Satisfaction and complacency are not words that I know. I am grateful for the stellar reviews of this website, but I want to continue to refine and make this website more user friendly and more extensive in its scope. With that, I am rolling out the beginning of some major additions and changes to this site that will probably take 6 months to a year to complete in full. I have been working on some of these preliminary elements for over 6 months now with my webmaster with a focus specifically to help out-of-town patients get in and get out of Dallas more easily and to make their stay more seamless, enjoyable, and less difficult.

As a huge percentage of my patients come in from out of town, I am trying to help them out. In fact, I cannot remember a day in the last 3 to 4 months that a patient did not come in from somewhere out of town, state, or country. With that in mind, I have aimed to streamline this large percentage of my practice in a unique way through a custom-built “hospitality kit”. I would like to thank Jeff from Chicago who came up with and executed in great detail his idea of a “hospitality kit”, which in short is intended to help the out-of-town visitor truly be able to visit Dallas effortlessly and with less trepidation. He was the $5000 contest winner with his elaborate idea of the hospitality kit, which I am presenting today.

Some of the features of the hospitality kit include 360 virtual tours of the various hotel rooms in Plano and the immediate surrounding area that I personally shot and edited; a video tour through the hotels and attractions as well as my building to familiarize you with the Plano area; a custom-built map that permits you to view Plano and attractions that include restaurants, hotels, laundry services, tech services, atms, banks, book stores, etc.; full menus from area restaurants that feature takeout and delivery focused on the recovering patient; a peer-to-peer (P2P) sharing on travel assistance so that an experienced patient can help a prospective one; a list of DVD movies that you can rent from me including a player for no charge; a new concierge service that is both reasonably priced and offers such amenities as fully stocking your refrigerator with items you request in advance of your stay; and the whole shebang can be downloaded as a single pdf file for your convenience to help in planning your trip to DFW (the pdf feature should be live within 1 to 2 days).

Btw, even though my hospitality kit launches today, it is already in need of an update! I just learned of two new hotels opening in West Plano that I have not had time to explore but look absolutely amazing: Aloft and Nylo. For the first time, West Plano is getting extremely COOL hotels here! I am really excited. I have already made some comments in the new Patient Submitted (in this case I submitted) Travel Assistance section.

In addition, you can now see additional features (that we are still working on at this time) including web tutorials in which I personally navigate you through parts of this website that may interest you but you cannot find given that this website has now expanded beyond 3,500 total pages (I have just finished shooting all those videos last night. My webmaster just needs to upload them and put the page together). An updates section that automatically lists each day what sections have been recently updated (this should be up today or tomorrow). Besides the blogs and forum section, I update many sections almost daily so you might not know, for example, that I added a new video testimonial or photos from Emina’s trip to Tibet (which i just did) but now you will not have to scour the site for those changes. It will be listed with a direct link to the change in the updates section. Many thoughtful visitors have sent an email to me or my staff about problems they were facing with videos, text, pages, etc. not loading correctly. Now, that problem can be sent directly to the webmaster through “Report Bug” in which the problem page is already flagged when the message is sent. (Also, I will be radically overhauling your video experience in the coming months to make some of the infrequent problems much less frequent or eliminated all together.) I hope these changes will make your visit to LFP a much more enriching, educational, and enjoyable experience!

Before we begin, I would like to thank Mike again for quickly accomplishing a request I made. If you notice on the bottom of this blog, you can now subscribe to my blogs so that you don’t have to keep checking back in to see if I have posted my blog. Most often I have my blogs posted in the morning before I go off to surgery. However, I sometimes forget or don’t have it done on time so it comes later in the day. Now, you can receive an email (if you so desire) informing you the exact moment a new blog is posted and can then link you straight to the new blog. It also allows you to send an interesting blog straight to a friend who might be interested in the topic covered. You can also post my blog to various social media outlets as you see fit. Now on to today’s blog:

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.

I am interrupting my blog for today (the 2nd part on defining culture, which will be postponed until tomorrow but this blog is actually rather on target for this theme) to announce the results from Allergan’s independent patient satisfaction survey and the rare distinction we received for our 2008 Patient Satisfaction Award. Congratulations to all of my hard-working staff members at LFP for their great work and for winning this prestigious award.

We scored almost perfect 5.0s across the board and received incredible written words of support from our randomly selected patients. What is great is Jan, our Allergan rep, said our results look so good that it almost looks as if we “cherry picked” the best patients for opinions. But she witnessed several times how the surveys we sent out were entirely random. Just as a reminder our STAFF satisfaction score last year was a perfect 10: Jan said that was the first time in her 12 year history doing this job that she every saw a perfect 10 across the board from every staff member on satisfaction.

Too often, many companies pay lip service to quality customer service but they have no metrics on defining customer satisfaction. Here at LFP, customer service is job #1 and we have proved our merit with the 2008 survey results, which I have published in their entirety. Also, watch my video log summarizing the results.

Blink by Malcolm Gladwell

I was attending a lecture by my colleague in St. Louis 2 weeks ago and I really liked how he envisioned the facial aging process. He likened it to the book, Blink, by Malcolm Gladwell. For those who have not read Blink or Gladwell’s other phenomenal book, The Tipping Point, I would highly recommend both reads.

Gladwell’s thesis is that we judge another individual or almost anything in a visceral blink of an eye. It does not take 5 minutes to figure out something but we can tell almost immediately about something and we are typically correct in our initial assumptions, which are also very hard to shake if we are wrong.

That is how we view each other when it comes to aging. We can almost instantaneously tell if the other person is older, younger, attractive, or unattractive. We can tell in a blink of an eye from 10 feet away. However, when people come in to fix something, usually they are focused on the minutiae that no other human being can even see. In particular, because women put makeup on, the tiny lines around the mouth (that no one can see. believe me.), the crepiness of the upper eyelid, the dot on the right cheek, the tiny asymmetry of the upper lip, etc. are on the top of the wish list for correction even though after paying all the money to do those things nothing really looks any better.

Instead, I truly believe that overall facial shape (geometry) and proportion is how we make a judgment about another person in a blink of the eye. So, when people come to see me, I would rather help them create a favorable blink impression on all those around them than try to fix the minor flaws that only they can see. If you want to understand how we view aging geometrically, you can watch the first part of my video lecture I gave 2 weeks ago in St. Louis that discusses in my opinion an original thesis on how we see aging. Here is the link to the video.

Btw, a patient of mine told me that Gladwell’s new book is coming out in a few weeks so I checked it out on Google, and it’s called Outliers, about how successful people are successful not just because of who they are but where they are from (at least that is what Amazon says).

I have learned to be much more selective in what projects I choose to move forward with. In the past, whatever someone asked me to do, I would invariably say yes. In fact, up to about a month ago, I fail to remember whenever I said, “No.” That has led to a devastating compression of my personal life to zero.

In the past month alone, I have said, “No” three times. I was asked last week to write another chapter in the book, Master Techniques for Rhinoplasty and Nasal Reconstruction, on alar-base reduction because the editors loved my first chapter that I had already submitted. (Perhaps they loved the fact that I was one of the few authors to get the job done on time and done well.) I said, “No” to my distinguished colleague and friend who asked me to fly out to China as an honored guest speaker all expenses paid for his Rhinoplasty Workshop. I also said, “No” to my colleague who asked me to write yet another book. That is a world record for me. Not Michael Phelps but at least a personal milestone.

I don’t say no to everything. I said, “Yes” to my colleague who asked me to be the course director for a hair transplant workshop in St. Louis next year but I have reasons for saying yes. First, I am very interested in the project, since this will be a unique platform to advance hair restoration in a hands-on cadaver workshop that I think has never been offered before. Second, I like being challenged to be a course director, which is something that I don’t have a lot of experience with. Third, I have already finished the entire syllabus and speaker list in two short hours on Saturday. Efficiency is something that I am known for.

I assumed the Editor-in-Chief position last year for a consumer’s guide for facial plastic surgery, entitled, The Face Book (don’t worry, we copyrighted the first edition before facebook.com), which was something I really had no interest in doing. I did it because a senior member in the Academy basically asked me in front of 20 board members, “Sam, please do this. You are the only one that can do this.” I was honored and also in my state of never saying no last Fall. However, the project has now morphed into something that I think will radically alter the landscape of my field in that it is no longer targeted for surgeons’ reception areas (which is an untenable and antiquated concept) but now I am seeking a literary agent to push this into the mainstream and making it a major (hopefully) blockbuster.

My friend Robert said, “Sam, a wife and kids will be the worse thing for your career.” I think he may be right. However, I believe that our passions can remain unmitigated but we can choose what we want in life by following those passions and not following every opportunity presented to us simply because it was presented to us. I will never give up my passions, but I have learned to choose projects more wisely and I have learned to say, “No.”

I go to many meetings throughout the entire year to learn more about my field and to keep giving you the very best that I possibly can. I hear oftentimes from my colleagues, “Boy, I didn’t learn a single thing at this meeting. It was a complete waste of time.” Even though I would say that each meeting could be judged by the quality of the speakers and the organizer who put it together, there is always something that we can get from a meeting or an encounter. Actually, one of the best meetings that I have attended (and lectured at) was this past weekend in St. Louis. It was simply fantastic, and I got a lot out of the lectures as well as the interaction with other faculty members during the course.

Whatever the course is, I am always looking for the little “pearl” that can effectively change my practice for the next 30 years. I look at the fact that if I can attain one small idea, the dividends that such a small bit of knowledge can have on a single patient and then compounded over the many years to come can be quite dramatic in scale ultimately.

I always say a weak mind says, “I didn’t learn anything.” A great mind says, “I am so happy that I learned one small thing that will change my practice.“ Today, attaining CME (continuing medical education) credits mandates not just having a physician attend a course but asking at the end of the course what did you get out of it and how will that change your practice? These are the things that I constantly look for when I am at a meeting.

In life, we tend to always focus on the negative from an experience or how limited that experience was for us. Perhaps we should focus on the small thing that was positive and how that small idea will change the way we think and behave for the coming years.

I had a patient sitting pensively looking at one of my paintings one day, and when I passed by she asked me, “I really like this painting and am trying to figure out what it means.” I started to explain how I designed the pattern and why I chose the colors, then stopped and realized that was not at all what she was driving at. She was asking for a deeper intellectual meaning behind my work. Here is the short of it: there is nothing deeper than what you see.

Perhaps classical art has a narrative behind what you see. Even some modern art has a “meaning”: the Dada movement that poked fun at art and that carried political overtones comes to mind. However, no matter what art is trying to say, ultimately art is intended to appeal more fundamentally to an aesthetic level that does not carry with it any other higher motivations.

When I create my art, I am purely focused on color, shape, pattern, material, and composition. If any meaning comes to it, perhaps when I give it a name I come up with some contrivance that really has no serious meaning but is meant to be more playful. For example, I have this spray painting of drippy white lines on a blue-green background entitled “Nimbus”, and a patient’s husband asked, “Why do you call this Nimbus? It does not look like a cloud but a flat-lined EKG.” Well, that is a nice, positive interpretation compared to my celestially inspired appellation. Nevertheless, I really didn’t care if what I painted resembled a cloud or not. It just sounded cool, and it had some vague resemblance to a cloud in my perception.

I oftentimes hear, “I just don’t get modern art.” What the heck is there to “get”? I don’t like a lot of modern art myself, especially the splashy stuff that looks uncontrolled. I like things a bit more restrained in terms of the color palette and the geometry in most cases. For me, whatever art from whatever epoch, I must relate to it aesthetically. Intellectually is practically irrelevant to me.

I remember I took a summer class on art history in high school and I had to go to the Dallas Museum of Art to stare at this Monet painting of a large green bush sitting in the middle of this lake (no, it was not a waterlilly or a haystack) and I had to write an essay on that painting. Boy, I got pretty creative on that one. Although coming up with interesting intellectual ideas about a painting can be fun, it should be irrelevant to one’s appreciation of the artwork. Historical context (for a history major like me) is a nice adjunct but should not be a prerequisite to enjoying art.

I remember in 9th-grade high school, my English teacher, Dr. Pruitt, talked about how basically everything was art down to the clothes you wear, etc. I almost laughed. Clothes being art? Now, I truly get it. I see art in everything small to big. Perhaps my art is more “graphic art” than traditional painterly efforts. Maybe you can see that in my extensive catalog of logo work. Whatever category you want to append to my art, it is not cerebral but visceral. My favorite artists are Agnes Martin, Sol Lewitt, Ellsworth Kelly, Morris Louis, and Henri Matisse. I will do a small homage to some of my artistic mentors in coming blogs.

I was truly touched by so many nice words from so many nice people. I am also so happy when I see one of my patients come back to see me again. I was doing a facelift last week on a lady and her husband said to me, “Thank you Dr. Lam for your wonderful relationship you have with my wife.” I was really touched by his choice of words. As much as he and hopefully his wife saw it, I was engaged in a relationship with a patient not just an encounter.

In a relationship, there are few things that are very important that I do not violate. First and foremost is trust. I want you to be able to meet with me and know without a shadow of a doubt that I will not perform a procedure that I think will hurt you or waste your money. Sometime I get a bit too passionate about my work when I think you will injure yourself with something dangerous. I also carry that trust forward to state perhaps something you did not notice but that I would help you with. It is my fiduciary responsibility to mention to you what I see you need.

In this circumstance, when you build that level of trust with me, you know that I don’t “sell” you something. I educate you on your options and I really want to help you make responsible choices so that you make the right choice. I always say that during an initial encounter with me before you know me, I want to establish guidelines of what I am trying to achieve during the present and in the future, and those are “education” and “trust” not a “sale”, a term that I literally want to throw up when saying. Everything that I stand for is in opposition to that.

I also believe that your relationship with me extends far beyond me but to my staff as well. We hope that we are seen as part of your extended family. My culture of love, respect, and care permeates everything in my building. We are here out of passion and love. I just read 3 very touching cards that my patients sent to me that really have brought such a beaming smile on my face, you probably can see it from where you are sitting. Thank you to all my patients who have honored me for choosing me as your doctor.

Okay, here’s another blog on Botox. I think Botox is one of the most misunderstood products and also one of the most important anti-aging treatments we have around but so under appreciated by everyone that more people could be benefiting from it if they could only bypass their misconceptions. I know I have facts and thoughts on Botox scattered all over this website but I thought I would like to review the 4 BIG misconceptions that plague prospective patients. (more…)

For those of you who did not read Part I of this blog on the subject of symmetry, please do so. I split the blog into two sections because it just got way too long. Okay, if symmetry is not so important, what makes one beautiful or attractive? In a word, harmony. What is harmony? Harmony is the balance of facial features in terms of relative size and distance. The best analogy that I like to use when I talk about harmony is picture a glass of water in your mind. If I ask you how big does this glass of water appear in your mind? You will probably not have a precise answer for me. However, if I asked you to picture a glass of water three times the size of the first glass of water, then how big does that original glass of water appear to you now? Probably pretty small. Conversely, if you picture a second glass of water that is 1/3 the size of the original, then I am certain you would state that the new glass of water appears much bigger than originally conceived. (more…)