We are striving to find our real selves not a fabricated one.  We oftentimes short change ourselves and feel that we are inferior because of certain something or another.  Maltz argues that there is no such thing as a superiority complex because someone who feels superior is most likely covering their own inferiority about something.  We must escape our own self sabotage by envisioning where we want to be using a visualization exercise through a mental movie we talked about.

Focus vividly and concretely in your mind where you want to be in life.  Sometimes it is easier to have your image projected on a movie screen that you are watching.  Then for 30 minutes a day watch this movie and fill in all the details so that it becomes seemingly reality.  Rather than force of will (which is our conscious mind), use your imagination so that your unconscious mind will begin to take over and effortlessly fulfill what you desire to be.  Creating the right self image means first eliminating all of your false beliefs.   More about that coming up.

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***NEWS FLASH***
I was featured on Channel 33 9 pm News last night.  For those interested, here is the video segment entitled “Facial Fillers: The New Face of Hollywood, Patients Flock To North Dallas For Procedure”:

It’s been close to a month since my last story of the week, but finally here is another story.  I believe all of my patients’ stories are real and worthy.  That is why I have created a section in the forum of this website for patients to tell their own story:  the story of how LFP has affected them (patient submitted testimonials) and what they love in life (tell me about your passions).  This is a story that has profoundly shaken me and reinvigorated me.

I had one of the nicest ladies come to me a couple of weeks ago who was going through a divorce and other major life changes.  She told me that she had kept an ad of mine for quite some time before deciding to come in.  She was clearly shaken a bit and nervous.  I reassured her that she would be fine and that I would not waste her money or time and would do the right thing for her whatever her decision might be.  She said she trusted me, and we talked a bit about life philosophy and healing.  I truly felt compassion for her as a human being first without the imposed barriers of gender, race, etc.

She decided on some Restylane treatments, which were within her budget, and I was able to focus on small areas of aging to get her tear troughs, anterior cheek, and anterior chin balanced and looking good.  I saw her as I usually do a week later to photograph the improvement and to make sure I could answer any of her questions.  In the photography room, her hands were shaking and she had multiple post-it notes and note cards where she was composing her testimonial about what I had done for her.  She apologized that English was not her first language so she needed time to compose her thoughts.  I said the words did not matter as much as her expression of them.  I was in tears as she was during her reading of her testimonial to me.  I showed her the before-and-after photograph comparison, and we were both elated with the improvement.

She then told me the most profound words that I have heard in a long while.  Paraphrasing a bit, she said, “I was about a year from entering medical school to become a doctor when a mentor of mine whom I respected said these words to me, ‘A doctor heals bodies, and a teacher heals souls.’  So with those words, I became a teacher of little children, which I have never regretted.  However, Dr. Lam, you have shown me that a doctor can heal both, and you have done that for me.”

I can say that I was on a very high cloud for the entire day and for several days thereafter.  It gave me back once again a profound mission of why I have been put on this earth, and it far exceeds what I do as a plastic surgeon.  That is why if you wonder if there is some kind of incongruity in a surgeon writing a lot of blogs on self-improvement, life philosophy, and life psychology, there really isn’t.  I am not here just to fix faces.  I am here hopefully to touch a life.  Thank you Sylvia for touching mine.

I just finished this book, The E Myth Revisited, that focused on why entrepreneurs succeed or fail. In the book, the author Michael Gerber talks about getting to the root “feeling” that you are delivering to a customer. He argues that a company oftentimes focuses on the fact that they are selling a certain type of widget but in fact that may not be what they are truly “selling”. He used Revlon as an example. He said that in Revlon ads, they focus on a certain dream of how beautiful someone will look after using their product, so they were not at its core in the cosmetic business but in the business of selling hope.

I thought to myself, “What is the core thing that I would love a patient to feel after I work on them?” I came up with a pretty quick answer: confidence. It is not pride or arrogance. It is not even vanity. Those have pejorative connotations and to be honest do not reflect the feeling that I want someone to feel. I can tell you certain points in my own life that my confidence soared: getting into an Ivy League college, getting into a competitive residency and then fellowship, getting my first book published. I also remember small things in appearance that boosted my confidence: the end of my acne years, getting nice looking glasses, a good hair cut, and nice clothing. Although these are peripherals to aesthetics, they are all part of a sense of self and a sense of confidence.

I really enjoy seeing the beauty of my work and how I see a patient smile broadly and carry himself or herself a little differently. I particularly like it when I see someone shy and reclusive become more gregarious and open spirited in public. I can see the transformation and the feeling I have is a great one. Of course, I am in the beauty business and in a larger sense the wellness industry but at the core feeling that I am “selling” is confidence. I hope that is the feeling you get when I have finished with my work for you.

I routinely read the New York Times every morning and several weeks ago I came across this very interesting article concerning an art exhibition “One Life: The Mask of Lincoln” featuring two plaster casts of Abraham Lincoln as part of the celebration of his bicentennial year in 2009. The first plaster cast was made in 1860 when he was campaigning for the presidency and the second one made 5 years later in February 1865, just two months before he was assassinated — which reveal the nature of the aging process in stark relief.

Although there is a more corrugated appearance to the latter plaster cast, the volume loss of the face is unmistakable. Looking at both faces, the viewer can see that the face looks older despite the relative absence of wrinkles and gravity. Volume loss is the significant player here for aging in an unequivocal way.

Interestingly, what strikes me the most is the buccal zone, the area below the cheek bone. The scooping out of this area truly makes Lincoln look significantly older and already gives the middle-aged appearance of the earlier cast a wizened appearance. The buccal area is a zone that is so little appreciated and in my opinion is a critical area to focus on for rejuvenating the face. Obviously, this is not the case in every individual. Some individuals who are slightly heavier do not need buccal fat or Asians who have a rounder face certainly in many cases do not need buccal fat. However, I truly believe the buccal hollowing can be one of the most dramatic areas of aging that exists.

In my new book, Aging Face: The New Paradigm, coming out next year I have come up with a unique way of looking at the buccal area, subdividing it into 3 zones, which I have previewed in a lecture that I gave earlier this year in St. Louis. The central buccal zone is the area that we are all familiar with, the area that sits below the cheek bone and that we suck in when we suck our cheeks in. However, a refinement into thinking of the buccal area is that there is an area that is near the mouth that I call the medial buccal hollow that represents bone loss of the teeth that I also target in some individuals. The outer portion of the buccal area that lies immediately below the outer cheek bone and in front of the ear I call a “backfill” zone which I target with fat transfer to create a more uniform transition from the augmented cheek downward.

I think we are so focused on the “midface” (cheek) and the lower face (jawline and neck), we forget to look at the importance of the watershed region that is situated between the mid and lower faces. Remember that a youthful face has very few transition zones. I look at fat transfer as a way to unify areas of the face that have separated and to rejoin these areas. It is almost like airbrush work. In essence, that is how I apply artistic interpretation to facial aging and truly target the face for optimal rejuvenation. So those surgeons out there who suck out the buccal zone in my opinion make no sense to me even if the area is full because it will become eventually depleted and will worsen one’s aging in many cases by doing so.

I don’t think I’ll have a new patient story for you every week, but this one really touched me a lot. I had a patient who was looking for lip enhancement and had called around town. After Marcy worked her phone magic that she does so well, she really believed that I was the best suited to help her out (which I not so humbly believe to be true). She enjoyed most of the day at my spa then came over to my office for some fillers. I explained to her that fillers could also be used in the face, and I discussed with her the merits of Botox for long-term wrinkle reduction. She decided to do the fillers for facial rejuvenation, lip enhancement, and Botox.

I always see my patients back a week later to make sure that they are doing okay and to show them their before and after photographs. When I was taking her photos in the photo room, she said, “Dr. Lam, I know you don’t know this about me, but my daughter suffered anaphylactic shock when she was 15 years old and died in front of me. I got very close to my second daughter, my only other child, but who was then killed with my sister in a car accident 2 years later.” She then said, “Dr. Lam, you have given me my face back as it was before all this happened to me. You have erased 15 years of grief from my face.”

I can tell you it was hard to hold back my tears when I heard that. I told that story to all my staff. Even something “small” like Restylane can have a profound impact on people’s lives. I always say to my staff we are not in the business of plastic surgery but in the business of “taking care of people and transforming lives”. I can think of no better incidence than this one. I am so proud of performing such a small thing that had such wonderfully unintended benefits. I always remember that every person that I treat is special no matter what the motivations they have or the treatments that I perform. You never know when a small thing can mean a lot to the other person you were so blessed to encounter. Wishing all of you a special holiday season, and I hope this story touched you as much as it did me and my staff!

I had a Christmas party a couple of weeks ago for my EO (Entrepreneur’s Organization) forum group. One of my forum buddies, Larry Patterson, owns part of a franchise known as the Glass Doctor. He specializes in glass, both auto and flat. He came into my bathroom and looked at my all-glass shower and said, “Sam, if I had done your glass I wouldn’t have used this green-tint job. I would have used an all clear glass so that you could see the tile better. In addition, if you look at this hinge here, they put a spacer in because it is easier but I would have made the glass flush with the other piece without needing the rubber in between. Also, I would have used a teflon-like coating so that you would never have to wipe the smudges and water stains away.” I was floored a bit. I am still very happy with my shower, but I now recognize when someone specializes in something, they truly possess an entirely different eye for what is going on.

I actually plan on featuring some very interesting specialists in the next few weeks both in video and written format but more about that when the time comes. I have been asked by many people, “Do you see faults in every face you look at?” Of course, I sort of humbly shrug that off and say, “Well, not really.” However, the truthful answer is yes in many respects I do. That is my job, which I live, sleep, eat, and breathe. I am trained to see a pinched nose with an exposed tip graft and alar margin retraction; a rounded canthus of the eye that looks unnatural from a lower eyelid procedure done through a skin incision (which I never perform); and an upper lip that looks like a big McDonald’s Golden Arches staring at me. Even though you may be able to detect half of the individuals who look fake, I can see about 98% of them and tell you the reasons why that person looks off. In addition, I can see where maximal facial deficiencies are and how to correct them, i.e., I can help you prioritize the issues of maximal benefit to help you.

That being said, not to beat a dead horse, but I hope you now understand why I sit with you and look at you even without much of your input on what bothers you because I want to be able to help you achieve 2 goals: 1) if you have had obviously bad surgery even if you can’t detect that it is bad, I need to cover the problem so that instead of 80% not seeing it that hopefully 95% or more people won’t, 2) i help you prioritize where to spend your money best. With discretionary income, of course, you can ultimately do anything with me so long as I don’t hurt you. However, you should expect from me a more detailed analysis that can help you…within reason. For example, if you come in for rejuvenation of the aging face and you have a pretty strong hump on the nose, I probably will not mention it to you. However, if you came in for aging face work and your nose was pinched in and your bridge scooped out and I see that perhaps 70% of onlookers are looking at something not right, then i will gently help you see that even if you can’t.

I love how I see many plastic surgeons’ ads that read “Specializing in the Face and the Body”. What? Are you kidding me? Shouldn’t the ad read, “Generalizing in the Face and the Body”? Is it oxymoronic to say that one specializes in everything. You could say, “Specializing in Plastic Surgery” but you can’t say specializing in everything. That makes no sense.

After listening to my friend’s expertise on glass, it makes me more aware of how much I truly “see” that others do not. I would hope that when you come in for consultation that I don’t just rush you to a treatment or respond on what you want done without offering my opinion but to do so in a deliberate and intelligent fashion and offer my best advice to help you.

Here is another study with beer. In Predictably Irrational, Ariely asked a group of individuals sitting down at a table in a bar to order from a limited list of beers: Summer Wheat Ale, Franklin Street Lager, India Pale Ale, and an Irish Stout. The first individual would call out his or her beer and then the ordering would progress around the table. At the conclusion of imbibing, the individuals would be asked to write down their rating of their beer. Interestingly, the person who asked for the beer first consistently rated his/her beer satisfaction to be the highest. The ratings would then go down proportionately to when the beer was ordered. The same experiment was tried by having individuals hand in their beer order silently without declaring their wishes aloud. Interestingly, almost every individual rated the satisfaction of their choice very highly. Also interestingly, when beers were ordered out loud, almost every person ordered a different type of beer; whereas when beers were ordered silently there was much more similarity in what was ordered. The same experiment was carried out in Hong Kong. However, in this case, when people ordered out loud, the second, third, etc. person would order most likely the same thing that the first person had ordered. As would be expected, their enjoyment was greatly less than what the first person ordered. What we learn from this experiment is that in the United States we value our maverick individualism even in spite of our best interest, and in Asia conformity is prized to a similar detriment. In summary, if you are going to order, order it first before everyone else so that you can enjoy your meal!

Sometimes in our society, we want to be different just for the sake of being different. Sometimes different is bad. Sometimes there is a reason why no one else is doing what you are doing. Sometimes different is good because the majority out there are doing things that are not good. We should fight against any of our cultural legacy (whether from the Occident or the Orient) that is our natural tendency to be “predictably irrational” so that we can make choices that are the right ones. In my field, I truly believe that too much lifting is being done for all the wrong reasons with absolutely dreadful results. As you know, I believe that the majority of docs out there who believe that lifting brows and cheeks is right are in a word wrong. However, I believe that Botox, almost despite its popularity, is so very right thing to do for long-term gains and to avoid what would otherwise be ineluctable aging. (If you don’t know what I am talking about, watch my 3 video logs: 1, 2, 3). I believe that Restylane and Perlane, which are the most popular fillers on the market in Europe and the U.S., are the most popular for a reason (which is corroborated by my clinical experience). Believe in the right thing whether it is popular or not, but don’t believe in something either because it is popular or because it is not.

One of the psychological experiments mentioned in the book, Predictably Irrational, concerned how Duke University students viewed the value of tickets for the Final Four in which Duke would be participating. A lottery was instituted in which a certain lucky number of students won tickets gratis for this event, whereas others obviously were resigned to watch it from a sports bar or their dorm room. Ariely then called the abject losers of the lottery to see how much they would fork over for the right to see the event live. Somehow almost all of those polled arrived at a figure of about $170 some odd dollars. Ariely asked them how did they come up with this amount? The typical response was that they could easily watch the event at a sports bar and that is how much it would cost them in drinks, food, and also a bit on the side to purchase CDs and other frivolities that would make up the difference of not seeing the game in person. Ariely then asked the winning lottery holders to see how much they would accept as a reasonable offer for their tickets. Most ticket holders settled on a sum that hit approximately $2400 without much variance. He then asked the winners how did they arrive at such a figure. The responses involved how that Final Four event would define their entire 4-year time at Duke and how they would be able to pass that cherished memory down to their children and their grandchildren. How did their rarified view of the event stand in such stark contrast to the more pedestrian perception of the non ticket holders?

There in lies the rub. We oftentimes hold ownership at a much higher level than the non-owner. Accordingly, be careful about the 30-day, money-back guarantee. The couch you just bought that you might have had only passing interest in has now become your personal possession which you could not bear to forgo after the expiration of the 30-day period elapses. The gold digital cable connection that you were given as a 90-day trial period becomes part of your privileged right that you can no longer part with to accept the more mundane silver package lacking 4 HD channels as well as some other premium channels (that you conveniently never watch).

When I talk about aesthetics of the face, there is oftentimes a misalignment of perceptions regarding the magnitude of a problem or the lack thereof. For instance, I had a lady come in who wanted her eyelids managed when all I could see were her over-inflated lips staring back at me. I think the corpulent nature of her lips probably obstructed her vision as much as any eyelid issues she might have had. Most surgeons are trained to simply give a patient what he or she wants. I simply refuse to do that. My goal is to help you see what other people perhaps more clearly see but simply won’t tell you owing to genteel discretion.

Alternatively, you also are aware that I tend to help calibrate perception of a problem by de-emphasizing what many women perceive is the problem, which is invariably some small lines around their mouth, a small upper lip, or asymmetry of their upper lip. Simply put, 99.99999% of other people looking at you do not see that deficiency. Of course, I can manage it but I would like to help someone see the big picture of what is the problem so that I can help provide a more balanced appraisal in order that whatever money you spend there can be a wow effect from the observer. We are social creatures and we tend to cherish approbation from another and become crestfallen at any negative observations from a third party (or the absence of another’s perception of the benefits of a particular treatment.) My goal during a consultation is to help you be educated on what may be priority #1 in terms of what any person would see is making you look not as attractive, rested, or youthful as you could be. In fact, it is my fiduciary responsibility to help you perceive the relative value in something by putting it into perspective and prioritizing what I see would most likely benefit you.

I wrote a blog a few months ago on perspective that was actually stimulated by a patient’s comment regarding the book, Predictably Irrational, as source material. I would like to use this blog that borrows heavily from PI, for more inspiration. The opening psychological study presented in PI was quite brilliant. Using a real-world subscription plan by the famed British magazine, The Economist, Ariely the author subjected students at MIT, where he is a professor, to a small test in human psychology. The Economist offers 3 subscription plans: Internet only for $59, Print only for $125, and Internet plus Print for the same $125. With these 3 plans, the students overwhelmingly chose the combined Internet plus Print option. Removing the “print only” decoy, he offered the Internet only for $59 and the Internet plus Print for $125. The students overwhelmingly chose the Internet only at the bargain price of $59.

We as humans tend to require a comparison for us to make good decisions (or not so good decisions). As mentioned in a previous blog, the patients who are truly loyal to me are the ones who have had Botox, fillers, surgery somewhere first before coming to me. Without a comparison, people enjoy the experience and results that I offer but their mind may think for a moment I could get it cheaper down the street. That thought almost never crosses the mind of a patient of mine who has been down the street. By offering a uniquely better product, service, and experience, I think I have garnered more loyalty from my patients who have chosen me after they have been elsewhere.

Well, we have covered that ground before in a previous post so I wanted to explore this idea in greater detail. I am about full disclosure and not trying to trick a prospective patient into choosing me. Instead, I would like to think of how could I help a prospective patient truly understand the service difference that I offer. What I have done in the past and would like to continue is to try to frame the differences of a procedure that I do to contrast that with another practice down the street or, to be honest, anywhere else. I have done that in many ways without ever mentioning a competitor by name, just the philosophical, technical, and artistic differences that LFP is all about. For example, I explain how my Botox is intended for long-term goals not short term which I reinforce with baseline photographic documentation and photographic progress reports with how their skin is doing over time through sequential photographs. That alone is almost a comparison within itself, that is a comparison of one’s current state and one’s former state.

I really enjoyed this book, Predictably Irrational, and would like to help my patients not to think irrationally but to think things as rationally as possible. Knowing our own irrational behavior can help us free ourselves from it. Comparisons are important, in my opinion. Without them, we fail to judge the quality of something because we only see that attribute in isolation. The language I use is oftentimes trying to articulate what I offer so that if the comparison is not immediately obvious, it will become so by your speaking with your friends about their experience elsewhere or simply put you would already know this fact if you had tried services elsewhere in the past.

In fact, besides trying to have a service down the street, I ask my patients a small favor if they have never tried any services besides my own is to ask their friend some explicit questions: 1) How painful was your Botox? 2) Did you get a wow effect from just filling your smile lines with Restylane? (no) 3) Were you educated about your options or just brought back and injected? 4) Did you get baseline photographs and shown the before and afters of the work? 5) Were you offered free touch ups and asked to come back to make certain the result was good enough? 6) Were you given long-term goals so that you could determine what would be in your budget and goals for now versus where the physician desired you to be in a year? 7) Were you educated about options that would clearly be harmful or a waste of time and money for you and actually talked out of a service that was not right for you? REALLY? “My doctor, Dr. Lam, did all those things for me.” I hope that you can say those things about your experience at LFP.