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.

Simon Sinek talked about Apple’s success. The reason that Apple succeeds is not because they make good looking computers. They succeed because they have inspired their customers to aspire to be what they are all about, i.e., making good looking computers (among other things…that work well). I myself aspire to be an Apple aficionado because I cherish their values: great design, simple to use, and passion not to compromise that aesthetic vision. Do you think the reason that someone wears a Harley-Davidson tattoo is that they want to promote a Harley so that their stocks will rise? Well, that is a lot of dedication if it is the case. No, in fact the reason that someone has a Harley-Davidson tattoo is that the individual has taken that vision unto themselves as their own. They have assumed that vision and internalized it and made it theirs. Sinek said the reason that people marched on Washington D.C. in the 60s was not for Martin Luther King. It was for themselves because they assumed Reverend King’s vision for themselves.

One of my proudest moments this year (you might chuckle) was when a newscaster here in Dallas whom I do Botox, fillers etc. for told me she had walked into a room of 20 women where one woman was talking about not doing browlifts but to focus on balancing the anterior cheek, etc. Afterward, my patient went up to the lady and said, “Are you Dr. Lam’s patient?” She said, “Yes, how did you know?” Of course, my patient said, “Because you sound just like him.”

I hope that my vision for changing this world from an overlifted bizarre looking alien race to a natural beautiful ethnically sensitive balanced result will challenge you to assume my vision and make it yours. If you are not there yet, I hope you will be. I know that is sounding arrogant but I am not intending it to be. I hope you can be my agent of change and to renounce the status quo that noses need to be over-elevated in Asians, over-reduced in Middle Easterns, and individuals need brows in the middle of their forehead. That is why I was angry sounding this weekend in response to a forum posting because I would hope my patients not allow others to be subjected to antiquated surgery and what I view as an untenable philosophy.

BTW, THE WEB TUTORIALS ARE ALSO NOW LIVE!

Many of our businesses are predicated on the what and the how. What are we producing? What is it that the consumer wants? How do we improve things? How do we make the consumer happier? Let’s take a look at the real core issue: Why. I was listening to Simon Sinek last year at an EO event who talked about getting to why (more about that tomorrow as well). The why is why we are doing what we are doing.

I had a spa event a few weeks ago where a lady said what really bothered her were a few fine lines on her upper lip. No one in the room could see what she was talking about, and she asked me, “Dr. Lam, would you mind if I just came to you to fill these lines and nothing else?” I said, “No, that is fine. However if you continue to do that over the next 3 years, you are wasting my talent and I am wasting your money.” That being said, MOST women come to me solely to fill those fine lines because that is what they are programmed to think ages them. Obviously, if I have done what it takes to get you where I think you should be then we can fill those lines. That is fine with me to see you and to educate you but I do not roll out of bed to fill a line. I get out of bed for an entirely other reason…

What is my why? It is in a nutshell “to take care of people and to transform lives”. Audacious? perhaps but it is something that is driven into my staff’s brains. The why is not just the reason that I get out of bed, it is the reason that all my staff get out of bed too. Yes, they come for a paycheck no doubt. However, they come because of the difference they know we are making every day.

If any of them look at what I do as trivial, then they will not stay with me oftentimes not because I am going to fire them but because they are going to fire themselves. They can’t survive in a culture that is dedicated to relentlessly addressing our core why. Stephanie, who works as my MA, left her last job because they had no why. Their why was to gouge and steal from the customer. She has seen what our why is every day. She sees that I turn away as many customers’ desires as I accept. I fundamentally cannot and will not waste your money. I really love what I do until I bleed. However, my staff does too. We are here every day impassioned by YOU.

Remember that as much as you choose me as a surgeon, I choose you as a patient. This is a marriage of sorts. If you are principally negative and micro-managing. If you are here to do something that fundamentally is a waste of your money, you should not be my patient and I should not be your physician. Am I taking risks with this website? Absolutely, I am NOT all things to all people. I have defined my vision and my patients who are attracted to it come and stay. Those who are not, do not. They leave or don’t stay and I am more than happy about that. Same with my staff. Those who cannot share my vision at a fundamental level don’t last. Are they wrong? Am I wrong? No. No one is wrong. The fit is just not right.

Do you know what your why is? Why do you get of bed every day? Why do you go to work every day? Is it just for a paycheck? Is it to punch in the time clock and leave so that you can party with friends? Fundamentally beyond the what and the how lies the why. That is the core of any vision.

BTW: THE UPDATES SECTION IS NOW LIVE. ENJOY!

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.

This is the Latin motto that was used by my high school, Cistercian Preparatory School, that simply means “to be enkindled and to enlighten”. I like this two part saying because the first part talks about oneself and the second is the effect of the first part on those around you. Let me clarify: “to be enkindled” literally means “to burn” so I interpret that to mean you are set ablaze with passion for what you do and that burnished passion rubs off on other people around you in an infectious way. Further, it just means that you are burning and on fire for life and whatever you are doing.

The second part “lucere” means “to be enlightened” so that you can also be in a learning capacity but I also see it as its literal meaning “to shine” meaning your burning “ardere” serves as a light and a beacon for others around you. As I have mentioned in previous posts, my mentor, Ed Williams, taught me, “You can inspire but you can’t motivate”, i.e., you can shine a radiating light that will fall on the shoulders of those who can see your passion and make it their own but you can’t force someone to do something that he or she has not motivation to do to begin with.

I think we all should be burning with desire and with that burnished energy impart that to others as a shining light so that they can be touched to burn themselves and then to light others forward. Ardere et lucere.

Today I turn the tender age of 40! I celebrated with friends and family this past weekend (see photo), with my sister and my brother-in-law flying in to offer me their best wishes from New York as well as some “over the hill” balloons and a cake that read “Oh No The Big 40″ for fun.

Of course, at this juncture I pause reflectively on my life’s journey thus far. I was on a date last week and was asked, “Do you have any regrets?” I said, “No. I never have regrets.” I think the past is something we can’t change but helps guide us for a better future. I would say that I have had a lot of learning during the 40 years I have graced this planet and hope that I can become a better person every day forward.

Too often we become the sum of our accomplishments or a sum total of our past. I can look at the writings and surgeries that I have accomplished and all the patients I have been so fortunate to touch their lives and feel deep satisfaction. Yes, that is fantastic and quite an honor for me. But, more importantly, I look forward to the future and what is in store for me during life’s journey. If we look at life like a journey (as mentioned in yesterday’s blog), we can savor the ride and look forward to the next road stop coming up.

My spa director, Linda, said to me “Dr. Lam, you are 99.9% right about things.” I said, “No, perhaps in life I am only 70% right but the 30% of the time that I make a mistake, I don’t make that mistake twice or try terribly hard not to repeat that error.” I am in a constant battle to be more self aware, which I think is the most critical thing that we can do. We need to be a better person tomorrow than who we were yesterday. As I mentioned in this blog, my organization EO (Entrepreneur’s Organization), also affectionately known as “AA for Business Owners”, helps me focus on my personal and professional growth.

I am very grateful for where I am today and look forward to where I can become in coming years! I would like to thank the love of my family, the love of my staff, the love of my friends, and the love of my patients who have buoyed me all these years and will do so I hope for many years to come. I leave you with this birthday card wish I received: “My birthday wish for you is that you always have people to laugh with and be close to, things to dream about and work hard for, places you can go to rest and reflect on all that is good in the world and especially in you…and may you always know how much you are thought of and loved.”

This is my second favorite latin quote, “festina lente”, meaning hurry slowly. In short, it means be deliberate and consistent in your application but don’t trip over yourself to try to get to the end result. I really love this saying. Sometimes we get so wrapped up in what we do that we become impatient to get to the end result. That can lead to producing an inferior product that we would not be proud of. As an example, the hospitality kit that I know is shortly forthcoming in this week or in a few days has been something that I have worked on with my staff and webmaster for several months now. It will only be released when it is mature and ready to go with only a few bugs and kinks left after going live. I could have released an inferior version months ago but that would not have been right.

Also, life is a journey. Sometimes, we get so obsessed with the destination we forget to savor the journey to get there. We need to “make haste or hurry”, that is, not waste time going in 50 directions but move forward slowly, deliberately and with open eyes and and with an open mind. This fundamental component informs how I treat my surgical patients. I do ONE surgical case a day. Instead of trying to cram in 3 to 5 surgeries a day, I savor each procedure and want to be as fresh as possible for the case, as my patients deserve. Never heard of such a thing? You’re right. I haven’t either in all my surgical training. That is how I set up my practice, and I love it.

I think “festina lente” is a companion to “per aspera ad astra” (monday’s blog) since through hard work we can attain the stars (the latter saying) by steady and forward-minded application of our talent and efforts. Whenever I feel stressed or want to push too quickly for the end result, I think “festina lente.”

Get Out and Vote

Need I say more? I will not disclose my political affiliations as this blog is meant to be free of both religious and political overtones (no fights, right?). I will say that I am not a very “political” person and hate engaging in political debate. However, I think we all should get out there (in the U.S.) and do our civic duty to make our voice heard and to participate in our glorious democracy.

Coming from another country and being naturalized as a United States Citizen during my teenage years makes my citizenship more acutely aware for me than for many who were born here and take that right for granted. My parents moved from Hong Kong back to the United States when I was 3 years old specifically so that I could enjoy the freedoms that the U.S. would offer me. Obviously, there are many great countries out there, but my parents chose this one for my upbringing.

Last week on Thursday I cast my ballot during early voting in Texas. Let me tell you a little of the saga I went through to actually vote. First, I went to a township called Addison which based on my computer was where I was registered and only 15 minutes away from my office. After a 30-minute wait in line I got to the front of the line where the lady asked, “Do you still live at the address where you registered?” I said, “No.” That led to me talking to the judge, who denied me (and the lady in front of me) the right to vote in Dallas county. I was informed that I would have to go to Denton, my current place of residence. I plugged in the address on my GPS and headed northward. The GPS indicated that my travel time would be 30 minutes, leaving at 5:50 pm during traffic to make my arrival at 6:20 pm (assuming no traffic) with polls closing at 7 pm. I had to go to that location because I had to vote what was called Limited Ballot, meaning I could not vote for officials in Denton County, which was fine with me. Fortunately, there was not heavy traffic but by 6:40 pm, I realized my GPS had taken me into a blind cul-de-sac, and I was afraid that I would not make it. I called the Denton location moderately panicked and then plugged in the nearest cross street into my GPS that the lady gave me and my GPS read arrival time 6:50 pm. I made it there with a combined GPS and verbal navigation at 6:55 pm to vote, 5 minutes before the polls closed. With an accident in front of me and closed lanes coming back southbound, I faced an hour and a half traffic making my voting experience a 3 and a half hour journey that did not even involve extensive lines!

I hope all of you will have a more pleasant experience than I and get out there and vote!

Olympian Michael Phelps

After 4 years of Catholic high school and 4 years of Latin instruction, some of that knowledge will linger in my soul regardless if I want it to or not. I also taught Latin over the summers and still can remember my declensions and some conjugations (frightening huh?). I was thinking that some Latin maxims have really stuck with me over the years, and I thought I would share with you the 3 maxims that have the most meaning to me personally in today’s blog, Wednesday’s, and Friday’s. I have other blogs prepared for Tuesday and Thursday and you will see why on those days.

My absolute favorite Latin saying is “Per Aspera Ad Astra”. It simply means through hard work to the stars. I truly believe that with application of a rigorous work ethic that I have applied since childhood, you can succeed beyond your wildest dreams. If I want something, I don’t take no for an answer but plunge forward to get what I want. I think the work ethic in America has been steadily declining and we suffer from that lack of discipline. Interestingly, the next 2 maxims will touch upon this idea but from a different angle.

It is interesting that I have pursued my career with singular focus based on a deep-rooted passion. I work tirelessly in large part because I love what I do. I think there are two things that we should be careful with when we focus on “per aspera”, i.e., the hard work part. If we do not know where we are going, then hard work is for naught. We need to know what our short and long-range goals are for that hard work to have any merit. Put it another way, if we do not know where we are going, we do not know which direction we should travel in the first place.

Second, I had a leader of mine who came to me and said, “Sam, I have worked really hard. I have spent 10 hours doing this and 10 hours doing that.” I responded, “What was your result?” There was silence. When I talk to my staff, I am more interested in the “ad astra” and less in the “per aspera”. If it takes you 5 minutes to envision and execute a vision, that’s great. If it takes you 10 hours to try to do something but you consistently attain no results, then I am unimpressed. I am completely results oriented. That is where judgement and talent come into play. I really admire raw talent combined with a forceful work ethic. Work should not be just for work sake.

All that being said, I think when we want something badly and our goals are driven through a deep-seated passion and unbending vision then we can achieve it through tireless hard work: per aspera ad astra!

Heart Math

As I alluded to in Tuesday’s blog, a leader is an individual that commands quiet respect without having to ask for it. The person who needs to ask for it most likely does not own it or deserve it. Leaders however are not born in many cases and are not born out of crisis. Instead, they are mentored by someone more senior than they are who have inspired them to be leaders. I have had many mentors. As mentioned before, Ed Williams was my singular hero who taught me my flaws more indelibly and who showed me a path that I needed to see.

Along those lines, when a leader leads because he or she naturally draws people into a followership position, it is important that the leader not drag down his or her staff through negative emotional energy. In fact, a strong leader will draw down everyone’s energy unwittingly in many cases. Oftentimes, anyone within 15 feet of this leader will either be buoyed by his or her presence or demoralized by it without that leader actually opening his or her mouth. In It’s Your Ship (a book given to me by my nurse Beth to read), the author suggests that if you are the leader and you are not having the best day, get out of the way and allow your followers freedom not to be shackled by your emotional slavery, albeit unintentional.

Also as I have mentioned, we are all leaders in many respects and we all draw and give energy to those around us. That is part of the reason that I started the “Tell me about your passions” forum to just have fun with imparting a little happiness and joy through related passions. The California group Heart Math has claimed that the electromagnetic forces of our hearts radiate about 15 feet around us and when our energies are low and negative we impart that out to those who are in our proximity. Accordingly, to buoy those around us rather than to anchor them downward, center your emotional gravity first before you inflict that negative energy on all those who see you. Over time if your energies are sustained negatively, you will either attract those who thrive on negative energy or you will polarize away all those who embrace positivity.

I think that is why in large part my patients are happy ones because I attract those kinds of patients, who are inherently happy individuals. I think as much joy as my patients get from seeing me, I in return attain the same level of joy in seeing my patients. My patients are truly the driving force behind why I wake up every morning and enjoy coming to work. For all of you out there who struggle with negative energy, remember that whatever energy we think we are containing within us actually can affect all of those in near proximity to us even without our knowing it (or at times their knowing it). The stronger an emotional force you are as a human being the more effect you will have on those around you, positively or negatively. I hope you will learn to radiate positive energy around you by being, thinking, and feeling as positively as you can every day.