The speaker, a plastic surgeon, discusses two key observations from his practice: the tendency for patients to seek doctors who resemble them, and the crucial distinction between idealistic patient desires and realistic, safe surgical outcomes.
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hey guys
I mean I waved it right I don't know how
to wave uh it is Wednesday January 25th 2023
2023
doing a Wednesday lesson of the day
after we have just finished our console
day lesson of the day is gonna change at
some point from Wednesday to Thursday
because I'm changing my schedule around
again to make life fantastic
today we were kind of all over the place
but the there were two patterns that we
saw today in patience one of them was uh
we saw a few people who didn't really
look fully normal and they had gone to
doctors who I know don't look fully
normal and um
um
the other one was
idealism versus realism so these are
like two things that uh we saw and yes
we're in California Argentina and I
thought they were just interesting
topics which are not fully strictly
Medical but it's interesting to really
understand people and the first one I
want to go over is how patients are
usually nowadays that we have social
media and you get to know the doctor
they are attracted to going to the
doctor who is like them and in this case
I get bombarded with questions all day
about am I going to look natural am I
going to look natural is everything
going to be natural but I really just
don't want this it's gonna be natural
and I have to explain to them you know
please stop asking me that look where
you are that's why you came here isn't
it yes but I just really want to look
natural I'm like but that's what you
came here for and this is a good thing I
appreciate this because I want the
patients who want to look natural and I
tell them and I said this before I'm a
car person I say you don't walk into a
Ferrari dealership and say are you
selling me are you gonna sell me a
Toyota uh I don't want to tell you I
really just want to Ferrari because
obviously they don't carry Toyotas
nothing wrong with this Toyota if they
don't carry it at the Ferrari dealership
and in this practice we don't do
unnatural but the interesting part about
this is that you start to see that
patients are attracted to their doctors
and a lot of weird looking patients or
let's say exotic to be nice uh go to
Exotic looking doctors
um doctors who have an altered view of
reality which is in the Beauty World not
correct or incorrect you can make people
look like cats and foxes and tigers and
lions and whatever you know animal you choose
choose
but most of the world looks at it like
the person looks harsher and they look
not as nice and in our world my job for
me is not necessarily to make a nose
perfect or make the eye perfect or do
anything perfectly is to make them look
like a nicer person like they're more
pleasant people want to talk to you and
you don't make other people tired when
you speak to them because in this world
you have projection you have emotional
projection which is a psychiatric
phenomenon whereby you have somebody
who's heart goes up and they get angry
or hostile and the person they're
talking to starts to feel the hostility
and they start to feel hostile that's projection
projection
then you have physical projection which
means you look like this because your
muscles are strong not because you're an
[ __ ] your muscles are strong and
people see you and perceive you as kind
of being an [ __ ] or you look like
this and RBF and they think oh my God
she's so [ __ ] or you have ptosis oh my
God they're so sleepy this is physical
projection so my job the reason I do
what I do is not to change people or
alter them is to make them just slightly
a more pleasant version of themselves
where they're very sweet and nice
looking and pleasant where people want
to talk to you and interact with you
and that is a next level of plastic
surgery that I've gotten to in my life
where that's really what I want to do I
don't want to try to alter people and
change people do that and the people
who've been coming to me now more and
more are seeking the same thing even
though they can't verbalize it or say
exactly what it is
so they come in and they just want to
look like the better version of
themselves or not look so tired all the
time or not look mean all the time and
these are things that they do not just
for themselves they do it because of the
interaction they have with other people
and the way other people interact back
with them and it's the same as if a
child is two years old they can have a
giant mole on their face or a birthmark
and it's no problem and when you get to
four years old the recognition complex
in kids starts to change to where they
start to lose Grandma recognition they
get I forgot whatever other kind of
recognition and they start to notice
differences between themselves and
others and that's where they start to
pick on things and look and say you know
the guacamole thing and they can do that
and affects the way the kid interacts
with people similarly your appearance
affects the way you interact with people
which is why good looking people from
birth have it so much easier in life and
that's the reality of the world when you
look Pleasant life is easier now not
just good looking happy people have it
so much easier mean looking people have
benefit too mean looking people can
scare you into not [ __ ] with them
they can scare you into not robbing them
if you walk with confidence same thing
so all these things project onto others and
and
for me I like to have the patients who
come to me who just want to look more
pleasant who don't have a specific do
this to me do that to me do that to me
so I don't get that that often and the
ones that I saw today who looked so different
different
exotic had coincidentally gone to
doctors who look exotic
um I don't do this by the way if you do
that when you talk all the time you
don't even know how to use the quotation
marks because you're supposed to quote
someone so exotic
which means these doctors have slight
dysmorphia in many cases and we've
noticed this over time more and more
that the leading cause of patients
looking strange is that their doctors
are strange and like to make things look
strange and
um it's a this morphic little world
sometimes and it doesn't mean people
can't look like that I just don't agree
with it I like people to look very
subtle natural Pleasant and nice and
this is why I don't brow lift somebody
who doesn't need a brow lift because
then yeah you get the arching but then
they look crazy like they're staring at
you and you think they want to like eat
your face and not in a good like sexual
way in a bad way where you're missing
your face
so that's that um
um
point of this is if you see a doctor who
looks weird and you walk in this I've
said it before run out the door unless
you like looking weird and it's up to
you another thing to know is please
don't look at weird patients and assume
that they went in asking to look weird
even if they did the nice smart doctor a
tasteful doctor would say no it's gonna
look weird and scare you out of it like
I scare people all day long
um I try not to make them cry I didn't
make someone cry today which I feel
terrible about and she's the sweetest
girl but long story she's lovely
weird is weird so where were we with the
second part of this
I worked a lot of hours today so I'm not
sure I can fully remember what I was
talking about
anybody remember what the second part
about this was um
um
I don't know but I did tell somebody
today that patients look like their doctors
doctors
yes patients start to look like they're
doctors just like dogs look like their
owners so this does happen and you can
see patients start to resemble their
doctors and I've seen patients with like
kind of penis looking noses and all
their patients have like penis looking
noses uh it happens
yeah they love themselves so what was the
the
second part realism versus idealism
Rochelle Van wagener thank you so much
here is uh an important thing to realize
in plastic surgery and it's hard
to fully accept this for surgeons and
for patients it's about the ideal versus
realistically what you want to get
looking natural inside typically means
that you can look natural outside so if
you go in and do a surgery on a patient
put things back to where they really
belong and you go in 10 years later and
everything is structurally where it
should be you haven't changed the enemy
they typically look and function
normally outside
this is how most of my surgery is done now
now
idea ideally I look at somebody and
would say wow it'll be great if I can
get this thing snatched up to there or
that thing up to there or this thing up
to there or this thing up to whatever
um that's the ideal and the patient
might say I really want this to be I
hear all the time I want the lip to be shorter
shorter
but the reality of these things is that
my job is to take care of you and to
make sure that nothing happens to you
and the interesting part of med school
you don't remember much
but the part you do remember is the
Hippocratic Oath which the first part of
it most people know is to do no harm and
this has substantial significance
because anytime you touch somebody with
a needle with botox filler drawing their
blood you've got the potential of
harming them
and you don't want to introduce this
risk into their lives unless you can
have substantial benefit so big benefit
little risk gamblers
um like some people I know which I won't
mention who are just terrible because
gambling is almost always an addiction
um it's not really social for the most
part but unless you just do it once
every couple months which is not the
case but either uh
it's one of those things where you don't
want to gamble and
um you don't want to gamble with the way
you look you don't want to gamble with
your health you want to gamble stuff
like that so if someone offers you
something that gives you this much
benefit with the risk that's this tiny
then you can take that risk and I think
it's a smart move if someone says 50
chance of success 50 chance of failure
that's not a good chance and you want to
walk away from that so idealism you
might say I want to have the lip a
little bit shorter but I look at you and
I say listen it's multifactorial there's
so many things going on when I'm
assessing you that you aren't seeing and
you have to say this to a patient
without offending them but the reality
is they have to accept you're the expert
in this field and they are the know
nothings in this field and that's why
they come to you they didn't come to you
so you can confirm what they read on
Google they came to you because you know
everything that they read on Google Plus
you have experience in it for many years
plus you trained in it plus you know all
the risks plus everything else and
that's the reality of medicine in
California personalities are a little different
different
um they don't respect doctors so much as
you guys do in other states and countries
countries
and you get a little push back on your
training and reality
so idealistically you have these
patients that come in and really want
more but as the doctor you have to think
about every possible thing that can go
wrong and you do not allow them to put
themselves in risks way or to look
possibly fake or to take the chance of
having to fix something you want to
minimize that as much as possible so
several of the discussions I had today
were about this idealism where you tell
a patient because you understand what
they're saying you want them to know I
am on the same page as you I fully get
it however I am seeing a million things
that you're not seeing it's like that
movie Butterfly Effect I think with
Ashton Kutcher when he was a good actor
for that week I hope he doesn't see this
or ever come to me because that would be
embarrassing because I said that but
that's why I never talk about actors
because they might just walk in one day
and I'm like [ __ ] burn that bridge
um but it is like the butterfly effect
or uh Groundhog's Day where you've lived
it so many times you already know what's
gonna happen as you're walking down the
street and when I see people I've lived
it so many times that I look at them and
I have fear in me because I've seen so
many things go wrong in my patients and
in other patients and I'm just scared
all the time
so I'm that doctor I'm always scared and
I'm a cowboy in the sense that I do as
much as I possibly can to get them
towards that ideal goal but I know when
to stop
but it's hard to always tell people you
know that this is the stopping point and
why it's the stopping point um
um
so that's really all of it uh
I read some really nice comments over
here we'll see if there's any questions
there's a question box consulta
um fantastic
that means I hope you operate on me with
um fantastic you're the pro thank you
no thank you thank you do you support
the lgtbq there's more letters to them I
guess we stopped it plus it makes it easier
easier
um yeah I mean why wouldn't I
people are people and I like people
freedom for Iran and LG tobq Daniel
Morad I'm like both those things all
right can people stop saying weird [ __ ]
and just listen to the man what were
they saying oh man we gotta go look at
this then now I'm more Curious to read
the comments because he's my daddy see
I'm going backwards so we're kind of
missing the commentary we're putting it
uh in Reverse which is like another movie
movie with
with
the guy from
okay the movie where they go backward
it's not called Temple or steeple
whatever good movie great actor he's a
guy that played in uh black klansman so good
good
that's by the way one of the most
underrated movies of all time black
klansmen and the other guys I don't know
why people haven't seen those when I
mention them why is everyone calling you
Daddy how did you get so smart Daddy
okay see I'm missing this stuff man DM
me Daddy scaring people there you go I
like it my ex looks like her new husband
not sure how I feel about that see this
happens people start looking like people
that they hang out about and part of it
is because personality you start to act
like other people and your mannerisms
start to change meaning your facial
expression so when you see two sisters
or a sister and mother they may look
alike to you even though physically they
don't look alike and it's because of
their mannerisms and that I see very
commonly and I see someone I'm like you
remind me of somebody I'm like do I know
your mom and I say yeah you do know my
mom and I've done that a lot all right
so do you have a signature yeah it goes
like this or is it like a signature
thing that I do I'm not sure um
um
oh no someone says they didn't ask to
look weird that's what I tell patients I
said please stop assuming that somebody
went in because they always said I don't
want to look weird I know people want
that and I keep thinking I'm like who
wants that like nobody wants liquid I'm
wrong just so you know I am wrong uh
people do want to look weird I have
friends who post videos and photos that
have completely [ __ ] dysmorphic
photos where people look like this and
crazy people do want that doesn't mean
other people are gonna think they look good
good
but this world is filled with bad
decision making everybody thinks that
the average person is above average in
intelligence or taste the truth is it is
what it is average person is average
below average large and we do have a
range there's nothing truer in this
world of the description of the World by
math math is a universal language
because what we did was try to find a
language to translate what's happening
in the world with numbers and patterns
and things like that so standard
deviations are one of those things and
the standard deviation curve or the bell
curve is one of those things where you
do see that up here the five percent
those are the really super intelligent
super tasteful super artistic whatever
you say in Talent world or basketball
for super talented and basketball and
the bottom five percent are just
terrible and then everybody else is in
between so as far as weirdness goes yes
you have a variety of people in the
world who have not so great taste or
that taste that we share right because
you would ask a narcissist is there
anything wrong with being a narcissist
they would say no they're just a
part of the blend of people that we have
in this world and they're in the cluster
B of A Grand [ __ ] that we have so
looking natural and pleasant
what's my waitlist I don't know um
um
you're right about everything Daddy all
right I got another daddy fantastic love
your puppy all right okay so dysmorphic
Little World fantastic
all right I did have people get mad at
me once for saying dysmorphia in this
cancel culture where these little
[ __ ] tweens are going around trying
to dictate what people do um
um
good luck uh go [ __ ] yourself I'm not
really cancelable
um I live my own life but I do like that
nobody who is in the cancel culture
follows me anymore so it would just be a
random occurrence that they like end up
on my page after they saw something so
everybody here is actually very normal
and I appreciate you all especially Matt Steinberg
Steinberg
um okay
why is life so easy for me Ritu Chopra
Ritu shropra is
should have been a supermodel if you
guys haven't seen what he looks like
um there's no Indian man alive who looks
that good and it's not an offense to
Indians or India or Pakistan which is
the neighbor
um he just happens to be the best
looking one that's been ever made he's
also a very very talented surgeon and
one of my BFFs and uh he trolls
sometimes and says funny things but it's
a positive troll
all right I think we'll stop the
nonsense because if anybody who doesn't
know me ever watches this video right
before they come to me and they're about
to like refer like I don't know Sandra
Bullock to me which is one of my dream
list or something
um then they're probably not going to
refer them anymore so
hopefully they don't get this far
and watching this should I even post
this in that case that would be like my
dream patient okay wonderful so that's
it I hope everybody has a fantastic uh
Wednesday and then soon as of Friday
it's going to be even better because
sorry as of February Friday February it
starts with f f words F words are great
so as of February I'm going to Monday
Tuesday Wednesday operating
I stopped Saturday as a while ago I stop
Fridays and then Thursday is going to be
uh my
day of fun which was I used to say
Wednesday is hump day that I get um
today was actually fantastic dude it was
really really really good
um and I really saw very nice people and
just a few strange ones who were very
nice though so it's not like they're not
nice it's just they look strange and I
can't tolerate strange here's another
thing I was talking to this girl who
said and I've heard this question a lot
and it's funny and it's not a girl I'm
like dating or anything it's just a girl
that I know says or asks me when a
plastic surgeon looks at other people do
they pick them apart right away and try
to think about what to change and I told
her yes in most cases they do and that's
how you know they're not a good plastic
surgeon This falls into what I teach my
residents the first time they come in or
what I said offensively on this doctor's
chat the other day and offended like 500
people at once which I can do real quick
uh is I said you have to realize that
most of what we learn and do is
inherently bad and I go back to that
standard deviation curve where you have
95 percent of people are under a and a
plus five percent or a A plus and if
you're doing plastic surgery do you
really want to be the B minus do you
really want to learn from the C maybe if
that's the skill level that you're
having that's the max you can get to but
I tell my residents who are here the
first thing you need to know before you
get into learning or understanding is
understanding people and understanding
patterns and patterns are very very
important in this world because you can
prevent car accidents by patterns
pattern recognition you can see cars
pulling on the freeway and you can see a
blue car versus a black car a Prius
versus an X5 you know what happens in
these situations so they're pattern
recognition you can see a redhead and go
might be trouble you can see a Latina be
like oh might be fiery so there's
patterns in this world uh which for
people we call them stereotypes which
may be negative maybe positive but
there's patterns and patterns in people
and the way they act and the way they learn
learn
the pattern that I've noted in the world
of Academia plastic surgery art music
music
especially is that 95 of people fall
under that a and I don't want to learn
from them doesn't mean I can't learn
from them little tiny tidbits but I
don't want to generally learn from them
because I want to follow the best of the
best at the top of the top um
um
so that's why I teach the residents and
that's what I tell patients as well when
they come in uh
why I can't remember lose track I should
stop talking at this point but I do
appreciate everybody I think you're all
fantastic and
um
I don't remember what I was saying but
fun day overall fantastic day
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