Predictably Irrational Part 5 of 5: How to Order off a Menu
December 19, 2008 by dr. lam · Leave a Comment
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.
Predictably Irrational Part 4 of 5: Expectations
December 18, 2008 by dr. lam · Leave a Comment
In Predictably Irrational, Ariely gave a certain subset of participants in an experiment a vinegar-tainted beer to try while disclosing to these individuals in advance that the beer would be laced with vinegar. Almost all subjects who tried the beer reacted instantaneously in a negative way and refused to continue drinking the beer after the initial sip. In a second subset, the participants were told they were going to drink a quality brew and after consuming the first tastes, they were asked what they thought of the beer. After they finished drinking the beer, they were informed that balsamic vinegar had been added to enhance the taste of the beer. Almost all of the participants in this group did not change their mind about the taste of the beer when told of this unusual addition. Then, group one who had been informed in advance of the presence of vinegar was offered the chance to add the right amount of vinegar to help enhance the taste of the beer, which was two dropperfuls for every ounce of beer. Not suprisingly, no one accepted the offer to add the vinegar. When group 2 was offered the chance to enhance their beer with vinegar, most of them actually added the vinegar to the beer to make it more flavorful. This is a powerful study to show how perceived expectations can alter our enjoyment of an item, event, etc.
As you probably know, I tend to err on the side of conservative expectations rather than simply creating a false and uneducated bias toward how rosy everything will be. I outline for you in great detail all the limitations of any procedure you choose with me because I want to make sure that expectations are met rather than not. I tell you the vinegar in advance of your drinking the beer, so to speak. Perhaps not how marketers would recommend engaging in business, but this is plastic surgery not selling couches. I tend to create as realistic an expectation on the front end as humanly possible, as many of you who have sat in on a consultation with me know full well.
A great video log that I shot discusses the differences between education, expectations, and excuses. In short, an education is the same thing as an excuse, except that it was told to a patient before a procedure rather than afterward. Creating realistic expectations is critical. I always say that the only thing that I can predict about human nature is that it is absolutely unpredictable. That being said, expectations are so very hard to define. “Hey doc, will anyone notice your work at one week following a procedure?” How would you honestly answer that question? Who knows???!!! I simply cannot account for all facets of human responses. However, I help guide you to calibrate proper expectations by asking willing patients to film themselves during their recovery through diaries and journeys, shooting videos entitled companions to help you wade through the psychological dimensions you need to know, and to ask countless questions in the forum and shoot as many educational videos as possible. Even with all of this work, I still sometimes fall short of trying to capture every single patient’s expectations appropriately.
Predictably Irrational Part 3 of 5: Differences in Perceived Value
December 17, 2008 by dr. lam · Leave a Comment
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.
The Two-Finger Rule
December 12, 2008 by dr. lam · 2 Comments
I have been thinking about writing this blog for the past year but have forgone writing it because I had so many other ideas floating around in my noggin to write about. However, last week when a patient who came into my office for Botox said, “Dr. Lam, I was thinking of fat grafting but I really don’t want that. I just want this,” then she lifted two fingers on her skin to show me the lifting effect that she desired. Ugh! I knew at that point I needed to commit thought to paper (or thought to keyboard in today’s parlance).
We oftentimes think that our fingers can relay to the plastic surgeon a feasible, realistic goal. “Heck, if I can just take two fingers to pull up on a certain part of the face, why can’t a skilled surgeon replicate such a maneuver?” The simple truth is that is what the threadlift that came out a few years ago was purported to accomplish. It would pull the skin upward in the trajectory accomplished by one’s fingers. The aesthetic result of such a maneuver, the threads and the company were short lived and so was my patience for these touted results.
Without making this blog interminably long, suffice it to say that the two-finger rule simply does not apply to reality. Surgeons can’t reproduce it to your satisfaction, and oftentimes it bespeaks the wrong intuition to begin with. I can’t remove pores, acne scars, definitively smooth out folds with a lifting maneuver that in many cases you simply do not need and that would worsen your condition or not help it. As a summary of my thoughts on facial gravity, please watch my video “Rethinking Gravity” in full to understand why our a priori notions of facial aging are pretty much screwed up so is that of 99% of plastic surgeons out there and their thoughts about what constitutes facial aging (of course, i am unbiased in my comments…not!).
Life in Perspective Part 1 of 4: Your Past
November 24, 2008 by dr. lam · 2 Comments
This week we will only have 4 blogs in respect for the deserved respite that you will share with your loved ones over Thanksgiving holidays. In that spirit, I thought that I would turn reflective on one’s life overall. Today we will cover your past, tomorrow your present, the following day your future, and on Thanksgiving Day, your entire life in synopsis.
This blog was spurred on by a forum question that led me to think in a more structured format about what our lives mean and how we can get the most out of our lives. This blog was also inspired by a few patients whom I saw this past week and who really helped me realize that I needed to write something to help more individuals out there who desperately need it.
One woman had come to me from another state after having experienced a burn injury on her face from a medical treatment I believe over a year ago or so. She had sought plastic surgery intervention to correct this problem using Fraxel and Restylane treatments. When I received the initial email correspondence from her, I was alarmed at what I saw concerning the degree of the burn. However, when she came in I could barely see a trace of the injury. Yes, with the makeup off and with my getting up close I could see what was going on but it was a work for me to see the problem. That was a good sign. The only residual problem that I saw was some redness and fullness of her nose left by the plastic surgeon who was trying to correct the problem in the first place. I saw that she was visibly distraught and quite depressed. She said that she was sad about the situation. I informed her that I did not actually see a problem and that others probably did not as well. She said her family was upset about it. I informed her that most likely her family was upset about it because she was overly focused on the problem, leading to their reactions of negativity.
I told her that she had created her own living hell and was fully ensconced in her past. I said that you can live in your own past, but for me I have chosen to live in the present and the future. We can’t change the past, and every intervention that we engage in is undertaken to correct the past further pushes us into an uncorrectable past. Every time she passes a mirror or takes a photograph I am certain that she is staring at it to see if she sees the deformity. It will always be there and no one will be able to correct it to her satisfaction because she will always seek to see if the problem will still be there and, of course, it will be. I can probably tell you a million stories like that one. I actually plan on shooting a video to recount some of these stories to help someone learn from it.
I learned one thing from my mentor, “Happiness comes from within.” I love this saying because it is true. Plastic surgery will not give one happiness. You have to want happiness. Some people love being depressed. Some have allowed themselves to sit within a deep depression because they can’t get out of their own past. They are buried in it out of their own volition. Did the plastic surgeon create the problem? Well, in certain circumstances, yes. I saw a lady who had 17 eyelid surgeries to fix a problem that the first surgeon created. I had to remove a lump of fat out of her face from bad fat grafting she had done elsewhere. I told her the moment I saw her we needed to fix this thing because it was truly a deformity. This circumstance was a disaster that needed correcting. Other times, I see that the patient created his or her own future by living in the past.
The past cannot be changed but it can be valuable tool for us to learn from. As they say, “Fool me once, shame on you. Fool me twice, shame on me.” I believe that. We are not perfect creatures (surgeons and patients alike). However, we can learn from our mistakes and move forward to live in the present to define the betterment of our future. The past is valuable but only as a resource for not repeating it (if it was a mistake) but not to live within it so as to shadow our present and future. More about that tomorrow.