Dr. Niamtu’s Weblog

….on cosmetic facial surgery

Joan Rivers and Cosmetic Facial Surgery


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

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

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

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

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia


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


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

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

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


February 1, 2010 Posted by | Can Cosmetic Facial Surgery Change Your Life?, cosmetic surgery addiction, Risks of Cosmetic Surgery | , , , , , | Leave a comment