The central theme is a call to embrace reality and critical thinking, particularly within the medical and surgical fields, by challenging commonly accepted but often flawed practices and beliefs.
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today is Wednesday lesson of the day on
Thursday as we've continued the
tradition on Wednesday to Thursday is
pretty much me talking and the
point of this lesson of the day is that
there was a recurrent pattern of
visitors this week
who believe incorrect things and
patients who believed incorrect things
said by doctors
so the point of this is to ground
everybody to live in reality and stop
living in imagination and the problem
with really intelligent creative people
is sometimes they can stray and deviate
from reality and make up their own
realities and live in them
I was raised by a dad like this so we
need to ground ourselves when we're
looking at uh surgeons and surgery and
everything that we're doing and
um the first thing that I teach the
fellows that come and visit in the
residence is really how to become a good
surgeon is to figure out these things so
the first thing is to change the way you
look at the world because most people
look at the world very positively and
look at it as though everybody's
intelligent everybody's smart
everybody's great and that's fantastic
to be an optimist unfortunately it's
it's not reality not every surgeon is
great not every artist is great not
every Chef is great not every bus driver
is great this is the reality of the
world is that there are exceptional
people and non-exceptional people and if
you want to learn and you want to
advance and you want to be the best you
have to follow the top the top five
percent and those people so that's the
first thing I tell them is realize and I
say what's the most popular filler in
the world
they said what's the worst pillow say
what's the most popular facelift in the
world it's Mass specification what's the
worst type of facelift it's Mass
glycation so you have to understand that
the most popular is usually the worst
thing uh common sense
is common people don't get that it's
common it's not great sense it's common
sense that's what the sense that most
people would have what we're doing here
in surgery is trying to be the best what
you're doing in any field is really
trying to be the best you don't want to
be common you don't have common sense
you don't want to have common taste
common sense and common taste are
average and those things are not
impressive they don't impress me they
don't impress anybody and it just keeps
people average and the same there's no
advancement there's no change and the
way to be the best surgeon people get
confused they think it goes by patient
satisfaction that's great to keep
patients happy and I love to keep
patients happy and I care about patients
and it's important to care about
patients but that's not what makes you a
great surgeon that's not what produces
great results being selfish is what
produces great results looking at your
results and analyzing them over and over
again and always thinking that it's not
good enough that's how you become a
great surgeon so you're not doing the
surgery for the patient necessarily
you're doing it for yourself and you're
doing it for your own results to look at
your own before and after to be critical
about it and to judge yourself and say
am I good enough and if you're not you
keep getting better and you keep
improving if you do it for the patients
you're probably never going to be that
great because patients can be happy with
average results and they can come in and
say doctor thank you so much they're
like some nice people with low
expectations and they love you and they
say it's great it doesn't mean your
results are great the only way to really
Advance the result is to put the patient
expectations kind of a side that's a
whole different thing you want to keep
them happy of course but it's really to
do it for yourself and to be selfish
about the results and I tell my patients
all the time they say you know you must
really go overboard trying to do these
things for patients that's why you're so
great and I correct them I say well I'm
pretty selfish actually that's why I do
this is because I like to do it for
myself and I like to look at my before
and afters and be proud of them I go on
medical missions not because I'm
somebody who loves to give to other
people I like that it's nice but I do it
because I love going on these trips and
I love doing the surgeries and I love
playing with kids and I love doing those
kind of things and my selfish nature
helps benefit other people and the world
works out better for you when it's like
that but the things that I went through
today and recently that are
not reality
um and I want to kind of repeat this
over and over again until people
understand that just because something
is parented or repeated in the surgical
world or any kind of world does not mean
that it's true okay
um most people again have common sense
which is common it's not that fantastic
and you can you can look at our
political world and our last few
presidents and you'll understand
um yeah we we sometimes make wrong
choices and we sometimes repeat things
that we think are correct and they're
not correct so the things that I've
noticed let's talk about a few of them
one of them and this is a lecture that I
gave in San Diego recently and I
insulted everybody in the audience they
all took it kind of well fortunately was
I asked who in the audience believes in
the concept of over correction over
correction in a surgery is when you pull
something this far back and then people
look crazy and then you expect it to
settle like 20 or fail 20 percent that's
the concept of over correction over
correction for me it's one of the
dumbest things I've ever heard because
you are inherently putting into your
recipe disaster you're putting in a
little bit of failure over correction
means you're putting it this far to fail
20 30 and the thing that's wrong with
that is it's not predictable you don't
know if it's going to fail 20 30 you
know how much it's going to fail they
say it's settled but it's really failing
so you don't know how much it's going to
fail and when it fails it fails from
somewhere and it usually fails from the
incision meaning
you get scarring there because it's
pushing or pulling away from the
incision so rather than having over
correction why not figure out a better
way to do a brow lift or a better way to
do a surgery where there's no over
correction you just get it to where it
needs to be with no tension be a little
more logical about it and everything
tends to work out same as where they
pull brow lifts if you pull someone's
brow lift in the direction of surprise
so the direction of surprises frontalis
contracture this is your frontalis
muscle Inquisition surprise it's that
direction what's gonna happen when you
lift somebody in the exact same
direction as surprise
you're gonna always have some kind of
appearance of surprise it may be minimal
it may be major it really just depends
but that's the wrong direction so these
are things that people have to
understand the other thing I heard uh
over and over again was it will smooth
out meaning you're doing a surgery and
you leave a bunch of ripples on the
field and the doctor says oh it'll
smooth out why would you leave somebody
you know something to chance when a
doctor is so neurotic about every other
thing they do
everything has to be perfect in the
operating room the yellow people they
scream at people everything has to be
perfect and at the end of the surgery
they say ah that'll smooth out it's
crazy to think that you would be a
doctor whose type A personality and
everything has to be perfect yeah and
yet you say I'm going to over correct
and let it settle or I'm going to leave
Ripples and let it smooth out over time
now Ripples and irregularities they do
happen after surgery and those do smooth out
out
but if you're on the field and you've
got a dog year you've got something else
like that you don't leave it to chance
you fix it
the reason people leave things to
Chances because their predecessors told
them that it would be normal their
predecessors repeated things so many
times that they said it would be normal
there are many things in plastic surgery
that are repeated and repeated in
literature and they're interpreted
incorrectly and because they're repeated
so many times people take them as a fact
they misread statistics they misread
articles in literature they don't fully
understand them so the other
non-realistic thing is misinterpretation
of data patients come in and they say
well I heard that five percent of people
get revisions for whatever so that means
I have a five percent chance I heard
that 60 of fat survives when you do fat grafting
grafting
this is a misinterpretation of data a
doctor doing a fat grafting procedure
assuming that 60 of fat Will Survive
he will inherently or she will do an
extra 40 percent of fat assuming that 60
will survive in order to get the proper
result this is a misinterpretation of
data they read an article that looked at
a thousand patients in a population that
said the average was 60 percent survival
of fat when you did fat transfer from
the abdomen to the face
that's a population statistic it's not
an individual statistic which means if
you look at the individuals in that
study all thousand of them one of them
could have had zero percent one of them
could have had a hundred percent one of
them had 20 percent one of them had 70 percent
percent
which means the doctor's chance of fat
survival is 60 percent
the patient's chance is zero to a
hundred percent however doctors will
misinterpret that data they'll take a
population statistic which applies to
them and they'll apply it to the
individual patient they're treating
which means they'll inject the patient
with an extra 40 instead of assuming
that the patient may have zero percent
or a hundred percent so they they don't
know how to apply statistics this is the
misinterpreted misinterpretation we
always see
the other thing I hear all the time is
uh during facelifts is getting muscle
tightening or smash tightening I had
several patients come in today saying do
you do muscle tightening do you do smash
tightening I read about it and I'm like
what the are you talking about what
and it's not the patient's fault they
read this from doctors and I asked
doctors what are you talking about
muscle tightening what is muscle
tightening I don't understand like if
you could do muscle tightening I would
tighten my muscles like I I don't
understand what muscle tightening is a
muscle contracts so I don't know what
muscle tightening is is it muscle
flexing is it muscle contraction is what
is muscle tightening I've heard this so
many times yet I don't understand
conceptually what it really is because I
don't think it exists but people have
repeated it so many times that you think
muscle tightening exists it makes no
sense muscles contract they relax they
contract they relax they contract
there's no such thing as muscle
tightening then you hear us Mass
tightening smash tightening also makes
no sense this Mass which is The
Superficial musculoponeurotic system is
a system of fascia connected to muscle
how do you tighten the muscle how do you
tighten this mask this mask the fascial
components are a hydratory layer with
fat and fascia and water it's a cushion
layer that provides support and volume
under the skin
it supports it so when you heat it you
don't tighten it like this you shrink it
like this it deflates
so everybody says smash tightening smash tightening
