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!

Wall Drawing #146. All two-part combinations of blue arcs from corners and sides and blue straight, not straight and broken lines. September 1972

We are going to define a different type of culture than the last 3 days of blogs: a little more refined culture so to speak (just kidding). As you would surmise, these blogs are about getting to know me, your surgeon, a little bit better and for me to reach out to you, the reader, with my aesthetic sense of what I consider beautiful. Of course, if you do not like modern art, this blog will be devastatingly boring or foolish. My buddy, Mark Wettreich, who owns an incredible European Art Gallery that focuses on “real art”, would look askance at this blog. I doubt Mark reads my blogs. However, if you are, please stop reading here.

Perhaps the best way that I conceive of my art is of its high graphic design quality. In essence, I really appreciate good design. It appeals to me fundamentally at every level. I love beautifully designed clothing, furniture, cars, anything really (and you know by now my obsession with Apple.) I would have loved to have been an industrial designer. Johny Ive move over (he is the Apple brainchild who has revolutionized the world more times than I can remember.)

Okay, now to the core of this blog. I absolutely love Sol LeWitt. He just died last year. He was an amazing American artist whose structure, clean, and graphic sense of the world I absolutely loved. I am going to insert here my paper that I wrote for the Archives of Facial Plastic Surgery in 2003, which never saw the light of day since the editorial board believed (perhaps rightly so) that my monograph on art did not highlight the beauty of the face. Well, besides the editorial board, you will be the first to read this article that never got published:

“Wall-to-Wall Beauty”

Samuel M. Lam, M.D.

Although Sol LeWitt has produced a prodigious amount of art over the past half century – from sumptuous two-dimensional geometric prints to elaborate three-dimensional cubed lattices, his most significant contribution to the art world remains the wall drawing. When asked if the sobriquet “originator of wall drawings” properly applied to him, he replied, “I think the cave men came first.” His cheeky reply aptly evokes his self-dismissive attitude that permeates his entire life and career. He has constantly upheld the primacy of ars gratia artis and subserved his ego to his artistic ambition. He often declines to attend media events in his honor, arriving late or not at all, and has refused to pose for a portrait by his celebrated artist friend, Chuck Close, because he wanted the public to pay attention only to the art rather than the artist. Even the large-scale retrospective of his work that opened at the San Francisco Museum of Modern Art in 2000 required years of coaxing before he could be convinced that he should participate, given his concentration on the future direction of his art rather than the past.

Part of an entrenched anti-commercialism is expressed in the very idea of a wall drawing. Unlike canvassed works that can be bought and sold as a commodity, a wall drawing lacks this vital attribute of market viability. Although LeWitt never explicitly foreswore a commercial intent, he stated, “I never think about selling a work while doing it.” LeWitt had even naively proposed that any artist that desired to replicate his wall drawings could do so to widen the public consumption of his work but has since retreated from this untenable position given the inferior reproductions that were spawned without his oversight. LeWitt’s massive wall projects are often executed by hired hands under his supervision, as he subscribes to the Conceptualism school that embraces the artistic idea more than the mechanical process, so long as the construction effort remains true to the original design. In fact, the colossal wall installations that are delicately fabricated for a specific site are often completely destroyed at the conclusion of the prescribed event.

LeWitt embarked on his first wall creation in 1968 for a group show at the Paula Cooper Gallery in New York. He wanted a medium that could offer him the most two-dimensional representation of his two-dimensional art, in a word, flatness. He wanted his created work to convey its true two-dimensional essence, which could not be accomplished on a canvas that by its very nature was a suspended three-dimensional object. Beyond this consideration, the artist was motivated by early twentieth-century Russian art that celebrated visual art within the context of a defined setting. His architectural sensibility may have also been partly informed from LeWitt’s time spent in I.M. Pei’s studio a decade earlier. His later sculptural monuments would also resonate with architectural vibrancy. This pairing of art and architecture achieved its fullest expression in the German Bauhaus and the Dutch De Stijl movements of the early twentieth century that prefigured LeWitt’s efforts fifty years later.

LeWitt’s contemporaries of the 1960s were also explicitly and subtly exploring the immediate environment in which their art was displayed. Dan Flavin’s fluorescent light sculptures illuminated the entire room in which they were exhibited and cast a luminescent glow and shadow on neighboring walls, floors, and ceilings. In fact, Flavin is credited with introducing to LeWitt the expressive and intellectual nature of serial, permutated forms that would become an integral element in LeWitt’s idiom. Donald Judd’s wall-mounted sculptural pieces were also intimately tied to the wall from which they were suspended. Similarly, Andy Warhol canvassed the Castelli Gallery with Cow Wallpaper, a work that must have resonated with LeWitt; and Eva Hesse’s Accretion that consisted of numerous fiberglass tubes propped along the expanse of a blank wall echoed LeWitt’s aesthetic ethos. Despite all of these varied concurrent artistic endeavors, LeWitt would most fully exploit the architectural interior and transform it with his site-specific wall installations.

Over the past thirty years LeWitt has continued to evolve his style of wall drawings from the intimate to the dramatic. Initially conceived in the 1960s, his drawings represented little more than transference of his paper drawings to the wall without a premeditated link to the environment in which it would be presented. In the early 1970s, he began to develop an artistic idea more specifically for the physical space that it would occupy. In Wall Drawing #51 in Turin, he hired three draftsmen to connect every architectural point on the wall (light fixtures, door knobs, wall corners, etc.) to each other in every conceivable combination using blue chalk. In 1975, his art underwent a transformation yet again: he began to alter the background wall color to suit his artistic needs rather than be satisfied with the typical, preexisting white facade. He relinquished part of his artistic control to his draftsman, ordering only that “White lines from the center of a [black or yellow] wall [be connected] to specified random points” as would be determined by his skilled draftsmen. By the 1980s, LeWitt’s work achieved a strong visual vitality through use of bold geometric shapes and vibrant color schemes. LeWitt himself has commented that the newfound boldness of his work reflected the size and grandeur befitting the architectural space. His wall drawings continued to expand in scale to occupy neighboring walls, adjacent rooms, and even moving out to the outdoor environment. By the 1990s, LeWitt began to use acrylic as his favored medium rather than pencil, crayon, and India ink, which he had relied on in the past. Although LeWitt still refers to his collective works as “wall drawings”, use of acrylic transformed his drawings into paintings. The austerity of his early works gave way to the playful exuberance of his acrylic pieces that exuded bright, saturated, glossy colors with a simplified geometric vocabulary. Despite all of the intellectual rigor that LeWitt has applied to his art through his writings and advocacy of the Conceptual movement, his oversized wall drawings provide an immediate, seductive appeal that remains truly unique in twentieth-century art.

Somehow the past several weeks, I have really enjoyed compartmentalizing my blogs into 3-part series. Perhaps I am trying to get you to come back to read more the next day. Perhaps it is in homage to my good friend in South Korea, Dr. Young-Kyoon Kim, who is both a cosmetic surgeon and an artist and who is fascinated with the number 3. Whatever reason, I enjoy these mini-serial blogs that explore a topic more in depth than a single longwinded blog could accomplish. (This one is longwinded enough.)

I really enjoy my job and one of the most fascinating parts to me is the human relations we have with one another. I am also fascinated by leadership. This blog is about both. Exhibiting a positive force on those individuals around you. Today we are going to talk about controlling one’s temper. I had a leader of mine who came into my office with staff in tow and who was visibly irate. Reportedly, my leader had lost her temper and fired off some less than genteel words toward her followers (I am putting this mildly.) I could clearly see that her followers had lost significant respect for her (and so did I). I realized that her leadership skills were deeply in peril, and I alleviated her of her job almost immediately.

I separated out my staff from her and first talked to my staff and apologized for her behavior and that I considered it unacceptable. I then moved my former leader into a room and said, “If you can’t control yourself, how do you expect to control those around you.” Obviously, I did not mean “control” in a dominating way but control in the sense of having people under you inspired to follow you. Essentially, she had no answer and that compelled me to end her career as a leader in my workplace.

I really look at all my staff as leaders influencing everyone around them. Don’t think you have to be the “boss” to have this blog relate to you. Oftentimes the boss is not the titular boss. If you read Emotional Intelligence you will understand that the real boss is the person who walks into a room and instinctively commands respect and followership. Typically, if no one is following you, there are two reasons for this problem. You didn’t inspire followership or you didn’t hire the right people that can be inspired. Accordingly, I blame the leader not the followers for most things. My leaders are held to a higher accountability.

Back on subject, I have experienced so many terrible leaders during my surgical apprenticeship in large part because surgeons have a God mentality and their arrogance obscures their ability to inspire followership. Honestly, I chose not to do my residency at Baylor College of Medicine, my alma mater, in large part because I was going to be exposed to a group of general surgeons who did not exemplify what I strived to be. I intuitively avoided being abused so that I would not perpetuate that abuse forward. My mentor, Ed Williams, with whom I did my fellowship is an exemplar of leadership excellence and humility in the face of adversity. After 18 fellowship interviews, many of which I truly loved, I realized that I needed to be with Ed because he was going to teach me as much as how to be a surgeon as how to be a gentleman. Thanks Ed for your foundation for excellence!

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.

Our spa event last night was tremendously well attended (with over 200 people) and was truly a success. Watch the video of the event. In order to enhance your experience with our spa, I have spent the past 2 weeks tirelessly expanding and creating an improved website for my spa (www.spawb.com). I put together 21 Quicktime Virtual 360 tours that I think you will enjoy perusing. I also put together a single 18 minute video tour of the spa that I segmented into 11 shorter clips that highlight each of our wonderful services. I expanded and updated our team section so that you can get to know our wonderful team, and I took the promotional photographs for our spa as well (since the photographer we hired did not live up to the expectations I had). I also just started putting together a new section entitled, “Spa Video Demos/Tutorials” in which the members and my team discuss with you our unique services (including one video of my taking a hydrotherapy bath!) I hope you can come to our premier spa and enjoy a non-virtual experience. We look forward to serving you.

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.

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).

Our beloved Vassi just gave birth on Tuesday, October 7th, 2008, to a healthy and beautiful new baby named Elizabeth Grace, weighing in at a magical 7.77 pounds. Her family at LFP would like to extend Vassi and Stravko (aka Zak) our most heartfelt congratulations to their new addition! If you would like, click here to watch my visit to the new bundle of joy!