.  With IV sedation the patient does not need a breathing tube and breaths on their own the entire case.  IV sedation can be light, where the patient is relaxed and can respond to commands, or deeper where the patient is totally unconscious.  MAC anesthesia is a very safe technique and is “fast on and fast off” meaning that the patient quickly is sedated then quickly wakes up when the drugs are stopped.  Many patients have had experience with this type of anesthesia from wisdom tooth surgery or colonscopy.  Newer drugs decrease the post anesthesia sickness, nausea and vomiting seen in the past.  For general anesthesia and IV sedation the patient must refrain from food or water for about hours before surgery.

Oral sedation is another option and involves taking a sedative pill before the procedure.  Although this relaxes the patient, it does little for pain control so local anesthesia must be used as well.

Tumescent anesthesia involves mixing saline with the local anesthetic Lidocaine and very small amounts of epinephrine.  This is most frequently used for liposuction and facial surgery procedures.  This mixture enables pain control and reduces bleeding.  Tumescent anesthesia has revolutionized cosmetic surgery anesthesia as many procedures may be done with this type of anesthesia, totally awake.

Local anesthesia is another popular form of awake anesthesia and is the same mechanism as going to the dentist.  Eyelid surgery and other cosmetic procedures are sometimes performed with only local anesthesia.  Local anesthesia or tumescent anesthesia is also frequently used with general anesthesia and IV sedation to enhance pain control.  This also reduces the amount of anesthetic agents necessary to keep the patient asleep as well as keeps the patient numb for a while after they awake.

Most anesthetic techniques are very safe and statistically patients have a higher chance of being in a motor vehicle accident than having a serious anesthetic problem or death.  Obviously there are risks of undergoing any type of anesthesia and all cosmetic surgery and anesthesia patients must be thoroughly evaluated by a doctor prior to having anesthesia.  Smoking, obesity, diseases and allergies can all put patients at increased risk for anesthesia.  Fortunately, most patients desiring cosmetic surgery are  usually healthy enough to undergo some type of anesthesia.  For those whom aren’t, staying alive is a better option than looking better.

If you are considering cosmetic surgery discussion your anesthesia with your surgeon is an important part of the informed consent process and should be given serious consideration by all patients. It is important to know what type of anesthesia you will be getting and who will be administering it.  Some surgeons are trained and experienced in ambulatory outpatient office anesthesia and along with their staff provide the anesthesia and surgery.  It is important that in this situation, the doctor’s office has the same level of monitoring, emergency drugs and devices as a hospital.  For more complex anesthetic or medically compromised patients, nurse anesthetists or physician anesthesiologists usually provide anesthetic care.

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

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

Kanye West’s Mother and Surgical Risks.

Earlier this year the life of rapper Kanye West’s mom ended tragically after undergoing a cosmetic surgery procedure.  This is an unfortunate and tragic event and besides the personal tragedy it also brought light to many other aspects of cosmetic surgery.

First of all, it shows that there is risk with any surgery.  Every year, patients die during or after surgery and anesthesia.  Some patients are sick and the high risk of surgery and anesthesia was known.  Some patients were perfectly healthy and some very unusual event occurred.  Some of these events are the fault of the surgeon, anesthesia personnel or hospital staff.  Some of these events are the fault of an undiagnosed health problem.  I recently read of a completely 16 year old patient who had a rare and undiagnosed cardiac condition and died during a tonsillectomy.  No one, the patient, hospital or surgeon had any idea that such a problem existed.  The bottom line is that any surgery, cosmetic or otherwise, carries some risk of complications including death.

When Mrs. West passed away the night of her surgery, every news station and tabloid show hovered tightly over “the dangers of cosmetic surgery”.  Allegations flew faster than speeding bullets and finger pointing started early.  Dr. Jan Adams, the celebrity plastic surgeon on TV was the biggest target.  This famous surgeon was used to being in the limelight and was suddenly cast into cold darkness.  The finger of blame pointed directly at Dr. Adams even though not official cause of death was determined.  He was tried, sentenced and executed by the media.  What’s more, his own people turned on him.  Organized plastic surgery, who has long been tooting the horn of “only board certified plastics surgeons” should do surgery”, condemned him for not being board certified.  Instead of sticking up for their own and coming out with a statement that no surgeon should be condemned until the facts are discovered, they simply turned on him.  By the way, saying that only a “board certified plastic surgeon” should do cosmetic surgery is as silly as saying that only Fords are safe cars and that you should not drive any other car.  There are many talented board certified plastic surgeons and there are many board certified plastic surgeons that have very little, if any cosmetic training.  On the other hand, there are thousands of very qualified board certified surgeons in ophthalmology, dermatology, oral and maxillofacial surgery, ENT, facial plastic surgery, general surgery and other specialties that have extensive cosmetic training.  It is the surgeon and his or her training that is important, not what specialty they come from.

Dr. Adams was getting pounded by everyone that had an opinion.  Former patients came out of the woodwork with accusations of malpractice.  Entertainment Tonight showed bad scars caused by Dr. Adams and women stood in line to denigrate Dr. Adams.  Funny they did not complain prior to the West tragedy.  In addition, other cosmetic surgeons in the area where Dr. Adams practices also got their 15 minutes of fame by condemning the actions of Dr. Adams, even though not one single person had the facts. I have no idea if Dr. Adams is a good or a bad surgeon, but I would bet that he is pretty talented to be selected for a national show and I bet when he wakes up and goes to work in the morning he has the main goal of performing his specialty in a safe and effective manner and to do his best to help his patients.  I am sure that he received many benefits from being surgeon to the stars, but I guess being famous has a big downside as well.

Fast forward six weeks.  The coroner released the official cause of death report.  Preexisting cardiac conditions and nondescript post operative problems.  Guess what?  Nary a mention of Dr. Adams was made.  Not a single sentence in the report detailed a single problem during surgery or any wrong doing of Dr. Jan Adams.  Too bad his career has been ruined, too bad that the media and detractors could not hold their tongues for six weeks to find out the truth.  In this age of sensational journalism, people do anything to sell a show.  We were all tired of the Anna Nicole Smith and Paris and Lindsey scandals, so we were hungry to feast on the new meat of Dr. Jan Adams.

Apparently Mrs. West had some preexisting heart problems and there may have been other non surgery related problems like over dosage of pain medications.  Yes, once the patient leaves the surgery center or hospital, there are many potential problems that could lead to complications.  Sometimes it can be from patients not following directions, sometimes it can be from unforeseen coincidence, and sometime things just happen.

The bottom line is that all medical procedures, including cosmetic surgery carry risk.  Fortunately, the risk is very low for elective cosmetic surgery procedures.  Fortunately, you have a better chance of dying from falling out of bed in the middle of the night than you do from dying from cosmetic surgery.  It is important to know that all procedures carry risks.  It is also important to discuss the informed consent with your surgeon before the procedure.  Don’t be afraid to ask questions, I actually love it when my patients have questions about complications, as it means they are educated.  Also, the patient and surgeon should have a plan in place if complications do occur.  Good questions to ask are how will these potential complications be managed, when will they be treated and who will pay for the treatment.

Although it is impossible to prevent post surgical complications, you can do some homework to insure standard of care treatment.  Some good points to follow are:

• Choose a surgeon who is experienced in your procedure.  There may be a big difference in a surgeon who performs 2 facelifts a year and a surgeon who performs 2 a week.
• Insist to see your surgeon’s work.  Experienced surgeons should be able to show you many before and after images and allow you to talk to patients that have had that specific procedure.
• Your surgeon should be board certified in his or her specialty
• Your surgeon should operate in an accredited facility.  Stringent rules apply in order to have an accredited facility in ones office and this means that the doctor has met these qualifications.
• Your surgeon should be available.  If you cannot reach your surgeon when you have a problem, you choose the wrong surgeon!  I personally give all of my patients my home and cell phone numbers and it is my privilege to assist them when they have questions.
• Choose a surgeon you can communicate with.  A great surgeon with poor communication skills may not be as good as an average surgeon who is personable, approachable, available and affable.
• Is the surgeon’s practice limited to cosmetic surgery?  Although there are many fine surgeons that dabble in cosmetic surgery, those who limit their practices obviously have more experience.
• The standard of care prior to many cosmetic surgery proceudres is a history and physical as well as lab work and sometimes EKG and chest X-ray.  Very simple procedures my not require these tests, but longer or multiple procedures or medically comprimsed patients need a thorough pre surgical work up.

 

Many patients spend more time picking out a pair of shoes than they do researching a cosmetic surgeon.  Fortunately, most times everything works out well but heeding the above points can make your choice easier.

 

Joe Niamtu, III DMD