Dr. Niamtu’s Weblog

….on cosmetic facial surgery

Lip Piercings Gone Bad

Facial piercings have become popular but sometimes present problems.  This video shows a patient with overgrown lip piercings that could not be removed.  Dr. Niamtu removes them with a quick surgical procedure under local anesthesia.  Warning: shows live surgery procedure.

For more information about cosmetic facial surgery by Dr. Joe Niamtu, III visit http://www.lovethatface.com

Joe Niamtu, III DMD

January 27, 2013 Posted by | Body and Face Piercing | , , , , , , | Leave a comment

Injectable Fillers in a Busy Cosmetic Facial Surgery Office

collage3 January is always an interesting time of the year as we review and reflect on our procedure numbers from the previous 12 months.  I was both amazed and intrigued to have injected 1,761 syringes of filler in the past 12 months.  I knew I was in the top 10% of injectors nationally, but did not ever really count the volume in the past as we mostly tracked surgical procedures.  What is also notable is that I personally do all filler and neurotoxin injections in my office.  Some practices have multiple physician injectors or non-surgical staff such as nurses and nurse practitioners that may inject.  In our office it is just me, so 1,761 syringes of filler means I was really busy.

In further reflecting about the popularity of injectable fillers, so much has changed in 15 years.  For those of us that were using fillers in the 1990’s, the choices were pretty slim.  Basically we had Zyderm and Zyplast which was collagen from cow tissue.  One big draw back was that some patients could have severe allergic problems and when mad cow disease surfaced, it upped the scare factor for animal collagen.  Allergy was rare, but allergy testing was a hassle because the patient had to come in a month before injection to have a test dose to determine allergic response.   Hard to imagine now in this day of “walk in/get injected” treatment.  The other and biggest problem of collagen filler was that it simply did not last.  It did OK for fine lines and wrinkles but sometimes only lasted a matter of weeks.  It was also pretty “creamy” in texture and did not do much for lifting or plumping.

Fast forward 10 years and NASHA fillers were introduced.  This stands for Non Animal Stabilized Hyaluronic Acid.  Hyaluronic acid is a naturally occurring carbohydrate that is found in many body tissues.  It has the consistency of hair gel and can be produced in thin and thick formulations.  The thinner (more watery) formulation (Restylane, Juvederm Ultra, Belotero) are used more for fine lines and wrinkles or outlining lips.  The thicker formulations (Perlane, Juvederm Ultra Plus, Voluma) are well suited for more robust applications like lifting or volume restorations, such as filling cheeks and smile lines.  If you desire more trivia, this viscosity or adhesivity is referred to as “G Prime”.

These hyaluronic acid fillers have been game changers because there are no allergy problems, and the results last for up to a year.  Another huge advantage of the hyaluronic acid fillers is the fact that they can be reversed overnight.  Although most patients want their filler to hang around, there are times where they may not like the result.  Injecting hyaluronidase (an enzyme that dissolves the filler) can reverse the result in a matter of hours.  That can be a great insurance policy.  Although we have semi-permanent and permanent fillers, they cannot be reversed and permanent filler can turn into a permanent complication.  I personally inject Radiesse and fat which are semi-permanent filler and silicone oil which is permanent filler.  Where and how we use these types of fillers is different from every day filler applications.  95% of patients are best suited for hyaluronic acid fillers.

Finally, the other reflection about fillers is how our usage has changed over the past 15 years.  I can promise you that no one ever walked into my office in the mid 1990’s and asked for cheek, teartrough, or brow filler.  In one respect, we did not think about it and in the other respect, it would not have worked well with the available products at that time.  Today, we use fillers in the upper face for forehead lines, eyebrow lift, and crow’s feet wrinkles.  We use them in the midface for teartrough, cheek, smile line and nose treatment, we use them in the lower face for lip, chin, jowl, mandibular angle and jawline augmentation.  The versatility of modern fillers has been both exponential and amazing and is truly an enjoyable part of my practice.  I routinely publish on filler use and technique and teach courses major filler companies to train other doctors.  I love performing surgery, but I also enjoy the artistry and sculpting that involves injectable fillers.  This is one of the reasons my job is so much fun.

January 27, 2013 Posted by | Lip and Wrinkle Fillers, Lip Augmentation, Minimally Invasive Cosmetic Facial Surgery, Removing Excess Lip & Wrinkle Filler | , , , , , | 3 Comments

Tell Me About Belotero, the Newest Injectable Filler

Belotero is the newest FDA injectable filler available in the USA.  It has been used for years in Europe with excellent patient satisfaction and safety margin.  This filler is unique in several ways.  Most notably, it is made with a dual cross linking process that gives it some of its unique properties.  The biggest advantage with Belotero is that it can be injected very superficially for fine lines and wrinkles.  This is important as many other fillers are too thick (honey like) to be injected in the very superficial dermis and when this is done, it can leave a thickened line.  Belotero, on the other hand is engineered specifically for superficial injection.  I must say that when I began using it for fine lines and wrinkles it was hard to believe how superficial it could be injected.  Having said that, it can also be used like conventional fillers for deep wrinkles and lips.  I think the biggest innovation is that the company states that due to the Belotero’s particle properties, it does not cause a Tyndall effect when injecting in the tear trough region.  The Tyndall effect (in this case) is when a clear product is injected under the skin and produces a bluish hue due to the way the light is reflected.  Although harmless, it produces dusky skin that can make a patient look older, as in dark circles.  To avoid this, most fillers are injected deep on the bone in the tear trough region.  Belotero, however, due to its unique composition, can be injected much more superficially which gives the doctor more control of improving wrinkles and rejuvenating this region.  I have been using Belotero and so far have found it to live up to the claims of the company.  I will keep my blog updated on this topic.

Click here to see a video of Dr. Niamtu injecting Belotero.

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

www.lovethatface.com

March 7, 2012 Posted by | Belotero, Lip and Wrinkle Fillers, Minimally Invasive Cosmetic Facial Surgery, New Cosmetic Surgery Technology | , , , , | 1 Comment

Do I Need a Full Facelift?

I can’t tell you how many times that I (and every cosmetic surgeon) hear that question.  I think that the word “facelift” has more meanings to people than any other word in cosmetic surgery.  People ask about a “full facelift”, “half facelift”, “neck lift” and so on.  This can be very confusing to patients and some may forego treatment because of preconceived notions that are not true.

A “facelift” by definition is a procedure called rhytidectomy.  A rhytid is a wrinkle and “ectomy” means to surgically remove, so technically it refers to a surgical procedure with incisions removes skin to tighten wrinkles.  A traditional facelift includes hidden incisions in front of and behind the ear.  The skin is then separated from the underlying tissues and the deep layers are tightened.  Then the skin is pulled in a natural direction and the excess is removed.  Traditionally, the platysma (muscles in the central neck) are also tightened.

A traditional facelift does very little (or nothing) for the central oval of the face (brow, central forehead, eyes, nose and mouth).  It also does very little, if anything for tissues above the nostrils.  So, a “facelift” is more for the jowls and neck, in fact, all about the jowls and neck. Now you know what a facelift really is!

The “wrinkle” in this description (yes, pun intended) is that not all surgeons do the same surgery the same way.  Some surgeons omit the platysma procedure.  Personally I think that is short changing the patient, although very young patients may not need a platysmaplasty.  Also, some surgeons “invent” shortcut facelift procedures where they omit the incision behind the ear.  I am always leery about someone who takes a procedure that is 100 years old and puts his or her name on it, or even worse, a corporate name.  Again, facelift surgery has been around for a century and all the tricks have been attempted and abandoned because a short cut in surgery almost always translates to a short cut in result and longevity.  Some surgeons try to avoid several inches of incision behind the ear and end up doing a procedure that will begin to relapse in several years.  These types of shortcuts always claim easy surgery with fast recovery.  Remember, in cosmetic surgery, you always get what you pay for….not in terms of money, but in terms of recovery.  The cosmetic consumer should always be cautious about any surgery that deviates significantly from the standard of care in technique.  Just because something is new, does not make it better.  Obviously, we do make advancements in materials and techniques, but if and when that happens, it becomes widely adapted and the norm.  Any patient that is looking at a “new” or “miracle” procedure should ask the surgeon to see 20 pictures of patients that had this procedure by same surgeon and the pictures should be 1-2 years after the procedure.  If a surgeon can’t show you that (for any procedure) you better think closely about getting surgery that is different from the way most surgeons do it.  Cosmetic surgery patients often get the short end of the stick from hype delivered by companies, media and surgeons.  If it sounds too good to be true, it is!  If someone invents a new and radical improved facelift procedure, it won’t be in TV ads, it will be front page news.

So, back to the“facelift” definition.  Much of the confusion about the definition of the word comes from a patient’s experience.  A patient may have “rhytidectomy” but also have a brow lift, eyelid surgery, cheek implants, chin implant, laser skin resurfacing, etc.  So when this patient tells someone they had a “facelift” the listener may assume that a facelift includes all that additional surgery.  They would be wrong!  Rremember, a facelift primarily addresses the jowls and neck.  The patient merely had other procedures along with their facelift.  When you get your engine tuned up, it may include a wheel alignment at the same time, but technically, an wheel alignment is not part of a tune up.

The best way to keep this all simple is to divide the face into 4 segments:

  • Upper face
  • Midface
  • Lower face and neck
  • Face and neck skin

Each of these regions concerns separate cosmetic procedures to address the aging in that area and the facelift concerns the third item on the list.  Also facelifts come in three sizes; small, medium and large.  It is basically the same procedure in different versions.  Patients in their early 40’s may need a small lift, while patients with more aging need bigger versions of the same operation.

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

http://www.lovethatface.com

February 27, 2012 Posted by | Cosmetic Facial Surgery Consultation, Cosmetic Surgery Education, Facelift Surgery | , , , , , | Leave a comment

Niamtu Cosmetic Facial Surgery Course recieves 17.5 AMA PRA Category 1 Credits™

Dr. Niamtu has been training surgeons from multiple specialties with live observational cosmetic facial surgery courses since 2004.  Hundreds of surgeons from the USA and all over the world have come to Richmond, Virginia several times a year for this course.  We are honored to have been accredited through St. Louis University School of Medicine for continuing medical education credits.  This is an honor for our course and now eligible attendees can officially obtain CME credits.  This is truly a milestone for our course and underlines our committment to provide cosmetic facial surgery education to teach contemporary cosmetic facial surgical procedures to enhance patient safety and predictable outcomes.  For more information visit www.cosmeticsurgeryeducation.com

ACCREDITATION:  Saint Louis University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. AMERICAN MEDICAL ASSOCIATION: Saint Louis University School of Medicine designates this live activity for a maximum of 17.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

To find out more about cosmetic facial surgery in Richmond, Virginia by Dr. Joe Niamtu, III visit www.lovethatface.com

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

http://www.lovethatface.com

February 22, 2012 Posted by | Academic Cosmetic Surgery, Cosmetic Surgery Education | , , , , , , | 1 Comment

Dr. Niamtu on NBC 12 discussing gauged earlobe repair

Click above to view video

I have written a blog on repair of gauged earlobes in the past ( https://niamtu.wordpress.com/category/earlobe-repair/) and was recently involved in a news story on NBC 12.  Anchor Curt Autry discusses the societal impact of earlobe expansion and interviews two female patients on what let them to expand their earlobes and why they had them surgically corrected.  The story provides good insight into the practice of earlobe gauging.

To find out more about cosmetic facial surgery by Dr. Joe Niamtu, III in Richmond, Virginia, visit http://www.lovethatface.com

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

http://www.lovethatface.com

February 20, 2012 Posted by | Earlobe Repair, Gauged Ear Lobe Repair | , , , , , | Leave a comment

Joan Rivers and Cosmetic Facial Surgery

 

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

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

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

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

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

http://www.lovethatface.com

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

Dr. Niamtu’s Textbook Published in Spanish

 

One of the biggest honors of my academic life was being asked by Elsevier Inc. to publish a major textbook on cosmetic facial surgery.  Most textbooks are published by many authors, but I published the text by myself (except for one awesome chapter on nose surgery by Dr. Angelo Cuzalina) which was a nonstop two year project, of course in my “spare” time.

The textbook has done very well and has sold several thousand copies to date which are good numbers for medical textbooks.  I was excited when Amazon.com began offering my book in a Kindle version as that represents another milestone.

I was recently informed by the publishers at Elsevier that the book has now been translated to Spanish, which of course in a great honor.  Cosmetic facial surgery  is very popular in many Spanish speaking countries and it is a great feeling to know my work will contribute to international surgery education.

I have also been told that other translations are pending which of course makes me proud.

To learn more about cosmetic facial surgery visit www.lovethatface.com

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

http://www.lovethatface.com

February 12, 2012 Posted by | Academic Cosmetic Surgery | , , , | 1 Comment

Simultaneous rejuvenation of the lower eyelids and the cheeks is a winning combination.

This image shows an actual surgery patient of Dr. Niamtu.  The aging midface (left) is rejuvenated by lower eyelid surgery and cheek implants (right).

 

Facial aging is an interesting multi factorial phenomenon.  Many things contribute to an aged midface including sun damage to skin, atrophic and gravitational changes to fat, muscle and bone.  Two of the biggest things that make us look old and tired occur in the lower eyelids and cheeks.

The lower eyelids can undergo aging changes as early as the third decade.  The skin becomes crinkly and sags, fat can protrude from around the eyeball and produce sausage shaped fat bags on the lower eyelids.  This protruding fat also causes a shadow from overhead light which contributes to the dreaded “dark circles” under the lower lids.  In addition, due to the aforementioned changes, the “tear trough” (technically the nasojugal groove) becomes accentuated.  This produces a deep grove under the eye from the side of the nose across the cheek.

Extremely related to midface aging is volume loss in the midface.  Young patients have full, plump and rounded cheeks.  This good fat in good places produces a smooth, continuous contour under the eyes and around the cheeks.  Gravitational and atrophic aging changes causes volume loss in the cheeks and gives us a drawn, gaunt and hollow appearance.  This is also very related to the lower eyelid aging as the lower lids are the upper cheeks.  The combination of aging produce an old and tired look and the only means to address this aging comprehensively is to address both the lower eyelids and cheeks at the same time.  I find it rare that patients with lower eyelid aging don’t need attention to the cheeks (midface).  I would say that 95% of my lower lid patients that are over 40 would benefit from simultaneous midface augmentation.  Fortunately, many of these patients understand this and combing procedures.

My approach to the healthy lower lid is pretty simple.  I remove conservative fat with a laser incision from the inside of the lid (transconjunctival blepharoplasty).  This means no external scar and no bleeding due to the laser.  No bleeding means faster surgery and recovery with less bruising and pain.  I am always very careful to only recontour the excess fat as not to produce further volume loss.  The second step of lower eyelid rejuvenation is addressing the aging skin of the lower lids.  Although some surgeons still cut off lower eyelid skin, I think that is a bad idea.  It only stretches the skin; it does nothing for rejuvenating the skin.  The skin will return to its normal wrinkling in a short time.  More of a problem is the fact removing skin from the lower eyelid can also contribute to lower eyelid malposition.  Due to the scarring that can occur inside the lower lid, the eyelid can be pulled down which looks unnatural and can cause problems.

To truly rejuvenate the lower eyelid skin, it needs to be resurfaced.  I prefer CO2 laser resurfacing or chemical peeling.  These modalities actually remove wrinkles and brown spots and makes new, younger skin. That is truly rejuvenation!

Since the aging does not stop at the lower lid, this is an excellent time to also address the midface.  The patient is already sedated and will be taking a week off of work, so why not be comprehensive with the rejuvenation?   My most common method of augmenting the aging midface is the use of silicone cheek implants. (Click here to view a video about cheek implants and facial aging)There are many reasons that I like cheek implants.  Among them is the fact that they are inserted from the inside of the mouth so there is not visible scar.  They are held to the cheekbone with a micro screw, so they are permanent, but they can be changed or removed in 30 minutes if the patient desires.  Not many things in cosmetic surgery are permanent but reversible!

By placing cheek implants, the youthful contour of the midface is reestablished and many times the tear troughs and even the nasolabial folds are also improved.  Alternatively, the cheeks and tear troughs can be volumized with injectable fillers.  This is non-surgical and is also reversible.  The downside of midface filler augmentation is that it is a temporary fix.

Simultaneous rejuvenation of the lower eyelids and the cheeks is a winning combination.  If a patient seeks lower eyelid rejuvenation and the surgeon does not discuss the midface aging, a second opinion may be in order.

To find out more about cosmetic facial surgery by Dr. Joe Niamtu, III in Richmond, Virginia visit www.lovethatface.com

 

Joe Niamtu, III DMD

December 6, 2011 Posted by | cheek implants, Cosmetic Eyelid Surgery, Eyelid Surgery, minimally invasive facelift | , , , , , , , | 4 Comments

Dr. Charles Hard Townes: I Met The Man That Invented LASERS

Dr. Niamtu and Dr. Townes in 2010 

I have had my picture taken with a lot of people, I guess you could say it is sort of a hobby, like some people collect coins, etc.  I have John Glenn, Neil Armstrong, Steven Spielberg, a President and a VP as well as many celebrities and sports figures.
One of my proudest handshakes was with Dr. Charles Townes.  This guy pretty much invented the LASER.  That includes the one on your key chain, the ones I treat patients with and the ones on our military aircraft.  Talk about a cosmetic surgery super hero!  When we chatted, he talked about Einstein’s  opinion of his project!  He worked with Einstein, I had goose bumps, I felt like I was standing next to Sir Issac Newton! The following is a shortened biography courtesy  of Wikipedia.  Thanks for all you have done Dr. Townes!  The hundreds of people that I have helped with scars and wrinkles with my lasers have you to thank.
Townes was born in Greenville, South Carolina on July 28, 1915 and in 1964 received the Nobel Prize in Physics with N. G. Basov and Aleksandr Prokhorov for contributions to fundamental work in quantum electronics leading to the development of the maser and laser.
Townes completed work for the Master of Arts degree in Physics at Duke University in 1936, and then entered graduate school at the California Institute of Technology, where he received the Ph.D. degree in 1939 with a thesis on isotope separation and nuclear spins.
A member of the technical staff of Bell Telephone Laboratories from 1933 to 1947, Townes worked extensively during World War II in designing radar bombing systems and has a number of patents in related technology. From this he turned his attention to applying the microwave technique of wartime radar research to spectroscopy, which he foresaw as providing a powerful new tool for the study of the structure of atoms and molecules and as a potential new basis for controlling electromagnetic waves.
At Columbia University, where he was appointed to the faculty in 1948, he continued research in microwave physics, particularly studying the interactions between microwaves and molecules, and using microwave spectra for the study of the structure of molecules, atoms, and nuclei. In 1951, Townes conceived the idea of the MASER, and a few months later he and his associates began working on a device using ammonia gas as the active medium. In early 1954, the first amplification and generation of electromagnetic waves by stimulated emission were obtained. Townes and his students coined the word “MASER” for this device, which is an acronym for microwave amplification by stimulated emission of radiation. In 1958, Townes and his brother-in-law, Dr. Arthur Leonard Schawlow, for some time a professor at Stanford University but now deceased, showed theoretically that MASERS could be made to operate in the optical and infrared region and proposed how this could be accomplished in particular systems. This work resulted in their joint paper on optical and infrared MASER, or LASERS (light amplification by stimulated emission of radiation). Other research has been in the fields of nonlinear optics, radio astronomy, and infrared astronomy. He and his assistants detected the first complex molecules in the interstellar medium and first measured the mass of the black hole in the center of our galaxy.
In 1961, Townes was appointed Provost and Professor of Physics at the Massachusetts Institute of Technology (M.I.T). As Provost he shared with the President responsibility for general supervision of the educational and research programs of the Institute. In 1966, he became Institute Professor at M.I.T., and later in the same year resigned from the position of Provost in order to return to more intensive research, particularly in the fields of quantum electronics and astronomy. He was appointed University Professor at the University of California in 1967. In this position Townes is participating in teaching, research, and other activities on several campuses of the University, although he is located at the Berkeley campus.
In addition to the Nobel Prize, Townes has received the Templeton Prize, for contributions to the understanding of religion, and a number of other prizes as well as 27 honorary degrees from various universities.
To find out more about Dr. Joe Niamtu, III Cosmetic Facial Surgery in Richmond Virginia, visit www.lovethatface.com

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

October 10, 2011 Posted by | Academic Cosmetic Surgery, Laser Resurfacing, New Cosmetic Surgery Technology, Personal, Technology | , , , , , | Leave a comment