Start with either bare feet or stockinged/socked feet so that you can feel the ground under you.  Plan a path where you will be walking either in nature or indoors.  Even if the path is relatively short, you can traverse this distance and redouble on your tracks without a problem.  Just plan your path out in advance so that you don’t need to worry about where you will be going.

As you begin the exercise, remember to start with the fundamental of your breath.  Focus on the rhythm of your breathing and allowing yourself to breathe more quickly or more slowly depending on your body’s needs.  As you breathe, enjoy the rich breath that is giving you nourishment and life.  Then start to focus on your legs and toes as you walk over the terrain and enjoy the feeling of the ground under your feet and the related sensations.  As you walk, enjoy the feeling of walking.  If your mind wanders, bring it back to the focus of walking and the feeling of the air against your face if you are outside and the sounds around you or if you are inside just stay centered on your breathing and walking.  As you conclude the exercise, return your thoughts back to your breathing and finish with your breath meditation.

Here is a video guide to help you with this meditation.  Namaste.

Most oftentimes, we do not work at self-improvement but look at everyone around us as needing work.  Maxwell says that when we criticize someone else, that is called constructive criticism.  However, when someone criticizes us we call that destructive criticism.  I am certainly not perfect at taking criticism, but I am a lot better today than I was even last year and last year I was better than the year prior.  Remember from the 4 agreements, “never to take anything personally”.  That is very important in this case.  Too often when we judge others, we judge them by THEIR actions, whereas when we judge ourselves we judge ourselves by our intentions.  This two-tier system of criticism leads us to failure because we never meant anything by what we did or so we rationalize, but that person certainly should have known better.  We must strive to create a harmonious congruity by how we perceive ourselves and others.

Maxwell, a former preacher, still says that he ultimately does not trust himself to lead himself.  That is why he has established external accountability for his actions.  That is why I wrote about accountability a couple of weeks ago and why I emphasized how I am accountable to other business leaders/owners in my EO forum group.  How have you made yourself accountable?  To whom?  What interval?

We as leaders (and that means all of you too!) must hold ourselves to a higher level of accountability.  Linda, who is my spa director, asked me last year why I have apologized to my staff for seemingly small infractions, and I explained that as a leader I hold myself to a higher level of accountability of who I am and who I should aim to be.  There is no other person that can truly hold you to that level of accountability than yourself.

When we first lead ourselves, we can then have a chance at leading others around us.  I have learned a lot about real-life leadership this past year and have worked even more diligently at becoming a more centered leader.  By virtue of that, my patients and my staff and everyone around me has benefited.  I must start with myself.  You must start with yourself.  We must start with ourselves.  I look at my readership as part of my extended team at LFP because I would love for all of us to grow as humans in our common fraternity.

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!

We talked yesterday about life being a journey and how to savor our present time. However, if life is a journey, where are we going? Some people who relish the present so much in a hedonistic fashion do not prepare for the future or have no idea where they are going. I think part of being on a journey is knowing what should be our life’s destination. Are we moving along a path toward a goal or just going in circles? Sometimes we try too hard to know our future, which is unknowable but I like the saying, “Chance favors the prepared mind.” If you are lackadaisically living entirely within the confines of the moment, you may not have a future that can sustain your present lifestyle.

Also, meaning in our life is defined by having a sense of purpose. We will talk about this more tomorrow. However, in short, we actually derive pleasure in life to know that what we are doing on a daily basis is meritorious and beneficial for others. I think even the most hedonistic, self-centered person can feel a sense of joy in having a defined purpose in life. It can also help us limit our present fears and vicissitudes in our emotions when we know firmly where we are going in life. What are your 5-year plans? What are your 10-year plans? What are your 20-year plans? Do you have them? I do.

Once you define your goals you should then divide them into your BHAG (big hairy audacious goal) — to steal a term from Jim Collins — and your smaller goals. These goals should fit within your vision of what you want to be. (See last week’s blogs to understand what I mean by vision.) Your BHAG is your dream, perhaps unattainable, perhaps unrealistic but who cares. My BHAG is to be a household name across the U.S. and the world in facial plastic surgery. My steps to get there are to continue video production to disseminate my knowledge as an immediate goal; continue to improve my website as a twin goal; write a major laypress book published by a major publishing house to define a new paradigm and aesthetic; and become a speaker in the lay circles (not just academia) in major venues in the coming 5 years. Those goals are my 5-year goals. MY BHAG is my 10-year goal. My 20-year goal is to attain another BHAG regarding expanding my concept of wellness and establishing a model for other surgeons, health-care professionals, and individuals related to the industry to follow. I think wellness is the future of health care in America and for most of the developed world out there. My passion is to see that what I have defined for the Willow Bend Wellness Center can be a replicable model, where we lead the industry by business acumen and vision.

If you laugh at my BHAGs, that is fine with me. I don’t. Discover your BHAGs but don’t live entirely for them. You must define small steps for you to attain your BHAGs, things that are attainable in the short term, measurable steps that are discernible through fixed metrics and time points. Be flexible to open yourself to new BHAGs or replace ones that simply don’t mean much to you anymore but don’t throw a BHAG away simply because you don’t think you will attain it.

Many times a BHAG is defined by money. I would say if you are a company, that may be okay. But I would argue that monetary goals should be short term metrics to attain a BHAG but not a BHAG. A BHAG should be a larger, all-encompassing vision that you as an individual or your company can follow, be inspired by, be motivated by, and live for. I always help those around me who are struggling with their BHAGs to define them by anything but money. I like to say, “Follow your passion and money will come. Follow money, and money will go.”

The core of any individual or business should be a burning passion. I recently had a fireplace with the glass shards (instead of the wood) made by an expert in these kinds of fireplaces. I asked the woman, Nadine, who designed the glass why do you do what you do. Her eyes lit up brighter than the fireplace and she said, “I’m 46 now and the vision came to me at 17 in a dream. I somehow knew that is what I needed to do.” She did not have to tell me that because when the fireplace was lit, I could see this broad beaming smile like a child captivated by her creation. It is the same smile that I have when I see my work.

I had to take my ACLS (Advanced Cardiac Life Support) renewal this past weekend, as a requirement for maintaining my surgery center’s credentialing. I have always been bored out of my skull during these courses but not this time. Robert Twite, RN, brilliantly created a session that allowed me to sense his passion and his “why” (see Tuesday’s blog). His mission in life was to help others truly save others’ lives. I assume his vision for myself and as part of his crusade (see Wednesday’s blog), I posted a video on how to do good CPR and why to do it. My teaching skills for CPR pale in comparison to his so forgive me Robert for my feeble attempt but I need to get this message out to my readers and followers of this website.

What I found very interesting were a few things. First, he mentioned the idea of “hands only CPR” that has come into vogue recently was very very intriguing. He argued that many advocates have shown that just doing chest compressions without mouth-to-mouth can have very similar or same outcomes in survival. There are a few reasons for this. First, the air that is recycled from your lungs and breathed into the individual is filled with CO2. Second, if you breathe too often and too much (which is the natural tendency to do), you can make chest compressions less viable owing to a rise in pressure inside the chest wall. Rapid, early, and hard chest compressions can save a life.

Second, he talked about how we believe in the past that we better check a pulse before starting CPR. Well, yes, that is not a bad idea but not at the expense of starting early CPR. What he argued is that without chest compressions in someone who does not have a pulse will lead to a quick death. If you perform chest compressions in someone who has a pulse, the only negative outcome is a sore chest. Even if you find a weak pulse, additional CPR can oftentimes supplement the cardiac output of blood and lead to a better outcome. He offered the example that in children who even have a pulse but a slow one like at 60 beats per minute (that is slow for a child), the advice is to actually do CPR to improve blood flow. So if you check a pulse, then I check a pulse, and we both don’t know if there is a pulse, we are wasting precious time for no reason. Forget all that and start high quality CPR. Crappy chest compressions do nothing. High quality chest compressions only offer 25 to 30% of a normal amount of blood to flow out of the heart. Also, remember that you must lift off the chest, i.e., let the chest completely recoil back to an inflated position because you need the blood to return to the heart as well.

Finally, if your business does not have an AED (automatic extrenal defibrillator), you need to get one. Early shocks from this device will lead to a life saved. Without one, even chest compressions might not be enough. These devices will actually guide you when to shock and when not to. Basically today, the goal is 2 minutes of sustained high quality CPR with chest compression to breaths of 30:2 followed by the AED announcing when 2 minutes are up to determine if you need to be shocked or not. Even after a shock or not shock, continue CPR until told to stop. The AED however should interrupt CPR at the earliest time possible since the earlier you get an AED on someone the higher chance of survival for that person in many cases if the rhythm is shockable like ventricular fibrillation, which is a common cause of cardiac arrest.

This blog is not intended to replace formal basic life support training but to encourage you to get certified. In the meantime, if you haven’t yet and the occasion arises where you need to save a life remember early and hard chest compressions with recoil time and get an AED fast and furiously then continue until help arrives. Don’t err on the side of checking pulses, checking pulses, then looking at each other. Most likely CPR and an AED will save a life more than whatever the ambulance or physician can do. Outcome studies have shown that only 2 things matter for survival: good quality and early CPR and an AED early, not fancy drugs or airways. Two things in conclusion: get CPR certified and make sure that your workplace has an AED on site. Thanks Robert for the brilliant education. I hope I can spread your message out there to all who can hear.

My favorite quote of all time is as follows:
“Vision without action is only a dream.
Action without vision is only passing time.
Vision with action will change the world.”

I have used these words to close many of my lectures on leadership. It is the core of my belief system. It is the core of this website. I had a blog entry (you will see that many blog entries relate to one another, partly because I have a finite brain but also because I have deep abiding passions that are focused in nature) that talks about “walking the talk.” I have dealt with a lot of dreamers who have seen the glorious building I have built and who want to be part of the vision. My tagline which has become a bit of an inside joke is “Join the vision now”, which is what I used when I was first recruiting physicians for my building. I found that physicians (pardon me) can be divided into one of two types: the lone maverick whose ethical decision making is circumspect to say the least or the risk-adverse individual who is ensconced in his or her own fears. The first type is a big dreamer but I do not like their actions. The second type is neither a dreamer not a doer, leading ultimately to failure at getting the bigger slice. I infrequently encounter a medical professional in whom I have the rare respect of having both the right vision and the right action. In any case, I have not compromised my vision for anyone (not even for my patients. We’ll get to that on Wednesday.)

A huge reason that I joined Entrepreneur’s Organization (EO) is that these are gentlemen and ladies who have a big vision for changing the world and who have put all their risk behind that vision. I slavishly defend my brethren in that organization and have rarely if ever missed a meeting. I missed only September’s this year for our learning event because I was in Montreal at the hair restoration meeting. I have missed no forum meetings this year because I make that a priority. We are all given one miss. I take that to mean zero if at all possible.

Reading this weekend entries from a young gentleman from the UK in my forum postings, I like what he said, “a mentor/friend of mine said that you become the top 5 people you surround yourself with. it led me to change my entire social circle, create a mastermind, and my life has changed so drastically over the last year, and continues to every single day. It’s really hard to get rid of negative influences in your life, especially when you bonded and create some level of co-dependency. So I absolutely agree with thoughts in this post!” Thanks Vince for your wonderful entries. He also offered his apologies for talking about irrelevant subjects on this website. I have made it a point that there is no such things by opening a section called “Tell me about your passions”. This website aspires to be much more than a website on facial cosmetic surgery. It is about a community inspired to change the thinking of the world. Okay, once again I get ahead of myself. Read Wednesday’s blog.

Jan May, our Botox business development rep, just gave us the good news: we have the best wait times in Texas based on a uniform customer satisfaction survey provided nationally. Remember these are only the top practices across the U.S. that even get these services so these are the busiest practices that at least reach platinum status with Allergan (300+ bottles of Botox a year, which we are way over). Obviously, for a slow practice with 10 patients a day, you would expect the wait times to be great. However, we are the best of the busiest and that says a lot.

I am obsessed with quality customer service and so is my staff so I am extremely proud that despite our very busy practice that we can garner this distinction. In addition, I always make it a point to make sure that my patient knows that I am running behind if I am, and I do so personally myself rather than delegate that responsibility to my staff. Further, my staff tries to ensure that every waiting patient is attended to with appropriate amenities to make their time more enjoyable and perceptually less prolonged. In short, I am really happy with our results, and I am glad that my patients overall are satisfied with our expeditious service!

I just got back last night from Los Angeles where I gave 3 lectures at Cedars-Sinai and had a fabulous time. I also learned a tremendous amount and would like to thank my friend, Babak Azzizadeh, for inviting me to speak there. I was particularly enlightened by Val Lambros’ lecture on understanding the evolution of facial aging in which he used superimposed images of an individual at youth and after aging with morphed animations between the two images controlling for facial position. What was remarkable is how the upper and midface DO NOT FALL but just lose volume and deflate.

I like what he said which was, “The brows do not fall as much as we pick them up.” When he showed images of the brow over time, some came down literally only 1 or 2 mm, others stayed the same height, and still others actually went upward with aging as the skin retracted upward. Therefore, even for the occasional brow that came down 1 to 2 mm, a browlift would oftentimes exaggerate the brow position upward making the eyelid look different and unrejuvenated. He also mentioned that (and he demonstrated this on himself) when he lifted his brow up with his finger his eye actually looked smaller, making him look older. The fuller outer brow contributes to the lengthening of the eye shape further outward, which is similar to the shape in youth.

Let’s discuss eye shape in youth. He mentioned that in most individuals, Caucasian, Asian, or any race, there is a relatively almond-shaped eye that becomes increasingly rounder as the lateral canthus (outer part of the eye) starts to move inward toward the nose. This beadier, smaller, rounder eye is less attractive than the more open, almond eye shape that is more prevalent in youth. As mentioned, by exposing the narrowness of the outer eye by lifting the brow, the eye can look smaller and thereby more aged. That is why a traditional lower-eyelid surgery that involves cutting of the lower eyelid skin and tightening the skin thereafter further constricts the outer eye and can make the eye look even older. By filling the outer brow, you visually extend the outer eye shape to make it appear younger since the eye appears wider. Okay, this is really hard to explain but a simply brilliant thesis predicated on empirical evidence of aging using unequivocal superimposed images from youth to aging. In addition, a fuller framed brow is simply what exists in youth. For all of these reasons (both illusory and real), a browlift can actually age someone further.

He evaluated positions of moles and other static landmarks during the aging process. He found that moles simply do not change direction gravitationally downward. The moles that did migrate with facial aging did so in a radial fashion along muscular pull lines, i.e., almost horizontally that would indicate that the face is radially contracting, i.e., deflating, rather than falling downward. Again, remarkable insight using powerful superimposed young and old photographs of the same individual.

Unfortunately, for the neck and jawline, oftentimes a facelift is still required to accomplish the required rejuvenation. However, what he also showed was that the jawline matched out from youth to aging actually shows the jowl because the surrounding tissues are lost. That is the soft-tissue in front of and behind the jowl begin to disappear to reveal the jowl. At times bringing the jawline down with fat transfer in front of and behind the jowl could actually be better in certain circumstances. I think with a very prominent jowl and neck descent, a facelift is still mandatory to get the desired results. However, I have come to appreciate the power of filling the outer jawline in select patients who would benefit from this fill both for the sake of facial rejuvenation as well as for creating a better-balanced face. All of these ideas represent a remarkable revolution in thinking that justifies volume replacement as the singular technique for upper, midfacial, and parts of or the entirety of lower facial rejuvenation.

Herb Kelleher, Founder of Southwest Airlines Playing Doctor

Fortune Magazine stated in its 1995 Corporate Reputations survey: “There is a growing concern that companies cannot live by numbers alone. The one thing that set the top ranking companies in the survey apart is their robust cultures.” I would agree.

The one thing that I try to do almost every single day with as many staff members as possible is to share with them our success stories. Oftentimes, we tend to focus so much on how many units of Botox to draw up, did we get the proper medical clearance for next week’s patient, did the patient get the proper follow-up visit assigned, etc. that we forget why we are doing what we are doing.

I believe that my entire staff believes that we are here to “change and transform lives.” That in essence is another credo that we have. Along those lines, when I get a patient testimonial (written or video) back or a beautiful before and after photograph or a verbal testimonial, we stop all the presses and we celebrate for a moment why we are who we are and why we do what we do.

Southwest Airlines is perhaps the paragon of culture. They celebrate everything. There is always a party going on. Although we make it a point to celebrate birthdays, holidays, and other milestones, we celebrate why we are here every day every waking moment when we see how a life has been touched and transformed. I had a patient say to me at the consultation last week, “I hope you are as good as how much your staff says you are. It is unbelievable.” I just smiled.

I really like the word “Credo” instead of “Mission Statement”. I have always used the word “Mission Statement” until I read The New Gold Standard on Ritz Carlton’s legendary service. The word credo for all of you Latin neophytes (I took and taught Latin for four excruciating years!) means “I believe”. I think that my staff must buy in to our “credo” and know it. Before I give you my credo, here’s the Ritz Carlton’s:

The Ritz-Carlton is a place where the genuine care
and comfort of our guests is our highest mission.

The Ritz-Carlton experience enlivens the senses,
instills well-being, and fulfills even the unexpressed
wishes and needs of our guests.

I really love the last part, “fulfills even the unexpressed wishes and needs of our guests.” I think my staff does a lot of that without my prompting. They are truly hospitalitarians. (For my blog on my spawb site on hospitalitarians, click here.)

Now, here’s my credo. It is a simple mnemonic, my name, SAM LAM. (Thank goodness my name is not Alberto Gonzales. That would be hard to remember.) The “SAM” stands for Serve Always Mentality which is focused on how we serve our loyal patient base, putting the consumer first with the mind of serving always at the core. “LAM” is not focused on the patient at all but on each individual staff member. Remember we are all essentially selfish people, “WIIFM” (what’s in it for me.) L stands for Laugh: I want my staff to come to work every day and have a blast. A stands for achieve: I want them to come to work and feel self-actualized on the Maslow’s triangle. They should learn something every day and feel as if they are growing. M is for Mentor: I believe that as a team our goal is to mentor the next person next to us. We can’t oftentimes motivate the unmotivated but we can inspire the uninspired.

If you call my office or come in as a patient, every one of my staff members should be able to recite our credo by memory. I instilled this into them about a year or more ago, and I do occasionally quiz them on it. I hope you guys find your own credo. In my EO forum group, I learned an interesting thing is that a family can also have their own credo. Perhaps if you are not part of a company where you are in a position to create or sustain a credo, you could try this at home to define the culture where perhaps it matters most, with your family.