Dr. Niamtu’s Weblog

….on cosmetic facial surgery

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

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December 15, 2011 Posted by | Can Cosmetic Facial Surgery Change Your Life?, Choosing A Cosmetic Surgeon, Cosmetic Surgery by Unqualified Personnel, Cosmetic Surgery for the Wrong Reasons, Lip and Wrinkle Fillers, Lip Augmentation | , , , | Leave a comment

Buyer Beware: Cosmetic Facial Surgery

In this day and age of media hype, it is not uncommon to see, hear or read about “miracle” skin and surgery procedures that “can be done awake without anesthesia”, have “little or no down time” and promise to “take years of aging” off of the skin.  BE CAREFUL!  Some general rules to consider are:

• If it sounds too good to be true, it is.
We see so many patients that fell for these “miracle” procedures, spent a lot of money and saw no results.  Do your homework.  Research the procedure you are considering.  You may be surprised how many unhappy patients and doctors there are out there with that specific procedure.  Many of the procedures and devices you see on TV and Doctor shows turn out to be duds.  When you see infomercials on “miracle or revolutionary” facelifts or procedures, stop and think.  If something was truly revolutionary, would everyone be doing it?  Wouldn’t you be more likely to read about this tremendous advance in the mainstream media?  Believe me, if someone invents a facelift that is truly revolutionary and can be done awake with no downtime, they will receive a Nobel price, be on cover of Newsweek, etc.   And no one would do “old style” lifts.  This is called a paradigm shift.  You don’t see horses on the expressway because the combustion engine was such an advancement that everyone drives cars.  If and when we see paradigm shifts in cosmetic surgery you won’t learn about it from infomercials!  Some examples of true cosmetic paradigm shifts include Botox, lasers and liposuction.

• Any skin resurfacing or tightening procedure that can be done without anesthesia is probably not going to do much, especially in a single treatment.
To truly address skin aging, deeper dermal treatment is important and this is simply too painful to be done without sedation.  I see many patients that were treated awake and it was a terribly painful experience.  Remember, in this day and age of safe and easy sedation, there is no reason to suffer for a procedure.  I feel the same way about facelift surgery.  Small facelifts can be done with local anesthesia, but larger lifts, in my opinion, can be done faster and better with sedation.  I recently heard a surgeon discuss how he does facelifts with local anesthesia and his patients take bathroom breaks and have snacks.  Not the way I want to do it, I can do a comprehensive facelift with platysmaplasty and SMASectomy in under 3 hours, but it requires sedation.  Please don’t misinterpret me, some surgeons are very versed at local procedures, and do safe and effective surgery but the average facial surgeon uses sedation.  Patients should have a good idea about the “standard” means of performing surgery and anesthesia and look closely at those surgeons that deviate from this definition.  Does not mean they are bad, maybe just different.  It is the safety and outcome that matters, so do your due diligence, look around.

• How many procedures are required to see a difference?
This is important as I see patients that were treated elsewhere and thought that their “light laser” was a single treatment.  When they saw little or no difference, their doctor told them they need 3-5 more treatments to be effective.  Personally, I think it would be advantageous to have a single Classic laser treatment and take 10 days off of work than to have 3-5 “fractional laser” treatments that take 3-5 days to heal.  Remember, there are no miracle treatments and your result is equal to your recovery.  Procedures with short recoveries have small results.  Procedures with longer recoveries have much more impressive results.

• Don’t be afraid to ask!
Too many times, patients are hesitant to ask their surgeon to see actual before and after pictures of a procedure.  It is important to make sure that the before and after pictures are from your doctor and not from a laser company.  If you are considering a procedure from a doctor and they cannot show you ten before and after pictures, there may well be a reason!  Ask the surgeon how many of these procedures he or she has done and ask for some patient references.

• Every Picture Tells a Story
As digital photography has progressed there should be no reason for any doctor to use poor quality or unstandardized before and after pictures.  Although it is rare that surgeons “photoshop” their pictures to improve the outcome (yes, it happens) it is very common for some doctors to have very poor pictures.  In my experience, surgeons that take pride in their images and pay attention to detail, do the same with their surgery.  Beware for before pictures take without a flash (shadowy) and after pictures taken with a flash.  This always makes the outcome look better because the shadows are gone in the after picture.  Also look for before and after pictures that are not the same size, not the same background, not in focus.  This is just astute observation I have made over the years.  Doctors that have sloppy or misleading before and after pictures may not pay attention to detail.  I always tell young doctors that “your images represent you and your ability”.

What kind of Surgeon Should I have do my Surgery?
This is important and the true answer is that in reality there are many specialties that are qualified to perform cosmetic surgery.  Some specialties are deeply involved in turf battles and would like the consumer to think that only their specialty is qualified to perform cosmetic surgery.  Nothing could be farther from the truth and these arguments are self serving to attempt to capture patients and dollars.  If you are considering facial surgery, you could choose a cosmetic trained dermatologist, oculoplastic surgeon, oral and maxillofacial surgeon, ENT surgeon,  or plastic surgeon.  No one specialty is better than the other and it all boils down to the competency of the individual surgeon.  Their training, ability, patient safety, and clinical outcomes are the most important thing.  Numerous specialties are qualified.  When seeking a surgeon, look for:
• A doctor that you feel good about and that has time for you.
• A doctor that has training in the area that you are considering.
• A doctor that has experience and can show you many examples of his or her work including patient testimonials.
• A doctor that has an accredited facility.
• A doctor that you can easily get in touch with if you need them.
• A doctor with a caring staff.
• A doctor that will back up their work and be able to handle complications.

For more information on cosmetic facial surgery by Dr. Joe Niamtu in Richmond, Virginia visit www.lovethatface.com

Joe

Niamtu, III DMD
Richmond, Virginia

September 7, 2011 Posted by | Choosing A Cosmetic Surgeon, Cosmetic Facial Surgery Consultation, Cosmetic Surgery for the Wrong Reasons, Minimally Invasive Cosmetic Facial Surgery, New Cosmetic Surgery Technology | , | Leave a comment

Please Don’t Call Me a Plastic Surgeon

The field of cosmetic surgery has increased at an exponential rate over the past several decades.  Many paradigm shifts have occurred and this has changed the entire landscape of aesthetic surgery.  If a practitioner that performed aesthetic surgery procedures 40 years ago were to spend a day in my office they would be amazed by the new changes and technology.  Botox, lasers, endoscopic surgery, injectable fillers are just a few of the changes that have improved the profession.

Also among the changes is the fact that numerous specialties include aesthetic surgery in their core curriculum.  These procedures are taught in most residency programs to ophthalmologists, dermatologists, ENT docs, plastic surgeons, oral and maxillofacial surgeons and gynecologists to name a few.  In most of these specialties, cosmetic surgery procedures are part of the resident’s training, they are part of the board exams for those specialties and they are covered under the malpractice policies for those specialties.  Contemporary educators will freely admit that aesthetic surgery is well within the accepted scope of numerous specialties.  No single specialty owns the body or the face and each of these specialties have brought advancements to the collective table of aesthetic surgery.  For instance, dermatologists pioneered laser surgery and invented tumescent liposuction.  The current American Society of Plastic and Reconstructive Surgeons were originally founded by oral surgeons and physicians and was called the American Society of Oral Surgeons until 1931. Oral and maxillofacial surgeons also made significant advanced in aesthetic skeletal surgery and facial implants.  Ophthalmologists have contributed many techniques for cosmetic eyelid surgery and gynecologists have introduced or improved cosmetic vaginal surgery.  ENT physicians have advanced the field of cosmetic nose surgery on a continual basis. The list goes on and anyone that disagrees with the fact that contemporary aesthetic surgery is a multispecialty realm simply has their head in the sand or has intentions of secondary gain, such as limiting the competition, turf battles, and the desire to control patients and dollars.

So…what is “plastic surgery” and how does it differ from “aesthetic surgery” or “cosmetic surgery”?   A Plastic Surgeon is a noun (or could be an adjective) that describes a surgical specialty of medicine.  When used as to describe a type of surgery it has a much broader definition.  Any surgery that is intended to improve form, replace or restore missing or damaged tissue can also be called “plastic surgery”.  So, having said that, if one calls them self a plastic surgeon, it should indicate that they performed a general surgery residency and then a plastic surgery residency and they would be considered a plastic surgeon.  There are, however, exceptions.  Otolaryngologists (ENT’s) changed the name of their specialty to “facial plastic surgery” and ophthalmologists developed a specialty designation of “oculoplastic surgery”.  These practitioners often refer to themselves as “plastic surgeons”.  Other specialties will surely follow this lead in the future to represent their contemporary scope.

In my situation, I am a board certified oral and maxillofacial surgeon.  I am very proud of my unique qualifications to provide aesthetic facial surgery.  My early dental training (I never practiced general dentistry, but had to have a dental degree to enter a maxillofacial surgery residency) gave me excellent dexterity and artistic perspective as well as four years of studying facial anatomy.  My oral and maxillofacial surgery residency provided me not only with medical and surgical training, but also with an unparalleled level of head and neck anatomy and expertise in that region.  I feel that my specialty has an intense level of head and neck training (if not more) than any specialty.  As with any specialty, a surgeon can decide to focus on specific areas that he or she likes to do or excels in.  My true love is cosmetic facial surgery and over the years it became a bigger and bigger part of my practice and in 2004, I limited my practice to only cosmetic facial surgery.  If a doctor does nothing but cosmetic facial surgery then I believe it is practical to refer to them as a cosmetic facial surgeon. 

One huge misconception is that “plastic surgery” is synonymous with cosmetic surgery.  This could not be further from the truth.  Some plastic surgeons have excellent cosmetic surgery training and do a lot of cosmetic surgery.  Others have very little cosmetic surgery training and do very little cosmetic surgery.  Remember, plastic surgery is not necessarily cosmetic surgery.   I have some plastic surgery friends that are excellent at cosmetic procedures and do a bunch and others that are not so proficient and do more reconstructive and wound surgery instead of cosmetic procedures

 In reality, it is not about the specialty, it is about one’s training and expertise in what they do.  A poor cosmetic surgeon does not stay in business long regardless of the specialty.

Why don’t I want to be referred to as a plastic surgeon?  The reason is simple.  Number one, that is not my specialty and I have no need to feign credentials.  Number two and most important, I limit my practice to cosmetic facial surgery and “plastic surgery” is not necessarily cosmetic surgery, so if I did attempt to call myself a plastic surgeon, it would be detrimental to my practice as it would indicate that I do not spend 100% of my time doing cosmetic facial surgery.  The third reason that I do not want to be called a plastic surgeon is that I have many plastic surgery friends on a local, national and international level and it would be an affront to them and their training.  Most plastic surgeons are pretty sharp people and do some amazing reconstructive procedures all over the body, but having that specialty designation does not automatically imply proficiency in aesthetic surgery.

The real bottom line is that numerous specialties perform competent and safe cosmetic surgery.  That can’t be disputed.  Some competitive practitioners who are still fighting the worn out turf battles will attempt to say that other specialties have more complications, but again, the people that usually are saying this are the ones with the most complications.

So, I am not a plastic surgeon, but no one can dispute that my practice is limited exclusively to cosmetic plastic surgery procedures of the head and neck.

I am quite happy and secure being a board certified oral and maxillofacial surgeon and a DMD that only does cosmetic facial surgery.  It is very difficult for any practitioner of any specialty to limit their practice solely to cosmetic surgery and very few ever get to that point.  It is even more difficult to limit a practice to cosmetic procedures of the face and neck because not doing body surgery significantly reduces available surgical options.  I am proud to be one of the few surgeons of any specialty in my state to have a practice limited to cosmetic facial surgery, as well as one of the busiest.  I am also proud to be a fellow of the American Academy of Cosmetic Surgery and the American Society of Laser Medicine and Surgery.  I am proud to have published and lectured on cosmetic surgery more in the last decade than most of my naysayers will in their lifetime.  I am proud of my most recent textbook, which has set sales records and has sold well to all the recognized cosmetic specialties.  Cosmetic facial surgery is my passion, my life’s work, my job and my hobby.    I teach cosmetic facial surgery (to all specialties including plastic surgeons) at over 20 venues a year.  This sounds like bragging, but it isn’t; instead it is passion. I love cosmetic surgery, I love going to work, I love the patients and I love operating. Finally, this is how I feed my family and take care of the numerous expenses required by being the father of two severely handicapped children.  This I take the most seriously.

I do what I do well.  It is not a problem to call me a cosmetic facial surgeon because all I do, all day; every day is cosmetic facial surgery.  But please don’t call me a plastic surgeon.  It does not accurately describe a practice that exclusively performs cosmetic surgery.

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

 

Joe Niamtu, III DMD

March 18, 2011 Posted by | Academic Cosmetic Surgery, Choosing A Cosmetic Surgeon, Cosmetic Surgery Around the World, Cosmetic Surgery Education, Doctors Badmouthing Other Doctors, New Cosmetic Surgery Technology, Only Use A Board Certified Plastic Surgeon? | , , , , , , | Leave a comment

5 Questions to Ask Yourself Before Having Cosmetic Surgery

People turn to cosmetic surgery because they want to look better, feel better and increase their self-confidence. Cosmetic surgery is generally a positive experience that changes lives, but it can become a nightmare if the patient chooses the wrong surgeon or the surgeon chooses the wrong patient—it is truly a mutual relationship. If you are considering cosmetic surgery, first ask yourself the following five questions:

1. Why do I want to have the procedure?

Good reasons to have cosmetic surgery are to look and feel better and boost self-esteem and confidence. Patients who think cosmetic surgery will change their entire life are likely to be disappointed. Having cosmetic surgery to save a failing relationship or vie for a job promotion are not reasonable motivations. And patients who have cosmetic surgery just to get attention will likely remain insecure despite their rejuvenation. The best answer I like to hear when I ask my patients why they want cosmetic surgery is, “I just want to look as good as I feel and look as good as I can for my age.” Whereas a  60 year old woman who brings a picture of Angela Jolie to her consult sets off red flags.

2. Is this the right time in my life to have cosmetic surgery?

Depending on the procedure or procedures, cosmetic surgery can be an intense experience from choosing the right surgeon, to deciding on the best correct procedures, to the recovery process. Your recovery will require your full attention of you and your family and it is not advisable to bite off a big recovery if your life is tumultuous at the moment.  Patients that are grieving, having marital problems or problems with children, etc. can distracted.  you may only do this once in your life, pick a time when it is “all about you”.

3. Can I afford the procedure?

Cosmetic surgery can be expensive, especially if you want multiple procedures. Like any other elective purchase, you should not place unrealistic financial burden on yourself just to look better. Impulsiveness has no place in making medical decisions. Postponing surgery, obtaining in-office financing or limiting the number of procedures may be solutions for some patients. Remember, it takes most of us a half a century get our wrinkles, you don’t have to correct them all overnight.

4.  What is my support system at home?

Recovery from any type of surgery can be intense and, depending upon the procedure, patients may need physical and emotional assistance for several days or longer. There is nothing more helpful than a compassionate, supportive spouse, but this is not the case in some households. I have seen husbands or wives disapprove of their spouse’s decision to have cosmetic surgery.  Sometimes it’s jealousy, sometimes it’s the expense. When you are in bed, bruised and bandaged, the last thing you want to hear is “I told you so.” Support at home cannot be underestimated.

5. Have I chosen the right surgeon?

Patients need to do their homework. It’s important to choose a surgeon who is board certified in their specialty and one who routinely performs the specific procedure(s) you are considering. An experienced surgeon should be able to show a prospective patient many pictures of his or her work and have patient references readily available. An accredited office surgery center and discussion of who will be performing the anesthesia is also important. It is a myth that only doctors of certain specialties are qualified to perform cosmetic surgery. It is the skill of the surgeon’s hands that makes the difference, not what specialty they represent. Finally, you must be able to communicate openly and effectively with your surgeon. Trust your instincts. If you don’t like your surgeon’s personality or demeanor, don’t hesitate to interview another surgeon.

 To learn more about cosmetic facial surgery from Dr. Joe Niamtu in Richmond, Virginia visit www.lovethatface.com

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

www.lovethatface.com

February 22, 2011 Posted by | Choosing A Cosmetic Surgeon, Cosmetic Facial Surgery Consultation, Cosmetic Surgery for the Wrong Reasons | , , | Leave a comment

Choosing the Right Patient

It takes a long time to become a surgeon and when it is all over and the shingle gets hung, all physicians must spend a great deal of energy for the rest of their working lives soliciting patients.  Some surgeons do this very aggressively with marketing, TV, Radio, etc. while others do it more subtly while still others merely join a busy group.  Whatever route a doc takes while he or she to put time and effort into pleasing current patients and procuring new ones. With all this focus on “getting patients and getting busy”, young surgeons are very attuned to accepting almost any case.  “you go into practice, you are not busy, you need patients and bang, here is one sitting in front of you with a check book and surgical request” .  It can be really hard to say no, especially for those surgeons just beginning their surgical journey.  “If someone walks into a car dealership and wants a car and has the cash, no one would ever consider saying no; but patients are not commodities and lives can be affected (doctor and patient) by accepting the wrong patient.

Any surgeon that has been in practice for a decade or longer at some time or another knowingly or unknowingly accepted a surgical case that, in retrospect, they shouldn’t have.   This is how we learn.  Unfortunately, it is not easy as there is not frank quantification.  I have always said that if someone could invent a device that you touch on a patient and it says “good patient, average patient, or bad patient”, our lives would be easier.  Too bad for us, that is not possible.  “I really think it takes years and unfortunately, getting burned a few times for the average doc to realize, wow, I will never do that again, on that type of person!”  Even experience docs sometimes miss the mark.  I have accepted patients that I thought were extremely stable, only to see them become noncompliant and problematic.  I have, likewise, hesitantly accepted some patients that had questionable stability and they turned out to be model patients.  “we will never get it right 100% of the time, but realizing the “red flags” can make our lives easier.

Surgeons can have red flags too.  No surgeon should ever do any case “just for the money”.  We all know this but in tough economic times, some surgeons may relax their principles.  Apparently unstable patients should also be another red flag.  As much as we may want to do this surgery, this type of patient can make our professional and personal lives miserable as these patients can be very litigious and in some cases violent. A number of cosmetic surgeons have been murdered by disgruntled patients.  My advice to novice surgeons, pretend the board of medicine is sitting in the room when you evaluate this patient, follow you surgical instincts, (they got you this far), if something does not feel right, “just say no”!

Saying no sounds very easy, but in reality can be quite difficult.  Most of us are polite people and are running a business.  Most of us are honored when chosen by patients to be their surgeon and most importantly, most of us want to help our patients and please them.  So, when a patient presents to your office, requests your talents, has the situation that you know you can improve and has the financial ability to pay for it, saying no can be difficult.  Sometimes the patient makes it more difficult as they don’t want to take no for an answer.  They keep pushing and sometimes begging.  Then they pull out their tricks and begin ingratiating the surgeon.  They speak poorly of previous surgeons and over complimentary of you.  They may point out that they traveled a long way to see you or that “no one else understands them”.  Most of these people are experts at getting what they want (or think they want, or want at this second) and can be extremely persuasive.   I have been in practice for 27 years and have at times accepted the wrong patient.  These are the people that want their money back, will defame you with other people and surgeons, will call you 24 hours a day, and can be very disruptive.  It has  been said that 1% of your patients cause 99% of your problems, well, this is the 1%.  I have noticed a huge increase of this type of patient as the Internet has developed.  I, like many surgeons, went from seeing patients from all over my city, to all over my state, to all over other states, to other countries.  This increase in the patient pool can bring proportionally more unbalanced patients to the office.  Also, manipulating patients feed of off the Internet as it can find them more prospective “hits” as many surgeons in their geographic may have turned them down or know their M.O.  By the same token, I have had some of my best patient experiences with out of town patients.  There is not guarantee either way.

What are some of the signs that should alert a surgeon of a potentially problematic patient?  Much has been written on this subject and this list is never ending.  Here are some

Red Flags during the consultation.

  • Patients with known Body Dysmorphic Disorder or psychiatric condition.
  • Any overly narcissistic or immature patient.
  • Unfriendly or impersonal patients
  • Patients that don’t smile or may eye contact.
  • Patients that are too busy or too important for surgery
  • Patients that speak negatively about previous patients be are complimentary to you
  • Patients that won’t listen and just talk.
  • Patients that are having surgery for the wrong reason such as a failing marriage, promotion or in the midst of a loss.
  • Patients that cannot decide on a surgical plan or say “do what you think I need”.
  • Patients that are overly impulsive, want to book surgery at first evaluation appointment.
  • Patients with unrealistic expectations.
  • Patients the “know” more about a procedure than the surgeon.
  • Patients that tell the surgeon what procedure to in extreme detail.
  • Patients obsessed with online cosmetic surgery bulletin boards or cosmetic surgery sites.
  • Young patients that have already had numerous surgeries or request surgeries generally performed on older patients.
  • Patients over reacting to a small flaw.
  • Patients that complain about financial arrangements or are pushy about discounts or are otherwise “shoppers”.
  • Patients that insist on absolutely no photographic documentation or are resistant go give important information such as cell phone numbers, etc. and insist on “secrecy”. 
  • Patients desiring surgery with intense familial disapproval.
  • Patients that are rude or pushy.

So, how does a doctor say no to a patient?

Good surgeons frequently say “no”! This sounds easy but in reality may be difficult.  The best means I have found in doing is to simply tell the patient that I have considered their request and looked at everything carefully and “I don’t think I can make them happy”.  I do not get into details that may lead to arguments.  Although many surgeons may ask a patient to see a psychiatrist, I never do, that is not my job, and if a patient is in need of that much evaluation, it is probably a mistake to operate on them at this point.  Also, many patients are offended by such a request.   I am always polite and stay away from issues that may be offensive or insulting.  A patient can argue with me if I question their mental stability or motivations for surgery, etc.  No one can argue with my appraisal that “I don’t feel that I can make you happy”.

My advice to novice surgeons is to try to learn these pearls without making these mistakes themselves.  Speak to older colleagues that have experience with this type of patient.  Sharing others “war stories” can assist in optimizing the surgical experience.  An ethical surgeon and balanced and compliant patients are a rewarding experience.

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

http://www.lovethatface.com

October 16, 2010 Posted by | Choosing A Cosmetic Surgeon, cosmetic surgery addiction, Cosmetic Surgery Around the World, Cosmetic Surgery for the Wrong Reasons, out of town cosmetic facial surgery, Risks of Cosmetic Surgery, Surgeons Picking the Wrong Patient | Leave a comment

A Touching Experience: How Doctors Connect with Their Patients

 

 For 30 years I have been very involved in teaching medical and dental students, residents, interns, fellows and experienced surgeons.  One of the things that younger doctors always want to know is “how do you perform a consult?”  This is a very difficult question to answer as every doctor has his or her own style of communicating with patients.  Some surgeons (usually very successful ones) are great at it and others fumble through the consultation process and never really connect with the patient.  Developing a successful consultation persona is a process that continually matures over decades and most physicians usually learn these things the hard way through trial and error.  Not every doctor can act the same way around every patient.  Some patients are very formal and are turned back by levity or casualness while this is very relaxing and engaging to other patients.  Astute surgeons temper their demeanor and consultation process to individual personalities.

Classical medicine discusses laying of the hands and there is no doubt that a warm and sincere touch is comforting to a sick patient or one who is nervous about discussing their aging face in a cosmetic consultations.  Appropriate greeting and communicating touches with patients put them at ease, introduce a mutual energy, and show a caring physician.  Whether a handshake, a gentle touch on the shoulder or arm or touching the patients face when describing their condition, it makes most patients feel more connected.  Obviously there is a personal space to be respected and with some patients any touch may make them uncomfortable, but if you watch a masterful clinician in consultation with their patients, the chances are you will witness tactile communication.  I have professed this for years and frequently see this confirmed by science.

I rarely post verbatim copy on my blog, but every once in a while, someone says something perfectly and to try to express that without crediting that person detracts from the message.


New York Times

February 23, 2010

Mind

Evidence That Little Touches Do Mean So Much

By BENEDICT CAREY

Psychologists have long studied the grunts and winks of nonverbal communication, the vocal tones and facial expressions that carry emotion. A warm tone of voice, a hostile stare — both have the same meaning in Terre Haute or Timbuktu, and are among dozens of signals that form a universal human vocabulary.

But in recent years some researchers have begun to focus on a different, often more subtle kind of wordless communication: physical contact. Momentary touches, they say — whether an exuberant high five, a warm hand on the shoulder, or a creepy touch to the arm — can communicate an even wider range of emotion than gestures or expressions, and sometimes do so more quickly and accurately than words.

“It is the first language we learn,” said Dacher Keltner, a professor of psychology at the University of California, Berkeley, and the author of “Born to Be Good: The Science of a Meaningful Life” (Norton, 2009), and remains, he said, “our richest means of emotional expression” throughout life.

The evidence that such messages can lead to clear, almost immediate changes in how people think and behave is accumulating fast. Students who received a supportive touch on the back or arm from a teacher were nearly twice as likely to volunteer in class as those who did not, studies have found. A sympathetic touch from a doctor leaves people with the impression that the visit lasted twice as long, compared with estimates from people who were untouched. Research by Tiffany Field of the Touch Research Institute in Miami has found that a massage from a loved one can not only ease pain but also soothe depression and strengthen a relationship.

In a series of experiments led by Matthew Hertenstein, a psychologist at DePauw University in Indiana, volunteers tried to communicate a list of emotions by touching a blindfolded stranger. The participants were able to communicate eight distinct emotions, from gratitude to disgust to love, some with about 70 percent accuracy.

“We used to think that touch only served to intensify communicated emotions,” Dr. Hertenstein said. Now it turns out to be “a much more differentiated signaling system than we had imagined.”

To see whether a rich vocabulary of supportive touch is in fact related to performance, scientists at Berkeley recently analyzed interactions in one of the most physically expressive arenas on earth: professional basketball. Michael W. Kraus led a research team that coded every bump, hug and high five in a single game played by each team in the National Basketball Association early last season.

In a paper due out this year in the journal Emotion, Mr. Kraus and his co-authors, Cassy Huang and Dr. Keltner, report that with a few exceptions, good teams tended to be touchier than bad ones. The most touch-bonded teams were the Boston Celtics and the Los Angeles Lakers, currently two of the league’s top teams; at the bottom were the mediocre Sacramento Kings and Charlotte Bobcats.

The same was true, more or less, for players. The touchiest player was Kevin Garnett, the Celtics’ star big man, followed by star forwards Chris Bosh of the Toronto Raptors and Carlos Boozer of the Utah Jazz. “Within 600 milliseconds of shooting a free throw, Garnett has reached out and touched four guys,” Dr. Keltner said.

To correct for the possibility that the better teams touch more often simply because they are winning, the researchers rated performance based not on points or victories but on a sophisticated measure of how efficiently players and teams managed the ball — their ratio of assists to giveaways, for example. And even after the high expectations surrounding the more talented teams were taken into account, the correlation persisted. Players who made contact with teammates most consistently and longest tended to rate highest on measures of performance, and the teams with those players seemed to get the most out of their talent.

The study fell short of showing that touch caused the better performance, Dr. Kraus acknowledged. “We still have to test this in a controlled lab environment,” he said.

If a high five or an equivalent can in fact enhance performance, on the field or in the office, that may be because it reduces stress. A warm touch seems to set off the release of oxytocin, a hormone that helps create a sensation of trust, and to reduce levels of the stress hormone cortisol.

In the brain, prefrontal areas, which help regulate emotion, can relax, freeing them for another of their primary purposes: problem solving. In effect, the body interprets a supportive touch as “I’ll share the load.”

“We think that humans build relationships precisely for this reason, to distribute problem solving across brains,” said James A. Coan, a a psychologist at the University of Virginia. “We are wired to literally share the processing load, and this is the signal we’re getting when we receive support through touch.”

The same is certainly true of partnerships, and especially the romantic kind, psychologists say. In a recent experiment, researchers led by Christopher Oveis of Harvard conducted five-minute interviews with 69 couples, prompting each pair to discuss difficult periods in their relationship.

The investigators scored the frequency and length of touching that each couple, seated side by side, engaged in. In an interview, Dr. Oveis said that the results were preliminary.

“But it looks so far like the couples who touch more are reporting more satisfaction in the relationship,” he said.

Again, it’s not clear which came first, the touching or the satisfaction. But in romantic relationships, one has been known to lead to the other. Or at least, so the anecdotal evidence suggests.

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

Joe Niamtu, III DMD

March 23, 2010 Posted by | Choosing A Cosmetic Surgeon, Cosmetic Facial Surgery Consultation | , , | Leave a comment

What goes around…..comes around.

comes aroudn

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

September 1, 2009 Posted by | Choosing A Cosmetic Surgeon, Cosmetic Facial Surgery Consultation, Doctors Badmouthing Other Doctors, Only Use A Board Certified Plastic Surgeon?, Risks of Cosmetic Surgery | , , , , | Leave a comment

How to Choose the Right Cosmetic Surgeon

thegooddoc

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 http://www.lovethatface.com.

 

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

http://www.lovethatface.com

April 2, 2009 Posted by | Choosing A Cosmetic Surgeon, Cosmetic Facial Surgery Consultation, Doctors Badmouthing Other Doctors | Leave a comment