Dr. Niamtu’s Weblog

….on cosmetic facial surgery

Dr. Niamtu Speaks at Harvard University

harvard

fretaAcademically oriented cosmetic surgeons enjoy speaking and lecturing.  I have had the pleasure and honor to have been invited to lecture on six continents to every type of cosmetic surgery specialty.  I generally average a trip each month although I have traveled over 20 weekends in a year, speaking nationally and internationally on cosmetic facial surgery.

Probably every speaker that is in demand wishes, at some time, to be invited to speak at Harvard University.  This is such a famous bastion of learning, speaking there was on my bucket list.  That opportunity was fulfilled in April.  I was invited to lecture to the oculoplastics surgery department at Mass General Hospital by Suzanne Freitag, M.D. professor and director of the ophthalmic plastic surgery service.  My lectures topics included surgical browlifting, facial implants and injectable facial fillers.

Our day began with a tour of the facilities in Boston and a great dinner with the department faculty and residents that evening.  It was a true honor to be asked to give these talks and an enjoyment to see and be around one of the most famous learning institutions in the world.

Our hotel was at Copley Square and as we were leaving to go to the airport we could see the signs of the preparatioin for the Boston Marathon which was coming soon.  Driving across Boyleston street where the permanent finish line resides was bustling with the usual daily activity and unaware of the carnage soon to come.

 

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

http://www.lovethatface.com

May 20, 2013 Posted by | Academic Cosmetic Surgery | Leave a comment

Lip Piercings Gone Bad

Facial piercings have become popular but sometimes present problems.  This video shows a patient with overgrown lip piercings that could not be removed.  Dr. Niamtu removes them with a quick surgical procedure under local anesthesia.  Warning: shows live surgery procedure.

For more information about cosmetic facial surgery by Dr. Joe Niamtu, III visit http://www.lovethatface.com

Joe Niamtu, III DMD

January 27, 2013 Posted by | Body and Face Piercing | , , , , , , | Leave a comment

Injectable Fillers in a Busy Cosmetic Facial Surgery Office

collage3 January is always an interesting time of the year as we review and reflect on our procedure numbers from the previous 12 months.  I was both amazed and intrigued to have injected 1,761 syringes of filler in the past 12 months.  I knew I was in the top 10% of injectors nationally, but did not ever really count the volume in the past as we mostly tracked surgical procedures.  What is also notable is that I personally do all filler and neurotoxin injections in my office.  Some practices have multiple physician injectors or non-surgical staff such as nurses and nurse practitioners that may inject.  In our office it is just me, so 1,761 syringes of filler means I was really busy.

In further reflecting about the popularity of injectable fillers, so much has changed in 15 years.  For those of us that were using fillers in the 1990’s, the choices were pretty slim.  Basically we had Zyderm and Zyplast which was collagen from cow tissue.  One big draw back was that some patients could have severe allergic problems and when mad cow disease surfaced, it upped the scare factor for animal collagen.  Allergy was rare, but allergy testing was a hassle because the patient had to come in a month before injection to have a test dose to determine allergic response.   Hard to imagine now in this day of “walk in/get injected” treatment.  The other and biggest problem of collagen filler was that it simply did not last.  It did OK for fine lines and wrinkles but sometimes only lasted a matter of weeks.  It was also pretty “creamy” in texture and did not do much for lifting or plumping.

Fast forward 10 years and NASHA fillers were introduced.  This stands for Non Animal Stabilized Hyaluronic Acid.  Hyaluronic acid is a naturally occurring carbohydrate that is found in many body tissues.  It has the consistency of hair gel and can be produced in thin and thick formulations.  The thinner (more watery) formulation (Restylane, Juvederm Ultra, Belotero) are used more for fine lines and wrinkles or outlining lips.  The thicker formulations (Perlane, Juvederm Ultra Plus, Voluma) are well suited for more robust applications like lifting or volume restorations, such as filling cheeks and smile lines.  If you desire more trivia, this viscosity or adhesivity is referred to as “G Prime”.

These hyaluronic acid fillers have been game changers because there are no allergy problems, and the results last for up to a year.  Another huge advantage of the hyaluronic acid fillers is the fact that they can be reversed overnight.  Although most patients want their filler to hang around, there are times where they may not like the result.  Injecting hyaluronidase (an enzyme that dissolves the filler) can reverse the result in a matter of hours.  That can be a great insurance policy.  Although we have semi-permanent and permanent fillers, they cannot be reversed and permanent filler can turn into a permanent complication.  I personally inject Radiesse and fat which are semi-permanent filler and silicone oil which is permanent filler.  Where and how we use these types of fillers is different from every day filler applications.  95% of patients are best suited for hyaluronic acid fillers.

Finally, the other reflection about fillers is how our usage has changed over the past 15 years.  I can promise you that no one ever walked into my office in the mid 1990’s and asked for cheek, teartrough, or brow filler.  In one respect, we did not think about it and in the other respect, it would not have worked well with the available products at that time.  Today, we use fillers in the upper face for forehead lines, eyebrow lift, and crow’s feet wrinkles.  We use them in the midface for teartrough, cheek, smile line and nose treatment, we use them in the lower face for lip, chin, jowl, mandibular angle and jawline augmentation.  The versatility of modern fillers has been both exponential and amazing and is truly an enjoyable part of my practice.  I routinely publish on filler use and technique and teach courses major filler companies to train other doctors.  I love performing surgery, but I also enjoy the artistry and sculpting that involves injectable fillers.  This is one of the reasons my job is so much fun.

January 27, 2013 Posted by | Lip and Wrinkle Fillers, Lip Augmentation, Minimally Invasive Cosmetic Facial Surgery, Removing Excess Lip & Wrinkle Filler | , , , , , | 3 Comments

Why Do We Turn Away From People with Disabilities?

Last week, “The Greatest” Mohammed Ali threw out the first pitch of the season for the Miami Marlins.  This was a very noble act with one of the most recognized humans on the earth bestowing an honor for a great city and team.  The problem began when Ali was driven out to the mound on the back of a golf cart and the audience saw his condition.  The once muscular and bigger than life superstar was huddled over, very thin and unhealthy looking and flailing his arms uncontrollably.  He looked more like a nursing home patient in the last throes of life than the celebrity athlete.

Immediately, thousands of tweets went off about how inappropriate it was to show this man in this frail condition and what poor taste it was.  It was a very news worthy event that day.

Why does this happen and what does it mean?  There is a lot of discussion here and many people can weigh in on many opinions, but what can’t be disputed is that able bodied people frequently want to turn their heads when they see a severely disabled person in their space.  It has happened to all of us at some time, at a park, at a mall, when walking downtown, etc.  We see a disabled, maimed, contorted, crippled, individual and we look away.  Why do we do this?  Most of us don’t do it to be mean, but we do it because we are hurt about the unfairness of life and it pains us to see a fellow human in such distress.  Many do the same thing when stopping at an intersection and see a homeless person begging for money.  We look away because the sight disturbs us.  Some look away because they don’t want to contribute as well.

In any event, we “sterilize” our vision to eliminate unpleasant imagery.  We don’t want to see things that disturb us.  It may be a natural protection mechanism, but that does not make it right.  We need to condition ourselves to do the opposite.  We need to fight the urge to look away and we need to take a good look and embed the image into our minds.  We need to do this not only to remind ourselves how lucky able bodied people are, but to keep in mind how tough other people have it in life.  The next step we should do is to take a few seconds and approach these people and say a simple “hello” or ask them how they are doing.  Remember, these people are quite used to seeing people quickly turn away when they enter their line of sight.  Please remember that these people are in fact people.  A small chat with someone who is used to being shunned may be a huge boost in their happiness.  We, as a society, are used to sweeping unpleasant things under the rug and often times it is at the expense of others feelings.

We can become better people by accepting all types of people and not only looking at them, but also touching their life with a simple smile or chat.  It is sad that people were repulsed by the condition of “The Champ” as Ali is what he is.  He has severe Parkinson’s disease and that is what people with severe Parkinson’s look like.  It should not repulse us, we should not look away.  On the contrary, we should look directly at the person and look into their eyes and their heart.  We need to look into their lives and think about how they must differ from our lives.  This is a great impetus for us to get involved with causes like Parkinson’s, or the thousands of other conditions that strike people down in the prime of their lives.

I am the father of 9 and 12 year old sons with severe intellectual and physical disabilities.  I, at one time, was guilty of looking away as well.  It was just too painful for me to see disabled children.  Now, being in the middle of the situation, see things from a very different view.

We cannot and should not try to filter life by ignoring or turning away from those less fortunate.  I hope that this blog can inspire at least one person to change their behavior and next time they encounter a situation, they do the opposite.  When they see a person with a disability, they embrace the opportunity to be thankful for what they have and make an attempt to try and embrace the person in their view.  You never know where this can take you or the person you approach.

So, Mohammed Ali is very sick and not the athlete he once was.  Get over it, this is life.  He is our grandfather, our father and our brother.  He is one of the millions of disabled people in our society.  That is what life is, sometimes it is not pretty.  Sometimes it is sad, but it is still life.  Make it better!

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

http://www.lovethatface.com

April 8, 2012 Posted by | People with disabilities | , | 17 Comments

Tell Me About Belotero, the Newest Injectable Filler

Belotero is the newest FDA injectable filler available in the USA.  It has been used for years in Europe with excellent patient satisfaction and safety margin.  This filler is unique in several ways.  Most notably, it is made with a dual cross linking process that gives it some of its unique properties.  The biggest advantage with Belotero is that it can be injected very superficially for fine lines and wrinkles.  This is important as many other fillers are too thick (honey like) to be injected in the very superficial dermis and when this is done, it can leave a thickened line.  Belotero, on the other hand is engineered specifically for superficial injection.  I must say that when I began using it for fine lines and wrinkles it was hard to believe how superficial it could be injected.  Having said that, it can also be used like conventional fillers for deep wrinkles and lips.  I think the biggest innovation is that the company states that due to the Belotero’s particle properties, it does not cause a Tyndall effect when injecting in the tear trough region.  The Tyndall effect (in this case) is when a clear product is injected under the skin and produces a bluish hue due to the way the light is reflected.  Although harmless, it produces dusky skin that can make a patient look older, as in dark circles.  To avoid this, most fillers are injected deep on the bone in the tear trough region.  Belotero, however, due to its unique composition, can be injected much more superficially which gives the doctor more control of improving wrinkles and rejuvenating this region.  I have been using Belotero and so far have found it to live up to the claims of the company.  I will keep my blog updated on this topic.

Click here to see a video of Dr. Niamtu injecting Belotero.

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

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

www.lovethatface.com

March 7, 2012 Posted by | Belotero, Lip and Wrinkle Fillers, Minimally Invasive Cosmetic Facial Surgery, New Cosmetic Surgery Technology | , , , , | 1 Comment

Do I Need a Full Facelift?

I can’t tell you how many times that I (and every cosmetic surgeon) hear that question.  I think that the word “facelift” has more meanings to people than any other word in cosmetic surgery.  People ask about a “full facelift”, “half facelift”, “neck lift” and so on.  This can be very confusing to patients and some may forego treatment because of preconceived notions that are not true.

A “facelift” by definition is a procedure called rhytidectomy.  A rhytid is a wrinkle and “ectomy” means to surgically remove, so technically it refers to a surgical procedure with incisions removes skin to tighten wrinkles.  A traditional facelift includes hidden incisions in front of and behind the ear.  The skin is then separated from the underlying tissues and the deep layers are tightened.  Then the skin is pulled in a natural direction and the excess is removed.  Traditionally, the platysma (muscles in the central neck) are also tightened.

A traditional facelift does very little (or nothing) for the central oval of the face (brow, central forehead, eyes, nose and mouth).  It also does very little, if anything for tissues above the nostrils.  So, a “facelift” is more for the jowls and neck, in fact, all about the jowls and neck. Now you know what a facelift really is!

The “wrinkle” in this description (yes, pun intended) is that not all surgeons do the same surgery the same way.  Some surgeons omit the platysma procedure.  Personally I think that is short changing the patient, although very young patients may not need a platysmaplasty.  Also, some surgeons “invent” shortcut facelift procedures where they omit the incision behind the ear.  I am always leery about someone who takes a procedure that is 100 years old and puts his or her name on it, or even worse, a corporate name.  Again, facelift surgery has been around for a century and all the tricks have been attempted and abandoned because a short cut in surgery almost always translates to a short cut in result and longevity.  Some surgeons try to avoid several inches of incision behind the ear and end up doing a procedure that will begin to relapse in several years.  These types of shortcuts always claim easy surgery with fast recovery.  Remember, in cosmetic surgery, you always get what you pay for….not in terms of money, but in terms of recovery.  The cosmetic consumer should always be cautious about any surgery that deviates significantly from the standard of care in technique.  Just because something is new, does not make it better.  Obviously, we do make advancements in materials and techniques, but if and when that happens, it becomes widely adapted and the norm.  Any patient that is looking at a “new” or “miracle” procedure should ask the surgeon to see 20 pictures of patients that had this procedure by same surgeon and the pictures should be 1-2 years after the procedure.  If a surgeon can’t show you that (for any procedure) you better think closely about getting surgery that is different from the way most surgeons do it.  Cosmetic surgery patients often get the short end of the stick from hype delivered by companies, media and surgeons.  If it sounds too good to be true, it is!  If someone invents a new and radical improved facelift procedure, it won’t be in TV ads, it will be front page news.

So, back to the“facelift” definition.  Much of the confusion about the definition of the word comes from a patient’s experience.  A patient may have “rhytidectomy” but also have a brow lift, eyelid surgery, cheek implants, chin implant, laser skin resurfacing, etc.  So when this patient tells someone they had a “facelift” the listener may assume that a facelift includes all that additional surgery.  They would be wrong!  Rremember, a facelift primarily addresses the jowls and neck.  The patient merely had other procedures along with their facelift.  When you get your engine tuned up, it may include a wheel alignment at the same time, but technically, an wheel alignment is not part of a tune up.

The best way to keep this all simple is to divide the face into 4 segments:

  • Upper face
  • Midface
  • Lower face and neck
  • Face and neck skin

Each of these regions concerns separate cosmetic procedures to address the aging in that area and the facelift concerns the third item on the list.  Also facelifts come in three sizes; small, medium and large.  It is basically the same procedure in different versions.  Patients in their early 40’s may need a small lift, while patients with more aging need bigger versions of the same operation.

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

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

http://www.lovethatface.com

February 27, 2012 Posted by | Cosmetic Facial Surgery Consultation, Cosmetic Surgery Education, Facelift Surgery | , , , , , | Leave a comment

Niamtu Cosmetic Facial Surgery Course recieves 17.5 AMA PRA Category 1 Credits™

Dr. Niamtu has been training surgeons from multiple specialties with live observational cosmetic facial surgery courses since 2004.  Hundreds of surgeons from the USA and all over the world have come to Richmond, Virginia several times a year for this course.  We are honored to have been accredited through St. Louis University School of Medicine for continuing medical education credits.  This is an honor for our course and now eligible attendees can officially obtain CME credits.  This is truly a milestone for our course and underlines our committment to provide cosmetic facial surgery education to teach contemporary cosmetic facial surgical procedures to enhance patient safety and predictable outcomes.  For more information visit www.cosmeticsurgeryeducation.com

ACCREDITATION:  Saint Louis University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. AMERICAN MEDICAL ASSOCIATION: Saint Louis University School of Medicine designates this live activity for a maximum of 17.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

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

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

http://www.lovethatface.com

February 22, 2012 Posted by | Academic Cosmetic Surgery, Cosmetic Surgery Education | , , , , , , | 1 Comment

Dr. Niamtu on NBC 12 discussing gauged earlobe repair

Click above to view video

I have written a blog on repair of gauged earlobes in the past ( https://niamtu.wordpress.com/category/earlobe-repair/) and was recently involved in a news story on NBC 12.  Anchor Curt Autry discusses the societal impact of earlobe expansion and interviews two female patients on what let them to expand their earlobes and why they had them surgically corrected.  The story provides good insight into the practice of earlobe gauging.

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

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

http://www.lovethatface.com

February 20, 2012 Posted by | Earlobe Repair, Gauged Ear Lobe Repair | , , , , , | Leave a comment

Joan Rivers and Cosmetic Facial Surgery

 

Lover her or hate her, Joan Rivers is funny.  She has become the self proclaimed poster child for cosmetic surgery and is the brunt of many jokes, but old Joanie actually looks pretty good these days.  Anyhow…..every day I do numerous consults and people have to decide how to budget get their cosmetic surgery around other expenses. I came across a Joan Rivers quote which is of her typical humor.

“Better to get out of an old car with a new face, than to get out of a new car with an old face!”

Wish it was that simple, but Joan has a way of putting things.

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

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

http://www.lovethatface.com

February 16, 2012 Posted by | cosmetic surgery addiction, Uncategorized | , , , , | 1 Comment

Dr. Niamtu’s Textbook Published in Spanish

 

One of the biggest honors of my academic life was being asked by Elsevier Inc. to publish a major textbook on cosmetic facial surgery.  Most textbooks are published by many authors, but I published the text by myself (except for one awesome chapter on nose surgery by Dr. Angelo Cuzalina) which was a nonstop two year project, of course in my “spare” time.

The textbook has done very well and has sold several thousand copies to date which are good numbers for medical textbooks.  I was excited when Amazon.com began offering my book in a Kindle version as that represents another milestone.

I was recently informed by the publishers at Elsevier that the book has now been translated to Spanish, which of course in a great honor.  Cosmetic facial surgery  is very popular in many Spanish speaking countries and it is a great feeling to know my work will contribute to international surgery education.

I have also been told that other translations are pending which of course makes me proud.

To learn more about cosmetic facial surgery visit www.lovethatface.com

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

http://www.lovethatface.com

February 12, 2012 Posted by | Academic Cosmetic Surgery | , , , | 1 Comment