Dr. Niamtu’s Weblog

….on cosmetic facial surgery

……on writing my textbook


In an earlier post, I described the work involved with writing a major cosmetic facial surgery text.  I literally spent 3-4 hours a day (and sometimes up to 11 hours) writing chapters on common topics of cosmetic facial surgery.  Being a major text from one of the best known medical publishers (Elsevier Saunders) there is no room for short cuts or nonfactual information.  Undoubtedly, young surgeons will use this text (and others) to learn how to do cosmetic facial surgery.  This means that everything has to be correct and referenced.  For the past quarter of a century, I have been a photography addict and it has paid off.  My text will contain several thousand images in a “step by step, how to do it” format.  Currently I am reviewing proofs (see picture) of all the pictures in each chapter.  Each image has to be rechecked for accuracy, clarity and to check that the captions are correct.

I am also knee deep in videos.  Contemporary textbooks contain DVD’s in the back cover that provide multimedia instruction on the various procedures.  Again, no room for amateurish movies.  I purchased a high end, high definition digital camcorder and although I already have movies of all my surgical procedures, I am remaking them in high definition to compliment this detailed book.  This is a task of awesome proportions.  Doing surgery and doing surgery for a movie is very different.  I have to narrate each step during the procedure and make sure that bloody gauze, drapes and instruments remain clean.  The videographer must focus on the key aspects of the procedure.  It is a lot of work but just the beginning.  The next step falls on my shoulders.  I must take all the raw video clips and assembly them into a movie.  This takes significant editing to makes sure that the movie flows properly, has transitions between scenes and the audio is acceptable.  Once this is put together, the movie must be rendered, or formatted to work on the average DVD player.  This editing process takes many hours but when I view the final product it is a warm and fuzzy feeling.

Having done most of the heavy lifting for this book, the next task will be to review all the text that I wrote and I hate that part.  It is hard for an author to go back and reread hundreds of pages (probably over a thousand) that he or she already wrote.  I am told by the publisher that the book should be available by July 2010.  Too long for me, but because the unusually large amount of color pictures, the book must be prepared overseas and shipped back and forth during production.  I am really excited to get that first copy as this project reperesents the most comprehensive and intense project that I will ever embark upon.

To find out more about cosmetic facial surgery and facial plastic surgery in Richmond, Virginia visit www.lovethatface.com

Joe Niamtu, III DMD

Cosmetic Facial Surgery


August 27, 2009 Posted by | Digital Technology and Cosmetic Facial Surgery, Technology | Leave a comment

Cosmetic Surgery Bulletin Boards: Can you believe everything you read?


One of the true joys of being alive in this day and age is the Internet.  For those of us that are older than 20 years of age it is hard to imagine life without it.  The Internet has empowered us and made encyclopedias and dictionaries obsolete.  It seems that you can find out anything with just a few clicks.  To Google has become a common verb!

Information is definitely power, but if that is true, misinformation is then weakness.  The decision to have cosmetic facial surgery and the ramifications that go along with it can be tasks of awesome proportion.  There are many surgeons to choose from, many procedures to have done, there are also considerations of patient health, recovery and budget.  When you think of all of this at one time (as most patients do when walking blindly into a consult) it is a miracle that a decision can be made.  So much information, so little time!

Bulletin Boards have become common and popular forums for humans to share information….or misinformation.  I have picked up some great tips on various bulletin boards like how to repair my 1965 Jaguar, how to tune my boat engine, what fishing lures to use on the James River, the best abdominal exercises, etc, etc.  Sometimes I have to wade through some incorrect or opinionated data and it can vary from confusing to dangerous.  With the Internet you have to take the good with the bad.  Cosmetic surgery bulletin boards are numerous, frequently factual, sometimes entertaining and frequently misleading.  On a positive note, these bulletin boards allow patients to discuss and compare data and experiences on various procedures, products and surgeons.  I have seen a lot of very good comments, ideas and advice on these bulletin boards, but I have also seen downright false, mean spirited, confusing and doubtful information as well.  Cosmetic facial surgery is not only my job, but it is my passion, so I am basically consumed with it during my waking hours.  It is my profession and my hobby.  At work, I see patients and operate, at home I work on my website and blog and for leisure I read cosmetic journals and text books.  For fun, I write journal articles and textbook chapters.  My wife thinks I am crazy, but she understands a man driven.

It was my honor to find out that I came highly recommended on several of these bulletin boards.  It is downright flattering to have your passion reflected by nice comments and appreciation of your work.  Sooner or later, however, I (like many compassionate surgeons) may be maligned by an unhappy patient with an ax to grind.  No one likes to hear negative comments about themselves, if they are serious about what they do for a living.  I have one friend who is truly a world class surgeon and is very good at what he does.  He had an unhappy patient (as all doctors will from time to time) that made it their hobby to assassinate this surgeon on virtually every forum that would accept a post.  Due to this, this surgeon has been very discredited for what was not really his fault.  To his defense, he did not deserve it.  There may be others that do.  Some doctors are complacent and are not patient oriented.  They may have consistent poor outcomes and unhappy patients.  A person like this may warrant the bad publicity, but we should all stop and take a deep breath before we discredit someone.  We have all gone to a great restaurant and had a bad meal, or gone to a famous vacation destination and had poor service, etc.  The same can happen with cosmetic surgery.  Because one patient had a bad experience or outcome may not mean that all patients would have the same.  A complication may be the surgeon’s fault (we are human too) or it may have been the patient’s fault.  Some patients refuse to follow pre or post op instructions, others use medications they are warned not to.  Some patients smoke and lie about it and some patients just had bad luck. 

I have been very fortunate that I have been able to have positive dialogue with 99.9% of my patients from the time I meet them.  I always try to personally answer emails on a timely basis, I give all my patients my cell phone number and I am surrounded by a great compassionate and caring staff.  It is not that we never have problems because if you have a very successful and busy practice, you will have problems from time to time.  The most critical thing is how they are handled.  Sometimes it is merely the fact that the patient does not understand, or they are anxious and communication, hand holding and compassion go a long way.  Sometimes, they feel that the surgeon is not responsive or has done something wrong.  Sometime it as simple as the surgeon saying “I am sorry”.  Sometimes the patient is totally unreasonable and sometimes the doctor may be unreasonable.  Fortunately, most successful surgeons have good people skills and are able to smooth out the things that happen.  Sometimes a good surgeon gets a bad patient and vice versa.  Successful surgeons become good at “picking” the right patients.  Over the years, the surgeon and staff develop a sixth sense about patients that may be problematic.  These include patients that are know it alls, patients that don’t listen, patients that talk bad about previous surgeons and patients that are not dependable.  Many patients also have a sixth sense about surgeons, offices and staffs and can tell a genuine proficient and caring surgeon from someone who is faking it.  Having said all of this, usually the patients choose the correct surgeons and the surgeons choose the correct patients.  Everything works out well.  When it does not, it takes responsible communication from both sides to try to make things better.  The problem with some bulletin board postings is that they only tell one side of the story.  If I said that one specific hospital had a high mortality rate, it may cause many people to speak badly about it.  If I said in the next sentence that it was a hospital that only treats terminal cancer patients, you hear the other side of the story.  Some patients will never be happy no matter whom they see because they are not happy with themselves.  Cosmetic surgery requires a stable, rational and psychologically secure patient for the best outcomes.  Some patients have psychological and or image problems and have no business having cosmetic surgery.  The surgeon that operated on them has made a mistake before the first scalpel cut.  Don’t get me wrong, there are surgeons with these issues as well, most of them aren’t busy or popular.  The more good work you do, the more good press you get.  Unfortunately, it only takes one bad apple to spoil the whole bunch and we all should keep that in mind when things get sticky.  Doctors should not talk bad about other doctors or patients, that is a matter of ethics (by the way, doctors that talk bad about other doctors probably talk bad about their patients and that should be a warning sign).  Patients should not go out of their way to demonize a well meaning surgeon who may have been a victim of circumstance.  There are no official ethics here, just the Golden Rule…”Do unto others”.  Just great words for which to live ones life.

I see many patients each day and those whom have visited my website (or other sites and bulletin boards) usually have an advantage of education about what we do and how we do it.  Occasionally, I see a patient that has been brainwashed with misinformation to the point that they feel they know more about the technique than I do.  Obviously that would be a poor choice to operate on that patient.  A know it all or a patient that tells a surgeon how to do a procedure is a gamble and a set up for problems.  It is fine to ask about a given technique or discuss options, but it should be the surgeon that directs the care.  I may present the patient with 4-5 options (filler vs laser vs facelift, etc) and by providing them information such as before and after pictures, patient references, brochures, etc. they can make and informed decision.  I have heard many patients discuss things that they saw on a bulletin board and were not true, or at least not true the way I practice.  Discussion should be two way. The patient and surgeon should both talk and listen.  A bullheaded patient (or doctor) is hard to deal with. The beauty of it all is that no one “has to have” cosmetic surgery, it is totally elective.  If they don’t have a good feeling about a surgeon, they should find another one.  Same for the doctor.  If a certain patient has personality traits that do not blend in with the way you practice, then they should not operate on that patient.  One thing every patient and surgeon should evaluate between each other is “how will he or she act if there is a problem”.  That goes for surgeons and patients.

Education and bulletin boards are great things when they are factual.  You can’t believe everything you read or hear.  Remember, there are Liberian Bank schemes, people trying to steal your identity and a host of other examples of misinformation on the Web.  Be rational, fair, consider the source, hear both sides and most importantly, as you parents told you…………….if you can’t say someting nice………

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

July 8, 2008 Posted by | Cosmetic Surgery Bulletin Boards, Digital Technology and Cosmetic Facial Surgery, Doctors Badmouthing Other Doctors, Risks of Cosmetic Surgery | | 1 Comment

The Digital Age and Cosmetic Facial Surgery

Welcome to word one, day one of my blog. 

A lot has changed since the last century (8 years ago)!  While in my surgery residency I, one-day, saw a bunch of people in the surgery office huddled around a new fangled machine shaking their heads in disbelief.  One of the doctors was saying “you mean to tell me that I can put this letter in that machine and send it across the phone lines across the country and the other person can see it?”  Hail the fax machine.  Although this technology was invented years earlier, it ushered in a new age in communication.  No one in that room, on that day, had any idea that in just a few short years that the concept of email and digital images was right around the corner.  If someone would have told me that I could send a communication with pictures and video half way around the world and the recipient would read it in seconds, I would have called them crazy.  Silly me!

Now, here we are, talking on a blog…………..another word that until recently did not exist.  All of this digital progress (let’s not forget cell phones) has simplified (but sometimes complicated) communication tremendously in all facets of daily life.  For the cosmetic surgery arena, it has also been a sensation.  Previous to the Internet and digital technology, information on cosmetic surgery pretty much traveled by word of mouth and some print ads. This created pretty much a local mentality.  You knew who were the popular surgeons in your hometown or maybe a somewhat larger radius and you knew about the surgeons to the stars on both coasts.  Besides that, you did not know all that much unless you made an appointment to seek information.  Even at that, you were pretty much captive to the knowledge, skill, hype and procedures of that particular doctor.  How would you know if he or she was qualified, what their work looked like, what other options were available, what articles they have written, etc., etc.  Again, it was a local process.

The Internet and digital age has changed the local process to a global process.  You can now obtain reams of information about a doctor, his or her work, other options, what is hot and what is not in a few mouse clicks.  Now that’s progress.  In addition, you can even get preliminary consults by emailing some digital pictures, without leaving your desk chair and cup of coffee.  What’s more is that you now can challenge the suggestions with countless options presented by other surgeons performing procedures.  Pretty amazing when you stop and think about it.

What do you do with all this information?  Information can be a great thing, but too much information (TMI) can be a negative or confusing thing.  Also, with all the strengths of the Internet, there is no filter for misinformation.  So you have to take much of what you see or read or hear, with a grain of salt.  Like everything in life, we have to take the available data and balance it with a judicious decision.  Handing your face (and for that matter your life) to a surgeon is not a decision to be taken lightly.  Thankfully for doctors and patients the digital age and blogging have made this easier.  You still have to watch out for traps.  Don’t fall for “only a certain specialist is qualified to do cosmetic surgery” this is obviously self serving for that specialty.  Like Lexus saying one should never drive a Mercedes.  There is not scientific data to show that any one specialty does better or worse than another.  Another pitfall is “miracle procedures”.  When you were young, your parents told you that “if something sounds too good to be true, it probably is”.  Shame on you if you forgot that!  Although, both patients and surgeons, want easier procedures with less recovery, there are no miracles.  Unaware patients continue to fall prey to surgeons promoting “miracle procedures” only to waste time and money and having to have a “real procedure” to do the job.  More on that later.

My goal as a cosmetic surgery blogger is to provide a forum for my thoughts, goals and involvement in cosmetic facial surgery, which is not just my job, it is my passion.  I welcome your participation and thank you for taking time to peruse my written word.

Joe Niamtu, III DMD

Cosmetic Facial Surgery 

February 21, 2008 Posted by | Digital Technology and Cosmetic Facial Surgery | Leave a comment