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The Art of the Consult


The cosmetic facial consult is probably the most important time spent during the entire cosmetic experience.  This time is not only important for the patient but also for the doctor and staff.  To appreciate the true nature of the communication the patient and the surgeon must understand each other’s role.  The patient should keep in mind that the surgeon and his or her staff do this all day every day and are used to discussing personal details with patients.  For this reason the patient should not be nervous.  It is not uncommon for patients to be somewhat nervous (or sometimes embarrassed) to discuss their esthetic shortcomings.  After all, no one likes telling someone else about the things that make them look old.  Frequently patients will actually be sweating during the consultation because they are nervous.  The problem with a nervous patient is that they will not be able to talk or listen as well as a relaxed patient, so my prime advice is to relax!  The main job of the patient is to talk, but it is up to the surgeon and staff to set the stage.  By the way, I am not a big fan of surgeons that do not personally participate in the consult.  If I am a patient and I go to a surgeon’s office for a cosmetic consult and I don’t speak personally with the surgeon or have an exam by the surgeon, a red light goes off.  If a surgeon is too busy or too important to do a consult, then I question how much he or she will participate in the remainder of the surgical experience.

The way I personally set the stage is to hand the patient a mirror and simply ask them “what would you like to change about your face and neck, Mrs. Smith?”  The wrong answer is “what do you think I need doctor?”  This is an incorrect response because the patient must take responsibility and participate in describing what actually bothers them.  If a patient cannot describe what they want improved then they have not put enough time and thought into the consideration of cosmetic facial surgery.  This is no time to be spoon fed as it is extremely important for the patient to actually list the exact things that they would like to change, in the order of their importance.  Now, this does not mean that the surgeon won’t supply guidance, but again, the patient must have a good idea of what they want improved.  Then, it is the job of the surgeon and staff to assist them in expressing the problems and provide a succinct explanation of what options exist.  The surgeon must first be a good listener, then a good advisor. 

For the doctor and staff participation, it is important to remember that we consult and operate on thousands of patients a year, but the patient in the exam chair may only do this once in their life and are not accustomed to the complicated words and many times what the surgery actually does.  I tell my staff that we must pretend that each patient is the only one we will operate on this year and to assume they don’t know anything about the procedures and we must educate them like they were family.  An example is a patient that comes to the office complaining about their eyelids and requesting cosmetic eyelid surgery.  The patient may not realize that their real problem is their sagging brows and forehead and that instead of upper eyelid surgery, they may actually need a brow lift.  There are many different combinations of procedures to treat a given problem and a good surgeon will take the time to explain the options to the patient.  Please don’t misinterpret that I am saying that the patients are dumb and don’t know what they want or need, as that is far from true.  In this day and age of the Internet, most patients are very sophisticated and already know a lot of information about their aging and the contemporary treatment.  The problem is that not all information out there is accurate and sometimes it takes some reeducation.  I think it is a great advantage for my patients to study my website prior to the consult as it makes the consultation much easier.  Knowledge is power, but it has to be the right knowledge!  By the way, if something you read or hear about sounds too good to be true, it probably is!  In terms of patient pre consult “homework” it really helps to write down your concerns is descending order of what bothers you the most.  Also relevant questions about the procedure, anesthesia, recovery, complications, etc. are beneficial.  Actually having a list prevents the patient form forgetting to ask about important questions.

When the surgeon examines the patient he or she will look, touch and question.  In my consults I also use pictures of actual patients with similar problems to further explain things to the patients.  I also use models of chin and cheek implants if relevant and provide written information about the various procedures.  At the end of the consult I like to have a list of the patient’s problems as they preceive them as well as a list of the problems as I see them (and how my staff perceive them,  as I value their judgment and experience).  Finally I have a third list which involves various treatment plans and finances.  This is based on the individual patient’s health status, available time off for recovery and finances.  It is not uncommon to have several treatment plans that revolve around health, recovery and finances.  Some patients prefer to have multiple procedures all at the same time while others (for reasons of health, recovery, and finances) prefer to have fewer procedures over an extended time period.  I frequently explain to patients that “it took a half of a century for the aging to occur, so it does not have to be corrected overnight!”  Some of my happiest patients had everything treated on the same day while I have hundreds of other patients that are happy by treating their aging in steps.  The most important thing is not what you do at one time but rather what is best tolerated by the patient.  Some patients are in poor health, some patients can’t get time off and some patients can only afford a limited amount of surgery.  Each patient is different and has different circumstances and each case must be customized and approached in a different manner.  In addition, it is important to not be stressed out for the procedure and recovery.  If the patient can’t get adequate time off or if the finances put the patient in significant debt, it just adds stress to the entire situation.  Since cosmetic facial surgery is stressful in itself, additional stress only makes things worse for the patient and surgeon.  Also important to remember is that a patient never “needs” cosmetic surgery.  It is a totally elective procedure and you should never be pressured to have a procedure or multiple procedures.  There is a lot of information to digest after the consult and any surgeon or office that is “pushy” about signing a patient up for surgery may be a red flag.  A patient should only do what makes sense to them, what fits their recovery window and what they can afford.  A discount “for signing up today” may be no bargain but rather reason for a second opinion.

Another misconception is that one consult is all that is necessary.  Since I do not charge for my consults, there is no problem coming back to the office for multiple discussions.  There are multiple advantages in multiple consults as there is truly a lot of information to cover, even for simple surgeries.  In addition, it is helpful to have the patient’s spouse or caregiver present at the consult to “coach” them and understand the surgery and especially the recovery.  I welcome all my patients to return for as many consultations as they feel are necessary to have their questions answered.  Many of them take me up on that offer.  In addition, I give all my patients my cell phone and email as I believe if a patient can’t reach their surgeon, they picked the wrong one.

I encourage my patients to go home and reexamine my web page after the consult as it will make more sense after our discussions.  They leave the office with an estimate of their surgical and anesthesia fees and other pertinent material.

In summary, the initial consult is the first day of the rest of your cosmetic life and should be an equal exchange of information between the surgeon and the patient.  It should set the stage for the prospective procedures and the patient should leave with adequate information to consider having surgery.  Rarely do patients return for surgery after a single consult and in my office we have a pre op appointment to go over everything one more time.  This includes further explanation of surgery and recovery as well as the usual paperwork such as informed consent, medical forms and prescriptions.

The best patients are those whom have a firm understanding of their diagnosis, treatment and recovery.  Elective cosmetic facial surgery can positively change a patient’s life in many ways and a cooperative and informed patient can make the surgeon’s job easier.  Finally, the initial consult gives both parties a chance to “feel each other out”.  If the patient does not get the “warm and fuzzies” from the surgeon and office they may want to seek alternate opinions.  If the surgeon does not feel comfortable with the patient then they may not be eager to take them on as it has to be a win-win situation on both sides.

For more information about Dr. Niamtu’s consultations see or for more information about cosmetic facial surgery see


Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

Office Address

Joe Niamtu III, DMD
11319 Polo Place
Midlothian, VA 23113

Office Hours

Monday - Friday
8:00am - 5:00pm

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