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

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

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

Free Offer for Heidi Montag

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

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

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

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

www.lovethatface.com

December 22, 2010 Posted by | Can Cosmetic Facial Surgery Change Your Life?, Cosmetic Surgery for the Wrong Reasons, Facial Scar Treatments | , | 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

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