Buy•ology Part 2 of 5: Smoking, NASCAR, & Subliminal Messages
February 10, 2009 by dr. lam · 12 Comments
How effective are the anti-smoking campaigns we see? The answer that Lindstrom argues in Buy•ology is not very. He actually found that smokers craved more smoking when they were shown an advertisement in which a group of smokers were engaged in the activity of smoking but instead of smoke, caterpillar-sized wads of fat emanated from the end of the cigarette as representing the artery-clogging effect that smoking can have on the body over time. He found that the smokers were more focused on the convivial atmosphere that the smokers were sharing rather than the absurd and sickening effusion of fat wads that was the more obvious element in the commercial. In fact, he found using fMRI that smokers shown advertisements without a warning were less inclined to smoke than those who were shown the anti-smoking warning. The effect of the written ban that accompanied an advertisement served to elicit the craving center in our brains, the nucleus accumbens, which is very fascinating to me.
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.
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 2 of 5: Comparative Perspective
December 16, 2008 by dr. lam · Leave a Comment
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.
The Two-Finger Rule
December 12, 2008 by dr. lam · 6 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!).
My Travels in Asia: Remembering Seoul (Part 3 of 5)
December 3, 2008 by dr. lam · Leave a Comment
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.