Dr. Sheila Nazarian - Beverly Hills Plastic Surgeon and Star of NetFlix's Skin Decision

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Hello, this is Guy Kawasaki and this is the Remarkable People podcast. Today's Remarkable guest is Sheila Nazarian. She is a plastic surgeon in Beverly Hills, California. She was born in America and then returned to Iran with her family. When the Iranian revolution occurred, she was smuggled out in a vegetable truck through Pakistan. She attended Columbia University in New York. She graduated with a BA in Economics and a pre med concentration. Then she studied medicine at the Albert Einstein College of Medicine at Yeshiva University. Her plastic surgery residence was at the University of Southern California. She also earned a Master's in medical management at USC's Marshall School of Business. She operates a medical practice called Nazarian Plastic Surgery, and she markets a line of organic skin care products. In short, she is both a doctor and entrepreneur. In this episode we cover topics such as how to pick a plastic surgeon who should and who should not get plastic surgery and the relationship between confidence, self esteem and beauty. This episode of Remarkable People is brought to you by Remarkable, the paper tablet company. Yes, you got that right. Remarkable is sponsored by Remarkable. I have version two in my hot little hands and it's so good. A very impressive upgrade. Here's how I use it. 1. Taking notes while I'm interviewing a podcast guest. 2. Taking notes while being brief about speaking gigs. 3. Drafting the structure of keynote speeches. 4. Storing manuals for the gizmos that I buy. 5. Roughing out drawings for things like surfboards, surfboard sheds and office layouts. 6. Wrapping my head around complex ideas with diagrams and flowcharts. This is a remarkably well thought out process product. It doesn't try to be all things to all people, but it takes notes better than anything I've used. Check out the recent reviews of the latest version. I'm Guy Kawasaki and this is Remarkable People. And now here is the remarkable Sheila Nazarian. Do you identify as Persian, Iranian, Jewish, or American, or all of the above?

I think all of the above. Persian Jew is typically like when people ask me, where are you from you come from. I was born in America. I was an anchor baby. My mom came here when she was nine months old. Nine months pregnant and had me. Yeah, no, she just. She just like, literally flew. And I think I was like a month late being born. But they just wanted a US citizen.

So wait, your mom comes to America, you're born, and then they go back to Iran and then the regime changes?

The revolution started.

Yeah, revolution started, and then you're smuggled out in the back of a truck, covered with corn into Pakistan.

That's right. That's right. Yeah. So we went to a bazaar and they put us in the back of a truck. And I remember there was little stakes coming out, like little metal stakes. Cause I guess that's what they would tie the rope to whenever they had to transport vegetables. And so I remember one of the. One of the stakes was going up into my ribs. And I was seven, six. Seven years old at the time. And I told my mom, and she's like, you have to be very quiet. So they got us over, you know, the border within that way. And then we made a stop where we transferred to, like, a pickup truck. But we went to this almost like a clay shack where it was. That was the toilet. There was a big hole in the ground, and you basically had to straddle it. So I was too small. My mom had to hold me over it to go to the bathroom. Yeah, you'd fall in. And while we were in that bathroom, she told me, no, we're going to America. And I just remember being like, oh, my God, we're gonna meet Michael Jackson. Because she didn't tell me before that because I would have told my friends. That was dangerous. That could have been life or death. So she didn't tell me until we actually made it across the border.

How do you feel about the current relations between Iran and the U.S. i.

Mean, I think the people of Iran aren't very happy. I think that's clear. I think the government is not what's. Is not what's best. And I think taking a hard stake on that government is probably the best way to go.

If. If an American were to fly into Tehran today, would you feel like this anti American sentiment or is it just.

It's the government? Yeah. No, the people of Iran love America.

And I've heard that.

Yeah, yeah, yeah. It's beautiful there too. It's beautiful. It's such a shame.

So if we could just get the governments together, the people are fine.

Yeah.

Isn't that always true?

It's so true.

So plastic surgery, first question, is it accurate to say that plastic surgery more or less got its start because of wars?

It is, actually. I mean, it's been happening for a very, very long time. Like the ancient Indians, there's actually evidence that they were doing nose jobs. And there's a picture of a guy, it's like an old, old painting, a picture of a guy holding to the post of a bed while some guy's coming at him with a ch to his nose. So I think beauty and that sort of body modification has been a thing for a very, very long time. But I think modern day plastic surgery, yeah, it got its origins from reconstructing soldiers who'd been injured in war.

And do you think today, just statistically, is most plastic surgery reconstructive or cosmetic?

I think the majority is probably still reconstructive. But being a good reconstructive surgeon means understanding aesthetics and being a good aesthetic surgeon means having training in reconstruct, knowing that you can fix anything, any complication, or if you've reconstructed a breast from scratch, doing a breast augmentation's not going to be as difficult. And vice versa, knowing what a nice breast looks like after it's been aesthetically modified allows you to make a better reconstruction after cancer, mastectomy, things like that. So I think the two go very much hand in hand and have very similar effects on people. Actually.

Does it irritate you to think that people think of you as a, quote, Beverly Hills plastic surgeon and that it's all about giving stars treatment as opposed to reconstructive and changing?

No, not at all. I mean, I think that's why Instagram's there. And I think that's why I've been so focused on branding myself. And the show that we put out on Netflix, really, I think, spoke to the fact that it's not just about stars and the reason why the majority of people not to their own fault. I think that's just what's been put out on media. Sort of like this sensationalized view of plastic surgery about people looking like clowns or really just exaggerated results where I think what I always tell my patients is you don't realize the people that look good. If you saw somebody walking down the street, they might have had plastic surgery from head to toe. But if it's natural, you would never know. You'd be like, oh, they're so lucky. Or wow, they age so well. But no, I think these things, Beverly Hills plastic surgeon and putting people in that box is for people who just haven't learned enough about it. And I think that was the major things that I wanted to accomplish with the show is showing people that no plastic surgery is for everyone. And whether you're getting a breast reconstructed or a mommy makeover, the results can be equally as gratifying. And improving quality of life for people can have ripple effects to everyone that person comes into contact with.

Why do people come to you? Is it. Is it for making something good even better, or is it making something that's bad acceptable or what's in their brains when they come to you?

I think it's a little bit of both. And I don't think there's any shame in either. People come to be optimized and people come to be their best selves, Whether that's mental health or emotional health or becoming a better leader or looking and feeling your best. I think all of those things go hand in hand. So what we've put out on our branding and marketing online is very secure. Woman or man who has their shit together, to be honest with you. And this is just one thing that they've been working on that they can't accomplish on their own, and they just need a little bit of help. The way that I look about it, it's no different than a life coach. It's no different than a therapist, and it's no different than eating better. It's all self care.

And what do you think is the relationship between beauty and self esteem?

The relationship with beauty and self esteem have gone hand in hand forever. There's like Cleopatra rubbing olive oil on herself. Back in the day. There's been studies. I remember seeing like a 60 Minutes, maybe 15 years ago that this teacher walks in to a kindergarten class and says the same line in the same tone of voice, but she kind of looks a little disheveled. She leaves, same actor, comes back, repeats the same lines in the same tone, but she looks well put together. And they asked the kindergarten students which teacher was nicer and they said, the second one. Which teacher did you like better? The second one. So there's definitely. These relationships were built like that were hardwired like that. And I always tell people, and I was just speaking to somebody else about this beauty on the inside and self esteem on the inside matter. If you're getting surgery to make you happy when you're not already happy or think it's not going to work, you have to be happy. You have to be grounded. You have to know who you are and that you just need help with this one Little thing.

Do you think that self esteem causes beauty or beauty causes self esteem?

I think they go hand in hand. It's like saying, work life balance, you know, guy, like, is there work life balance? Like, you spend most of your time at work, so you better love your work if you want to love your life. So it's the same thing.

So if I were to ask you, like, what is your product? Is it beauty or self esteem?

It's confidence.

It's confidence. And the confidence comes because of the physical looks.

I think the confidence comes about how you feel about yourself in many aspects. I think if you have a totally messed up life and you look completely beautiful, you're not going to be confident. And it's vice versa as well. And beauty can mean different things for different people. The way that we put ourselves out there is like natural results always. We always put out like a powerful vibe. We always put out a confident vibe and natural results above everything else. So, for example, my practice guy, we never get people walking in with a picture of a celebrity, ever. Ever. Our breast implants are the smallest size always. So it's always just people wanting to look natural but optimizing something that they can't work on themselves.

So you probably don't think that plastic surgery can, quote, unquote, fix somebody and make them happy, right? It starts within, of course.

Yeah.

So what happens if you meet somebody who's not happy within and says, give me plastic surgery?

I send them to a therapist.

You do?

Yeah.

You turn them down and send them to a therapist?

100%. And I've only had one person in my entire career get upset about that recommendation. Everybody else says, oh, my God, thank you so much. You're right. That's what I should be spending my time and money on. And when they're ready, they'll come back. But if I don't think they're happy, I want to sleep well at night, too. Like, I want to go to bed. I want happy patients. I want patients that are writing those five star Yelp reviews. So if I don't think that I could deliver that because that person has issues beyond my control, I will turn them down.

Would you say that that attitude is typical of plastic surgeons or is just a Sheila thing?

I think it's becoming more typical, but for a long time it was a Sheila thing.

Yeah. Yeah. Do you think of yourself as a life coach, a therapist, or an artist?

All of the above. All of the above. Every day.

Every day. If you go to Santa Monica mall or something, and when you look at people. Do you think, oh, my God, what I could do for you? Or can you ever turn it off?

I can turn it off.

Yeah.

Yeah, I can turn it off.

What do you say to detractors who think that plastic surgery is superfluous and a poor use of medical expertise and resources?

Every one guy says that until their kid falls and hits their head and needs to stitches. And guess what they ask for when they're in the emergency room?

Okay.

They asked for the plastic surgeon.

Is that literally true?

That's literally true. Everyone, everyone. Poo poo plastic surgery until they need it.

So that woman in the. In the Netflix series who was shot nine times. Okay, Katrina. Yeah. So Katrina, that was miraculous. That has to be an extreme case, right?

Yes and no. I mean, once you sort of hit a certain level of people knowing who you are, you start getting cases that are more difficult. And I just did a lady who had had nine abdominal surgeries for a perforated diverticulitis that had to leave her abdomen open. She had all these scars on her belly going up and down underneath that were placed there over the years to save her life. And no plastic surgeon would operate on her because they said it was too risky. The skin's gonna die. And she's this young, single woman who's just like, I can't live my life like this. So helping people like that is actually really gratifying. Or the extreme weight loss patients that just have tons of skin hanging everywhere, they can't even do a plank without their belly skin rubbing on the floor. Those types of cases are so gratifying because you just took someone who is completely non intimate, won't get naked even in front of their husband, and you just gave them a second chance.

So I obviously watched the Netflix and.

Did you cry?

I gotta tell you, first of all, I had to avert my eyes. I mean, sometimes when. Wasn't there a scene where you said, okay, this is like two and a half pounds of fat we took off this person? I mean, yeah, jeez. And that's what it's like. You just go in there and.

Yeah, I think in training you're kind of made into a little bit of a robot in the sense that you have to shut empathy off a bit in order to be able to cut people. But at the same time, if I don't cut them, they're not gonna get better. I think that 2020 kind of gave me a little bit of a pause and gave me the time to feel again and to look around and see the hurt that are going through. Whereas up until 2020, I think I was so laser focused on success and goals and achieving that I sort of shut everything out other than what I had the emotional capability to take on at that time, which was like my kids and my husband, basically. So I think now I feel a little bit more, and I take time to look at my surroundings a little bit more rather than just being focused on my patients, my family, and my practice.

Do you ever maintain contact with your patients like this? I do.

I actually give all my patients who I operate on my cell phone number because I want them to not Google something and do something dumb. I'd rather just have them text me and I tell them what to do.

In the case of Katrina, obviously she had plastic surgery before. And why was it so botched?

I mean, what it was in plastic surgery, actually, the procedures she had before were to save her life. It's not botched. And I hate that word, like, ugh. I hate that wor. It's just because. Because now everybody's using it and it's like, listen, a surgeon tried their best and this was the result. That doesn't mean you're botched. It's just the priorities were different at that time. They had to stop the bleeding. They had to stop and save your life.

Fair enough. But what about the woman with the acne? Where didn't you and your nurse undo a lot of stuff?

No. So what happens a lot of times, guy, is that there are a lot of very expensive devices on the market. So one laser may cost anywhere, might cost me anywhere between 100 to $400,000 to purchase. So a lot of doctors, what happens is that they'll get one laser because that's all they can get, and they'll apply that. Everyone's a nail and that's their hammer. And what happens is there's lasers that are better for lighter skinned people, and there are lasers that are better for ethnic and darker skinned people. And when you use, I call it like a white person laser on an ethnic person, things can go wrong.

This is good to know.

Yeah, yeah, yeah. So in my practice, we have about 30 devices and we apply the correct device to the goals, the ability to have downtime and the skin type of each individual.

Wow.

Who Knew? There are 30 different kind of lasers.

Hundreds of different kinds of lasers, but we just try all of them and keep the ones we like.

Tell me about body dysmorphic disorder.

Yeah. What would you like to know?

What is it? How prevalent is it? What do you do when you encounter it.

When I was a resident at Albert Einstein in the Bronx, I did my psych rotation at Bronx Psychiatrics. So it was the type of, like, lockdown facility that, like, the door would close behind you before the door opened in front of you, and the lanyards with our IDs would break apart at, like, multiple areas so nobody could choke you with it. So my project in med school was body dysmorphia. Actually on that rotation. And at that time, and this was, God, probably 15 to 20 years ago at that time, there was an article that had come out that said 70% of plastic surgery patients have some level of body dysmorphia. And that was then, and I think it's probably, hopefully a little bit better now. I would say if I sense that a patient has body dysmorphia, I'll just send them to a therapist. But I think it's changed a bit. I think plastic surgery has become a little bit more mainstream. The patients that walk into my office aren't like, I hate myself. This is so disgusting. Usually when they say, this is so disgusting, like, it really is bad. Like, I don't get patients that come in with a normal nose, and they're like, my nose is huge. You know, I just don't attract that type of person. I'm not seeing that. But at that time 20 years ago, that was the level. So body dysmorphia is defined as when someone looks at a body part and they see it wildly exaggerated than what it would look like to anybody else. So somebody comes in with a slight, like a 2 millimeter hump, and they say, my nose has a big camel hump and all that, that's body dysmorphia. So again, if we see anyone that we think is unreasonable, and I have seen it. Like, I've seen people come in and they literally bring in a file of what it. What they look like before they put filler under their eyes and what they look like now. And this is from every angle, and they have micro selfies of every part of their skin. I'm just like, you know what? You are traumatized right now. You are not in the position to undergo even the downtime, even if you get bruised, you're gonna get further traumatized. And I don't think this is a good time or that you're in the right kind of state of mind right now to undergo this procedure. And I really think you should take a step back and analyze why you're doing these things. And maybe Get a little professional help to help you understand. And that's my talk.

But don't they go next door and find another plastic surgeon in la?

They can, but then that's on that plastic surgeon. I don't have to bring on that, that baggage into my practice. Because I'll tell you, Guy, the last thing you want to do is have 1% of your patients take up 99% of your staff's time.

You're saying that in a business sense.

Yeah, on a business. And you want your staff happy. You want your staff to be focused on delivering quality care to the, to all of your patients and not just spend 100% of your time, of their time or 99% of their time on 1%. So we try to. It's funny, like when I'm doing consults, I do a lot of virtual consults. So every Wednesday I'm doing virtual consults. I will take advice from my staff. If they say, this person was rude to me, if this person was mean to my employees, we will not accept them as patients. And people think that they're interviewing me, but in reality I'm interviewing them to see if they're ready and if they're a good fit and if they're above all capable of happiness.

So just step me down this path a little bit. You do a virtual consult. So let's say you and I are doing a virtual consult. I say, oh, Sheila, I just hate these age spots here. It makes me look so ugly and it's affecting my self esteem and I speak a lot. I need to look better. Do you tell me, guy, friggin don't worry about it, or do you tell me?

I always tell people, if it's something that's safe and you think about more than a few times per week, then why not fix it? Life's short. Why would you spend your mental energy worrying about something that can easily and safely be taken care of? So if it's something that you're thinking about more than three times per week and it's safe and you're in the right mental status, why not?

I'm not really asking you because I'm thinking about it. But so you look at this, you see these brown spots and you say, guy, you know, my nurse can take care of that in an afternoon. And what kind of seriousness is this? Just as a data point for me.

We would put you on a hyperpigmentation skin regimen just to sort of get your skin prepped. And also what we want you to do is do the Work at home a little bit as well. So I always tell people what you do at home is like exercising by yourself. What you do in my office is like exercising with your trainer. We're gonna push you a little bit harder than you would have pushed yourself with the right devices and the right equipment. But that doesn't mean you can't take care of it at home. So, for example, if you tell me, guy, you know, I like to surf, I like to be outdoors, and I never wear sunscreen, and I hate doing that, I'll be like, you know what, guy? Live with your sunspots. Because whatever. Yeah, it's like. It's like going to your dentist for cleaning and not brushing your teeth at home. What's the point?

Okay. Okay.

You have to gauge your level of commitment as well.

Okay, so if I tell you I surf and I. And I do put on sunscreen, then what do you tell me?

We would probably use a laser on you or a series of peels, depending on your ability to have downtime and how quickly you want it taken care of. But yeah, it can be taken care of.

And what does downtime mean?

So downtime is like peeling or flaking. And during that, like, week of peeling, you can't have any sun exposure. So I would have you, like, stop surfing during that week. Or we do it in the winter time if there's down time. Or we engage it with your life, forget it.

There's never a week where I will not serve, so that. That eliminates me. And honestly, I don't think about these spots three times a week. In fact, I haven't thought about it till today.

So I guess, yeah, I always tell people, guy like, this isn't a burst appendix. You know, not we do is an emergency. You take care of it if it bothers you. You don't. If it doesn't.

Okay.

I had this lawyer be sent in by his wife because he had these lines in between his eyebrows. He said, yeah, my wife sent me here. Everybody says I look angry, but I am angry, but doesn't bother you leave. And so he left.

If he was a divorce lawyer, he should look angry at it ups the settlement. Right. Do you think that, you know the perhaps a misperception or probably misperception of plastic surgery where you can achieve the perfect body, does that create unrealistic expectations? Just like I could make the case that TikTok and Instagram perpetuates unrealistic expectations. So how do you address this?

I actually post about it. So if there's like A TikToker who's doing 100 squats into the camera. And I can clearly tell she's had plastic surgery to make her butt that big. I post about it. I will say, you know what? This is what your favorite influencer is doing. And if you don't see these dips in her hip on the sides, that's not from doing squats because there's no muscle there. And I will post about it and I'll educate the public, because I have two daughters, too. And the reason why I went on social media and grew my following, because I don't want my kids looking to Instagram. That's where they live. That's where they're consuming information. So I don't want them to just be on Instagram seeing YouTubers and who I love. I treat a lot of YouTubers, but I wanted them to have an alternative role model if something like, what was it, 87% of kids in the U.S. now, when you ask them what they want to be when they grow up, they say they want to be a YouTuber. It's not like, Dr. No, it's not CEO. It's a YouTuber. And so I think it's our responsibility to be on there and give positive messaging and educate and say, this is real. This is not real. This is what they're doing. This is what, you know, if you don't see this or if you see this, this is what the surgery that was. That was done just to let people know what realistic expectations are. Also in the consults, realistic expectations are so important. They always say what you tell the patient before surgery is education. What you tell the patient after surgery is an excuse. So you have to spend that time educating the patient before they have a procedure and let them know what the risks are, what the possible downtime's gonn what the expectations, what realistically they can achieve, you know, with this device or with the surgery. And if those things can't make them happy beforehand, don't do it.

I noticed on the Netflix series that you were definitely low balling Katrina.

What do you mean?

Well, I mean, you were not promising that she'd come out perfect. And also the woman with the acne, you guys were definitely low balling her too, about how much you could really do. Yeah, but is that typical in your business? There's so many stereotypes in my brain about Beverly Hills plastic surgery.

I can tell you have a lot of stereotypes happening. No, I think it's becoming more typical. Yeah. Because what happens if you don't do that is, at the end of it, you get a very unhappy patient, and unhappy patients go online. So I think it is becoming a lot more prominent, letting people know exactly what it is that you can and.

Can'T achieve off plastic surgery. For a second here.

Thank God.

Listen, when I interviewed Jane Goodall, I asked her about chimpanzees. I'm sorry, you know what? What do you want me to ask about?

There's so much more.

Okay, so now let's talk about your business. So, yeah, you're the evangelist of thinking big. What does that mean?

So what I realized is I went to business school, too, and I was an economics major at Columbia. And I've always been fascinated by how creative marketing is and how it's ever changing. Now there's this app. There's that app. People look at me and they're like, plastic surgery. So creative. Well, yeah, it was for the first five years. But then after you've done a thousand breast augmentations, you know. Yeah, every anatomy is a little different. There's definitely nuances, but it's lost its thrill. Do you understand?

That's a quote. After you've done a thousand breast augmentation, it's lost its thrill. I'll have to.

That's going to print that out. Stick it on your.

I'm gonna make a. What do you call one of those?

Bumper sticker.

No, that too, but the Instagram little corner code gram or whatever they call those things.

Yeah, a meme.

Yes, that's right. That's gonna inspire me for quite a while, Sheila.

There you go. I'm so glad I do that for you. All right.

The thinking baby.

Yeah.

No.

So I just started looking outside of medicine, and a lot of My patients are CEOs and super successful outside the box thinkers. And whenever I'm in there doing their Botox or whatever, their skincare, I sit down, I talk with them for an hour. I'm like, what are you thinking about now? What's your company doing? What's the tax planning? What are we doing? Where are we buying a house? What are we. Where are we going? And I realized that everything's almost been done outside of medicine. And I'm a speaker on social media. They invite me all over the world to speak on social media. And I'm like, why are they asking me? I have 500,000 followers. They should be asking that person with 10 million followers. So I decided to create this conference where we bring people from outside of medicine to learn from each other. Like, almost like a think tank. The more diversity in the room, the better. And that was the impotence to creating the Think Big conference where it was bringing a meeting of the minds. And the people in medicine that are ready to grow and ready to think that way will self select and they will be the ones to attend, which means they're the ones that are going to help each other grow as well. And that's what happened. It became like camp. And the first day we really focused on business and branding tips. The second day we focused on imposter syndrome. What is it about you that's holding you back? I just gave you all the tips, but you're still not gonna post because maybe you said, or maybe the lighting was bad or what are your colleagues gonna say about you? And like all of these things we put on ourselves to cage ourselves in, prevent us. Wait, wait.

Time off for a second. So the people in the audience, they're all from the medical profession or this?

Most of them? No, it's. I really, my dream for IT guy was for it to be lawyers and hotel owners and business owners because I just think the more diversity in the room, the more creative the ideas get. But what happens is most of the people who are following me were from the medical space and looking to kind of learn from what I did. And maybe they can apply it to their spa or maybe they could apply it. So I ended up being. Most of the people in the audience were from the medical space, but we've certainly had lawyers, we've had boutique owners.

You know, but this may seem like a dumb question, but are you saying that doctors need a brand? Like, why does a doctor need a brand?

Of course, let me tell you.

I said it was a dumb question.

No, no, it's not a dumb question. A lot of doctors still feel that way. Why do I need a brand? But the thing is, is if you don't have a brand, if you don't control the conversation around what people think and feel about you online, then you're giving all that power to Yelp. If people know you online. You know that quote that says, live your life in such a way that if people speak badly about you, nobody will believe it. So the onus is on you to control your image online because if you don't, other people will.

And do you think that people pick their plastic surgeon based on Yelp?

A lot of people do, yeah.

Really?

Yeah. A lot of people do, yeah, yeah, yeah.

Is that good or bad?

It's a double edged sword. And it's not just Yelp. I think the thing that we found is people take a circuitous path to picking their doctor. They will look at Yelp, they will look at Instagram, they will look at your website, they will look at Google reviews, they'll look at your Facebook, and then they'll call.

Wow.

Yeah. So everything has to be consistent, and everything has to be on brand. And when they walk into your office, if you have a brand that's screaming luxury and elevation and optimization, and they walk in, your office is crappy, and your front office girl is wearing Uggs and a Bon Jovi T shirt, that's not good. So everything has to be consistent. So I always tell people, once you define your brand, everything you do as far as customer facing has to be consistent. And on brand, whether it's your office furniture, who you hire, how they speak, how they answer the phones, your website, what your Instagram looks like, everything has to be consistent so that you don't attract everyone. You attract the people that are really vibing with you and are going to be in your tribe.

I'm glad that Uggs is not a sponsor of my podcast.

I love Uggs, but just not in the office.

Okay, now, could you just define their first for your philosophy and how you use social media?

I use social media mainly to inspire.

You know, inspire what you could look like or. No, inspire what?

Inspire women, young women especially, and men, to let them know that you. Once you're a doctor, that doesn't mean that's the only thing that defines you. You can have other interests. You can be a mom, you can be an entrepreneur, you can be an activist, you can be fashionable, you can look good if you want to. You can be whatever you want to be. And that's, I think, why the following has grown, is because I'm giving people permission to be themselves and be authentic.

I did not anticipate going into this direction. Branding and doctors, that's kind of a new subject for me. Fascinating.

No, I mean, it's incredibly important, because when they're choosing a doctor, and it's so cool, too. Like in medical school, they always tell you right down at the top of the chart, their dog's name and their kid's name. And every time they come in, ask them, how's your dog? How's your daughter? What grade is she in now? But when you have opened up your life a little bit and what you're about on Instagram, your patients constantly feel connected to you. So when they come in, they're like, oh, how was Tahoe? Oh, I saw your daughter's getting so big. She looks so beautiful. She's learning Korean. What? Like, so I think it's a way to stay connected. And at this point, when people call for a virtual consult with me, they've already made the decision that I'm their doctor. It's just.

Oh, really?

Yeah.

Because of social media.

Because of social media.

But you have not yet made a decision if you're gonna take them.

Correct.

Huh?

Correct.

Wow.

Well, how is it, like, you know, in your business? How is it. Did you do take every client? No. You just have to see if they're a good fit and if you can form fulfill what they're envisioning in their head and whether they're kind of ready to take the next steps. It's the same thing.

I guarantee you that you put more thought into who you take as a patient than I do.

Your clients don't have your cell phone number guy, mind you?

Well, no, but, you know, they're not sitting beneath me, and I have a $400,000 laser in my hand either. Now, for people listening to this, I think a lot of people are learning so much about plastic surgery they never did before, which is good. That's the whole point of a podcast. So now can you give the advice to these people saying, okay, so if you're thinking of plastic surgery, this is what you do. This is your thought process.

I have literally made 300 YouTube videos. Some of them are along that exact line. How do you choose your plastic surgeon? What mental state should you be in before considering plastic surgery? And it's a lot of the things that we've talked about. I think. I think there's so many fake plastic surgeons out there now because they might be an emergency room doctor, or they might be a general surgeon, or they might be a dentist, but they're going to pick up that Botox needle, or they're going to pick up that laser, or they're going to pick up the knife and tout themselves as a plastic surgeon. So I think there's a few questions you should ask your plastic surgeon to make sure that they actually trained in plastic surgery. And one of those questions is, could you perform this procedure in a hospital? Because hospitals will not allow people who have not trained in a specialty to perform those procedures in a hospital. Okay, wait, wait, wait.

Say that again.

So let's say I'm telling you, if you want a real plastic surgeon who actually trained in plastic surgery.

Yeah.

These are the questions you ask. Could you perform this procedure in a hospital? That's number one Number two, what did you do your residency training in?

Okay, okay.

Are you board certified in plastic surgery? And it has to say the word plastic in it. Not cosmetic, plastic. So those are your three questions. If you want a real plastic surgeon. Because a lot of times it's frustrating for us too. They'll be like, plastic surgery. Like, this person dies getting plastic surgery. Guess what? That wasn't a real plastic surgeon. Because a real plastic surgeon refused that patient.

And what's the difference between plastic surgery, plastic and cosmetic?

So plastic surgeons actually went through a plastic surgery training. Cosmetic surgeons might have done like a one year fellowship, but they actually trained in ob, GYN or they actually trained in emergency medicine or general surgery.

So you're telling me that if I'm not certified plastic surgeon, a hospital somehow checks to see how I'm certified and says, nope, you can't do breast augmentation, Dr. Smith.

That's right.

And this is some kind of rule in the medical world that.

That's right.

And it's not even. You can't go to one of these, you know, surgery centers. And they'll say yes. Everybody will say yes.

No, the surgery center will say yes. That's what I'm telling you. You need to ask, could you do this in a hospital?

Oh, because the surgery center and a hospital are different. See, I see. I'm an. I am.

Yeah, that's correct. So a surgery center is just an outp. Surgery center. They'll say, you can do what you like, but hospital will not allow someone to perform plastic surgery procedures if they weren't trained in those procedures in their residency.

Wow. I'm learning so much. Okay, now I'm going to be giving.

You a tummy tuck soon. We're going to.

I have no esteem problems, so you can now. Okay, so now we figured out what to ask the plastic surgeon and all that, but now what do I ask myself? What mental state do you want me in?

You have to be generally happy and generally grounded. And I'm, you know, I've been, you know, lead a healthy lifestyle. This surgery isn't gonna make or break me. My husband's not gonna stay with me if I get this surgery. That, those kinds of things, it's. I'm happy, I'm settled, I'm cool. But this one little thing is something I've been. It's been on my wish list for a while. That's the mental state you want to be in. Not. I'm really depressed. I'm unhappy. And this surgery is going to bring me happiness. Or my husband's going to leave me and is cheating on me. If I get bigger breasts, he's going to stay. And we ask those questions like somebody. We ask those on our intake form. It'll say, is anyone. Did anyone make a comment? And that's why you're trying to. You want to get surgery? Did. Are you hoping that this surgery will save a marriage or a relationship? We actually ask those questions on the intention.

This is on the form.

It's on the initial form before I even consult with a patient. Yeah, it asks about their medical history, too. What medications are you on? What surgeries have you had? But the top right of the form has these questions, making sure that someone is doing this for the right reasons.

And did you learn all of this in plastic surgery school, or did you come to it as Sheila the plastic surgeon maven?

I think a little bit of both. I think a little bit of both. And every year, guy, I learned something new every year. As a business person, as a physician, you come to a new realization and you're like, oh, I'm gonna add that to my intake form. It could be anything. It could be. Why would I say. Coolsculpting sculpture, liposuction. People don't know what they need, but they will check off that they need maybe fat reduction. So before we had the names of the devices listed, they don't freaking know what those are. So we changed it to by concern. They know what their concerns are, and that's something they might check off to discuss with me during their consultation.

It's funny, this may sound like a bizarre application of this concept, but I interviewed someone named Colin Breyer, and he was the chief of staff of Jeff Bezos. And the name of his book is called Working Backwards. And the concept here is that rather than working forwards from what you can make or do you work backwards from what the customer wants? If the customer wants bigger breasts, that's working backwards. But if you're saying, well, I have such and such laser and that's what it does, that's what I'm gonna do to you. Because I have a hammer. You are a nail. That's the opposite. And so you are working backwards. Right?

All the time. And we always do that. I love it when my patients ask me in the room, like, oh, what skincare product should I get? I was looking for the one you posted about. I couldn't find it. I will literally grab their phone and go through the process of my E commerce site to see what the limitations are. Is it misspelled? Maybe they're misspelling it. And I should use the misspelling somewhere in the description of that product so that when anybody else misspells it, they'll be able to find the product. Or maybe the page went inactive and I didn't know. So I love it when patients give me feedback like that because I love seeing things from their perspective.

Could you make the case that during the intake process, if the intake process does not have questions like what you just posed, that is a warning sign.

Warning sign to the patient.

Warning sign to the patient.

That this is, you know, it's so interesting, guy people. I wish they would put a little bit more effort into thinking of things that way, but they don't. I wish they would, but I don't even think that's on most patients radar. I think just honestly, finding a real plastic surgeon, just taking it way back even before you get to the form, just choosing who to pick up the phone to call. If I can make patients ask those three questions, we've already made massive leaps.

The three questions about, would you be able to do this in a hospital?

Those questions, yes, those questions. If I have just like instilled those three questions into people, because doctors will be like, patients will call and say, are they board certified? And the person's like, yes, they're board certified. Board certified in what? Board certified in brain surgery, Board certified in podiatry. Board certified in what? So patients ask these questions and they think they're doing their due diligence. And really, no, those aren't the questions you should be asking. And you could be going to a guy who literally did his fellowship in, I don't know, oral surgery, and now he's putting breast implants in people.

So if we're gonna go down this path, just go, go down one more level. Please define exactly what board certified means.

So board certified means after you've finished your residency training. So you go to college, you go to medical school, and then you choose a specialty that could be GI doctor doing colonoscopies. It could be internal medicine, family medicine, dermatology, plastic surgery, ophthalmology, whatever you choose, what kind of doctor do you want to be? And after you finish that training, whether it's four years or eight years, you have to take a test, two tests. One of them is written and the other one is oral. So you actually fly into a place. It's the most nerve wracking thing that I've ever done in my whole entire life. And you sit in front of people and they test you older plastic surgeons or older whatever you trained in will ask you these questions and if you don't answer correctly, you fail and you're.

Not board certified and you have to PhD thesis defense.

There you go. So they could be board certified in. In something completely different. They could be board certified in a cardiology. Do you want that person cutting you?

Does each state have their own board? I mean, where did you fly into Does?

No. So the board is national. So everybody. We had to fly into Scottsdale, all of us. But like I know the dermatology board's in Florida. So there is one place you go and these older senior plastic surgeons will fly in to test the next batch of young budding specialists.

You may have noticed that in recent episodes, I've asked my guests where they do their best and deepest thinking. The reason I do this is because our sponsor, the Remarkable Tablet company, makes a product that fosters great and deep thinking. It's the remarkable tablet 2. The reason why it fosters great and deep thinking is because it is single purpose. You use it to take notes. This is unlike an iPad where you're checking email, checking social media sites and generally being defocused. So now here comes advice about how to do your best and deepest thinking. Sponsored by the Remarkable Tablet Company. Where do you do your deepest and best thinking?

It's either organizing my closet or doing laundry.

That's where you do your best thinking?

Yes. I need productive meditation. I can, I can't sit there and meditate. I'm so bad at it and it doesn't matter. And people are like, you have to practice it. But actually get my best thoughts and thinking done when I'm doing some sort of thoughtless work, like I don't have to use my brain power to work, but I'm accomplishing something. So I call it productive meditation. And it's funny, at my conference last year, we had Kris Jenner as the keynote. She does the same thing. And I was like, girl, we got this. We should have our like closet organization slash deep thought show. What about you, guy? Where do you do your best thinking?

I recently interviewed Julia Cameron, who I loved.

I love that one.

Yeah.

And she talks about writing every morning, right? And she also talks about. I forget the term she used about taking yourself on this sort of positive emotional date. And it can be anything. And I really do think that I do my best thinking driving a German manual shift car. How's that for rationalization?

No, I mean, is it brain? What, what makes you, what makes you think better in that car? Why that car?

I don't. Well, I'm trying to rationalize getting a German manual shift car. Besides that, I don't know. I just enjoy driving. I like, I would drive for the sake of driving. I'm. Greta Thornberg is going to hear this and condemn me for causing climate change, but I love to drive and my closet is a mess. So now you learn something. You can do your best and deepest thinking while doing laundry, driving a German stick shift car, or using a remarkable tablet. Now I lied. So the absolute last question is I interviewed a New York Times Pulitzer Prize winning investigative reporter and I asked her for tips about, you know, how to interview people. And she said, always end your interview with the question, is there anything I didn't ask you? So I'm asking you, Sheila, is there anything I didn't ask you that you feel that people should learn?

There's a lot. I mean, as an immigrant, there is. There's just so much, you know, I should write.

Are you saying an incompetent interviewer.

No, you're an amazing interviewer. The background work you do is just inspiring to me. No, I think what people don't see a lot is the amount of work and energy that goes into getting to the place and thought and intentional strategy that goes into becoming successful. I think I've gotten so much backlash. A little bit, oh, you're successful because you're on Instagram and why are you posting yourself in a dress? And especially from my colleagues who tend to be a little. So I think the thing that I'm grasping with right now is when will my accomplishments get me the same amount of respect that a man would get with less? Even from the people in my daily life, if I speak, you know, to my employees in a very direct way, like, hey, guys, the numbers were a little off yesterday. They might go cry. Whereas if a man said that, oh, the numbers were off, I'll look into it. And it's, at what point have I reached the level of success that I will be seen the same way as a man and responded to the same way? And the answer is never. But that's something that I've been giving a lot of thought to. And the amount of intensity and work that has gone into becoming who I am and where I am today, since the age of seven, coming to this country, not speaking this language, being in esl, the amount of teasing for being a nerd, the amount of commitment, sacrifices, having my kids during residency and pumping at 4 in the morning as I'm driving into the hospital and in between cases, all day at the county hospital, in a closet, all of those things. It's like, what more do I have to go through to achieve that level of respect? And that's sort of the things that I'm thinking about now and what I think needs to be explored a little bit. I think people, especially with plastic surgery, try to box people in. And I think also within plastic surgery, once they've given you the privilege of obtaining that profession, you die with a scalpel in your hand. And as soon as you start to pivot and maybe say, you know what? I'm also interested in fashion, pivot. I'm also interested in business. I'm also interested in philanthropy. It's almost like, how dare you? Like, we took the time to train you. Why are you not just obsessed with operating all day? And I think that's why physicians burn out, because that's the expectation. And we're conquerors. We're achievers. We want to be challenged. We want to constantly be growing. And when we're told that this is the only thing you can do, you graduated, you're board certified. Now go in your office and work all day long. Yeah. And so, you know, I think there's so much more to everyone, and everyone.

Has a story, and you're a woman doing all this, which just makes their heads explode.

It does.

I think it's good to see some exploding heads on the side of the road. Well, Sheila, thank you very much. And if I ever really start thinking about the eight spots more than three times a week, you will be the first person I know where to go. I do. I have a friend in the plastic surgery business.

You do?

Yeah. And I can fill out that intake form, no problem.

So, flying colors, Guy.

To put it mildly. I began this interview with some stereotypes about, quote, unquote, Beverly Hills plastic surgery. Let's just say a lot of those stereotypes were destroyed by Sheila. In fact, you can make the case that plastic surgery is a lot more constructive, no pun intended, than I ever imagined. I'm Guy Kawasaki, and this is remarkable People. I'm backed up by two remarkable people, Jeff C. And Peg Fitzpatrick, who always make my podcasts come out beautifully. Until the next episode. Remember, vaccines are on the way. But still, still wash your hands, wear a mask, don't go into crowded places, get vaccinated when you can. And this applies especially to people in Texas. Mahalo and aloha. This is remarkable people.