In this month’s “Meet the Aesthetic Expert” column, Will Kirby, DO, FAOCD, talks with Joe Niamtu, III, DMD, a certified cosmetic facial, oral, and maxillofacial surgeon, about what it means to be a KOL, his journey in aesthetics, and why investing in practice staff is always a good idea.
Welcome to “Meet the Aesthetic Expert,” where, each month, dermatologist Will Kirby, DO, FAOCD, of LaserAway, will connect with select industry leaders to get their expert opinion on the aesthetic specialty. With an emphasis on straightforward, candid questions, Kirby will focus on the best in aesthetics and get the experts’ frank thoughts on where the field is headed.
Joe Niamtu, III, DMD, is a certified cosmetic facial, oral, and maxillofacial surgeon with a practice in Midlothian, Virginia. He is considered a key opinion leader (KOL) by numerous specialties and is very prolific in academics. He has authored 7 textbooks, contributed 34 chapters in other textbooks, and has published hundreds of articles on cosmetic surgery. He has lectured on 6 continents, hosts an online video series, and cosmetic surgery courses at his surgery center. Niamtu is well-known for his intraspecialty participation and is frequently a speaker at plastic surgery, facial plastic surgery, dermatology, oculoplastic, oral and maxillofacial, and cosmetic surgery meetings.He has won “Best Plastic Surgeon” or “Best Cosmetic Surgeon” 25 times in Virginia. Niamtu is married to April Niamtu and has two special needs children.
Kirby: Hello Dr Niamtu! Let’s jump right in. What initially led you to an aesthetic career path?
Niamtu: In the mid-1990s cosmetic surgery became the core curriculum in numerous residency programs including plastic surgery, facial plastic surgery, dermatology, oral and maxillofacial surgery, Opthalmology, and others. I figured that this was the contemporary career path and the way of the future.
K: Can you please tell us a little more about your backstory?
N: Performing a 4-year maxillofacial surgery residency gave me the tools for cosmetic facial surgery. I was in practice at an interesting time in the mid-1990s when a lot of new things were introduced into the cosmetic surgery arena. This included liposuction, lasers, fillers, neurotoxins, endoscopic surgery, and material advances in facial implants. These were all a natural progression into the field of cosmetic facial surgery.
K: What's the best piece of aesthetic career advice you have received?
N: I have a few:
K: What adversity did you have to overcome on your journey?
N: My biggest adversity was not professional. I got married at the ripe old age of 47 and dreamed of having a son, which I did. My namesake Joey was born with severe cerebral palsy. One of the greatest fears of special needs parents is who will take care of the child if something happens to the parents. We underwent high-risk prenatal care with mega testing and were told that having another child with the same disabilities would be like winning the lottery twice. My second son was born 2 years after Joey and had the same level of disability. We really don’t know the genetic cause of their disabilities despite numerous genetic tests. My sons have had almost 50 combined surgeries and while other parents have memories of school plays, baseball games, and first dates, our life was spent in emergency rooms and hospital ICUs. My sons are my role models, they are the toughest guys I know. Although they are tube-fed, can’t walk, and will never say a word, they have taught us volumes about life and love. You can’t control the wind, so you have to adjust your sails. They give me incredible drive!
K: What is something interesting about you that’s never before been publicly revealed or isn’t widely known?
N: I participated in resuscitating Frank Sinatra when he passed out at a concert in my hometown of Richmond, Virginia. I was the first person to the stage and took his pulse while other doctors and, eventually, EMTs got there. My picture—along with the others on the stage—made People Magazine. I still have his EKG.
K: That’s incredible! What resources are the most effective in making your life in aesthetics easier?
N: I have a fully accredited in-office surgery center and all of my surgeries are performed with general anesthesia. Equally effective in making my life easier is my incredible team of staff members: my work family.
K: What resources (technology, human resources, staff education, marketing, etc.) should aesthetic providers invest in right now?
N: Investing in one’s staff and one’s practice are the best return of any investment. Never settling for “good” is important. Doctors that are truly immersed and passionate about what they do are continually striving for better patient safety and predictable outcomes. Investing in technology is also important. Having a qualified HR staff member is also important to keep everything and everybody on the straight and narrow.
Additionally, marketing has never been easier. Social media has given every practitioner the ability to promote their practice.
K: What aesthetic patient demographic do you believe is the most coveted? Has this always been the case? Is this shifting?
N: I think this really depends on what you want to specialize in and the “flavor of your practice”. For instance, my friends that do a lot of minimally invasive treatments and injectables spend a lot of time on TikTok and Instagram. I have primarily a facelift and eyelid practice, so my demographic is older. I have over 20 million views on my YouTube videos, so that appeals to a generally older demographic. I still have a presence on other platforms because, in this day and age, your marketing has to be contemporary.
K: What aesthetic patient population is the most challenging to deal with and why?
N: I personally think that millennials and younger patients are more demanding because they often have unrealistic views of themselves and expectations of social media. They alarm at the smallest aging flaws and think that perfection is possible. Many of them also have body dysmorphic tendencies and think they are surgical candidates when they are not. Their expectations are often inflated as well, and they want to look like male models or the Kardashians. I think there’s going to be a lot of sorry people as they age, running around with permanently overinflated facial anatomy, big butts, and fox eyes. Social media can be as damaging as it can be valuable.
K: Telehealth exploded during the pandemic. Is it here to stay?
N: Although I have always done some Skype consultation, it was never a huge part of my practice, and to be honest, I never really enjoyed doing it because I felt that there were a lot of tire kickers trying to get some free advice. I do think that the COVID-19 situation changed everything. It was a perfect storm because we have the technology with FaceTime, zoom, and other computer technology that allows accurate pre-consultation. Doctors and patients have become fond of virtual consultation. It definitely has become commonplace as 50% of my facelift patients are from out of town. We also don't use our waiting room much anymore. People find it comfortable to stay in their own vehicles in the parking lot where they have privacy and the freedom to talk on the phone or control their climate. Adversity usually begets positive change.
K: What steps should the aesthetic industry take to increase overall market penetration?
N: There are so many products, technologies, and competition out there that it has become somewhat of a rodeo. I think like anything else in life if you offer a good product and superior service you have a great chance of being successful. It is difficult in the aesthetic industry to be the second or third player in some type of technology. I always see reps, even if it's for products that I would not use. These people are trying to feed their families and I figure any person that comes into my office is a chance to show them what we do and how well we do it.
K: What role do allied health care professionals (RNs, NPs, PAs) play in aesthetics?
N: This has really changed over the last 2 decades because allied health care professionals are, —and will be—doing the market share of minimally invasive techniques, especially injectables. As much as many doctors disdain it, this trend it will definitely continue. As more and more injectors provide the same service, these treatments will become more commoditized and will probably not be profitable for physician administration. Of course, there will always be those boutique practices where people go because a doctor will treat them, but if someone thinks that they're going to prevent this trend, that ship has sailed.
K: I tend to agree with you. So, why then do so many people feel that the aesthetic industry is ripe for disruption?
N: I think that many practitioners feel that they are taken for granted and that the profiteering of many companies and industries has corporatized their practices. Many people feel that the market, industry, and conferences are stagnant with the same old stuff from the same old people. Many doctors are resistant to change, but many are movers and shakers and are inspired by change. It is this group that can change the “old guard” trajectory.
K: What is the biggest myth in the aesthetic industry?
N: That Will Kirby wears a toupee!
K: It’s all real, Joe! You can run your hands through it next time I see you! But seriously, what’s the biggest myth?
N: I think the biggest myth in the aesthetic industry is, “hey if you buy this device, you could have surgical-like results with no complications or downtime, and we will be there for you at any time if you have a problem with the device.” My recommendation is to do your homework.
K: What keeps you up at night?
N: Complications, unhappy patients (both of which are rare but happen), and thinking about retiring someday. I take off Fridays, and by Sunday night I am eager to go to work the next day. Worrying about my sons puts all the other stuff in perspective. Sometimes you look at a successful person and say “wow, they have a perfect life”. In reality, you never know the sorrows or tragedies that many people face.
K: So true. Ready for an uncomfortable question that not one of my previous interviewees has agreed to answer? What can a top aesthetic expert with your credentials reasonably expect to earn?
N: Impossible to answer but if someone is passionate about what they do and works hard, the sky is the limit!
K: In many ways, the concept of a ‘key opinion leader’ seems to have become synonymous with nepotism and greed. Why does our industry still tolerate antiquated ‘KOLs”?
N: It is a double-edged sword. I am a “KOL” with several companies. An honor to be chosen, but also an expected proponent. Luckily, the companies that I am involved with are legit and have good tech and products. We all know KOL’s that will say anything about anything as long as they get paid. I think that mainstream doctors and aesthetic companies want “testimonial” KOL’s. I take a lot of things with a grain of salt until I can investigate it. You can do a lot of harm to your credibility if you promote something that doesn’t work.
K: Why are we seeing new aesthetic products fail to launch properly?
N: I think it's very competitive out there and a lot of companies are in a rush to have their product hit the marketplace first. Sometimes this is done with haste and possibly marketed to the wrong group of doctors. Most of all, if they don't have evidence-based reinforcement, everything becomes hearsay.
K: What can the aesthetic industry do to increase diversity and inclusion?
N: I think the aesthetic industry is following the general trend of inclusiveness. Although many types of people are represented when we talk about inclusion, I still feel the people that are most underrepresented are handicapped individuals. Personally, we need to do a better job with that in general.
K: Why are we seeing decreasing interest in conferences and lower conference attendance?
N: COVID-19 has had the largest impact on the decrease of live attendance.
K: But the dramatic fall of attendance at aesthetic conferences can’t just be blamed on COVID-19, right? What went wrong? How do we fix it and/or should we even try?
N: Increased technology is also allowing high-quality CME on demand. Younger people are much less “club or group” oriented and are much more about learning things on their own time and agenda. As Netflix is replacing the cinema experience, virtual may be the wave of the future. People will always seek comradery, so maybe annual meetings will soon become biannual.
K: What advice do you have for people in the aesthetic space to avoid ‘burnout’?
N: I think the first part of your career you have to do whatever it takes to become successful and busy, period. There is a time, however, when you must start bending your work schedule to fit your life. Most doctors I know that are passionate and fulfilled know how to calculate work-life balance.
K: Name drop three individuals that represent the future of our industry.
N: Will Kirby, Suzan Obagi, Shelia Nazarian.
K: You are too kind, Joe. What is your current biggest personal operational hurdle and what could be done to fix it?
N: I’m at the top of my surgery game now, booked out for 4 to 5 months. I am satisfied with my 4-day work week for now. When I went from 4 to 5 days, I actually became more profitable. Someday, I will go to 3 days.
K: If you weren’t an aesthetic expert, what would you do for a living?
N: I would be a starving musician or stand-up comedian (again, starving).
K: What’s the funniest mistake you’ve made in your aesthetic career?
N: It may have happened today! I was zoom consulting a husband and wife for facelift surgery. I mentioned to the woman that I loved her dimples. We had a bit of a static reception and they both thought I said I loved her “nipples”. They were sort of speechless until we all figured it out and had a great laugh.
K: That's rough! What is your favorite aesthetic treatment to personally receive?
N: I am a bowhunter and fisherman with no hair. The only treatment I really do is Botox Cosmetic.
K: What is your favorite quote (mantra, etc.) that is applicable to the aesthetic industry?
N: “Be humble, work hard, be kind.”
K: With so much confusion in the industry, where do you personally go for trusted aesthetic information?
N: Mostly astute colleagues.
K: What advice do you have for someone not in the industry who wants to enter the field of aesthetics but doesn't know where to start?
N: Get trained! Start slow, walk before you run. Pick your patients carefully. Follow them closely. Always be available. Start with easy cases. Find what you are good at and pursue it. Avoid things that you don’t do well. We all have sweet and sour spots.
K: What advice would you give your younger self knowing what you know now?
N: Make as many friends as you can in diverse aesthetic specialties and visit their offices, see how successful people what do they do.
K: Excellent advice. What will the aesthetic industry look like 10 years from now?
N: As technology increases and outcomes follows, it will be survival of the fittest.
K: What does your aesthetic legacy look like?
N: “Damn, that guy was a surgeon, teacher and author. He was a nice person and made a reputation. Not sure how he got it all done!”
K: As an expert in the aesthetic industry in a powerful position, people are looking at you to lead. If you could inspire a movement in our industry, what would it be?
N: Try to get more non-monetary interaction between offices and industry.
K: How can readers get more aesthetic expert information from you?
N: Please visit www.Lovethatface.com, and check out my 20 million YouTube views by searching “Niamtu”!