Written for Scars1 by Michelle Alford
Joseph Niamtu, III DMD, has been practicing surgery for twenty-seven years. He is the founder, president, and medical director of one of the largest oral and maxillofacial surgery practices on the East Coast. In addition, he is currently an assistant professor in the Department of Oral and Maxillofacial Surgery at Virginia Commonwealth University in Richmond, Virginia.
Dr. Niamtu developed and operates the Niamtu Imaging System, a computerized imaging system used by plastic surgeons around the world.
In 2010, Dr. Niamtu was elected as Richmond Magazine’s “Best Plastic Surgeon to Take You Back 20 Years.”
Dr. Niamtu decided that he wanted to become a doctor in high school. He was interested in science and medicine, and had the opportunity to shadow a maxillofacial surgeon. “I watched them repair a complex facial fracture,” recalls Dr. Niamtu. “They took a destroyed face and put it back together. I knew that day that that is what I wanted to do for a living.”
|Dr. Niamtu’s Advice for Preventing or Minimizing Scars
Aggressively treat acne before it becomes uncontrollable.
When at the ER, ask the attending medic to recommend the best on call doctor to stitch up your wound.
Have a doctor monitor your new scar and make adjustments as necessary.
Ask about getting CO2 laser resurfacing within six weeks of your injury.
In addition to this experience, Dr. Niamtu chose to focus on facial surgery because of the face’s importance and complexity. He explains, “The face is unique from any other body part as it is always visible and there is little room for error. It also conveys more emotion than any other body part and is integral to our senses, communication, nutrition, breathing, courtship, and vanity.”
Dr. Niamtu spent the first part of his career working with congenital and traumatic facial injury, restoring form and function. In 2004, he limited his practice to cosmetic facial surgery only. “It’s all I do, and I love it! I am one of those lucky people that love going to work. On Sunday evening, I am excited about Monday morning!”
There is no best treatment for scars. “Each scar presents different challenges like the skin color, location, depression, or hypertrophy,” explains Dr. Naimtu. The most common techniques he employs include intralesional steroid injection, laser resurfacing, subcision and excision with plastic closure, and injectable fillers.
Acne scars are one of the few scars that can be avoided. Many scars are unavoidable, such as scars caused by trauma or surgery, but acne can be controlled to prevent future scarring. “I see many young kids that unfortunately are not getting aggressive treatment for acne and will most certainly become disfigured with acne scars. In this day and age we can control most acne, but many parents don’t understand the implications of not treating. It can devastate a patient’s self-confidence and appearance forever and is relatively easy to control before it gets bad.”
Despite the idea’s prevalence, requesting a plastic surgeon to do your stitches does not guarantee less of a scar. “Just because a doctor is from a given specialty does not automatically mean that they have expertise in wound closure. I personally know many plastic surgeons that are masterful with wounds and scars and some that clearly are not. I also know many ER docs that fall into both categories.” In addition, there are many different kinds of wounds that require different skill sets. Some wounds require anatomic expertise, such as nerve injuries, tissue loss, and severe eyelid injuries, while others are routine. Dr. Niamtu adds, “I think the best question to ask the ER doctor is who would they call if it were their family. They know the competence of all the on call docs and can be a good resource.”
Dr. Niamtu believes in the importance of monitoring new wounds and scars. Many surgeons choose to just sew up a wound and see how it’s doing in a year, but Dr. Niamtu monitors traumatic and surgical scars closely and makes adjustments as necessary. “Some scars may need pressure, some may need steroid injection, some may need resutured the next day,” he explains. He’s also a firm believer in performing CO2 laser resurfacing within six weeks of the injury. “I believe the collagen and reorganization and healing mechanics are more active in this period and that early treatment is much preferable to later treatment.”
Dr. Niamtu regularly performs pro bono surgery on children who would not otherwise have the ability to obtain treatment. “When I entered practice I made a commitment to help those less fortunate and have always had a soft spot for children,” comments Dr. Niamtu.” I also have an 8 and 10 year old son with severe physical and cognitive disabilities and that has reinforced my commitment even more.” He believes that all doctors should make a commitment to give back to their community. “I make a very good living performing elective cosmetic facial surgery and have many happy patients and impressive case outcomes. Despite this, nothing makes me feel as fulfilled as helping someone who had no chance of getting treatment.”
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