Dominic “the Shoe Surgeon” Ciambrone has never been afraid to step out on his own. Growing up in Santa Rosa, Ciambrone was always building things by hand in the backyard of his childhood home. Instead of following instructions when building forts and making things out of Legos, he created something new.

The 32-year-old Ciambrone’s backyard is now in Los Angeles’ Silver Lake neighborhood, and what he creates now are highly sought-after, one-of-a-kind sneakers. And those who surround him these days are famous athletes and musicians. But one thing remains the same from his early days in Sonoma County: he doesn’t follow instructions; he follows whatever’s in his head.

At one point, what was in Ciambrone’s head deteriorated into a cacophony of tormented voices brought on by severe anxiety and drug abuse. The noise became so unbearable that it eventually sent Ciambrone leaping out of a second-story window and landing in a muddling haze of prescription drugs and psychiatric care seven years ago. He says that he felt the need to turn to drugs and alcohol to feel “normal and escape reality.”

“After he jumped,” says his mother, Kim Ciambrone, “I remember the doctors telling us that our son was delusional—that he thinks he makes shoes for Justin Bieber. My husband and I said, ‘He does make shoes for Justin Bieber.’”

The doctors found it hard to believe, but truth is often stranger than fiction. Ciambrone’s big break came when he was introduced to Justin Bieber through a mutual friend while delivering a pair of custom-made sneakers for musician will.i.am to wear at an MTV Video Music Awards show. The Shoe Surgeon and the Biebs hit it off, and Ciambrone found himself fulfilling a few dozen orders of shoes for one of Bieber’s upcoming tours. Then, after Law & Order: Special Victims Unit enlisted his services for a 2011 episode titled “Personal Fouls,” Ciambrone’s work catapulted into the sneaker stratosphere.

But before he could continue to keep celebrities’ sneaker games looking fresh, Ciambrone needed a fresh outlook himself. Kim recalls her son being diagnosed with bipolar disorder and prescribed a cocktail of mood stabilizers, anticonvulsants and antidepressants. “Dominic had one of those Monday-through-Sunday pill boxes, and some pills he had to take were just to offset the side effects of the other pills. It really put him in a fog,” she says.

The lack of clarity was stifling his creativity and distorting his artistic vision. “He didn’t want to continue taking the medication because of the damage it was doing to his body,” she says. “He felt more like a zombie than a human.” Ciambrone turned to a traditional Chinese medicine clinic in Petaluma, where he underwent a full-body cleanse. He started meditating, resumed exercise activities and phased out his prescriptions.

Ciambrone’s interest in fashion began in middle school. “My older cousin let me wear her original 1985 Air Jordan 1’s in high school. It was the first time that I felt like I was able to wear something without having to say anything to express myself,” Ciambrone says.

The experience inspired the then-16-year-old to try his hand at sneaker design by airbrushing Jordan’s with model paint and tinkering with the iconic Nike “swoosh” by removing it from the side of the shoe and gluing it to the top. Ciambrone’s DIY-alterations caught the attention of his friends, who implored him to customize their kicks in the same fashion.

Taking liberties on an original design was nothing new for Ciambrone, as he told Hypebeast earlier this year. He was counterfeiting Chuck E. Cheese prize tickets with his brothers at the age of 12, and quite literally graduated from the ball pit with his next venture: hawking counterfeit high school graduation tickets for $15. It proved to be a lucrative racket, until his younger brother was caught and prohibited from participating in the ceremony.

When Ciambrone graduated from Santa Rosa’s Elsie Allen High School, in 2004, he didn’t ask for a new car or laptop as a graduation gift; he asked for a sewing machine. His grandmother gave him a Brother Pacesetter PS1000 13-stitch machine. Designed more for clothing than shoes, it was the perfect introductory tool for the young Ciambrone to realize his potential. In 2005, he enrolled at Santa Rosa Junior College to study fashion design, but there was one problem.

“I just couldn’t sit still,” he says. Ciambrone’s time as an SRJC Bear Cub was over before it started, and at the age of 19 he moved from Santa Rosa to Charlotte, N.C., to stay with his grandmother.

The move opened up his view on what fashion was and could be outside of his wine country stomping grounds. “You could go to a kiosk in a mall in Charlotte and people there were airbrushing shoes,” Ciambrone says. “That just didn’t exist back home in NorCal.”

While in Charlotte, Ciambrone teamed up with a local shoe customizer who designed the cleats for the Carolina Panthers in the 2003 Super Bowl—a connection that accelerated Ciambrone’s learning curve. Eventually, his fascination with Charlotte mall culture led to his first design job at a No Fear clothing store in Charlotte. As assistant manager, Ciambrone was able to put his customized kicks on display for $120 a pair, a price point that netted him a mere $20 profit after his labor costs.

When Ciambrone moved back to Santa Rosa, he began searching for local shoe-repair shops that would give him the chance to further hone his skills and expand his craft—easier said than done. “The first person I approached shoved me away,” Ciambrone says. “He was cussing at me, and said he wouldn’t work with me because I’d steal all his business.”

He finally took a step in the right direction when he and met his future mentor, Daryl Fazio, in Windsor. Initially, Fazio, who had more than 30 years changing soles under his belt, was reluctant to work with Ciambrone, due to the younger man’s relative lack of hands-on experience. The Shoe Surgeon eventually swayed Fazio with his determination.

“Daryl really helped me learn how to properly sand and sew,” and showed me “what machines were best to work with,” Ciambrone says. He would go on to apprentice at Fazio’s shop for five years, in conjunction with learning from Michael Carnacchi, a custom-fitted boot maker at the Apple Cobbler in Sebastopol. “I remember Michael’s eye for detail and passion for craft, and Daryl’s amazing work ethic, and how he built relationships with customers,” Ciambrone says.

Before Ciambrone could set up shop and begin work as a self-employed shoe stylist, there was some paperwork to submit. His father, Lou, owner of Santa Rosa’s Canevari’s Deli, required him to draw up a loose business plan. In return, Ciambrone’s parents made an investment in their entrepreneurial son in the form of a $3,500 sewing machine.

“It wasn’t like I wanted him to draw up this fully realized business plan that was going to work.” Ciambrone’s father says. “I just wanted him to see what that entailed and what needs to be presented to someone when you ask for a loan.” Ciambrone, 21 at the time, was able to enlist the help of Guy Fieri through a mutual friend, who provided him with some valuable financial insight.

The Shoe Surgeon remembers his humble beginnings, when he often worked for free and felt fortunate to charge someone $100 for his designs. “There were times where I wasn’t making any money,” he says. “The friends and family I had in Santa Rosa helped feed me and pay my rent.” Ciambrone can now pay his rent with just one higher-end pair of his current lineup of custom shoes. His website offers shoes ranging in price from $200 to $3,500—not bad for someone who once operated entirely out of his parents’ garage with one sewing machine.

Ciambrone hasn’t forgotten where he came from, crediting the “old leather spots” in Petaluma and Sebastopol with helping to trigger his success. He frequently returns home to visit family and friends, and credits his father with instilling in him a “strong work ethic and eternal sense of optimism” as a foundation that got him where he is today.

A husband and a father now himself, Ciambrone has a new appreciation for the pair that raised him. “I’m extremely grateful to have had the most loving, hard-working parents,” he says. “As a parent myself it puts life into a different perspective.”

Ciambrone recently collaborated with retail giants eBay and Farfetch on charity events that raised money for victims of the North Bay wildfires, and now has his sights set on raising awareness for mental-health issues. “The goal is to share my struggles of the mental challenges and diagnosis of what I went through to help others out of very bad situations,” he says. “This upcoming year I’m focused on devoting more of my time to be an advocator of mental health awareness. I want everyone to learn more about themselves and talk about the dark feelings they may have.”

By Michael Barnes

Q: A lot of women are posting pix of themselves on Instagram in very skimpy attire. I don’t feel comfortable doing that (though I’m in great shape), because I’m single and I’m afraid men would think I’m “easy.” Am I right in thinking men don’t take you seriously as relationship material if you post this type of pix? Or am I prudish and out of touch?—Curious

A: Ideally, if you tell somebody you have a few more weeks out on disability, they don’t immediately assume it’s because you got really bad friction burns working the pole. Evolutionary psychologist Cari Goetz and her colleagues note, not surprisingly, that men see skimpy attire on a woman as a signal that they can manipulate her into casual sex. (Women in their research also understood that men perceive skimpy attire this way.) But who actually ends up manipulating whom?

Goetz and her team speculate that some women—especially those who perceive themselves to be “low in mate value”—use revealing attire to advertise what seems to be their hookupability and other “exploitability cues.” However, these seemingly poor, defenseless sex bunnies may actually be looking to “advance their own mating and relationship goals.” As for how this might work, if a man likes the casual sex and keeps coming back for more, maybe, just maybe, she can draw him into a relationship. (Hookupily ever after?)

However, this approach is a risky strategy because, as Goetz and her colleagues point out, “men found women displaying cues to sexual exploitability to be attractive as short-term mates, but, importantly, not attractive as long-term mates.”

As for what you might make of all this, it’s best to avoid clothes with coverage just this side of G-strings and nipple tassels, as well as overtly sexual poses (like sucking on a finger—subtle!). However, you can take advantage of evolutionary psychology research that finds that men are drawn to women with an hourglass figure (as well as, heh, women who use deceptive undergarments to fake having one). In short, your best bet is posting shots of yourself looking classy-sexual. This means wearing clothes that reveal your curves to a man—but not your medical history: “I don’t know her name yet, dude, but I can tell you that she had her gallbladder removed.”

Q: I love my girlfriend, but she has some weird rules about her place: no shoes inside, cabinets can’t be left open, etc. We’ve gotten in fights when I’ve forgotten to do this stuff and then mentioned how ridiculous I find it. Should I have to do things I think are stupid?—Besieged

A: Your girlfriend reminds you of a well-known television star. Unfortunately, it’s Judge Judy.

You, like many people in relationships, have the expectation that your partner’s requests should make sense. This is where you go wrong. To be human is to be kind of an idiot. We’re all idiots on some level—meaning that we all say and do things that make sense to us but that others would reasonably find utterly idiotic.

That said, our idiocy is not without benefits. Economist Robert H. Frank observes that we evolved to sometimes behave in “seemingly irrational” ways that actually serve our interests. An example would be acting out in ways that test others’ commitment to us (though, typically, we don’t see it that way and may not even intend to do that).

So, though your girlfriend would probably list reasons for each of her rules—reasons you might find silly—what isn’t silly is her caring about your following them or at least caring enough to try. In short, you don’t have to endorse her ideas to try to act in accordance with them and to treat her kindly when she gets upset that you’ve forgotten. (For example, you could say: “I’m sorry. I know it’s important to you that I do this.”) This would be a signal that you care deeply about her, that you love her enough to do ridiculous things just to make her happy—maybe even to the point of handing her a shopping bag: “Look, honey! There was a sale at Prada on surgical shoe covers!”