Dr. Niamtu’s Weblog

….on cosmetic facial surgery

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


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

Laser Treatment of Burn Scars on the Today Show: Miracle or Not?


On May 28th the Today Show ran a very interesting segment about a very touching story of very pretty triplets that were badly burned in infancy and were treated with a new laser treatment to improve their burn scars.  The laser was the Lumenis Encore laser and the Deep FX laser, also made by Lumenis.

I have received many phone calls from excited patients who have burn scars or have relatives with burn scars, requesting the “new miracle laser that cures burn scars on the face and body”.  I want to say that I have the very laser that was featured and I am a huge fan of Lumenis lasers.  I also want to say that I am a bit disappointed that the general public may have come away from this feature with the idea that a huge breakthrough in burn treatment has been discovered.  I truly hope that it will advance the treatment of burn scars because that would truly be a huge advancement for humanity and the people that suffer from burn scars.  As a father of two severely disabled young sons, I personally know a parents heartache of seeing a disfigured child.

One problem of the media taking hold of a “new” treatment is that it is frequently presented as a huge worldwide breakthrough in medical advancements.  Sometimes it may be, but most frequently, these stories sensationalize these treatments and put the cart before the horse.  The problem is that viewers get the idea that this is world changing technology.  If a treatment is available that could truly and radically improve burn scars, it would be Noble Prize worthy, not just Today Show worthy.  We have seen the Today Show (and Oprah and other shows) present such “huge surgical advances” as the Thread Lift, The Fraxel laser, the Liquid Facelift and many other procedures that sounded sensational, but proved to be almost useless, let alone a breakthrough.  The key phrase with so many of these treatments is that “the results exceed the expectations”.

Dr. Jill Weibel is a friend of mine and she is one of the nicest and most compassionate doctors I have met and a leader in laser technology.  I believe this type of laser treatment for burns is in the really early stages of usage and that much more long term follow up must be done.  A study by a university burn center with long term follow up would be news worthy.  Single treatments with admittedly minor improvement (the video I saw showed one of the triplets stating that she thinks that she and her boyfriend can see a little improvement is not testimony for a medical breakthrough.  I say this realizing that she has only had a single treatment and perhaps more improvement will be observable with additional treatments.  I hope this is the case because Lumenis is a credible company that would love to be part of such a break through.  I do think, however, that the “miracle” hype on this story is premature and has been presented in too much of a sensational way.  The only bad thing about this is that it can lead the tens of thousands of burn patients to think that something has arrived to change their life.  I wish it were true, but I personally don’t think it is.  I really want it to be true.

Too often the media sensationalizes medical treatments and the public gets misled.  I am not expecting this treatment to be as sensational as presented and it is my fear that like the numerous patients that have contacted me that thousands of others around the country may be given false hope.  My phone rand many times after this story ran and I too have used the Deep FX technology on scars.  The thought of improvement with the new is exciting but it is too early to brand it as a “miracle”.  As academic surgeons like Dr. Weibel and others continue to blaze new trails with this type of fractional laser, the cosmetic treatment of burn scars may become a reality.

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


Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virgina

May 31, 2009 Posted by | Can Cosmetic Facial Surgery Change Your Life?, Facial Scar Treatments, Laser Resurfacing, New Cosmetic Surgery Technology, Technology | , , , | Leave a comment

Keloid Scars of the Face and Neck

Cosmetic facial surgeons frequently see patients with keloid scars.  There are many types of scars.  Hypertrophic scars are those which enlarge within the boundaries of the original scar and keloid scars are those that enlarge outside the boundary of the original scar.  Due to this, keloids can become quite large and disfiguring.  Although any race can develop keloids, they are most common in darker skin types.  The actual cause of keloids remains unknown but they frequently develop as a response to irritation, such as ear piercings, traumatic lacerations or surgical incisions.  Some areas of the body are notorious for forming keloids such as the earlobes or the sternum (breast bone) in open heart surgery incisions.

Over the years there have been many different treatments for keloid scars.  Although it is tempting to merely excise them, they will most often return with a vengeance, growing larger than the original keloid.

One of the most simple and frequently effective treatments for keloids is injection with an anti inflammatory steroid such as Kenalog (triamcinalone).  This causes the keloid to shrink and repeated injections can be quite effective in softening and reducing the size of the keloid.  A chemotherapy drug called 5 flourouracil can also be mixed with the Kenalog for even more scar dissolving power.  Sometimes injectable steroids are quite effective and can dissolve the entire keloid.


The patient above was treated with Kenalog injection only.

Another method of treating keloids is to surgically excise the keloid and begin immediate injection of Kenalog.  I have used this technique on smaller keloids with good success.

The most effective method for treating larger keloids is to surgically excise the keloid, then proceed immediately to the hospital for a single radiation to the area.  This has been my most successful treatment for very large keloids.  Although it is impossible to guarantee the the keloid will not reoccur, the combination of surgical excision and single dose radiation has been a very positive treatment in my practice.


The above keloids was treated with surgical incision and immediate single dose radiation.  This treatment is frequently covered by insurance.

For more information on the cosmetic treatment of head and neck scars and other cosmetic facial surgery procedures, see


Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, VIrginia

July 4, 2008 Posted by | Earlobe Repair, Facial Scar Treatments, Keloid Scars | , , | 1 Comment

The Cosmetic Treatment of Facial Scars

Facial scars are very common from injuries or surgical procedures.  If you call your average cosmetic surgeon and tell them that you have a recent scar, the chances are they will tell you that there is nothing that can be done for a year after the injury.  Unfortunately, this is frequently misinformation.

There is evidence that by treating a scar early, the outcome of the result can be improved.  Some studies have shown that when a scar is treated within 8 weeks of the injury or surgery that it can heal much better than waiting an extended time.  I have adopted this method of treating traumatic and surgical scars of the head and neck and it has worked well.  When a patient presents with a scar of the head or neck that is less than 8 weeks old, I will begin treatment with various modalities including steroid injection, silicone sheeting and pressure.  When the scar reaches its point of primary healing then I will most commonly treat it with the CO2 laser.  The laser performs several functions to improve the scar.  Number one, it allows uneven tissue margins to be blended or smoothed down.  Number two, it causes new collagen to be produced to fill in the irregularities and number three it helps blend the coloration with surrounding tissues.  Lasering the scar is usually done under local anesthesia and takes only a few minutes.  The area will be raw for the first 5-6 days and then be a smooth pink.  This pinkness will fade over the ensuing weeks but may last several months in some cases.

The above scar was treated with CO2 laser resurfacing about 6 weeks after the injury.  This was an exceptional result and not all scars of this type respond to such an extent from a single treatment, but this case shows the power of the CO2 laser for scar treatment. 

The above patient sustained this scar from a surgical procedure at another office.  Dr. Niamtu treated the scar with two sessions of CO2 laser resurfacing.

Sometimes the scar is lasered multiple times as it improves with each treatment.  While simple lasering may work great for simple scars, more complex scars may need surgical intervention first.  Many surgical procedures exist to make scars less noticeable by changing the direction of the scar, making it it more random (straight line scars stand out more) or making the margins even.  Sometimes Dr.  Niamtu will perform a surgical scar revision and then follow up with laser resurfacing to better blend the scar.

Some depressed scars (those that are like craters) respond will to filler injection.  By injecting silicone or other fillers, many depressed scars can be simply “popped out” by filling the base of the depression with filler.  This is useful in acne or pock scars.  Subcision is another useful technique.  Subcision is a process in which a special needle is used to break up scar tissue at the base of a depressed scar.  A depressed scar has spider web like bands called adhesions that, in part, are what keep the depressed scar tethered down.  By inserting this cutting needle under the scar and swiping it back and forth, these adhesions can be separated and allow the base of the depressed scar to rise up and fill in.  Subcision can be performed multiple times to improve a depressed scar.


This patient sustained a severe facial scar from a motorcycle accident.  This scar required surgical treatment followed by laser resurfacing and silicone injection.

There are many myths surrounding the treatment of surgical and traumatic scars.  Applying Vitamin E, commercial products like Mederma or Scar Guard or covering the scar with silicone sheeting are probably all useful, even if not scientifically proven.  Keeping a new scar protected from the sun is also important.

For more information on the cosmetic treatment of facial scars or other cosmetic facial surgery see


 Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

June 29, 2008 Posted by | Facial Scar Treatments | , , , | 2 Comments