Joe Niamtu III, DMD – Cosmetic Facial Surgery

Kybella: Lose your double chin without surgery

This month a drug called Kybella was approved by the FDA as the first and only non-surgical means of treating isolated fat deposits under the chin.  I recently returned from Kybella training in Miami and I am proud to be one of the first trainers in Virginia.  This video explains everything you wanted to know about Kybella and non-surgical facial fat removal.  The fee for Kybella will likely be around $600 to $900 per treatment (depending on the amount used) and most patients will require 2-4 treatments space 1-2 months apart.  This is not a substitute for facelift surgery but may offer an exciting advance in conservative treatments.

To learn about surgical and non-surgical options for cosmetic facial surgery visit


Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia



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Writing a Textbook……….Again!

both books

In 2011 I was honored to to have been asked to write a major cosmetic surgery text book for Elsevier, the largest medical publishing company in the world.  The first edition was over 1,000 pages and had over 3,000 pictures.  I did all of this myself except for a great chapter on rhinolasty by my good friend and cosmetic surgeon par excellence Dr. Angelo Cuzalina.  Looking back, I am not sure how I actually found the time to devote to such a project.

This book, despite having almost a $300 price tag sold quite well and was translated into a Latin version for Spanish speaking countries.  I have heard from surgeons all over the world who purchased this textbook and I am very honored to have written it.  When I finished the first version, I said that would be my last major writing  project of that magnitude.  I enjoy writing and have written 4 other smaller textbooks and hundreds of scientific articles, but the big book took all my spare time for 2 years.

Well, never say never!  I received a call from London from the plastic surgery division of Elsevier and was informed that my book is one that sold well enough to be rewritten as a second edition.  This was a  huge compliment as there are thousands of textbooks written every year but only a small percentage are chosen for future editions.  I was really going to tell them no, but I started thinking that it is quite an honor to write a major cosmetic surgery text for the plastic surgery division of the largest medical textbook publisher in the world.  I signed the final contracts several months ago and have been writing in every bit of my spare time since January.  I have spent some weekends typing for 10 hours.  I have to thank my wife for being a textbook widow and my staff for assisting with all the thousands of new  pictures and videos that are required for a new text.

This second edition will be a totally new book and not a reheated version of the first text.  I have rewritten each chapter and retaken 98% of all the previous photographs.  In addition I have invited friends from plastic surgery, facial plastic surgery, dermatology, oculoplastic surgery and oral and maxillofacial surgery to add new chapters to this edition.  For the surgeons that bought the first version, this will be a totally new book.

So as I pass up most of my free time again for a solid year, I am excited to turn out what I believe will be a classic cosmetic facial surgery text.  The first version was simply titled Cosmetic Facial Surgery, and the second version will be my opus, which might be a good name.  I will keep my friends posted of the progress and the availability date which I hope will be 2016.


Managing and arranging 400 photos for the facelift chapter.



Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

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Dr. Joe Niamtu and Team Win Best Cosmetic Surgeon for the Fifth Year in a Row

Style 2015

I am so excited to announce that for the fifth year in a row we have been voted first place for “Best Cosmetic Surgeon” in the 2015 Style Magazine Reader’s Choice Award.  Our goal from day one was to provide excellence in cosmetic facial surgery and I am passionate about my job.  I love going to work to interact with the greatest patients and staff in the world.  Every day we strive to deliver the best and safest patient care with most natural outcomes.

On behalf of my staff and myself I want to thank the citizens of Richmond and the readers of Style Magazine for voting us First Place for Best Cosmetic Surgeon once again.

For more information about cosmetic facial surgery visit


Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

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Busy Summer for Teaching Cosmetic Facial Surgery

Academics is a big part of my life and one of my favorite things is teaching cosmetic facial surgery.  Although I will be all over the globe in the next calendar year, I have several courses coming up soon that I look forward to each year and have been doing for a long time.

The first course is Enhanced Facial Rejuvenation at Tulsa Surgical Arts in Tulsa, Oklahoma.  My buddy and cosmetic surgeon par excellence Dr. Angelo Cuzalina and I are hosting this live surgery workshop.  We always have a great crowd and a great time and it is worth seeing Dr. C’s 25,000 square foot office that looks more like Vegas than Tulsa.


june course


In July I will once again have the honor to be part of the faculty of the St. Louis University Cosmetic Blepharoplasty and Fundamentals of Facelift Surgical Course.  There are so many well known oculoplastic, plastic and cosmetic surgeons on this faculty it is amazing.  The cadaver lab is part of the Department of Surgery, School of Medicine at St. Louis University and is a world class facility for teaching and learning.




In September this year I will host my own cosmetic facial surgery course in Richmond, Virginia.  This is our 11th  year of presenting this course and we host it every March and September.  We have doctors from all specialties and from all over the world here in Richmond and it is always a great teaching, learning and social weekend.





For more information about cosmetic facial surgery visit


Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

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Cosmetic Removal of A Sebaceous Cyst on the Face

This video shows Dr. Joe Niamtu, III removing a large sebaceous cyst on the face.  Expelling the cyst contents is graphic and may not be suitable for all viewers.

I frequently get asked about various lumps and bumps on the face.  Cosmetic surgeons frequently called upon on to treat cysts, lipomas and other soft tissue lesions because patients want the best scar possible.  A sebaceous cyst is similar to a very large pimple (marble size to ping pong ball size) and filled with various cellular contents depending upon the type of cyst.  These cysts are reoccurring and by squeezing them an expressing the contents, they temporarily improve, then return.  These cysts have a sac similar to the skin on a grape and if the sac (epidermal lining) is not removed, the cyst will return.  This video shows the entire procedure.


For more information on cosmetic facial surgery by Dr. Joe Niamtu, III visit


Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

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Inexpensive, Over the Counter, Skin Care Products that Really Work!

Oil of Olay

Although I spend my days performing surgery and injectables, skin care is a big part of our practice that can benefit each and every patient.  Women are pretty motivated and used to using products, but most guys are pretty lazy (like me) when it comes to using skin care products.  I have found 2 products from Oil of Olay that you simply use in the shower, making it easy for everyone to use, even the laziest guys.  The first product is the Ultra Moisture Body Wash with Shea Butter.  It is a great foamy shower wash and a little bit goes a long way.  So the first step is to wash with with this.

The next product is an  Ultra Moisturizer – In Shower Body Lotion.  After you wash with the body wash product, you turn the shower off for a second and apply the body lotion.  Finally you turn the shower back on and lightly rinse off.  Both of these products have generous amounts of moisturizer in them and you will definitely feel the softness on  your skin.  The great  news is that it feels smooth and not greasy.

You won’t notice a difference overnight, but I have been using this combo for several months and I really think that it has done a good job moisturizing my skin and making it less wrinkled (especially chicken skin on arms and legs :(

My wife and staff were always after me do something about my dry skin and I have finally found an effortless, inexpensive and most important……easy way to do it.

For more information about cosmetic facial surgery visit


Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

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Dr. Joe Niamtu & Staff Win Best Cosmetic Surgeon for the 4th Year in a Row


Staff Va living

I was elated to get the news yesterday that I have been voted number one “Best Cosmetic Surgery Practice” by Virginia Living Magazine for the 4th year in a row.  I am so fortunate to have the best staff in the world as well as a state of the art surgery center.  We are 100% committed to providing the safest and most contemporary surgical and non-surgical cosmetic facial rejuvenation to the best patients in the state.  My job is my passion and I truly love going to work and this award validates our hard work and commitment to “making Virginia more beautiful on face at a time”.

Thanks to all who supported us,


Dr. Joe and Staff

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Kybella: Will it be the Next Big Thing ?

Rejuvenation of the aging face and neck is my vocation, my avocation and my passion.  I have performed 1,000 facelifts and over 1,000 facial liposuction procedures.  I therefore feel extremely qualified to discuss treatments to this area.  If you have not already heard, Kybella (formerly known as ATX-101) is a drug that was approved today by the FDA for the treatment of fat fullness under the chin.  Kybella is a drug that is injected into the tissue under the chin with the intent to dissolve some of the fat.

Kythera is an extremely reputable company and has been working on this project over the past several years.  From the onset, they made the commitment to invest the time and money into developing this drug and did not take the short cut route to come to market for the quick buck.  The researchers and physicians that headed this project are all extremely respected and qualified.  I was invited to participate in the research/study at the onset but declined for several reasons.  First and foremost, true clinical research requires a special set up in the researcher’s office.  Clinical trials require a significant amount of time from the doctors and staff and the record keeping is a significant undertaking.  I have an extremely busy surgical practice and the level of research attention required to participate in such a study would be too much of a distraction to my practice.  Some of my friends that were participants in the Kybella project are very involved in drug research and have special sections of their practice and staff committed only to research.  These are be the most qualified people to perform clinical research.  The other reason that I declined to participate is because my practice is mostly surgical and my treatments to the fat under the neck are performed with liposuction and or facelift surgery, depending on the severity.  A medical treatment such as Kybella would have less impact on a surgical practice like mine.

“Getting a shot to dissolve fat under the chin” sounds too good to be true or a dream come true.  My goal with this post is to examine treatment of this region from various perspectives. It is impossible for any doctor or patient to make decisions about treating the submental area (the area below the chin and above Adam’s apple) without a firm understanding of the anatomy and most important, what is skin and what is fat.


The Anatomy

There are several types of changes to the submental area related to fat deposition and aging.  Some patients that are not overweight simply have a deposition of fat under the chin and it may be hereditary and resistant to weight loss.  It is not uncommon for some people to have genetic related areas of diet resistant fat on various parts of the body including hips, abdomen, cheeks and under the chin.  This is very, very different from patients that have fat deposits related to obesity.   Contours that are a result of being overweight can be improved with simple weight loss.  Contours that are a result of hereditary isolated deposition will not respond as well to diet and exercise.


Given the above information, the patients shown in figure 1 have isolated fat under the chin and would be good candidates for dissolving with an injectable drug.  The patients in figure 2 are not candidates for isolated fat injections because they have generalized fat, not isolated fat.   Injecting a fat dissolving drug under the chin of these patients would simply result in a dent in that region because the rest of the face and neck has excess body fat.  This is an extremely important concept.  To put this in other words, a patient with isolated fat deposit under the chin who DOES NOT have generalized excess facial fat could do quite well with isolated treatment.  This would be like doing body work on a car that only had an isolated region that needed painted.  On the other hand, reducing an isolated section of fat in a person that has fat all around that section will not have a balanced result because the surrounding fat is not treated.  In terms of rejuvenation it would be like painting only one door on your car when the entire car needs painted

kybella figure 1

Figure 1.  These patients have isolated fat deposits and may be candidates for dissolving submental fat.


kybella figure 2

Figure 2.  These patients ARE NOT candidates for dissolving fat with an injection as there fat deposition is generalized and not isolated.  Removing a small amount of fat in these patients would result in a “dent” and not be a natural reduction.


The Biggest Problem

The biggest problem that I think is going to occur as this news begins to filter through the media outlets is that people with “Turkey Gobblers” are going to think this treatment is a miracle and panacea for a youthful neck.  Again, this explanation is all about the anatomy.  As patients age, numerous changes occur.  The aging changes affect the bone, the fat, the muscles and the skin.  In a nutshell, everything sags, bags and drags!  In the submental and neck region, the deep muscles (platysma) which once formed a tight sling in youth begin to sag.  Older patients have changes in their fat deposition and the sagging skin forms jowls and the dreaded hanging neck skin (“turkey gobbler”).   If the reader does not get anything else from this post, they must understand that fat dissolving drugs such as Kybella (or liposuction) WILL NOT improve droopy, hanging skin that comes with aging.  This is usually not a result of fat, but rather a result of excess, aging skin.  In fact, in patients with excess skin and associated fat, removing the fat will actually make the dangling skin worse.  THE ONLY WAY TO EFFECTIVELY TREAT THIS TYPE OF NECK AGING IS WITH CONVENTIONAL FACELIFT SURGERY.  I capitalized the previous sentence intentionally to make that point.  The patients pictured in figure 3 would have no benefit from Kybella or liposuction because their problem is from skin excess, not fat excess.


kybella figure 3

Figure 3.  These patients have aging changes from excess skin and muscles and removing fat would have no positive impact on this type of patient.  Fat dissolving injections are ineffective in this type of patient.


Pearl #1- Kybella or other “fat dissolving drugs” will not be effective in patients with skin excess.  They will only be effective in patients with isolated submental fat.


Fat Dissolving Drugs 

Fat dissolving drugs are nothing new and have been around for decades.  They seem to come in and out of popularity every 5-10 years.  Fat dissolving injection treatments known as Mesotherapy are popular with some practitioners in this country and around the world.  Fat dissolving drugs have been met with variable amounts of success and failure.  Searching the Internet for “mesotherapy complications” will make this point.  One of the problems with many past fat dissolving treatments was the lack of standardization and much of it was “home brew”.  Hopefully the researched backed Kybella, which is FDA approved, will provide a safe and effective non-surgical treatment.


Who Will Use It?

After the hype of Kybella dies down and doctors and patients figure out where and when to use it, the true results will manifest itself and this will decide whether it is a “hero or zero”.  The first questions that patients and doctors will have is “how much does it cost?”, “how many injections are required?”, “Will it work on everyone” and “what are the complications”.  My prediction is that if this drug lives up to its promotion, it will be a procedure mostly used by non-surgeons.  Many doctors from numerous specialties are involved in cosmetic treatments.  Many of these doctors only offer non-surgical treatments which are extremely popular all over the world.  This includes neurotoxins, fillers, skin treatments, non-surgical skin tightening and non-surgical fat treatment.  Facial surgery is complex and requires years of advanced training.  Non-surgical treatments are simpler and can be much more easily learned and mastered.  Again, I think that non-surgical practices will more likely embrace fat dissolving treatments more than surgical practices.


Why Not My Practice?

I don’t think I will be using fat dissolving drugs in my practice to any significant degree.  First off, I want to say “I don’t think so” as I have learned to never say never.  If this therapy truly has a place and becomes a safe and effect treatment for selected patients, then I will be involved.  The reason that I don’t think I will be providing a lot of these treatments is the fact that I know I can effectively treat isolated submental fat deposits in 10 minutes with local anesthesia and liposuction.   Submental liposuction is a quick, safe and effective means to permanently remove or re-sculpt fat (figure 4 and 5).  It is usually a onetime procedure and the recovery is minimal.  More importantly, I can totally control and customize the fat removal and don’t have to rely on waiting to see what some injected drug will and will not do.  So for me and thousands of other facial surgeons, there is not a great advantage of an injection over simple liposuction.  For those doctors that don’t perform liposuction, the injectable produces may be a real advantage.


kybella figure 4

Figure 4. This image show a picture of liposuction being performed in the submental area.  Note the yellow fat coming out of the tubing.  This is a quick, safe and predictable treatment.


kybella figure 5

Figure 5.  These images show actual liposuction being performed in the submental and jowl regions.


kybella figure 6

Figure 6.  This patient was treated with liposuction and a chin implant.  This is an excellent patient for liposuction as she is young and does not have excess hanging skin.


kybella figure 7

Figure 7. This patient underwent submental liposuction only.  No other procedure was performed.


kybella figure 8

Figure 8. This patient underwent submental liposuction and neck muscle tightening (submentoplasty).


What are the Potential Problems?

Like any new treatment, there will be victories and defeats during the early phases of treatment.  I am sure that Kythera will control who has access to Kybella so that the initial treatments and results are safe and controlled.  If this drug does prove to be safe, effective and affordable then it may become a viable non-surgical option in the treatment of isolated fat deposits under the skin.  I am sure that there is also ongoing research for this drug to be used in the future for fat deposits elsewhere in the body such as the abdomen, hips, thighs etc.


Putting it all together

In my practice I treat isolated submental fat deposits with simple liposuction.  For advanced facial aging and for the “Turkey Gobbler” neck, my go to procedure is facelift surgery.  This is absolutely my favorite surgical procedure and I do almost one hundred facelifts a year and have done 1,000 lifts total.  This is what excites me and this is why I love my job.  There is no better feeling than reversing decades of aging on a patient.  Figures 9-11 show before and after pictures of face and neck lift patients.


kybella figure 9

Figure 9.  This patient underwent face and neck lift with chin implant.


kybella figure 10

Figure 10.  This patient underwent face and neck lift.


Kybella figure 11

Figure 11.  This patient underwent face and neck lift with other simultaneous procedures.


For more information about cosmetic facial surgery visit


Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

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Kylie Jenner Lip Challenge: Fail!!

About a year ago, the Web began to buzz with something called the Ice Bucket Challenge for ALS and it was an extremely positive, noteworthy and effective promotion to benefit ALS research.  Today there is a new challenge, the Kylie Jenner Lip Challenge.  This involves people placing a shot glass or other vessel (a baby bottle will do) and creating a vacuum for 5 minutes.  This is actually not a new thing and has been a party trick as long as there have been people, alcohol and shot glasses.



The lips are sucked into a shot glass or similar bottle to produce swelling.


The mechanism of action is that the high vacuum causes blood and cellular fluid to be pulled to the surface by the negative pressure.  The lips are very rich in blood vessels (this is why they are red) and the vessels engorge, leak and along with other fluid swell to giant proportions.  The negative pressure phenomenon can also pull enough blood out of the vessels and tissues to create immediate or delayed bruising.  This is the exact same process that produces a “hickey”.


Unfortunately, many young people actually think that this is how Kylie enhances her lips.  Although I don’t know her and have not treated her, I can promise you that this is not an effective or safe treatment.  In most cases the lips probably swell, bruise and then heal with the person saying “I won’t try that again”.  This IS NOT A SAFE Thing to do! By placing the extreme vacuum on the lips they become engorged with blood and fluid and severe bruising can occur.  When severe bruising happens, some of the pigment in the blood (hemosiderin) can stay in the tissues long after the swelling resides and cause long lasting or permanent pigmentation problems.  The lips are very fragile structures and the extreme swelling could also cause lacerations, tissue death and loss (necrosis) and scar tissue.  In short, there are not positive cosmetic effects of this fad and it could easily have a negative effects.


maxresdefault (1)  kylie-jenner-lip-challenge-cut-lip

The above images show bruising, severe swelling and lacerations from people trying the lip challenge.

Young females must also realize that although Kylie Jenner may have beautiful lips, they may or may not be natural.  I spend much of my professional life injecting filler into female lips and this is a safe and easy procedure that Kylie may also embrace.  Also, makeup and Photoshop can do things that are not reproducible on the average person.


Kylie has nice lips, but a lot of effort is probably achieved with makeup and possible filler injections.

Voluptuous lips will always be in style.  Lip injection by trained doctors with safe and effective products such as Restylane, Juvederm, and Belotero very safe treatments with natural results.  An additional advantage is these products can be reversed if the patient does not like the result.

For more information on safe lip enhancement click here

For more information about Dr. Joe Niamtu, III in Richmond, Virginia visit

Kylie llips


Just say no!

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia


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Fake Botox, FauxTox and Bogus Botox



There has been a lot of media attention recently about bogus Botox that has appeared in the United States. First of all, if you use a competent and honest doctor that only purchases their Botox from Allergan, then you have nothing to worry about. If you got your Botox treatment from a doctor in the United States who purchases Botox out of the country or from a distributor other than Allergan then you need to simply ask them to provide you the lot number of the vial from which you were injected. If your provider cannot answer this question then it raises serious questions. Fake Botox is nothing new and has shown up in this country and around the world for years.

Like Rolex watches and Louis Vuitton purses, Botox has and will be counterfeited. Counterfeit Botox can have several effects. If it is just water or watered down Botox, then either nothing will happen or a below average result will occur. If it is a preparation that has too much toxin than it can produce sickness or death. True, legal, authorized Botox is only available through Allergan or its official designates and they spend millions of dollars not only insuring a safe product and exacting dosage but also on validating legitimacy.

The biggest give away about the current fake product is (as mentioned) the absence of a Lot Number. All legitimate Botox has a lot number on the box and bottle (above figure). In addition the sealed Botox box has a double hologram protective seal. The actual bottle has a hologram on the label as well as a bar code and probably other secret identifiers. The fakes can be extremely accurate, but like counterfeit money, can be identified relatively easy. If you have or will have Botox injections, it is a totally fair question to ask your provider where they obtain their Botox and to see the lot number you will be receiving. Neurotoxins are very safe when regulated but can be deadly without control. It is illegal for any doctor to import drugs from outside the USA and many physicians have been investigated and or penalized by state medical boards for such activity.

Trying to save money is one thing, gambling with an illegitimate controlled substance with a potential to cause harm is an entirely different. I am proud to be a Diamond Level provider of Botox which puts me in the top 3% of all injectors in the USA and all my patients can rest assured that what they get at my office is one and only Allergan authorized Botox.

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

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