Last week, we talked about how we should reprogram our unconscious servo-mechanism with an Automatic Success Mechanism.  How do we do that?  The answer is with deep desire.  Desire motivates our thoughts.  When we feel that we deeply want something bad enough, we overcome insurmountable odds.  We overcome negative thinking, and we replace our Automatic Failure Mechanism with our Automatic Success Mechanism.  We don’t take no for an answer.

Specifically then, how do we reprogram these negative thoughts? We focus on the end result.  Of course, we have to have a desired end goal of what we want so that we can keep our eyes on the prize.  Too often we are still plagued with the notions of what we don’t want.  Instead, we should focus on what we do want…where our desires lead us.  Starting with a deep desire for what we want to attain will create a powerful reprogramming of our unconscious mind.  Remember that it is not force of will that Maltz talks about, i.e., it is not our conscious mind forcing us begrudgingly and exhaustingly forward.  It is our conscious mind that sets our much more powerful unconscious mind into motion to lead us forward to success.  Visualizing what we want every day can generate us to move forward in ways that we could not otherwise imagine.

Also remember that we talked about how our Creative Mechanism was the dividing element between us and the animals, i.e., how we enlist our imagination.  Our imagination oftentimes is an unconscious attribute that is set in motion by our conscious mind.  As a creative person myself, I open myself to inspiration and thoughts about everything.  I move with a conscious desire toward my goals and my unconscious mind oftentimes gives me the answer that I was looking for.

As an example of this, in December 2006, I was interested in getting my name more broadly disseminated out to the world so I began to upload numerous videos that I felt passionately about on YouTube (currently I have 573 videos on the site with over 1.9 million views), at the time a nascent site that certainly was not used for promoting a plastic surgical practice.  My mother and sister were both laughing at me at how I was wasting my time doing something so stupid.  I was completely passionate that such a move might benefit my practice but just followed my heart and soul.  Today YouTube accounts for the principle method by which I have a practice now that garners between 50 to 80% of my patients who have flown in from over 500 cities, 47 states, and from 18 countries for my services.  Follow your heart and intuition against all odds.

If you stand on tiptoe, you cannot stand firmly.
If you take long steps, you cannot walk far.

Showing off does not reveal enlightenment.
Boasting will not produce accomplishment.
He who is self-righteous is not respected.
He who brags will not endure.

All these ways of acting are odious, distasteful.
They are superfluous excesses.
They are like a pain in the stomach,
a tumor in the body.

When walking the path of the Tao,
this is the very stuff that must be
uprooted, thrown out, and left behind.

Too often we live with too much pride and arrogance.  We must feel that we are superior over others and live life with selfish disregard for all those around us.  Do you live most of your day only looking at yourself?  Are you overly focused on your own successes, trophies, goals, and gains?  Have you thanked someone around you recently for being who they are in your life and contributing to this world?

Many of the books that I read must invariably decry plastic surgery as an excess.  Obviously, I work with this paradox in which I talk about internal self-actualization and also disregard to ego.  Perhaps that is ultimately a Tao principle of holding a paradox in your mind.  However, I simply do not see it as a paradox.  As I have repeatedly stated, plastic surgery done correctly and with correct moderation and perspective can change one’s life in a profound and tangible way.  However, when we seek plastic surgery to fulfill an internal want that is absent then we are in trouble.  I look at plastic surgery as a method for providing congruity between what we see in the mirror as what we feel in our heart.  But when body dysmorphic disorder or overly obsessing over a body part leads to social crippling then we have crossed that fine line.

It is important that when we attain our own enlightenment that acquisition and acquisition and acquisition of material goods and status not be the motivating factor or dominating factor in our life.  These blogs are meant to put you into a peaceful sense of gratitude for where you are and not where you need to be.  Being a man of ambition almost my entire life, it has been a profound shift in my own paradigm not constantly to want and desire and be insatiable in my appetite for wanting more.  Today I truly cherish where I am and what I have and am not in a desirous mood for this or that, certainly not as much as I did in the past.  

Today it would be great if you could offer your gratitude (yes, a fourth blog indirectly on this important subject today) for where you are but even as importantly offer that gratitude for someone near you for who they are and how special they are to you.  Offer that gratitude to someone you know or even you don’t know that well today.

To keep on filling
is not as good as stopping.
Overfilled, the cupped hands drip,
better to stop pouring.

Sharpen a blade too much
and its edge will soon be lost.
Fill your house with jade and gold
and it brings insecurity.
Puff yourself with honor and pride
and no one can save you from a fall.

Retire when the work is done;
this is the way of heaven.

I truly love the idea behind this verse.  It tells us that enough is enough.  Hording more acquisitions for the sake of doing so only leads to fear, insecurity, and pride.  It leads to fearing the loss of these acquired goods that can in turn lead us to misery.  I also like how Dyer focuses on eating.  I have eaten many times after I was sated only later to regret it both in terms of how I felt afterward and the ineluctable weight gain thereafter.  I am constantly reminded of the joy of eating just enough, wanting just enough, and being contented with everything.

How do I reconcile all of this with plastic surgery?  Easily.  I have many individuals who are obsessed with plastic surgery or become so.  They know that I will only engage in things that will help them look and feel better about themselves but not in excessive things that waste money and create unchecked boundaries of ongoing want.  In fact, I help guide them to what would be the best thing to make their external selves a reflection of their inner selves.  We have talked about that in previous blogs.  I am in love with the creative work in facial cosmetic enhancement because done in moderation and with skill and artistry, you can create a beauty that lovingly radiates to all those in their proximity.

I had a case where a woman was a victim of domestic abuse, and I was planning to do her procedure to help her.  However, her story just did not make scientific sense.  I will spare you the details because I would like to keep things with full anonymity here.  I discussed this over with my staff and finally decided that I was going to do the case anyway for two reasons.  First, my first and foremost goal for LFP is to help people.  I don’t think I could live with myself if I made a false judgment and actually wound up not helping someone that I could have.  Second, I believe that when someone comes into my presence for the day that I will change their life.  I know that might sound arrogant to you but it is not coming from that.  I am dismissing my ego.  I am letting that go here.  I know that many people that I encounter in my practice need me and I need to be there for them.

As much as I can help someone do something, I can also help them to see that they don’t need something.  I had a lady who had a perceived physical defect of her lower face (we’ll keep it at that) and had spent a tremendous amount of money already trying to fix the problem.  When I saw her, I couldn’t even begin to fathom the problem that she had because I couldn’t see it.  I asked her, “Have you ever considered the option of NOT doing anything?”  She started to cry for several minutes, and I embraced her.  I felt all of her negative energy and perception start to leave her body.  Helping others in whatever shape or form can be a noble cause and be the ultimate cause for any life. It is a singular purpose for me.

That being said, do we have to live a life of self-abnegation then?  No, in fact, we must start with ourselves.  Dyer talks about first loving yourself and healing yourself before you can do that for those around you.  It is similar to the idea that I presented a few weeks ago from John Maxwell about “leading yourself” first before you can lead others.  You must first help yourself then help others.  Dyer talks about “self respect” which comes from a simple truism, “I love myself”.  This does not mean that we are focused on ego (on the contrary) but a perception of ourselves that is filled with an ideal image of ourselves.  I have tried to stop saying to people, “I’m not perfect” because it goes against our own creation and the perfect image that we should have in our own Creator’s eyes.  Instead I am perfect in the light of my own creation and thereby perfect in how I see myself.

When I work on my patients, they understand that I am not trying to make them a perfect human species but to offer them the objective of looking good outside that can reflect their own inner beauty. I think a patient from Arkansas said it best in a testimonial to me:

As the years have rolled by, the man in the mirror had seemed to age more rapidly and less gracefully than I had hoped. I still felt young, active and maybe a bit adventuresome, but the droopy eyes, wrinkles and hollow face did not reflect that. I earnestly wanted to look more like the mental image I had of myself.

One of my greatest concerns before my surgery was that I might be giving a wrong impression of being tired, inattentive or even bored while speaking with friends, family members or patients. (The sagging skin on my eyelids made me look like all of the above most days!) That really bothered me because I never wanted anyone to think I had a haughty attitude or what they had to say was unimportant to me.

With these issues I landed in your office, not at all sure that there was a solution for me that did not involve changing my identity or doing something really radical. I need not have worried. You seem to have understood my concerns better than I did. Your solution addressed all these needs better than I was able to express them.

I am honored to help my dear patients and those patients who are not yet mine to create a beautiful self image that reflects their own inner beauty.  My purpose in life is to help others through as many ways that I can:  plastic surgery, psychotherapy, empathy, listening, and simply put, extending my love to them.

He then talks about the king of sex in advertising, Calvin Klein, and looks at how controversy has sold jeans and various other apparel very well for decades starting back in the 80s with the famous Brooke Shields’ commercial, “Nothing comes between me and my Calvins.”  He goes on to discuss how Abercrombie and Fitch as well as a newbie American Apparel have done very well financially using sex as a potent vehicle in their advertising.  He then reconciles this seeming paradox that sometimes sex works and sometimes it doesn’t by suggesting that when controversy arises that it can favorably help a brand whereas when it does not do that it would fail and only serve as a distraction.  He also simply shrugs it off and says sex only can sell sex and nothing else.  I would argue that Lindstrom is right and he is wrong.  The examples of Calvin Klein, Abercrombie and Fitch, and American Apparel ARE selling sex since clothes really are a manifestation of how we communicate our sexuality to the opposite sex (or to your own, depending on your orientation).  I think controversy is certainly part of the story, but I think that all of his examples point to a simple fact that clothes are selling sex in a way.

He then looked at how women were attracted to certain types of female models.  He found that the more provocative and underdressed a woman was, the more that the female respondents were adversely repulsed.  However, when the model was wholesome, unadorned, and fullly clothed, the women responded favorably to the model.  

The next question then is does a celebrity help to sell a product or hurt it?  Lindstrom found that in many cases the über-attractive faces of George Clooney and Nicole Kidman actually acted like the previously mentioned vampire effect, i.e., it sucked the attention of a viewer away from the ad and made it less memorable.  All the viewer could remember was the celebrity and not the message.  For example, a series of anti-smoking campaigns in England with John Cleese were only remembered for the distracting elements of humor and the celebrity himself but the message of not smoking was entirely missed or forgotten, eclipsed by the distracting presence of the humorous Cleese.

Then do we respond better to real-life individuals rather than models? Well yes and no.  Lindstrom found that when real-life individuals were used in ad campaigns, we responded to them better because we viewed them as authentic rather than contrived like a celebrity endorsement.  However, Victoria Secret ads with women wearing lingerie still have a powerful effect in our psyche for the simple reason that we want to be that model or be with that model, which brings us back full circle to Monday’s blog that focused on mirror neurons.  Just as we want to be cool by buying Apple products or wearing a certain label, our mirror neurons are triggered when we see a cool or attractive person that we want to be.

Clearly, the answer about how sex in advertising works is much more complicated than a one-word, yes or no response.  Gender-specific, context-specific, and many other factors come into play when answering that question.  I think when thinking of plastic surgery that “selling sex” in the classic sense is not what it is directly about but selling attraction and confidence.  Of course, an aesthetic result should be precisely that, aesthetic.  I think we must be drawn to the after result so long as that after result is real and uncontrived (not a glamour shot, ugh!).  Too often, when my patients come in for what bothers them it is focused on things that will make no overall aesthetic impact whatsoever so my obligation is to refocus on how to get them to simply look more attractive to their spouse, colleagues, loved ones, and social/professional encounters.  If you are not drawn to my after results from attraction, then you should not choose me as a surgeon.

However, interstingly, he found that the only thing that tended to make the smokers want to smoke more was the absence of any reference to smoking, whether bad or good.  He found that when images featured Marlboro-red Ferraris and camels riding into the sunset or other cues that have been linked as images with smoking brands, that the craving center would light up even more.  Reportedly, NASCAR generates one of the most fiercely brand-loyal fans of any out there.  He found that when smokers watched Marlboro-red jumpsuited men who did not have any explicit logos celebrating the company, the smokers responded even more fervently in their brain’s craving center for smoking even more so than when watching the anti-smoking commercials and certainly more than your average smoking commercial in the past, free of such bans.  The thought is that this kind of subliminal advertising lowered the guard that a smoker might have regarding the commercial aspect of an advertisement and instead only stimulated them to make all the wonderful mental associations that NASCAR represented:  danger, masculinity, excitement, speed, and competition.

In a Harvard University study, the author reports that a group of seniors improved their walking gait when they were exposed to positive stereotypes of the elderly including such words as wise, astute, and accomplished as opposed to those who were fed the opposite words senile, diseased, and debilitated.  The effect that these seemingly sublimal advertisements can have on us is strikingly powerful and covert.  It is important that when we as consumers evaluate our purchases before we purchase that we evaluate how much a component is our subliminal brains influencing us.

During consultations with me, I actually engage your logical brain to override the emotional component of a buying choice with me.  I know that my before and after photographs can elicit a favorable response from you, which is perhaps one of the most important reasons that you choose me as a surgeon.  However, I told a patient on Friday that if you do not think I am the best surgeon to do your work I don’t want you as a patient.  I also explicitly said that I also want for you to know why that is the case in great and exquisite detail.  I am a very focused and elaborate educator and take pride in making you an educated consumer and overcoming irrational emotional responses that might cloud your ability to understand what I have to offer.  I go the extra mile in education because I do not want you to choose me based on emotion but based on intelligently infused education.  That is what this website endeavors to do and that is what I attempt to do every day in my practice.

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.

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.

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!).

The greatest airports in my opinion are in Asia: Pudong (Shanghai), Incheon (Seoul), and Hong Kong. There is nothing like these wonderful ports of entry into a new city. Incheon is one of the best and rivals Shanghai’s Pudong. I have travelled twice to Seoul, once for an extended several weeks during the 5-month trip to Asia and the second time for a week in 2004 to lecture, operate, and actually recover from a flu given the incredibly arduous hours I spent that week only to feel that my self-pity was unfathomable when I stood in line at LAX immediately behind the brave young girl, Bethany Hamilton, who had just lost her left arm to a shark attack a few months before.

Seoul is a complicated city. It bears vestiges of a colonial Japanese past with an imperial palace rebuilt to stucco over that legacy. It shows the strain of a city rapidly industrializing under the shadow of a totalitarian regime a stone’s throw away (with the discovered secret of multiple carved tunnels that the north covertly created to lead to rapid deployment of military southward at a blink.) For cosmetic surgery in Asia, it represents the height of both academic and clinical accomplishments, that have influenced my thinking and practice. It is also filled with warm and inviting individuals with whom I have bonded for life.

I wanted to tell the story of a good friend of whom I am very proud. Dr. Kim was recommended to me by Dr. Shu in Japan for me to visit and to observe. When I first visited him, he practiced out of a small, grayish clinic, and I remember very fondly that one night he wanted to take me out to an “expensive dinner” so he picked Bennigan’s. I informed him that I would rather dine on local fare, to which he first reacted with a puzzled expression that slowly gave way to understanding of sorts. Upon my return 2 years later, he had moved into a lavish new clinic and surgery center in neighboring Bucheon with a lecture hall and had been training fellows and international visitors. In fact, he even translated my book into Korean and got it published. I was wondering about the impetus behind his meteoric transformation. His wife confided in me that I had really changed his life by having him think big and getting him excited again about his work by publishing him in international journals. She mentioned that he had been suffering from ulcers and that his stomach conditions had since dissipated. I was thrilled that my initial short visit would have such a profound and lasting impact.

I remember that when I returned in ’04 to lecture and to operate, we drove up to the Hilton hotel where the lecture series was being given. Dr. Kim had plastered on the side of the hotel my clinic’s name. I really had done no work to organize the meeting but that was what he thought of me and he had me sign all of the program certificates as co-president. Another great surgeon, Dr. Jung, invited me to go to lecture next year 2009 in China but I simply cannot make these long trips away from my practice. I loved training with Dr. Jung and had the good fortune to invite him as a special lecturer in Washington D.C. for a course for which I was the director last year dedicated to the Asian face. I really cherish Drs. Kim and Jung for their convivial hospitality, genuine goodheartedness, and brilliant surgical acumen. They are the core of my remembrance of Seoul and to me are the embodiment of Seoul. Tomorrow we get Shanghai’d to Shanghai.