Frequently Asked Questions
Q: I have heard that a person should only have cosmetic surgery from a board certified plastic surgeon, it this true?
A: Although there are many board certified plastic surgeons that are very proficient at cosmetic surgery, this is no guarantee for a better result. There are plastic surgeons who had considerable cosmetic training in their residencies and others who had very little cosmetic training and who perform very little cosmetic surgery. Some plastic surgeons specialize in reconstruction, hand surgery, cleft lip and palate, or burn surgery and perform little or no cosmetic surgery. There is no study or evidence to show that any doctor from any given specialty has better surgical outcomes or lower complication rates. As with so many other things in life, it is more about the person and his or her experience and outcomes that are the most important factors. It is important that your surgeon is board certified in his or her specialty, regardless of what specialty they practice. No single specialty owns the face! To say that only a certain specialty is qualified to perform cosmetic facial surgery is like saying Ford is the only reliable car, etc. All specialties are proud of what they do and no one likes competition, but patients should be very cautious about going to any surgeon that demeans their competition. It is usually a sign of insecurity or jealousy.
Fact: 80% of cosmetic surgery is performed by non plastic surgeons*
*Source: Sacramento Bee from USA Today, January 18, 2000
For more information on this topic visit www.cosmeticsurgery.org. Cosmetic surgery patients are very picky and surgeons with bad outcomes do not stay in business long. There are poor surgeons in any specialty and great surgeons in every specialty. Busy surgeons with happy patients pretty much speak for themselves.
Q: What types of doctors perform cosmetic surgery?
A: There are many qualified doctors from various specialties that perform cosmetic surgery. Plastic Surgery, Dermatology, Oral and Maxillofacial Surgery, ENT, Facial Plastic Surgery, Ophthalmology and other types of surgeons perform cosmetic procedures. Some specialties can mislead the public by indicating that their particular are of practice is the most qualified to perform cosmetic surgery. Again, all the specialties mentioned above have contributed significant advancements to the field of cosmetic surgery. There are excellent doctors all over the world in all the above specialized fields who have the experience and patient results to support their qualifications. Although any doctor can legally perform cosmetic facial surgery, it is not the degree that is the qualification. You would not let your pediatrician or psychiatrist perform a facelift even though they are a medical doctor. It is the training of the doctor. For instance, Dermatologists have added much progress to cosmetic surgery with the development of tumescent liposuction and lasers. Oral and maxillofacial surgeons pioneered and developed many head and neck cosmetic procedures as did ENT doctors. Ophthalmologists have defined the anatomy and techniques for many cosmetic eye procedures. To say that these doctors are not qualified is simply untrue.
Q: How is Dr. Niamtu’s training unique?
A: As stated above, there are numerous pathways for doctors to be qualified in cosmetic facial surgery. After college and a year of graduate school in neuroanatomy, Dr. Niamtu graduated from dental school, although he never practiced general dentistry. He next performed an internship at Charlotte Memorial Hospital (now Carolinas Medical Center) then performed a 4 year hospital residency in maxillofacial surgery. Dr. Niamtu credits much of his artistic ability, manual dexterity and mastery of head and neck anatomy to his early dental training. His medical and surgical training occurred over his 5 years of internship and residency. Training intensively in the head and neck region for 9 years after college has provided Dr. Niamtu with a very unique ability to perform cosmetic facial surgery. In addition, Dr. Niamtu holds a cosmetic procedures certification from the Virginia Department of Health professions.
Q: What is the difference between a cosmetic surgeon and a plastic surgeon?
A: A cosmetic surgeon only does cosmetic surgery. A plastic surgeon usually performs other types of surgery and may or may not perform a significant amount of cosmetic surgery. Although some plastic surgeons may do more cosmetic surgery than others, cosmetic surgeons only do cosmetic surgery and usually have much more experience .
Q: At what age should a patient consider cosmetic facial surgery?
A: There is no correct answer for this question as cosmetic facial surgery is totally elective and no one “needs it”. For some patients, heredity and genetics produce situations that may be corrected early. Protruding ears on children are usually corrected before they are 7 years old or start school. It is not uncommon to perform corrective ear surgery at 5 years of age.
Lower eyelid fat bags or an isolated fatty double chin may be corrected in the second decade. There are no rules except that the patient is realistic about the deformity and result. In reality, most patients presenting for cosmetic facial surgery evaluation are between 35 and 70. One thing that has changed is that patients are having conservative surgical procedures at an earlier age and may repeat them in their lifetime, thereby avoiding the overhaul later in life. In the past patients oftentimes waited until they really looked quite old to have cosmetic facial surgery. The result was a big, long operation with a significant recovery and 4-5 days in the hospital. In addition, the changes were so drastic that the patients often time looked unnatural. With today’s technology, so much has changed and patients do not want to wait to look old, they want to stay looking young along the way. As cosmetic facial surgery is done as an outpatient accredited office procedure it has never been easier.
Q: How long will cosmetic facial surgery procedures last?
A: This is one of the most common questions asked. In short, we cannot stop the clock, but we can turn it back. Hopefully, most cosmetic facial procedures will last a decade (sometimes longer for some patients and shorter for others.) Mother Nature and time march on and it is unrealistic to think that any procedure is permanent as we are not permanent. If you had a twin sibling and you had a facelift and she did not, then you will probably look younger forever. So, depending how you look at it, cosmetic facial surgery is a good long term investment. Also in the consideration of how long a procedure will last one must consider multiple factors such as genetics, compliance and lifestyle. Unfortunately, some patients just don’t have good skin texture and elasticity. These patients will age quicker before and after cosmetic facial surgery because it is in their genetic code. Other patients will age faster after a cosmetic procedure because they do not change their lifestyle and continue with sun damage, smoking, and over eating. Having cosmetic surgery is a good time for one to change ones habits and embrace a healthier lifestyle to look and feel better.
Q: How long of a recovery do I need for cosmetic facial surgery?
A: Some cosmetic facial surgery procedures such as Botox and Lip Injections may have no recovery while other procedures may have one to two week recovery periods. Usually all cosmetic facial surgery patients can return to work in one to a maximum of two weeks. There are 2 stages of recovery. Stage one is when the patient feels good enough to be out of bed or off the couch and begin his or her normal daily activities. This is generally several days after most procedures. Stage two of recovery is when a patient can actually go back into the public eye. Most patients will get cabin fever after a week and can usually use sunglasses, turtle necks and make up to “sneak” around. By two weeks most patients are ready to return to work. Some patients heal quickly and may only miss 4-5 days, while others swell and bruise more and may take several weeks. In many cases, eyelid surgery patients can be back in public in a matter of days by wearing sunglasses. Many face lift patients can be back to work in a week or less by wearing their hair down over the suture lines, a turtle neck to cover any neck bruising that sometimes occurs and makeup for facial bruising if indicated. We never advocate pushing recovery, but certainly understand that most patients have jobs and responsibilities and want to return as soon as possible.
Q: Does all cosmetic surgery need to be performed in the hospital?
A: Today, most cosmetic facial surgery is performed in outpatient facilities. Not merely in an office environment, but in an accredited, outpatient surgery center. For instance, Dr. Niamtu is one of the few offices in the Richmond area to have the highest level of the prestigious AAAHC accreditation. This means that these offices have passed rigid standards to ensure the best and safest patient care. Most cosmetic facial surgery procedures can be safely performed on healthy patients in the outpatient surgery center environment. The surgery center of Dr. Niamtu is set up in the same manner as the local hospitals in terms of anesthesia and surgical equipment, emergency equipment, back up power sources and patient monitoring. We also provide outside anesthesia services when required. We also have a staff of private duty nurses to accompany the patient home and care for them when requested.
Q: Should I have multiple cosmetic procedures performed at one time or separately?
A: This is a decision that depends upon what the patient wants, their health, and their ability to take time off for recovery and how much they wish to spend. Many patients elect to have multiple procedures performed at the same time as it is more convenient and cost effective. Performing multiple procedures requires only a single anesthetic and a single recovery period. Some patients wish only to have a single procedure performed, say their lower eyelids. Other patients feel that they have put off surgery for a long time and wish to “catch up” as well as to maximize their time off of work and therefore wish to do as much as possible at the same surgical appointment. It is not uncommon for a patient to undergo facelift, eyelid tuck, brow lift and laser skin resurfacing at the same surgical appointment. The limiting factor is usually the patient’s health status and the remainder is a personal decision on the part of the patient with counseling form the surgeon.
Q: Do I really need to have a physical, labs and an EKG for cosmetic surgery?
A: Yes, definitely! No one wants to go through the hassle of extra steps, but this is extremely important and in some cases, lifesaving! Our office has an AAAHC accredited surgery center and there are only a handful of facilities in Richmond with this high level of accreditation. When a surgery center is accredited they adhere to the highest standards of patient care, just as local hospitals. Although some surgeons may skimp on preoperative labs and physical, it can literally make a huge difference in your health, recovery and anesthesia.
Our office has discovered diabetes, high blood pressure, thyroid problems, anemia, and blood clotting problems, heart rhythm problems and unknown heart attack from routine preoperative evaluation. If it were not for our high standard of care, these patients may have gone undiagnosed with these problems. Hospitals require this level of preoperative work up for a reason, and we adhere to these high standards as well. A patient should be suspicious of any office that would perform significant surgery without this level of preoperative work with labs, physical and EKG. One cannot be too careful.
Q: What type of follow-up is required for cosmetic facial surgery?
A: This depends upon the procedure. Some procedures require a follow-up appointment at one week to remove sutures. Larger procedures usually require a follow-up appointment 24 hours after surgery. Follow-up is important for the surgeon and patient and there is no rule for this. The best doctors closely follow their patients. When it is easy for patients to present for follow-up, we enjoy seeing our patients on an ongoing basis. We do not charge for follow-up appointments. For out of town patients we can arrange follow up with friends and colleagues of Dr. Niamtu.
Q: Can smokers have cosmetic facial surgery?
A: Smokers can have cosmetic facial surgery procedures, but some procedures such as facelift require more caution in patients that smoke. Smokers have fewer blood vessels in their superficial tissues and for this reason can have slower healing and more complications than non-smokers. As a general rule some procedures are treated in a more conservative manner with patients that smoke. We encourage all smokers to quit, but it is especially important to attempt to stop at least 2 weeks before and after surgery.
Q: What about procedures that sound too good to be true?
A: Remember what your parents told you. “If it sounds too good to be true it probably is.” Although technology has made cosmetic surgery easier, no one has found a reliable and safe means of avoiding surgery. The media and manufacturers (and sometimes unscrupulous doctors) frequently put forth claims of new “miracle procedures” that can tighten up a loose neck in an hour or erase wrinkles without any downtime. It would be nice if this was true as surgeons as well as patients would certainly enjoy an easier or faster treatment. If something like this does develop it will be famous and all doctors will use it, not just a selected few. You won’t see a horse on the road on your way to work tomorrow because when the combustion engine was invented it was such an advantage that everyone took advantage of it. If a non surgical facelift that actually works is invented, no one will ever do surgery. Until then, it is buyer beware. A lot of patients waste money on things that sound too good to be true. Botox is an example of a treatment that lived up to its expectations. Unfortunately there are many treatments that do not pan out. If a doctor offers a treatment that is new or special or miraculous, then ask them to see 20 before and after pictures of actual patients they have treated with the pictures taken 6-12 months later. Also ask for the names of several patients that have had the treatment so you can discuss it with them. The other side of this coin is that some doctors are better with some procedures than other doctors, so what does not work for one doctor may work well for another.