My wife won’t let me have lunch with Liv Ullman. At least she won’t facilitate my having lunch with Liv Ullman. My wife is Swedish. Liv Ullman is Norwegian (almost the same). We will be visiting Swedish friends outside of Nice next summer. Liv Ullman lives outside of Nice. I have asked my wife to call her best friend to find someone who knows Liv Ullman and to invite her to have lunch with me. My wife laughs. Maybe she is jealous! I really don’t know. But Liv Ullman is 70 and I am 65 and sometime in the future we will be dead and I won’t be able to have lunch with Liv Ullman so I need to do this now.
Suffice it to say I am infatuated with Liv Ullman. How many dreams, how many memories do each of us put away, put off, hoping that by serendipity one or more of them will come true. What we do pursue may happen. What we do not pursue almost for sure will not happen. At the very least we can each put ourselves in a position that something good can happen, or that something we want to experience will be there to allow us to interact.
Being a doctor is like that. I meet people from so many walks of life: rich and poor, famous and infamous; artists and trades-people. I have a woman patient who is attractive and svelt and operates heavy machinery at construction sites. I have met professional athletes from many countries, some highly educated, others not. All of my patients have a different experience, a different perspective on life than I do. In fact, I can say that every person I have met who may or may not read this blog has been a fascinating person for me to meet.
I watched Liv Ulman being interviewed. She said that for the drama of life to unfold each of us has to allow ourselves of us to keep our fantasy, our view of ourselves, our view of the world, our view of each other. She calls this acceptance. She paraphrased Tennessee Williams in saying that if the characters in a play recognized each other the play would never have occurred. She made a plea not to crush someone else’s fantasy.
Yet often that is what I do professionally. I crush people’s fantasies. I tell them their hair styles are not becoming, their make-up is too gauche, their waistline is greater than they think and they keep wearing their pants lower and lower. I tell women they look like men as they age and I tell men that when they are naked they don’t appear as powerful as when they are wearing a suit. I might feel bad about all of this except that I also promote other fantasies. I tell my patients that they can be anyone they want to be if they are willing to work for it. I tell them if they will leave the comfort zone of Kabuki make-up they might feel as attractive as they would otherwise look. I tell them that by walking 4 miles outdoors daily they will wash away many of the troubles of their day and they may self- actualize. Also they will lose weight. I tell teenagers and college students that they won’t have to search for a job if they will learn another language. I tell them that a degree in communication is a euphemism for learning how to talk, and I expect it is a given that someone with a college degree can speak. I tell them that a degree in marketing is a job description for Barnum and Bailey Circus and if they want to make a difference they need to create something or help someone instead of selling a nameless item in return for an ill-begot salary. I tell them there is a fabulous world out there waiting to embrace them but they must travel and think of goals to achieve. Most of all, I say that each day is a blessing to be lived with awareness.

The dichotomy in the hype of filler products for facial rejuvenation has confused physicians and made intelligent comparisons on the part of the public virtually impossible. In order to understand the confusion in marketing fillers I will divide the protagonists into 2 camps: the manufacturers and salons (medispas) vs. cosmetic surgeons which include sophisticated dermatologists, facial plastic surgeons, plastic surgeons, oral maxillofacial surgeons, and oculoplastic surgeons.
The hype looks like the following:
Manufacturers must sell as much product as possible to maximize profits. In order to increase consumer consumption, marketing revolves around simplistic notions of instant repair such as erasing nasolabial folds- the fold between the sides of the nose and the corners of the mouth and advising frequent re-treatments.
Medispas likewise promote simplistic makeovers which are quickly performed and provide instantaneous results.
These promoters can get away with such obfuscation by exploiting the difference between the forest and the trees. As the saying goes we tend to focus on the trees and not appreciate the forest much as we might not recognizing the elephant in the room.(Kindergarten: How can you tell if there is an elephant in the room. Answer: By the faint odor of peanuts on his breath). A typical patient complains about a line around her mouth and misses the point that her cheeks and eyes are sunken-in which not only causes the line but is the real reason she is looking older. By contrast a child with a scar on her cheek looks youthful and has a scar. (Don’t fall for the “I will just inject filler under your eyes and your circles will go away” either.)
Manufacturers and medi-spas also promote differences in products in order to justify more and less fee schedules for products. They do this primarily by claiming that different products have different longevities which is a concept that is easy for the public to understand. Longer duration of correction should provide lower cost over time and less need to retreat. They conveniently do not explain that in areas of the face with more muscle contraction fillers have shorter duration of action and visa versa. Therefore hyaluronic acid infiltrated into a cheek may last 2 or more years and sculptra may last up to 6 years whereas the same products placed around the mouth may last up to 70% less.
As I have been teaching at MetropolitanMD for the past 10 years rejuvenating eyes, cheeks, and temples not only lasts a relatively long time, the results do make one appear more youthful and healthy. The first step in facial rejuvenation is knowing why one looks older before it is possible to resolve the problem. It is kind of like putting a bigger burger in your sandwich vs. covering it with a larger bun. It’s all in what you want

President Obama is at least an immensely eloquent and intelligent speaker. At the beginning of his Presidency he outlined a series of goals with which he would initiate his administration of the nation. I propose to grade him in an objective manner based on his productivity and not on whether I agree with his goals.
I. He would create a bipartisan environment in which all factions of the public would be heard and served. One year later- the country has not been more politically divided since perhaps 1840. Hate messages are rampant in chat rooms and Congress is so politicized that members refer to each other in derogatory terms. Whatever this is, it does not represent successful leadership.
II. The President acknowledged the hemorrhaging of the economy and the need for jobs. One year later- not only has the jobless situation intensified, he has failed to initiate an economic stimulus package that emphasized infrastructure and job creation. During the same period of time the Chinese government has done so and their economy is thriving.
III. The President’s main objective was health care reform. One year later – Not only was no legislation passed, under his leadership the Republican party has become the party of obstruction and the Democrats the party of totalitarianism.
IV. The President acknowledged the risks of terrorism and the need to repair our relationships with our neighbors. One year later – we are getting more enmeshed in a war in Afghanistan and have not been able to resolve the Iraqi problems or the nuclear proliferation of the Iranians.
V. He would preserve his popularity on the basis of meeting the needs of the nation or he declared he would be a one term President. One year later- he is still popular however independents are defecting from his leadership in droves and even a Democratic party stalwart like Massachusetts has elected a Republican senator.
In summary this first year of the Obama presidency has resembled the impotence and arrogance of the Carter Presidency. As Hilary Clinton declared during the campaign for the Democratic Party nomination, the greatest detraction of an Obama Presidency might be his inexperience in public office. Year two will be a telling year as his majority in the Congress and the Senate will diminish substantially after the November elections.