Dr. Niamtu’s Weblog

….on cosmetic facial surgery

Facial Thirds: a good way to look at the face

I see a lot of patients this time of year who have made a resolution to look better and feel better about themselves.  This is a great time to have cosmetic surgery because you can cocoon in the winter and then the butterfly comes out in the spring!

The best way to decide what procedure is right for you is to divide your face into four parts: the upper face is the forehead and upper eyelids; mid-face is the lower lids, cheeks and upper lip; lower face is the jowls and neck; and the fourth area is the skin.

When patients come in for a complimentary consultation, I look at each of these areas separately and evaluate what kind of aging is there. Together, the patient and I decide whether it requires a surgical or non-surgical solution. All surgeries are performed in my fully accredited, in-office surgery suite.

For the upper face, surgical options consist of either a brow or upper lid lift. These are very effective procedures because the eyes are the first place to show age. Non-surgical upper face options include Botox, Dysport, and Xeomin and facial line fillers for mild to moderate wrinkles.

For the mid-face, lower lid surgery and cheek implants will lift the cheeks and eliminate bags, and can be performed in about an hour.  Injectible cheek, lip and smile line fillers are moderate  non-surgical procedures with no downtime.

For the lower face, surgical procedures include facelifts, liposuction and chin implants. There are varying degrees of facelifts, depending on the patient’s needs, budget and available recovery time. Botox Dysport, and Xeomin and fillers can also be effective non-surgical options.

Chemical peels and laser resurfacing are very effective for skin rejuvenation. Moderate aging and brown spots can be treated with fractional or light laser resurfacing for shorter recovery.  Non-surgical procedures include radio frequency mole removal, spider vein removal, and medically based (prescription strength) lifetime skincare.

If there’s something you’d like to change, 2012 is a good time to do it. I invite you to come in for a free consult and skin scan. You do so much for others. Let this be the year you do something for yourself!

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

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

December 14, 2011 Posted by | cosmetic facial surgery, Cosmetic Facial Surgery Consultation | , | Leave a comment

Festoons: the baggage you don’t need!

Malar Festoons are the baggy pouches that form under the lower eyelids and on the upper cheek. I have been treating them with laser resurfacing for the last 15 years.

Festoons are a result of numerous causes including sun damage to the skin, fat loss of the cheek area, periorbital changes of skin, muscle and fat. They are also caused by a back up of the lymphatic drainage of this area which causes the tissue to become boggy. The net result is crinkly skin or pouches that make us look old and tired. Before the advent of laser technology, festoons were often treated by surgical excision, which of course left a scar. Other treatments that were supposed to improve festoons have been disappointing.

I have used various types of lasers on this region (CO2, Erbium, Nd:YAG, KTP) and have personally had the best results with the CO2 laser. No other laser has been to shown to produce as much skin tightening or new collagen formation as the ultrapulsed CO2 laser. I believe it remains the gold standard in skin tightening. Although other lasers may claim to produce results with less downtime than the CO2, the result is often less or multiple treatments are required. In reality, the way the procedure is performed and the experience of the surgeon are the most important variables in terms of the best result. Experienced laser surgeons know how aggressive they can be with the skin resurfacing and yet not produce scarring. Good results can be obtained using CO2 and Erbium lasers.



The above patient was treated by Dr. Niamtu with upper and lower blepharoplsty and CO2 laser to the festoons.

Although festoons can be treated as a sole procedure, most patients that are having this area treated also benefit from upper and lower eyelid surgery as well. My most common combination of procedures to rejuvenate this region is transconjunctival blepharoplasty on the lower lids. This procedure does not involve a visible scar and is also safer in terms of not pulling down the lower lids. Instead of cutting skin off of the lower eyelids, the wrinkled skin is treated with the laser and the results are immediate. You can actually see the wrinkles disappearing as the laser contacts the skin. I prefer to treat the lower lids when I treat festoons as the aging process actually represents this entire area. More so, I encourage most patients to perform the laser treatment on their entire face if they desire more comprehensive rejuvenation. By treating the entire face, the patient does not have to worry about the festoon skin being a different color or texture if that is the only area treated.

As most patients that have festoons need their lower lids treated, the same can be said about their upper lids. It is very common to rejuvenate all four lids and the festoons at the same procedure.

In addition to improving malar festoons, the CO2 laser also revolutionized cosmetic blepharoplasty (eyelid tuck) as the surgery can be performed in much less time with no bleeding. That is not a misprint, there is literally no bleeding. During the procedure of operating of 4 eyelids, the total blood loss can be measured in a single Q Tip. Less bleeding means faster healing, less bruising and less pain. Those surgeons who have been using lasers for blepharoplasty can affirm these statements.

This patient was treated by Dr. Niamtu with upper and lower laser assisted blepharoplasty and laser to the lower lid and facial skin

Dr. Niamtu has performed over 5,000 eyelid surgeries with the CO2 laser since 1996 including festoon treatment and full face laser skin resurfacing. In addition, he has written numerous articles and text book chapters on laser treatment.









This patient was treated by Dr. Niamtu with lower transconjunctival blepharoplasty and lower periorbital laser resurfacing.









This patient was treated by Dr. Niamtu with lower transconjunctival blepharoplasty and lower periorbital laser resurfacing.


For more information about Dr. Joe Niamtu, III, cosmetic facial surgery in Richmond, Virginia visit www.lovethatface.com. Joe Niamtu, III DMD Cosmetic Facial Surgery Richmond, Virginia

July 20, 2011 Posted by | Cosmetic Eyelid Surgery, cosmetic facial surgery, Eyelid Surgery, Laser Resurfacing | , , , , | 8 Comments

When all you have is looks; what happens when your looks are gone?

It is human nature to appreciate physical attributes.  Most people have some physical attribute, i.e. nice teeth, great hair, awesome breasts, big biceps that they are proud of.  Some people are really lucky and have it all; doesn’t it seem that college quarterbacks and cheerleaders always seem to?

You can pretty much tell when someone is infatuated with their own attributes.  These are the women with large breasts that always wear revealing tops and blouses, the guys with big arms that always wear short tight sleeves, etc.  Again, this is a bit human nature; if you’ve got it, flaunt it!

The problem is that some people become so stuck on their given attributes, it becomes the defining portion of their life.  We all know people like this.  Women whose world revolves around their bust line, men who are obsessed with muscles.  Some are obsessed with several body parts so that they are simply “into themselves”.  I read (with sadness) the other day that the woman with the world’s largest breast implants (Sheyla Hershey) had to have them removed.  She also lost much breast tissue and is despondent because she will no longer be able to have M size breasts.  Really……….M cups!  The insanity of someone that would actually want breasts bigger than basketballs is startling.  The fact that a surgeon would oblige is sad.   This lady was all over Google Images with insane pictures of insanely huge breast implants.  This was her life and that is sad.  Now her sole asset and claim to fame is also gone which is even more sad.

Again, there is sometimes a fine line between a great physical asset and a personality defect.  Many individuals that are overboard with a physical attribute are actually masking some personality deficiency.  They may be using their breasts, hair or biceps to overshadow insecurity.  The big boobs gives them the security.  Some people simply are insecure and need the attention and hence the low cut blouse, tight jeans or short sleeves gives them just that.  Some are so obsessed that they may move to a warm climate as not to cover their body with bulky clothes.  We are all a bit narcissistic or none of us would own a mirror, but most people pull it all off with a balance and they know that what is here today may not necessarily be here tomorrow; and that is the crux if this story.

If one’s life revolves around big, firm breasts, what is going to happen when these breasts become droopy and wrinkled?  Guys that live in a world revolving around their arms or abs, guess what?  You are not going to look like that forever.  Many of the body builders that I worked out with in college (and I am talking about some big boys) look pitiful now.  The are big and fat and out of shape.  For those of you who attend your high school reunions, it gets pretty scary after year 20.  Most people get old, fat and out of shape.  Their great breasts, etc. provide no crutch to their personality.  Fortunately, most of us (even those who were over the edge) figure this out and adjust appropriately.  Some try to chase it.  Bigger breast implants every decade or tricep implants.  They will never catch up, you can’t out race time.

Individuals whose world revolves around a body part or those who use such to compensate for psychologic or personality defects are setting themselves up for a lifetime of insecurity and unhappiness.  Bottom line?

1. Be happy with what you have.  There are a lot of unfortunate people out there with birth defects and other significant problems. 

2. We are not all movie stars.  Get used to this.  Some people are born with “gifts”.  Some have great voices, some can run fast, some have great body parts.  It may not be you, that is life.

3.  It is OK and not unnatural to be proud of you body and it makes great sense to take care of it and fight aging as youth is the best gift of all.

4. Having cosmetic surgery is fine if it is for the right reasons.  If you are trying to outrace age or cover up personality defects, you will lose the race.

5. If you are one of the lucky people that get a lot of attention because of your physical attributes, keep in mind they are probably temporary.  You need to plan for the future.  People used to comment on my great hair, now I am bald!  You need to understand that what may get you through today may not be there tomorrow!  It is similar to having a 401K, you need to plan for the future.  Again, most people mature out of the severe narcissistic phase and can laugh at the way they were.  Some don’t  and as a cosmetic facial surgeon, I see this type of person every day.  They are desperate and trying to hold on to the only thing that has kept them afloat.  Some should be working on their personality instead of their face.  Fortunately this is a small percentage of most practices, but trust me, they are out there.

6. We need to make sure our children and friends understand this and someone has to have this talk with them sometime.

Poor Sheyla Hershey lost her M cup breasts.  I have the feeling it will change her life. I hope she has something else that keeps her going.  The story is sad to me.

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

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

September 23, 2010 Posted by | cosmetic facial surgery, cosmetic surgery addiction, Cosmetic Surgery for the Wrong Reasons, How We Feel After Cosmetic Surgery, Risks of Cosmetic Surgery | , , , , , , , | Leave a comment

“On Being on a Magazine Cover”


I recently had the honor of being featured on the cover of Plastic Surgery Practice magazine.  Usually people get on magazine covers if they do something really good or something really bad.  In this case it was the former.  This magazine profiles leaders in plastic and cosmetic surgery and has featured some of the best known surgeons in the country.  Obviously, it was a huge honor for me.

When I reflect on what it took to get there the thought takes me back over a decade ago when I first became interested in cosmetic facial surgery.  At the end of 1996 I noticed a trend that cosmetic surgery was really starting to blossom and permeate numerous specialties besides Plastic Surgery.  Many programs including ENT, Oral and Maxillofacial Surgery, Ophthalmology and Dermatology were teaching cosmetic surgery procedures to their residents.   In my specialty, Oral and Maxillofacial Surgery, cosmetic facial surgery became part of our board exam and was covered by our malpractice insurance.  Having seen all of these changes and always enjoying the cosmetic aspects of Oral and Maxillofacial Surgery, I began to seek more knowledge about cosmetic procedures.  I soon became aware of a group called the American Academy of Cosmetic Surgery.  This was a somewhat unusual group as it was made up of members from virtually every specialty that wanted to share their knowledge about cosmetic surgery.  This does not sound that unusual now, but in 1996, many surgeons and specialties operated in stealth, not willing to share knowledge with colleagues.  All of my life I have become obsessed with my passions and it quickly became obvious that I was about to become obsessed with cosmetic facial surgery.  Prior to this time, I had a very successful and enjoyable time practicing routine maxillofacial surgery.  I began a solo practice and with the help of awesome partners, grew it to an 8 man, 6 office machine with 75 employees. As much as I enjoyed what I did for a living, there was something missing.  I felt withdrawn from academics, as many practitioners do after a decade or so of practice.  I was looking for some mental and surgical stimulation and cosmetic facial surgery filled that need.

It did not start out as an easy ride.  As my cosmetic surgery acumen grew, I began marketing my cosmetic services and that ruffled the feathers of some local competing specialists.  A number of detractors attempted to keep me and others from performing cosmetic facial surgery, mostly by deception with other doctors, patients and politicians.  A driven person will not accept defeat at any cost and I was determined to pursue my practice in a cosmetic direction.  As my experience grew so did my patient volume and producing good results with happy patients will trump adversaries over the long run. 

Around 2003, I decided that I enjoyed cosmetic facial surgery so much that I would limit practice to that discipline.  It was a big decision as it is difficult to maintain a practice on cosmetic surgery only, especially a head and neck cosmetic practice.  Surgeons performing full body surgery have more to choose from.  Cosmetic facial surgeons are limited to that area and there is only one other surgeon in my city besides me who limits his practice to cosmetic facial surgery.  Many Plastic Surgeons dabble in cosmetic surgery and fall back on reconstructive surgery to fill the voids but having a dedicated cosmetic practice is much more difficult.

From the onset of my cosmetic surgery experience I meticulously documented my learning and surgical techniques.  I began using this information to publish and teach.  I have always enjoyed writing and used my free time to publish articles on cosmetic facial surgery.  To date, I have published over 200.  I have also always enjoyed teaching and seriously considered a career in academics when I finished my residency.  In 1997 I gave my first cosmetic surgery lecture at a surgical meeting.  As I progressed, I submitted abstracts to more and more meetings from various specialties and organizations.  This is a very time consuming process as it requires unbelievable time and effort to lecture.  I think I spend more time using PowerPoint than anyone on the planet!  Also, a teacher must remain at the cutting edge of what is happening, so it is a significant commitment.  Over the past decade, my ability to teach and lecture became appreciated by various societies and specialties and in 2008 I lectured nationally and internationally 27 out of 52 weekends.  There have been many drawbacks from this; time away from home, work and family, missing hobbies such as bow hunting and fishing and spending countless hours in airports.  There have also been many rewards.  I have met thousands of cosmetic surgeons from all specialties, all over the world.  Some of my best friends have been made on the road and I cherish this family of cosmetic surgeons.  With this experience came committees and board appointments with the American Academy of Cosmetic Surgery.  I have served on numerous committees, was on the board of directors of the Cosmetic Surgery Foundation and have served as a co-chair for two annual meetings.  Also with experience comes other honors and I have been appointed to editorial boards of such publications as Cosmetic Dermatology, Aesthetic Surgery and Medicine and Cosmetic Surgery Times.  Finally, I have been asked by Elsevier, one of the leading companies in medical publishing, to write a textbook on cosmetic facial surgery.  This is a supreme honor and my chance to leave something behind.

I feel very lucky to love my job and I am excited to move into our new cosmetic facial surgery office and surgery center which is a state of the art facility here in Richmond, Virginia.  This magazine cover comes on the same week that we move into our new facility and serves to make me feel good about all the countless hours I have invested in cosmetic facial surgery.  As many of my friends that I trained with ponder retirement, it is my hope that I can work another 20 years, because I love what I do.  I also feel great about the fact that I have given back to the community by treating many patients that were unable to pay.  There is no better feeling that helping someone who has no other place to turn, especially children.

So, I spend my days performing cosmetic facial surgery and my evenings making before and after pictures, updating my web site, working on my text book and writing on my blog.  I sometimes feel overwhelmed and wonder what keeps me going.  It is simply that I have a passion for what I do. 

So what does it take to get on a magazine cover?  It takes passion!

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


Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

November 23, 2008 Posted by | cosmetic facial surgery | , | Leave a comment