Dr. Niamtu’s Weblog

….on cosmetic facial surgery

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

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


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


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

He’s Just a Dentist!


One thing about life is that there will always be competition and competition can breed deceit, especially in people with little minds.  Some of this is natural and we see it in everyday life.  Washington Redskin fans hate the Dallas Cowboys, Democrats fight with Republicans (and vice versa), religions fight other, and so on and so on.  Most of this is taken in simple terms, but sometimes people distort fact to make themselves look better.  Case in point.  If a patient comes into my office and says something about being treated by another local cosmetic surgeon and let’s assume I don’t really care for that surgeon or that this surgeon did poor work on this patient.  It is always tempting to say something derogatory, but I never fall for the trap, I just say “oh, he is a nice guy” or simply say I don’t know them.  This is a win-win situation because we both win.  On the contrary, when the shoe is on the other foot, there are numerous surgeons in my town that will go out of their way to demean me (or other surgeons).  They are actually pretty good referral sources because I have had numerous patients leave their offices only to come to me as a patient.  These patients were either embarrassed at the unprofessionalism of the other doc or came to me and said “hey, this guy must really be hurting because he is obviously afraid of your presence, so I thought you must be pretty good to make someone talk like that in front of a patient”.  I have also had patients come to me after a good dose of bashing by some of the smaller minded competition because the patient felt that “if he talks about his colleagues like that, he (or she) probably talks about their patients in a similar vein”.  Anyhow, for that doctor it is a win-lose situation because for them to look good, someone has to look bad.  I kind of feel sorry for them that their life is like that.

On a somewhat humorous note, several of these plastic surgeons tell their patients not to come to me “because I am a dentist”.  I guess they think it scares the patient and I guess they also think that it is some type of insult.  They fail to mention that I am a board certified oral and maxillofacial surgeon, guess that year of internship and four years of hospital residency must have slipped their mind!  It is funny that a person is usually categorized by their last educational experience, not their first.  I think they should tell their patients I am a Zoologist, since that was my college major.  They also never tell their patients that I have published 4 textbooks and over 200 articles on cosmetic facial surgery or that I lecture to their peers on a regular basis or that I have one of the fastest growing cosmetic practices in the State, nope….”he is just a dentist.”

I did graduate from dental school, you have to do that to enter maxillofacial surgery.  My dental training was tremendous as I studied the head and neck (my area of expertise) for four years and honed my manual dexterity which truly has paid off in my cosmetic surgical career.  There are few people that can use their hands in such an artistic manner as dentists, so I would not trade it for the world, it has made me a better cosmetic surgeon.

Every once in a while, they may scare a patient away, but their bashing has actually encouraged patients to come to me once they find out the facts.  In addition, I have redone some of their work on patients that they scared away from my office and the patients returned with their tails between their legs admitting they were duped.  That part is not the biggest deal because all surgeons at some time probably have work redone by someone else (including mine), but it seems that I have seen more complications from my loudest opponents that the other competition.

Who ever said “if you can’t say something nice about someone, don’t say anything at all” was right on the money.  For more information about cosmetic facial surgery in Richmond, Virginia see www.lovethatface.com

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virgina

November 10, 2008 Posted by | Doctors Badmouthing Other Doctors | , , , | 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

When Doctors Talk Bad About Other Doctors.


Surgeons are no different than other people in society.  There are good ones, there are bad ones and there are jealous ones.  Since many specialties are involved in cosmetic surgery, there is certainly competition.  Realizing this, there will be some surgeons that are very successful and there will be surgeons that are barely making it.  The busy surgeons are obviously doing something right and probably have a good bedside manner, probably do good work and probably are ethical.  The ones that are not busy may have a problem with one of the above.  It is simply low class to berate a competitor in the presence of a patient.  Some doctors are known for this, they simply talk bad about competitors, somehow thinking it makes them look good.  In fact, it is a dead giveaway about their true personalities and possibly about their skills and outcomes.  Busy and fulfilled surgeons don’t have time to gossip because they are succesful in their profession.  Doctors that badmouth competitors are obviously hurting and/or  jealous.  The apparently don’t realize how petty this makes them look and they don’t realize that the patients see right through this behavior.  There are a few surgeons in my hometown that take great lengths to say negative things about me , my profession, my outcomes, etc.  What they don’t realize is that they have become good referral sources for my practice.  They actually embarrass  patients as no patient feels comfortable seeing childish and jealous behavior.  I have had a number of patients come to my office for surgery after having consults with some of these surgeons and they related their conversations and told me that they were so uncomfortable with that behavior that would never go back.  Thanks guys!I have recently had several patients come to the office and tell me that one of the local negative surgeons told them that I dilute my Botox and not to come to me.  I, and the patient, got a good laugh out of that.  First of all, everyone dilutes their Botox….it comes as a powder, it has to be diluted!  I am the only Platinum Plus Botox provider in my city and the surrounding area, and that includes a number of group practices and doctors of any specialty.  Obviously, I did not get that distinction by ripping off patients.  My Botox preparation is well within the accepted norms and the unkind works of my detractors underline their lack of knowledge about Botox, as it is the number of units that are given that makes the difference. Using 1 cc or 4 cc’s of saline has no bearing on the outcome.  Again, this doctor has referred me several patients by his grumpy nontruths and inaccuracies.  Doesn’t Dr. Badmouth realize that  patients are smart and informed?  Jealousy is a terrible thing.Another common means of berating a surgeon is for the detractor to say that “they fix all the problems from Dr. X”.  Again, how stupid do they think patients are?  If Dr. X is really that bad, how does he or she stay in business?Gossip is a very destructive force.  Gossip is a situation where one person says something about another person when they are not around to defend themselves.  Gossip is done by idle people.  Busy people don’t have time to gossip.  Do you think there is much gossip in the front lines in Iraq?  In my experience, busy, competent surgeons don’t gossip.  They are too busy and too successful.  Doctors who do gossip or go out of their way to be negative obviously have personal problems and problems with their own identity or ability.  Their false words are self serving and thinly-veiled admissions that things aren’t going well for them.  The best way for a surgeon to counter act these childish doctors is simply to succeed.  It just kills them!One of the patients that ended up coming to me for a large and successful surgery told me that after leaving the office of Dr. Badmouth, they wondered if a doctor would disparage another doctor in the privacy of his office, what does he say about his patients in the privacy of his other life?The funny thing is that we will all, from time to time, see complications from competitors and they will see some of ours.  When I see unhappy patients from Dr. Badmouth (and believe me I have seen some), I simply tell the patient that these things can happen to anyone and they should go back to that doctor to give them the opportunity to make things right.Big people say big things and little people say little things.  Any patient that hears such unprofessional gossip about a competitor should think long and hard about if they really want to deal with a doctor who is so insecure, as this can boil over into other parts of their care.Like your mom told you when you were young….”if you can’t say something nice about someone, don’t say anything at all”.  A few basic rules to consider when seeing any surgeon are:·         If they badmouth other surgeons, something is not right·         Can they show you many pictures of their work?  If they cannot, what kind of work do they do?·         Do they fear or talk you out of a second opinion?  This may indicate problem.·         Do they teach, publish in medical journals and lecture in their profession.  This is usually the sign of an accomplished and respected surgeon.·         Do they have a fully accredited facility in their office?  This is a task of awesome proportions and not having this type of accreditation may say something about their meeting these standards.·         Do they tell you that only surgeons in their profession are qualified to do cosmetic surgery?  Educated patients know that this is a myth as there are very successful and qualified surgeons form many specialties.  There is no proof that any specialty has better safety or better outcomes than any other specialty.·         Are they board certified?  Board certification in any specialty is important and means that the surgeon has met rigorous testing standards.·         Are they available if you need them?  Concierge care is not a new concept.  Caring surgeons make themselves very available to their patients.·         Finally, does the surgeon seem like a good guy or a good lady?  You want to trust your life and surgical outcome on a surgeon that you can feel good about.


Joe Niamtu, III DMDCosmetic Facial SurgeryRichmond, Virginia

March 26, 2008 Posted by | Doctors Badmouthing Other Doctors | , , , , | Leave a comment