Patient Versus Client
August 29, 2008 by dr. lam · Leave a Comment
I think one thing that my mentor, Ed Williams, drilled into my brain because I think his mentor, Gene Tardy, drilled into his brain was that as surgeons we treat “patients” not “clients”. During the course of my fellowship year, I was oftentimes corrected for this mistake, which gradually became part of my vocabulary, which I in turn have passed on to my staff.
I think when we as aesthetic plastic surgeons begin to perform purely elective cosmetic work, we can inadvertently start to break down the physician-patient relationship and look at the prospective individual as a “client” or “customer” since we must cater to his or her every whim. Of course, that is important but I think I agree with Ed (perhaps through the repeated brainwashing), that we have what is known as a “fiduciary” responsibility for each individual who is served under us to maintain a proper, respectful, and trusting relationship.
We are not a used car salesman (oh, sorry pre-owned is the word we like today). We are responsible for a patient in the role as a physician. That responsibility should never be forgotten. By using the right word, “patient” rather than “client” I think we can better serve that purpose, especially for all individuals (front-office staff, nursing staff, medical assistants, surgical techs, etc.) who will be involved in that patient’s care.
LEARNING TO DANCE
August 28, 2008 by dr. lam · Leave a Comment
Actually, this blog has little to do with dancing. I will explain in a moment why I am talking about dancing. This blog is about exercising your mind. We all talk about exercising your body, which you should do but we don’t talk about good exercise for your mind.
I was listening to David Fabricius a few weeks ago and he said he can spot the corporate leaders on a plane. He said look at those in first class versus economy class. Those who sit in first class are reading books on leadership, working on their laptop, and engaging with each other in fruitful conversation. Those in economy are listening to sugar-pop on their iPod, watching a mindless DVD, or reading Us weekly. Now, understand. I am not being elitist here. In fact, I usually fly economy. This blog is little to do with which class you are flying in the air but what class you are in your attitude and desires.
I think it is always important to engage in a little mindless activity. Relax and zone out. In fact, I have written blogs about that. But that is not what I am talking about here. We all should engage in a little bit of mind exercise to make sure that our mind is quick and agile.
I often here, “Boy, my mind is really out. I forget everything so easily.” Besides Alzheimer’s which is a serious condition, the reason that we become forgetful is that we don’t exercise our mind. Like our body muscles that are not subjected to good exercise, the mind also goes limp.
Every time I get a haircut from Nataliya in my José Eber salon, I learn a few more Russian phrases. First off, I really have fun doing it. Second, it helps me keep my mind sharp. Nataliya is always shocked that I can remember every single phrase she has taught me in the past year without even trying. She will teach me a very complicated sentence. Then I will promptly put the sentence out of my mind after repeating it 10 times. Then toward the end of the haircut, I see if I can remember it. In most cases I can. In fact, I can remember the phrase the next day. Now, do I have a natural facility with languages? Perhaps. However, I have trained my brain to adapt and remember things quickly. Trust me. Memory is a critical skill.
Here comes the dancing part. During my second year of residency at Columbia University in head and neck surgery, I had a 6 month block of research. I took that opportunity to spend almost every weeknight learning to do ballroom dancing. I mean everything from cha cha, meringue, hustle, waltz, foxtrot, tango, etc. When I first started learning ballroom, I couldn’t remember the third step after I learned the first step. That continued for a couple of weeks. I thought that I would never learn 10 steps, and if I learned those steps I would absolutely suck at them. What was interesting is that as the months progressed, my synapses started to become used to the movements. By the time I was done, I could literally learn about 20 to 30 steps almost the first time I was taught them. Was that a miracle? Perhaps. What it really was is the application of my mind and body through hard work and getting used to opening my brain synapses to be receptive to those changes.
My recommendation for you is to try to fill your brain with something intellectually stimulating hopefully every day whether it be reading something, working on a mental puzzle, engaging in intellectual banter, or something so that the old noggin doesn’t start to rust too prematurely.
UNDERSTANDING THE NATURE OF A TRANSPLANT
August 27, 2008 by dr. lam · Leave a Comment
Fat Grafting Evolution Photos
In January of this year, I sat for my hair transplant board examinations in Houston, Texas and am fortunate to be one of about 120 diplomates of the American Board of Hair Restoration Surgery in the entire world. It was a very rigorous examination, testing me on every aspect of surgical and medical hair restoration but also on hair loss diseases and basic science information related to hair. The thing that I want to focus on in this blog that I got out of that examination is understanding how a “free graft” transplant works. This knowledge is applicable both for my hair transplant patients and my fat grafting patients. I oftentimes joke that I am no longer a plastic surgeon but a transplant surgeon now. Okay, that was not that funny.
In Unger’s magnificent book, Hair Transplantation (4th Edition) he has a drawing of a hair follicle start to get fully connected to the surrounding blood supply somewhere around 6 months postoperatively. This is the time that a hair transplant begins to take root so to speak and start to show significant growth that continues upwards of 18 months to 2 years following a hair transplant procedure.
Now the main purpose of this blog is not to talk about hair restoration but to use it as a model for one to understand how I perceive the evolution of a fat transfer. Fat grafting, like hair transplantation, relies on placing a “free graft”, i.e., a graft placed into the surrounding tissue that must take hold for it to grow. Unlike a microvascular free flap that has the blood supply actually sewn together, these free grafts must have enough blood supply over time to become a live graft.
This is why I inform my fat grafting patients that there can be a dip in the result between the early swelling of 3 to 5 weeks and the “result” that begins to appear after 6 months when the blood supply begins to take hold. Like a hair transplant the result begins to manifest about 6 months out and improves up to 2 years post. That is also why I put together the fat grafting evolution series in my before and after gallery to help you better understand this principle. The photo shown is of my patient that I just uploaded last Friday showing her before, 1 week after, 3 months after (the dip), and 1 year following (the result but still improving).
I know many patients have a great fear that the fat transplant will not last. Simply put, that is what happens with other surgeons who do not know how to handle and inject the fat well. My fat not only lasts but improves over time. I think many surgeons at 3 months encounter one of two problems. Either their fat is gone because the fat graft did not hold well, or the fat is in the “dip” phase and they decide to go back and do a touch-up. If the fat is going to hold, the individual will look grossly overcorrected at 1 to 2 years post. This is why I always say to my patients put your seatbelt on at 3 months and patiently wait. If you dip hard (20% do), you should be fine. If not, let’s do a touch-up at a year on my nickle.
Tabata Intervals
August 26, 2008 by dr. lam · Leave a Comment
I had a menacing “spinning” cycling weekend thanks to Scott Whitten, my spin instructor, who usually does only Saturday’s class but took the helm of both Saturday and Sunday at LA Fitness in Carrollton. He is a beast, and I mean that in a good way. He is the best spin instructor I have had in the 10 years that I have engaged in this activity. On Saturday, he put us through a 100-minute spin class that focused on endurance. On Sunday, he did a shorter 60 minute workout (shorter, yeah right!) and introduced us to the concept of “Tabata Intervals”.
As you guys know in my blogs, I have focused heavily on life balance (which I am struggling to improve myself) and one of life’s balances is great exercise DAILY. I am going to introduce you to an idea that only takes 4 minutes of your time but with incredible results based on scientific studies. A Japanese exercise physiologist Izumi Tabata found that 20 seconds of intense working out followed by 10 seconds of rest cycled 8 times through for a total of 4 minutes could provide incredible improvement in both VO2 max (aerobic) and anaerobic capacities even in elite pro athletes. He found that over a 6-week period of time, this short 4 minute exercise led to a 28% increase in anaerobic functioning and a 14% increase in VO2 max.
Although his testing involved a stationery cycle, you can perform this activity with almost any exercise: sprinting, jump rope, pushups, squatting, chinups, etc. Remember this only takes 4 minutes. However, as Scott pointed out during class you must do an appropriate warmup and cool-down before and after this exercise because the higher the intensity workout, the longer the warmup and cool-down should be. Doing such a short, intense interval training can get you fitter by progressing your aerobic and anaerobic capacity but also increase basic metabolic activity to burn calories throughout the day even when you are just sitting still. For those of you working out in the dark, I truly recommend you getting a MAP test done at Lifetime Fitness (if you have one near you). You don’t have to be a member to do it. I still do it even though I moved over to LA Fitness which is closer to me. If you haven’t seen my video on MAP testing and RMR testing, click here.
One Size Does Not Fit All
August 25, 2008 by dr. lam · Leave a Comment
As you know, I have dedicated tremendous time in educating my prospective patients about my services. I really have a passion to do so. Obviously, this website only provides guidelines for what you might benefit from. That is what a personalized consultation process affords, a personalized and customized treatment plan. I spent part of yesterday adding descriptions to all of my primary (non-corrective) facial fat transfer before and after images in my new flash-based gallery to match those in the corrective section. I think if you spend some time to look at my descriptions, you will see how customized the treatment plan was for each particular individual and how I created the right mix of treatments for that person but also how I fashioned an artistic strategy based on that individual’s facial shape and desires. I think any of you coming to my office will feel the sense of how “special” you are and how not like a number you are by the way my staff treats you. That is part of our customized approach.
The idea of “functional medicine” which is practiced upstairs in my anti-aging center describes how an individual is completely unique and how a treatment protocol is completely designed based on that individual’s unique attributes. Traditional medicine says here are the parameters of “normal”. Let’s see if you fit those parameters. That is why I love how my building completely focuses on the individual rather than treating you like a statistic or a number.
Now, here comes the core of this blog that I have been leading up to. As you guys know, I have written all the blogs last week for my spa site, www.spawb.com, until my staff now is taking over that assignment. In the spirit of still having something more to say about my new spa, I want to get to how the spa services offered truly focus on and celebrate the individual differences for each customer. Let me explain by telling you about my Friday’s services. Waleska, the body wellness expert at the Spa at Willow Bend, started by asking me what symptoms I was having and what types of aromatherapy I would like to experience. I told her that it had been a long week and that I also just loved the smell of peppermint (I guess that’s the kid in me.) So she created a special treatment plan for me (as she does for every client there), which is then programmed into our computer system and remembered.
I started with a relaxing 10 minutes in our sauna. The great thing is our sauna starts at about 80 degrees F, then the attendant comes in with a specially mixed Japanese aromatherapy basin that is customized for you. As the aromatherapy bath is applied to the hot rocks, the sauna temperature gradually ascends to a sweltering 110 degrees all the while you can smell the wonderful aromatherapy that you requested or needed. I think I had a combination of Tea Tree and Peppermint. Then I received a small wooden bowl with ice in it containing two perfectly wrapped towels. I was asked to put a towel on my forehead and lie back. The towel was filled with peppermint which smelled great right next to my nose but also started to soak into my forehead creating a nice refreshingly tingling sensation. After a few minutes when the towel warmed up, I received the second towel. The combination of hot steam and a cold towel was incredible. I then went in for my body treatment that was also lovingly prepared with all the aromatherapy scents that I had requested. It was the most amazing experience that I have ever had. I showered and changed in the lounge. When I came out, I was greeted by a tray containing refreshing sorbet, spears of frozen grapes, and infused water. Boy, I was ready for my weekend!