Cosmetic Injectable Fillers Can Kill You: The wrong filler in the wrong hands.

You have to wonder what people are thinking when they agree to be injected by lay personnel.  Lately, the news has featured several high profile cases where patients sustained serious health problems and even death after injection of industrial substances instead of approved soft tissue fillers.  You may think it is because of the lower fee, but the case detailed below cost the patient $4,000 and maybe her life.  Medical or surgical treatments should only be performed in a clinic environment by experienced personnel; never in a hotel room, “filler party” or someone’s home.  The cases detailed below involve silicone purchased from a home improvement store and flat fixer from an auto parts store.  Cement was also used in the second case, but we are not told what type of cement.  Injecting anything into your body is serious stuff people and it can kill you.

Medical grade silicone is FDA approved and used off label to plump lips and wrinkles and is one of my favorite fillers.  I have been safely injecting silicone in patients for a decade and follow very strict principles of treatment and remain very conservative.  Silicone is a very good and safe filler when used by experienced injectors. It is permanent filler which is a good thing, as long as it is done correctly.  Otherwise it is a permanent complication!  No patient should ever allow any non-healthcare personnel to inject any filler anywhere in their body and when using doctors or nurses, do your homework.  Make sure that the person injecting you is experienced.  He or she should be able to show you many before and after pictures of their work.  Doctors that lecture or publish on fillers are generally the most experienced.  Don’t risk your life for an alleged “bargin”.

 

Baltimore — The Food and Drug Administration and other health agencies are investigating incidents across the country in which unlicensed, untrained practitioners are performing cosmetic procedures with supplies that may have been purchased in home improvement stores.

A Baltimore exotic dancer injected with silicone to enhance her buttocks has become another victim in a growing trend that has led to illnesses, injury and even deaths, the Baltimore Sun reports.

An FDA affidavit contained in court documents identified the woman who injected the unnamed dancer as Kimberly D. Smedley, 45, of Atlanta. Ms. Smedley was arrested in Washington in October with three 18-gauge medical needles found among her belongings. The case remains sealed, and the specific charges are unknown, the Sun reports.

The dancer was hospitalized twice less than four days after the last of her injections in March, according to court documents. On her second visit she was given blood thinners to alleviate clots, and she remained hospitalized for 10 days. A CT scan showed silicone in her lungs, where it remains.

Court records state that the silicone Ms. Smedley allegedly injected into the dancer came from an unlabeled jug that may have been purchased at a home improvement store, where it is sold as caulk and other adhesives, according to the Sun.

The dancer paid $1,000 for each of four sets of injections after meeting Ms. Smedley in the club where the dancer worked. She told authorities that Ms. Smedley also injected silicone into other dancers in a downtown Baltimore hotel, the Sun reports.

In similar incidents, a woman was arrested in Miami recently after allegedly injecting a woman with tire-repair liquid to enhance her buttocks, and earlier this year a British woman died after an improper procedure in a Philadelphia hotel room, according to the Sun. A New York City woman also was arrested on charges that she performed illegal breast- and buttocks-enhancement procedures in her home, according to news reports.

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

Free Offer for Heidi Montag

Earlier this year, Heidi Montag made huge headlines by having 10 cosmetic procedures in the same day at her young age.  This certainly was a negative incident for the  profession of cosmetic surgery.  Recently she has recanted and is now renouncing having cosmetic surgery.  This is also bad for the profession of cosmetic surgery.

It is appropriate that Heidi feels that she was excessive and that young people usually don’t need cosmetic surgery.  It is inappropriate to diss anyone who wants cosmetic surgery when only months ago you were promoting it.

Heidi is now showing of her surgery scars a badge of honor for her misdeeds.  Heidi……..I can make those facial and neck scars much better in several minutes with local anesthesia and minor laser resurfacing.  I will do it for free!  You don’t have to live with them.

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

www.lovethatface.com

Heidi Montag Addicted to Plastic Surgery: How much is too much?

The tabloids have been ablaze about a 23 year old B list reality show star who had 10 simultaneous cosmetic surgery procedures.  How could a 23 year old have any cosmetic surgery, let alone 10 procedures on the same day?  Ms. Montag responded that she is in the entertainment business and she needs these assets to ply her trade.  I have to give her credit in that she actually responds quite intelligibly to the sharp pointed questions from her interviewers.  She seems to see the situation no less different that an athlete who comprehensively trains in all aspects of physical demands to become and remain competitive in their sport.  The difference here after all is that thousands of athletes train and that is normal, but few 23 year olds have 10 cosmetic surgery procedures in a day.  Heidi, this is unusual! 

Heidi certainly got more than her proverbial 15 minutes in the spotlight so from a media aspect, her decision paid off.  Does she look better?  Well, she looked pretty darn good before her surgery so the improvement was minimal by my eye, but for Heidi, it was night and day.  What really looms here is the bigger question; why does our society place so much emphasis on physical attributes that young people feel a need for major body alteration to pursue perfection?  Being a cosmetic surgeon this trend is in my best interest, but it is nonetheless disturbing and I witness it first hand on a weekly basis.  Over the past decade, the Internet has thrust my business from a local to a global platform.  Where in the past, I rarely saw patients from out of town, I know see many from out of state and out of the country.  Although I consider this an honor, it also brings many young patients to my doorstep with extremely unrealistic expectations and accompanying psychological problems.  I have young men and women (in their 20’s and 30’s) that have had 5 and 6 cosmetic facial procedures and are bent on a quest to emulate a celebrity or starlet.  I recently saw a 19 year old who wanted a browlift, a mini facelift and cheek and chin implants!  I obviously refused this surgery but I really felt bad for this guy because he has severe body dysmorphic syndrome and is headed for a lifetime of unhappiness.  With my big old bald head, I am no double for Brad Pitt, nor aspire to be, but I continually see male and female patients that bring in celebrity photos and want Arnold’s jaw, or Johnny Depp’s cheeks or Brittany’s eyes.  They bring in pictures and have also taken the time to Photoshop their own face into an anticipated outcome.  Some surgeons may relish this opportunity, but I cannot in good conscious or ethics get sucked or trapped into this situation for several reasons.  One, they usually don’t need the surgery.  Granted I have performed facial implants or ear pinning on younger patients, but these were procedures that could be reversed or that truly had merit.  Another reason not to operate on this young age group is that they aren’t happy now and won’t be happy in the future.  They will be unhappy with themselves and I will by default become the next “bad” surgeon and get assassinated on the cosmetic surgery chat sites.  I have seen numerous healthy younger patients that have been disfigured by Dr. Givemeadollar and they look extremely unnatural. Don’t get me wrong, some young patients will benefit aesthetically and gain self esteem by having a nasal hump reduced or enhancing a weak chin, but these young patients are not the problem.  It is the patient who is seeking aesthetic enhancement for the wrong reasons.  Some people think they are ugly and are not.  Others see it as a way to gain attention and yet others have a serious issue with other aspect of their life and are attempting to compensate.

It is difficult for a surgeon to say no, but good ones do it weekly.  Unfortunately there are many cosmetic surgeons with open schedules and when a patient is standing in front of them waving money, they can’t say no.  Most younger surgeons will make this mistake once or twice until they see comprehensive picture of this unfortunate cycle.  I have patients get mad at me because I refused to operate and have seen others who I turned down return several years later begging for correction of disfigurement from the surgeons that said yes.  With experience, a surgeon can “feel” the legitimacy or lack thereof associated with patients.  Like good detectives who can tell if a suspect is lying by body language or appropriateness,  experienced surgeons can tell if a prospective case is a good fit or not.  Again this may be more difficult for the novice surgeon but after several unfavorable experiences they become savvy.  I love cosmetic surgery and I love the energy and exuberance of young patients and for years performed a lot of reconstructive surgery on this population.  I feel a responsibility for what I do and I don’t want to bear the burden of pointing a young patient down a path that I would not want my own family to follow.

Back to Heidi.  I frequently see patients that have their hair colored, wear colored contact lenses, have fake eyelashes, dental veneers, tanning bed tans, breast implants and artificial nails.  Now they are seeking cosmetic surgery at an age too young.  We all like to look good and believe me if I could get hair as easy as some patients get surgery, I would be combing it now!  There just needs to be a basis of acceptance of one’s real self, we all need to be somewhat grounded and here is where the biggest problem lies.  Heidi may look hot now, but someday, she is going to be saggy and wrinkled.  We can’t avoid it.  It is all a result of having birthdays.  When a person puts their entire self esteem in physical attributes, it is a losing game because they are not always going to be attractive.  They are going to age and there will be other beauties out there stealing the limelight.  When all you have is artificial beauty, there is nothing to fall back on because, your happiness will be temporary.  Look at yesterday’s icons.  We are harsh on our celebrities and idols because we expect them to be eternally youthful and when they age, the same media that put them on a pedestal crushes them for being wrinkled, grey or overweight.  They have been cast from one end of the beauty scale to the other, very often with severe psychological determent.  Beauty is youth and youth is temporary.  This is not to say that we cannot be attractive seniors, we all know men and women in their 60’s and 70’s that are truly beautiful people.  That beauty however is usually well coupled with non physical attributes such as self confidence, personality and simply staying fit.  High school reunions can be brutal testament to prom queens and quarterbacks that bear no resemblance to the popularity that embraced them year ago.

My message to younger patients that are wondering too far in cosmetic land is to find peace within.  Sure, it is OK to improve minor distinct deficiencies, even at a younger age, we all want to feel good about ourselves.  But remember, beauty is only skin deep and 20 cosmetic surgeries won’t make up for psychosocial deficiencies.  It is hard to undo bad or unnecessary cosmetic facial surgery and I have seen too many people that were unhappy with their appearance regret their actions and wish they could revert back to their natural look.  It wasn’t really that bad.  For younger surgeons that may be struggling to keep a full schedule, always remember that the best way to become busy is to make the best decisions for your patients.  Be ethical, treat them better than anybody else and say no to those who seek cosmetic surgery for the incorrect reasons.  That reputation will catch up to you and you will become busy the right way…….by serving your patients in their best interest.

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

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

http://www.lovethtface.com

Laser Treatment of Burn Scars on the Today Show: Miracle or Not?

On May 28^th the Today Show ran a very interesting segment about a very touching story of very pretty triplets that were badly burned in infancy and were treated with a new laser treatment to improve their burn scars.  The laser was the Lumenis Encore laser and the Deep FX laser, also made by Lumenis.

I have received many phone calls from excited patients who have burn scars or have relatives with burn scars, requesting the “new miracle laser that cures burn scars on the face and body”.  I want to say that I have the very laser that was featured and I am a huge fan of Lumenis lasers.  I also want to say that I am a bit disappointed that the general public may have come away from this feature with the idea that a huge breakthrough in burn treatment has been discovered.  I truly hope that it will advance the treatment of burn scars because that would truly be a huge advancement for humanity and the people that suffer from burn scars.  As a father of two severely disabled young sons, I personally know a parents heartache of seeing a disfigured child.

One problem of the media taking hold of a “new” treatment is that it is frequently presented as a huge worldwide breakthrough in medical advancements.  Sometimes it may be, but most frequently, these stories sensationalize these treatments and put the cart before the horse.  The problem is that viewers get the idea that this is world changing technology.  If a treatment is available that could truly and radically improve burn scars, it would be Noble Prize worthy, not just Today Show worthy.  We have seen the Today Show (and Oprah and other shows) present such “huge surgical advances” as the Thread Lift, The Fraxel laser, the Liquid Facelift and many other procedures that sounded sensational, but proved to be almost useless, let alone a breakthrough.  The key phrase with so many of these treatments is that “the results exceed the expectations”.

Dr. Jill Weibel is a friend of mine and she is one of the nicest and most compassionate doctors I have met and a leader in laser technology.  I believe this type of laser treatment for burns is in the really early stages of usage and that much more long term follow up must be done.  A study by a university burn center with long term follow up would be news worthy.  Single treatments with admittedly minor improvement (the video I saw showed one of the triplets stating that she thinks that she and her boyfriend can see a little improvement is not testimony for a medical breakthrough.  I say this realizing that she has only had a single treatment and perhaps more improvement will be observable with additional treatments.  I hope this is the case because Lumenis is a credible company that would love to be part of such a break through.  I do think, however, that the “miracle” hype on this story is premature and has been presented in too much of a sensational way.  The only bad thing about this is that it can lead the tens of thousands of burn patients to think that something has arrived to change their life.  I wish it were true, but I personally don’t think it is.  I really want it to be true.

Too often the media sensationalizes medical treatments and the public gets misled.  I am not expecting this treatment to be as sensational as presented and it is my fear that like the numerous patients that have contacted me that thousands of others around the country may be given false hope.  My phone rand many times after this story ran and I too have used the Deep FX technology on scars.  The thought of improvement with the new is exciting but it is too early to brand it as a “miracle”.  As academic surgeons like Dr. Weibel and others continue to blaze new trails with this type of fractional laser, the cosmetic treatment of burn scars may become a reality.

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

 

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virgina

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

http://www.lovethatface.com

Can Cosmetic Surgery Change Your Life?

I recently came across this article about cosmetic surgery improving the quality of one’s life. An excerpt is shown below. Report: Facial Plastic Surgery Improves Quality of Life Facial plastic surgery improves patients’ quality of life, but the effects are different for men and women, researchers report in the March/April issue of the Archives of Facial Plastic Surgery.Jason A. Litner, MD, of the University of Toronto and colleagues conducted a study of 93 facial plastic surgery patients, of whom 82 (88%) were female. While 49% of patients underwent rhinoplasty, the remainder underwent surgery for the aging face. They were assessed after surgery and again 3 months later using the 59-item Derriford Appearance Scale (DAS59).Overall, there were significant improvements in DAS59 scores across all the domains of the scale and for all females, the researchers report. For men, the quality-of-life improvements were only in terms of general self-consciousness of facial appearance, and the quality-of-life domains most affected by rhinoplasty and surgery for the aging face were different.“Studies such as ours call attention to the fact that cosmetic surgery is not a superfluous ‘want’ but rather an answer to an important health concern that, in the patients’ eyes, cuts to the very heart of social desirability. It can, therefore, have implications for psychological happiness and quality of life equivalent to or, perhaps, greater than any other medical intervention,” the authors conclude.

The above article is interesting as it showed that the study respondents felt that cosmetic facial surgery improved their quality of life.  I have seen this many times in my own practice, but never push the concept on my patients.  Every day, patients return to the office after having small and or large procedures.  The look better, they feel better and seem to have a glow about them.  At consultation, I never promise that a procedure will change someone’s life, and in fact, I get a bit nervous when that is a patient’s primary reason for seeking surgery.  Cosmetic surgery can change one’s life in many ways, but it won’t save a bad marriage or guarantee a job promotion.  When patients ask “how much younger will I look” that may send up a red flag on their true intentions of having cosmetic surgery.  Obviously we all expect to look younger after cosmetic procedures, but it is impossible to quantify.  A doctor can’t tell a patient “if you do this, you will look 17 years younger”!  There is no way to measure or guarantee that.  Believe me, it sometimes happens.  There are some of my patients that have multiple procedures (laser resurfacing and facelift especially) that do look decades younger, but I never promise that. 

I do think there is a certain glow that most patients feel after having successful facial and neck rejuvenation.  They frequently seem to have a bit more pep in their step, pay more attention to hair make up and clothes.  Patients have related it to me with the analogy of how one feels when they take their car to the carwash.  You drive in with a dirty car and although you leave with the same car, it really makes you feel good to drive out with a better looking vehicle.  One patient told me that they have that same feeling, every day, since having their cosmetic facial surgery.  Another example is how a woman feels when they get their hair done.  They feel like a new person when they leave the beauty salon.

The bottom line is that cosmetic facial surgery (or any cosmetic surgery) can add to self confidence and boost self esteem and  the mood of most patients.  There is no guarantee that every patient will feel like this, but in my practice, I see it often.  This is one of the most rewarding things for a cosmetic surgeon when he or she sees their work making a positive influence in a patient’s life.  There is also no stronger marketing effort as a satisfied patient will spread the work of the surgeon’s skill.

A rational patient and surgeon should not expect miracles but should look forward to many positive changes that accompany cosmetic facial surgeries.

 

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia