Blog — Notes of a Plastic Surgeon

Welcome to my blog. I am a plastic surgeon in Seattle and have been in private practice since 1991. I've seen more than a few interesting faces and cases through my years spent in the exam room, the operating room and the emergency room. And I have an opinion on just about everything relating to plastic surgery (and a lot of unrelated stuff). If you like my blog, let me know. Thanks for reading! Lisa

Capsular Contracture 102: Treatment

April 19th, 2018 — 3:59pm

My last blog discussed the difficult and frustrating problem of capsular contracture of breast implants.  As with just about every problem known to mankind, prevention is the best approach. But despite doing everything correctly pre-operatively, intra-operatively and post-operatively, a small number of patients will experience capsular contracture.

First a little history:  Way back when the Earth was cooling and breast implants were the newest and coolest thing, surgeons would treat capsular contracture by “popping” the breast, the so-called manual or closed capsulotomy.  Here is how it worked.  The surgeon would take his great big strong paws and basically mash the poor breast until there was a pop and the breast went soft as the scar capsule ruptured and released its pressure on the implant.   As you can imagine, there was a lot of moaning and screaming in the exam room during this process.  It wasn’t long before surgeons realized that: 1. the capsular contracture always came back, 2. this can rupture a breast implant, 3. this can cause acute bleeding and 4. women don’t like being manhandled this way.  I was just starting my training in plastic surgery just as manual capsulotomy was falling out of favor.  I’m happy to say that I have never done this crude procedure and it is likely that I would not have succeeded had I tried.  I have teeny tiny and not-so-strong hands.  I would have likely ruptured one of my tendons before rupturing a capsule or implant.

Okay, that was then and this is now.  For early capsular contracture, it’s worth trying medication.  A dozen or so years ago it was observed that implant patients on a certain kind of asthma medication has a very low rate of capsular contracture.  These medications are leukotriene receptor antagonists and they work for asthma by reducing inflammation.  And inflammation is thought to be the final common pathway to capsular contracture.  The two medications used are zafirlukast and mohnelukast.   Accolate and Singular are the brand names respectively.  I have had several patients resolve an early capsular contracture with these medications. I have also had a few patients who did not respond to these medications

These implants were 41 years old and had a grade 4 capsular contracture. I removed them and the capsule and inserted new implants. She is shown 18 months after surgery.

Once a capsule is well established, surgical intervention is the only way to resolve it.  Complete capsulectomy removes the scar tissue and then the question  is how to prevent a recurrent capsule.  And does it make sense to just pop in another implant right away?  This is just such a difficult question because none of us has a crystal ball to tell the future.  Sometimes capsulectomy and a new implant works great but sometimes another capsular contracture starts forming despite doing everything right.  Sometimes we create a new pocket and make a pocket under the muscle if the over the muscle implant had a capsular contracture and vice versa.  Adding Accolate or Singular makes some sense.  Sometimes adding a piece of acellular dermal matrix like Strattice (which should be spelled  $$$$trattice) will decrease the chance of another capsule.  And whenever there are several different approaches to a difficult problem, you can be sure that none of them works every time.

The only surgery I know of that will for sure prevent another capsular contracture is implant removal and total capsulectomy without implant replacement.  This definitive treatment is readily accepted by many of my older patients who are sick and tired of their nasty, rock hard and uncomfortable implants.  They look forward to being implant free.  For younger patients, however, this can be a very, very difficult thing to accept, especially if they were really, really flat to begin with.  I have at least one patient that comes to mind who had several capsular contracture related surgeries by me and finally we just threw in the towel and removed her implants along with her capsules.  Her breasts returned pretty much to their preoperative size and shape but let me tell you, her wallet was never the same.  A problem with capsular contracture can be very, very expensive and result in a lot of down time – off work, off exercise, off fun.  This particular patient went on to have some fat transfer several years later and did well.  She and I are both glad to have her implant saga behind us.

Just writing this post makes me feel like I never want to do another breast augmentation!  And then I think of the patient I saw in clinic this morning.  She was very, very flat chested and was too lean to consider fat transfer.  I inserted 250 cc low profile cohesive gel implants last week and this morning I could not wipe the smile off her face.  I think as long as there is Victoria’s Secret, there will be a demand for breast augmentation.  I am just grateful that implant technology keeps improving as does our surgical technique.  Hopefully sometime in the near future capsular contracture will be of historical interest only.

Thanks for reading and I would be honored if you followed me on Instagram @sowdermd and @breastimplantsanity.   Dr. Lisa Lynn Sowder

Breast Contouring, Breast Implant Removal, Breast Implants, Plastic Surgery, Uncategorized

Capsular Contracture – the final frontier in breast implant surgery?

April 3rd, 2018 — 10:52am

Capsular Contracture 101

Anyone who knows my practice well knows that I am not a big fan of breast implants.  I much prefer fat transfer and/or breast lift to get a breast looking nicer.  But sometimes only a breast implant will get the patient the size and shape of breasts they desire.  Implants have many issues including malposition (too high, too low, too whatever), size problems (too big or too small), leaking or rupture problems.  Those issues can usually be address with revision surgery.  There is one issue that has tortured plastic surgeons and their patients from day one of breast implants decades ago.  That problem is capsular contracture.

All implants develop a capsule.  Actually it is the body that develops the capsule.  This is normal reaction to a foreign body and, yes, breast implants are a foreign body, a large foreign body.    A capsule only becomes a problem when it become thick and/or tight.  As the capsule thickens or tightens, it puts pressure on the breast implant and turns any shape or profile of implant into a sphere because a sphere is the shape that supports the largest volume in the smallest surface area, or something like that.  Geometry was a while ago for me!  Thus most badly encapsulated implant all look sort of the same – like a ball.  And they all feel hard, sometime really hard and often they are very uncomfortable.  Capsules can even become calcified in which case the implanted breasts are literally rock hard.

Capsular contracture: Looks bad, feels bad.

So what causes capsular contracture?  Good question and I hope the smart researcher who breaks the code wins the Nobel Prize in medicine some day.  A lot of progress has been made, especially in the past 10 years or so and it sure seems like inflammation is the common pathway to capsular contracture.  The most common causes of inflammation around the implant and resultant capsular contracture are 1. bleeding in the implant pocket, 2. subclinical infection and biofilm in the implant pocket, 3. leakage or rupture of silicone gel implants.  Let’s look at these a little closer.

Bleeding in the implant pocket has been known to result in capsular contracture for decades.  Plastic surgeons take a lot of care to really “dry up” the implant pocket prior to inserting an implant.  This is usually done with an electrocautery device call a Bovie.  This little gizmo allows the surgeon to zap little oozing vessels and help prevent any significant blood from accumulating around the implant.  Also, in the rare incidence of post operative bleeding around an implant, surgeons are very quick to take a patient back to the OR to “wash out” the pocket, find and treat the bleeding and reinsert the breast implant.  Sometimes a very minor bleeds can avoid a trip back to the or but in cases like these, the surgeon is on high alert for capsular contracture.

Subclinical infection and biofilm have been on our radar screen for 10 years or so.  Biofilm (which deserves it’s own blog post) is a slimy substance that is produced by certain types of bacteria.  It serves as a protective hiding place for bacteria and is resistant to antibiotics.  The most common example of biofilm is dental plaque.  Yuck.  Anyway, once the biofilm issue became well known, much more attention was paid to reducing the exposure of implants to bacteria.  We are now compulsive about washing out the implant pocket with antibiotic solution, using a no touch technique with a Keller funnel when inserting the implant, changing gloves prior to touching an implant and such.  Remember the billionaire Howard Hughes and his OCD about germs?  Well, we really go totally Howard Hughes with implant surgery!  Also, the location of incision has been shown to have an effect on the rate of capsular contracture.  Incisions around the nipple, through the arm pit or belly button have the highest rates of capsular contracture.   Incisions under the breast (the inframammary fold) have the lowest rate.  This is very likely due to a lower level of bacteria in the area of the inframammary fold as opposed to the other areas.  I use the inframammary fold incision almost exclusively for this reason and also because it allows me to see the pocket really well.

Leakage or rupture of gel implants results the in silicone gel coming into contact with the capsule and this often seems to cause inflammation and hardening or tightening of the implant capsule.  When I am going after a particularly nasty capsule, I expect to see an leaking or ruptured implant and I am usually not disappointed.  The advances made in implant construction – thicker implant shells and more cohesive gel – will hopefully decrease this cause of capsular contracture.

So that is Capsular Contracture 101.  Next up will be a blog about what can be done for capsular contracture.  Stay tuned and thanks for reading.  And I would be honored if you followed me Instagram @sowdermd and @breastimplantsanity.  Dr. Lisa Lynn Sowder

 

Breast Contouring, Breast Implant Illness, Breast Implant Removal, Breast Implants

The truth about plastic surgery chains.

March 22nd, 2018 — 9:57am

I came across this well written article by plastic surgeon Jennifer Greer on www.Kevinmd.com.  I think it provides some good information about plastic surgery chains like Lifestyle Lift (out of business for a few years now) and SonoBello which appears to be expanding.  If you haven’t heard the SonoBello jingle you must never listen to the radio.  According to a recruiting letter I received from them today, SonoBello spends $75K – $100K per month on TV infomercials, radio ads and internet marketing in each market.  That is one ginormous advertising budget!  Anyway I don’t work for any of these chains mainly because I think they provide less personalized and inferior care compared to a private office like my own and I have a visceral disgust of high-pressure sales tactics.  Oh, and I’ve reviewed the records of three SonoBello deaths in the Pacific Northwest, one for a news organization and two for attorneys.   Anyway, the author of this article works both for herself and for a couple of years worked for a chain that sounds like SonoBello.  Here is her advice to prospective patients based on her experience.

One day? Really? I don’t think there is a single procedure I do where patients look their best after one day.

 Over 17 million cosmetic surgery and minimally invasive procedures were performed in the U.S. in 2016. With the increasing popularity of cosmetic procedures, it seems nearly everyone is out to get a bite of the apple.

Cosmetic surgery chains are growing in size and popularity in an attempt to cash in on this market. Examples include: LifeStyle Lift in the U.S., which declared bankruptcy in 2015 and Transform in the U.K. With this growing popularity, consumers should ask themselves whether having surgery at a cosmetic surgery chain is a good idea. Today, I’m going to explain what to look for during your cosmetic surgery consultation and what you should stay far away from.

The first red flag to watch out for is high-pressure sales tactics. If you check websites such as ConsumerAffairs.com and the Better Business Bureau, you’ll find this is a common complaint about cosmetic surgery chains. High-pressure sales tactics may include:
  • Requiring you to put money down before you ever meet a physician.
  • Pressuring you to make a decision that day.
  • Insisting on applying for a loan at your initial consultation.
  • Offering a special “limited time” discount.

High-pressure sales can occur at both a private practice and at a cosmetic surgery chain. Regardless of where you encounter them, they are a huge red flag. As a consumer, you want a doctor who is focused on providing the best care possible, not on meeting a revenue goal. Focusing on money over patient care can lead to some scary medical decisions, like operating on people who really aren’t healthy enough to have surgery.

The second red flag to watch out for is misleading statements about pain during and after surgery. LifeStyle Lift had many complaints that their advertising gave the impression the procedure was quick and the recovery painless. In reality, the procedure lasted three hours or longer, and the downtime afterward was about two weeks. When you see a surgeon for a consultation, she or he should tell you what the average experience is like, as well as best and worst-case scenarios for recovery time. If this part is glossed over in your consultation, alarm bells should be going off in your head.

The third red flag you should watch out for is a surgery center or physician that only offers a very limited number of procedures. The center I worked at did liposuction, but no tummy tucks or skin removal. So if you were looking for a flatter stomach, they would only be able to offer you liposuction, even if you would get a better result with a tummy tuck. This is where the high-pressure sales comes into play again as well; if you have a sales person who needs to meet sales goals, that person is highly motivated to sell you his or her product, regardless of whether it’s actually the best option for you.

The fourth and final red flag to watch out for is the safety of the facility. Hospitals have the strictest oversight for patient safety, followed by surgery centers. But if surgery is performed with only oral medication, it can legally be done in an office that has no type of accreditation. This doesn’t mean having surgery isn’t necessarily safe, but you do want to ask what happens if there is an emergency, and how the staff are trained to deal with that. You also want to ask your surgeon if he or she has privileges to do your surgery in a hospital; non-plastic surgeons usually cannot get privileges to perform cosmetic surgery procedures such as liposuction in a hospital because they don’t have the training. If your surgeon only operates in an office or surgery center, this is a red flag that he or she is not board-certified in plastic surgery.

In my experience working for a cosmetic surgery chain, I was able to give patients some fantastic results. And I myself had a safe procedure by a surgeon I trust. But I think there is a huge difference in the mindset between a physician in private practice and a corporation. Physicians go into medicine because we want to help people, first and foremost.

Corporations exist to make money. Although there are certainly exceptions in both groups, I hope you can use the information I’ve given you to ensure you have a safe surgery experience wherever you go.

Jennifer Greer is a plastic surgeon and can be reached at Greer Plastic Surgery and on Twitter @greerplastics.

Thank you Dr. Greer for giving us a little inside view and some very good advice.  Dr. Lisa Lynn Sowder

Body Contouring, Liposuction, Patient Beware, This Makes Me Cranky.

Today is Match Day – Maybe the Most Important Day in the Life of a Doctor

March 17th, 2018 — 8:40am

Seattle Plastic Surgeon goes back, way back to Match Day 1983.

I remember the excitement of MATCH DAY like it was yesterday.

Every March, fourth year medical students across the United States convene to receive and open a small white envelope that has a huge influence on their future.  The information contained in this white envelope is where they “matched” for post-graduate training.

The Match System works like this:  As a fourth year student, you apply to a dozen or so residency programs and if asked, go for an interviews at these programs.  Then you rank the programs in decending order of fabulous to surely miserable and everything in between.  And the residency directors rank all of the applicants in decending order of incredible to surely a disaster.  An all knowing computer takes these rankings and matches the applicants with the programs.  Supposedly, the applicants’ wish list has more weight than the residency programs’  but I bet that students are still advised NOT to list any program that makes them want to chew glass instead of go there.

This is a momentous day.  This Match determines where you will live and train for anywhere from 3 – 8 years, who will become your BFFs, often whom you will marry, where you will eventually live and how you will practice your specialty.  Every fourth year medical student wants a great residency experience both academically and socially.

Okay, enough about that and more about me.  I matched at my 2nd of 10 choices, the University of Utah and, as a skiier and a woman, was thrilled.  Of course Utah has the BEST SNOW ON EARTH and the University of Utah had a lot of women in their general surgery program, even back then.

I ended up spending 6 years in Salt Lake City, 5 years as a general surgery resident and 1 year working in the Intermountain Burn Unit.  My years there made a man out of me (even though I’m a girl).  I came away from Utah feeling I could handle just about anything that walked in through the emergency room door.  I also came away from Utah in fantastic physical condition (the altitude makes for a strong cardio-pulmonay system), with many, many lifelong friends and a deep love and appreciation for deep, dry powder snow and Mormons (really).

And then there was Match Day for plastic surgery.  Again I snagged my 2nd choice, the University of Cincinnati.  I loved the program and training but it was a bit of culture and climate shock for me.  I even took up golfing which was about the only outdoor activity available.  I learned to love fireflies, the Ohio River, badass thunderstorms, cicadas and the way the humidity turned my naturally wavy hair into a Brillo Pad.  I never learned to love Skyline Chile which involves spaghetti noodles and cinnamon.

And now I am living in my home state, Washington in my dream city, Seattle.  But I so cherish those years away.  They expanded my world view while giving me great surgical training and some interesting ex-boyfriends.

So I hope every fourth year student matches at one of their top ranked programs and  some 35 years hence, looks back on their residency program with as much fondness as I do.

Thanks for reading.  I would be honored if you followed me on Instagram @sowdermd and @breastimplantsanity.    Dr. Lisa Lynn Sowder

Surgical Eductaion

Silicone injections are deadlier than ever.

March 13th, 2018 — 2:34pm

Silicone has quietly become beauty’s own modern-day scourge. Here’s what you need to know about the infamous injectable.

From Haper’s Bazaar, January 30, 2018 by

We often write about—and unapologetically enjoy receiving—popular cosmetic injections, like line-relaxing Botox and hyaluronic acid fillers. Thankfully for our foreheads and lips, the FDA has deemed these injectables safe and effective. And we trust our board-certified dermatologists and plastic surgeons to administer these treatments 100 percent appropriately.

Marilyn Reed is spending 8 years in prison for her buttock enhancements done with industrial grade silicone and a calking gun. Her patients didn’t get off so easily.

But a disturbing number of news reports have surfaced detailing unlicensed providers injecting all kinds of life-threatening stuff—from industrial silicone to lamb fat—with the goal of Kardashianizing women on the cheap. The FDA issued a safety alert late last year warning the public of the catastrophic risks involved with liquid silicone injections in particular.

All over the country, “people are dying from these shots,” said Beverly Hills liposuction surgeon Aaron Rollins, echoing statements in the FDA alert. Silicone, a permanent synthetic substance, is not FDA-approved for cosmetic purposes, but since it was greenlighted in the 1990s for certain uses in ophthalmology (serious stuff, like retinal detachment), injecting it into the skin to plump and fill lips, breasts, and butts is technically considered “off-label”—i.e. not illegal.

Still, the insidious goo is an infamous troublemaker. “I wouldn’t touch it with a ten-foot pole,” adds Rollins. “It may look good at first, but over time, the body forms scar tissue around it, so the injected area keeps growing and growing, as the silicone weaves its way into your tissues, becoming lumpy and hard, and nearly impossible to remove.”

Subtract an experienced injector from the equation, and silicone goes from dicey to deadly. “You hear about these so-called pumping parties at hotels, where unlicensed doctors visiting from other countries are injecting patients with massive doses of silicone,” says Dr. Clyde Ishii, president of the American Society for Aesthetic Plastic Surgery (ASAPS). “They’re literally buying it from Home Depot or Lowe’s,” he explains, “because it’s so much cheaper and easier to get than medical-grade silicone.” To lower their cost even more, some of these unlicensed doctors mix in toxic filler-type materials, like cement and motor oil, says Miami dermatologist Manjula Jegasothy. “Even in Beverly Hills,” notes Rollins, “there are people using caulk guns to inject stuff into women’s bodies, and tragic things are happening.”

It’s not uncommon for these unlicensed practitioners—inexperienced with human anatomy—to inadvertently shoot silicone into a blood vessel. And when they do, it can travel to the heart or lungs, blocking blood flow, and causing sudden heart attacks and strokes. The risk is especially high when injecting the vascular buttocks. Yet, for some, silicone’s price tag is just too good to pass up. According to Atlanta plastic surgeon Wright Jones, “Silicone butt injections may cost a tenth of the price of a legal gluteal enhancement using one’s own fat”—which is currently regarded as the most effective way to boost a backside. A Brazilian Butt Lift, using liposuction and fat transfer, can cost upwards of $10,000.

In light of the recent wave of silicone horror stories, and with butt augmentation fast becoming one of the most popular plastic surgery procedures in the U.S., not to mention a burgeoning business for untrained injectors, the Aesthetic Surgery Education and Research Foundation (a division of ASAPS) felt compelled to publish a safety protocol for gluteal fat grafting in the current issue of the Aesthetic Surgery Journal.

That’s not to say fat is the only safe solution for a shapeless bottom. Many dermatologists and surgeons do use FDA-approved cosmetic fillers “off-label” here— to either produce an immediate, yet temporary, lift from hyaluronic acid gels; or a gradual, long-term improvement from the collagen-stimulating Sculptra (which is currently only approved to soften the appearance of nasolabial folds). But such shots can be wildly expensive.
Which brings us back to silicone and its unfortunate recipients, many of whom are millennials, says Jones. At age 22, Heather*, a model in Los Angeles, visited a Koreatown medical spa for silicone butt injections. “I was booked to do a big photo shoot, and wanted my bum to look perkier,” she says.

About six months later, she noticed several golf ball-size lumps in her bottom, a common side effect of silicone. On the advice of a trusted friend, Heather says she went to see Rollins, who was able to camouflage the hills and valleys by liposuctioning fat from her arms and injecting it into her butt—an $8,000 fix.

Lips have long been another hot spot for silicone. Tired of having to draw on a juicer pout each morning, Madeline paid $50 to have her lips injected with silicone in a salon basement in Queens when she was 26 years old. Now 40, she says, “I feel like I messed up my mouth for the rest of my life.”

The size and shape of her lips change daily, often with the weather. “Usually in summer [the silicone] lays okay, but in the colder months, it moves around a lot, and concentrates in one area, bulging out.” To have her smile repaired will cost roughly $10,000, she’s been told, and surgeons can’t promise a total improvement.

Cosmetic injections should only be performed by board-certified dermatologists or plastic surgeons. If your injector is not, ask thorough questions about their training and experience. How many years have they been injecting patients? What formula are they using? If you’ve found the injector through a bargain website or coupon—the deal is likely too good to be true. The bottom line: Heed the warnings. “Don’t allow silicone into your body—ever,” says Rollins. At best, “you’ll be buying a problem for the rest of your life.”

Now a word from Dr. Sowder:  The above article is very well written and is not, I repeat, is not alarmist.  People are dying from these injections and others are being maimed for life.  I have taken care of a couple of ladies who had silicone injected into their breasts in Asia and cleaning this up is such a mess.  Whenever I hear about another silicone injection disaster, usually done by a non-physician in some hotel room, I just shake my head.  I mean, really, how dumb can you be?  I do not endorse blaming the victim but in cases like this I think the person allowing a charlatan to inject their butt or breast with silicone bears some responsibility.  Those on the other end of the calking gun need to go to jail and many in fact have.  The lesson here is that you get what you pay for.

Kudos to Ms. Edgar for a cautionary tale and to Harper’s for publishing it.  Thanks for reading and don’t let anyone get near you butt or breast with a calking gun!  Dr. Lisa Lynn Sowder

 

Body Contouring, General Health, Patient Beware, Patient Safety, Plastic Surgery, This Makes Me Cranky.

The surgeon as teacher.

February 25th, 2018 — 12:21pm

This weekend I had the opportunity to participate in a suture lab at Whitman College, a small liberal arts school in Walla Walla, Washington.  This lab is designed for Whitman students who are interested in medical careers. The lab consisted of about 30 students and 7 doctors.  The participating docs included one general surgeon, one plastic surgeon (moi), two OB-Gyns, two ER docs and one family practice doc.  

Now you may be asking what the big deal is in tying a knot and that is a great question.  Proper knots are important in surgery because an improper knot can come untied and the thing the suture was holding together will fall apart.  Not good.  Other activities that require proper knots that come to mind are rock climbing and boating.  Knots need to hold. Also in surgery, it’s important to tie a knot that holds with the least amount of suture material.  Excess suture material can be irritating to living tissue and can also harbor bacteria so you always want to use the knot that is just enough to do the job.

The first part of the lab involved showing the students how to tie two-handed knots and one-handed knots with a length of nylon cord.  I immediately discovered how hard it was to teach a skill that I do without even thinking about  it!  I don’t need my brain because knot tying for me is now in my “muscle memory”, not in my head. It’s the same for many physical skills that involve repetition such as dancing, sports or playing a musical instrument.  And I found that the more I tried to explain it, the harder it was to do.  Fortunately I finally discovered I just needed to shut up and show the students how to do it and they were able to copy my movements.

The next part of the lab was showing the students how to suture.  For this we had a nice supply of pig’s feet.  Pig skin is similar to human skin although thicker and tougher.  Suture needles are different than a seamstress needle in that they are curved and require a instrument called a needle driver.   The force required is very different than a simple push.  It’s more of a stoke with a turn of the wrist.  Again, I found explaining it very difficult because it all comes so automatically to me after all of these years.  I was very impressed with the enthusiasm of the students and I think a number of them may very well make fine surgeons.

Another part of this visit included dining with the students in an informal lunch and dinner and answering their many, many questions about being a doctor.  I found it bittersweet to compare my current position with theirs.  I am nearing the end of my surgical career (I’m planning on 5 more years) and they are just at the beginning.  They have so much uncertainty and so many challenges ahead.  Most of that is now in my rear view mirror.  I tried to give them some honest answers and not sugar coat the difficult pathway to becoming a doctor and in particular a surgeon.  I really had a chance to reflect on all of those tough years of medical school and residency and the ongoing challenges of being in practice. I am envious of their youth but honestly would not want to trade places with any of them!

A real bonus for me was the information my 17 year-old daughter, who came with me,  received from these bright college students.  She is at the beginning of her college search and she got some great advice about choosing a college.  And she got a nice tour of Whitman.

I am hoping I get invited back again to teach another batch pre-med students a few tricks of the trade. And who knows, one of those students may be my daughter!

Thanks for reading.  Dr. Lisa Lynn Sowder

I would be honored if you followed my on Instagram @sowdermd and @breastimplantsanity.

 

Surgical Eductaion

How to lose weight in 4 easy steps by

February 14th, 2018 — 7:39am

I thought I would post this essay for Valentine’s Day.  It’s really not about losing weight.

This is cut and pasted from http://aaronbleyaert.tumblr.com/post/109959086957.  All I added was the cartoon.

HOW TO LOSE WEIGHT IN 4 EASY STEPS

I’ve spent the past year losing 80 lbs and getting in shape. A lot of people have been asking me how I did it; specifics like what diet I was on, how many times a week I worked out, etc etc. So I thought I’d just answer everyone’s questions by giving you guys step by step instructions on how you can achieve everything I have… IN JUST 4 EASY STEPS! Ready? Here we go!!!

1.) NO BEER
This is a big one, and one that you’ve probably heard before. Every time you drink a beer, it’s like eating seven slices of bread. That’s a lot of bread!

2.) PORTION CONTROL

Portion control according to B. Kliban

Portion control according to B. Kliban

This is especially true when you go out to eat at restaurants. A good trick to do is when your meal comes, cut it in half and right away ask for a takeout container, so that you can save the rest for later – and even better, if you start your meal out right by ordering lean meats and veggies, you’ll slim down in no time!

3.) HAVE YOUR HEART BROKEN
And not just broken; shattered. Into itsy bitsy tiny little pieces, by a girl who never loved you and never will. Join the gym at your work. Start going to the gym regularly, and even though you don’t know that much about exercise and you’re way too weak to do pretty much anything but lift 5 lb weights and use the elliptical machines with the old people, do it until your sweat makes a puddle on the floor. Then go home and go to bed early and the next day do it again. And then again. And then again.

Listen to stories of your ex-girlfriend fucking around with gross and terrible people, stories from your friends who think they are doing you a favor. Go to the gym and make more puddles of sweat. Buy books. Learn about different muscle groups and how they work together. Start eating healthy. Learn about nutrition. Plan out your week of meals. Try to forget her.

After work one night, go up up up all the way to the top floor of the parking garage and walk all the way to the back. Look out at the twinkling lights of the skyscrapers of downtown Los Angeles and think about how every single one of those office lights represents a person. Try to imagine how they feel. What they’re doing right then; if they miss someone special, if they wonder if someone special misses them. Then realize that most of those lights are probably shining into offices with no one in them except for a custodian or two. Realize you are alone, that you are staring at no one. Turn your collar up against the cold and drive home to a meal of a single chicken breast and steamed vegetables. Go to sleep. Go back to work. Go to the gym. Sweat.

Buy a scale. Pick a goal weight. Imagine the goal weight as a shining beacon on a hill. You are at the bottom, in the dark. Talk to her at work. Notice the awkward way she walks in high heels and her goofy smile when she looks over at you. Feel something clench inside your chest. Think about the gym and what muscle groups you are going to work that night.

Get on the treadmill. Push yourself to level 3, then level 4. Then 6. Run so fast you feel like you are going to die. Hit level 10. Pray for death. Think of how bad she makes you feel. Find the strength to keep going.

Late one night, make the mistake of looking at her Facebook and Instagram posts. Feel lower than you ever thought possible. Unfriend her and try to forget what you’ve seen. She is doing things with other people that you asked her to do with you. She is having a great time without you, and you are wasting your life listening to Taylor Swift on repeat and making sweat puddles on a gym floor.

Watch as your life shrinks down to four things: 1.) work, 2.) the gym, 3.) the food you eat, 4.) sleep. She wears the necklace you bought her and tells you that she got it “from someone who’s really special”. That night you discover that Slayer’s “Angel of Death” might be the perfect song to do squats to.

Start to make friends at the gym. Vince and you spot each other on Wednesdays; Chase and you spot each other on Fridays. You used to look down on bro nods and fist bumps – but since that’s how gym rats communicate, that’s become the language you speak most often. Work, Gym, Food, Sleep. Over and over. More sweat puddles. More fist bumps. You run hundreds of miles and lift thousands of pounds.

You start to see new people working out here and there and you realize you have done something you once thought impossible: You have become one of the regulars. Once in a while, you are the last one leaving the gym. You make a point to get to the gym earlier, but your workouts start to stretch from one hour to ninety minutes to two hours. You are now routinely the last person at the gym. You run. You lift. You make more puddles.

Your body changes slowly, then all at once – you are suddenly thin and muscular. You hit your goal weight, pick a new one, then hit it again. You go out and buy new clothes. You receive wave after wave of compliments. Your ex tells you that she’s seeing someone else. Your chest clenches. You feel exhausted.

That night you go to the gym. You listen to all her favorite songs. You run farther and lift more than you thought your body was capable of. It is a good workout. It leaves you numb. You go home and eat a single chicken breast and steamed vegetables. You go to sleep. You dream of a bottomless black puddle.

You’ve stopped drinking alcohol months ago, so now when you hang out at bars or parties you don’t talk to anyone new. But with your new body and new clothes, gorgeous women hit on you constantly. One time, a woman literally comes up to you and says she thinks you’d be good in bed and hands you a napkin with her number on it. As she is talking to you, her hand resting on your chest inside your shirt, all you can think of is how badly you need to beat your best time sprinting across the park across from your house the next day. That night when you get home you research the best shoes for trail running and click “buy”. The shoes are a hundred dollars. The phone number goes in the trash.

There is a girl you see a lot at the gym, who always does these weird leg exercises you’ve never seen before. She’s beautiful. You make it a point to not look at her – because you are overly worried about looking creepy like that guy in the blue shirt who never wears underwear and always hangs around the lat pulldown machine – but you notice this girl is always at the gym when you are, and seems to always choose the bench next to you. You turn up the Slayer and concentrate on making your puddles bigger.

Your ex parades her new boyfriend around, flatly ignoring you the entire time. He is taller than you, more ripped than you, better looking than you, and – according to the Greek chorus of your mutual friends – he comes from money. As you watch her introduce him to everyone but you, you remember how her blue eyes lit up underneath the ferris wheel on her birthday when you gave her those bracelets she’s wearing. In your pocket, your hand makes itself into a fist.

That night, you deadlift your body weight. You sneak a photo of yourself in the mirror and email it to yourself with the subject heading “You Are A Warrior”. The next day you are disgusted with yourself and delete it.

You make puddle after puddle after puddle and eat single chicken breasts and work and sleep and the weather gets warm and then gets cold and you know all of Taylor Swift’s songs by heart and the only things that exist in the entire universe are you and The Gym and then something different happens: a night comes where you are not the last person in the gym.

It is you and the girl who does the weird leg exercises. You end up walking out at the same time.

Her name is Melissa and she works in the building next to you. She’s worked there for two years. She asks you out to dinner on Friday, promising it’ll be healthy. The leg exercises are Pivoting Curtsy Lunges.

You start seeing Melissa a lot, both inside the gym and out. You tell no one. You add a couple cheat days to your week – for when you two get dinner and share dessert – and you start getting a lot less sleep. You phase out Slayer in favor of Springsteen. Vince and Chase note that you’ve stopped looking like you’re praying for death when you run. Your ex texts you late at night to ask you out to coffee, but you don’t write her back. You can’t remember the last time you fantasized about puddles.

One night you’re walking Melissa to her car in the parking garage and she is parked up up up all the way on the top floor. She says she wants to show you something and she takes your hand and leads you all the way to the back. You both stand there in the dark looking out over the twinkling lights of the skyscrapers of downtown Los Angeles.

“Isn’t it beautiful?” She says. “All those lights.”

You tell her that yes, it’s beautiful, but it makes you sad. All those pretty lights mean nothing; they’re just shining into cold lonely offices with nobody in them. Melissa squeezes your hand and says yes, each light is an empty office – but they’re only empty because the people have all gone home for the day. All those twinkling lights aren’t sad; each one is a person who’s at home, happy with the one they love. And how romantic is that?

You look at her in the lights and she smiles. Something in your chest expands.

Late one Sunday afternoon you are writing out your rent check and realize it’s been exactly a year since you started working out. You think of all those miles you’ve run and those pounds you’ve lifted and chicken you’ve eaten and puddles you’ve made. It doesn’t seem that bad. You realize that it’s not about hitting a goal weight, or lifting a weight. It’s about being able to wait. Waiting, being patient, and trusting that life will slowly inch along and things will eventually get better. After all, change takes time.

But time is all it takes.

4.) NO FRUIT JUICE
Too much sugar!!!

 

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IT WAS ALL A DREAM 

Thanks for reading and I bet Aaron thanks you too.  I’d be honored if you followed me on Instagram @sowdermd and @breastimplantsanity.  Dr. Lisa Lynn Sowder

 

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Uncategorized

What might the Cuban Sonic Attacks have in common with Breast Implant Illness?

February 1st, 2018 — 8:49am

You gotta read this from today’s Slate.com.  This will involve some heavy mental lifting so put on your thinking cap and take the time to read the entire article.

MEDICAL EXAMINER
Cuba’s Sonic Attacks Show Us Just How Susceptible Our Brains Are to Mass Hysteria
The symptoms so many Americans experienced were probably not caused by a secret weapon. That doesn’t mean they’re not real.

By FRANK BURES
FEB 01, 20185:43 AM

A few weeks after the 2016 presidential election of Donald Trump, several people working for the U.S. Embassy in Cuba fell mysteriously ill. Some lost their hearing. Some had headaches and a pain in one ear. Others reported feeling dizzy or nauseous, having trouble focusing, or feeling fatigued. Later, some would have a hard time concentrating, remembering things, sleeping, and even walking.

These symptoms were “medically confirmed,” as the State Department’s medical director Charles Rosenfarb put it, and brain scans were said to show abnormalities in the victims’ white matter, which transfers information between brain regions. The illnesses were believed by the government to be “health attacks,” carried out by a foreign power, though as Todd Brown, assistant director at the Bureau of Diplomatic Security, told the Senate Foreign Relations Committee, “investigative attempts and expert analysis failed to identify the cause or perpetrator.”

Nonetheless, investigators concluded the illnesses, which ultimately affected 24 people, were likely the result of a “sonic device.” This conclusion seems to be primarily due to the fact that some diplomats reported hearing a high-pitched noise in their homes and hotel rooms.

Despite a lack evidence for such a weapon, or any known way it could affect white matter, the sonic weapon theory proved irresistible for both media outlets and for Cuba hawks like Sens. Marco Rubio and Bob Menendez, both of whom immediately transformed the sonic weapon into a handy political weapon.

In the months following the “attacks,” new diplomats arriving in the country were warned of this sonic danger. Embassy employees were played a recording of what was thought to be the sound so they knew what to listen for. Soon, people at the Canadian Embassy in Cuba began reporting symptoms similar to what the Americans had experienced, as did a few tourists there. A husband and wife at the U.S. Embassy in Uzbekistan became ill as well. Whatever it was, it seemed to be spreading.

There is increasing recognition that these epidemics of hysteria, which usually mirror prominent social concerns, present real individual and public health problems.
With no details, no motive, and no plausible explanation for what kind of weapon this might be, doubts began to surface. The FBI investigated and reportedly found there had been no such attack (though it suggested maybe it was a “viral” weapon). Sen. Jeff Flake also cast doubts on the sonic version of events. A handful of skeptical stories began to appear amid the more alarming ones, suggesting this might be what in the past was known as, “mass hysteria,” but which is now referred to as “mass psychogenic illness,” or a “collective stress response.” (These include things like the twitching girls in Le Roy, New York, in 2011; the 600 paralyzed girls in Mexico in 2007; and the Belgian Coca-Cola scare of 1999, which affected 100 students with more than 900 others reporting a related symptom, and costing the company somewhere between $103 million and $250 million.)

Epidemics of this sort are well-known in the scientific literature. Robert Bartholomew, a New Zealand–based medical sociologist and the co-author of Outbreak! The Encyclopedia of Extraordinary Social Behavior, Mass Hysteria in Schools: A Worldwide History Since 1566, and other books on the subject, has collected a database of some 3,500 cases. While the precise mechanisms are difficult to pinpoint, and the diagnosis is always controversial, there is increasing recognition that these epidemics of hysteria, which usually mirror prominent social concerns, present real individual and public health problems.

Yet many people still assume victims of such phenomena are simply faking or imagining their symptoms. In the Senate hearings on the attacks, Sen. Rubio asked Rosenfarb whether he thought this was, “a case of mass hysteria, that a bunch of people are just being hypochondriacs and making it up?”

This was a loaded question, with Rubio deploying the term mass hysteria as a means of dismissing this possibility altogether. But Rubio’s assumption—that a mass psychogenic illness is the same as faking or hypochondria—is wrong, as was his dismissal of the idea that this might explain the illnesses in Cuba. Indeed, mass psychogenic illness is likely the best explanation for these illnesses. According to Bartholomew, if you removed the word concussion from discussion of what happened there (but left the “white matter tract” changes in its place), you’d have a “textbook case” of mass psychogenic illness, in everything from its symptoms to its spread.

“There’s no evidence whatsoever that this was caused by a sonic device,” Bartholomew says. “It is physically impossible to have brain damage caused by an acoustical device. And most of those symptoms are not symptoms of sonic weaponry.” Anxiety and nausea, he notes, can be caused by both mass psychogenic illness and acoustic weapons, but the noise would have to be incapacitating and high volume. None of the other symptoms reported in Cuba are associated with an acoustic assault.

And what’s more: “This is a small, close-knit community in a foreign country that has a history of being hostile to the United States,” he says. “That is a classic setup for an outbreak of mass psychogenic illness.”

History is filled with cases of “sounds” making people ill. In Kokomo, Indiana, locals have been plagued since 1999 by a low frequency hum, which one resident said caused, “short-term memory loss, nausea, and hand tremors.” In Taos, New Mexico, a similar sound causes resident “sleep problems, earaches, irritability, and general discomfort,” by one account. Similar hums are reported in Bristol, England, and Windsor, Ontario. In 1989, a “Low Frequency Noise Sufferers Association” was formed in London. The people reporting illness from the noise produced by wind turbines have given the phenomenon its own name: wind turbine syndrome.

Unfortunately, it is also possible to lose your hearing without being attacked by a secret weapon. The Handbook of Clinical Neurology volume on Functional Neurological Disorders lists “nonorganic hearing loss” in its chapter on “Functional Auditory Disorders,” alongside conditions like musical hallucinations, misophonia (“hatred of sound”), “acoustic shock” from a sudden noise (symptoms include “pain in or close to the ear,” tinnitus, balance problems, hypervigilance, and sleep disturbance), and others. In Germany, there is a common condition called Hörsturz, which is a sudden loss of hearing related to stress. In 1973, at a nursing school in Papua New Guinea, there was an epidemic in which students were struck deaf, among other symptoms, with no apparent external cause.

“It’s very easy to manipulate people’s physical well-being through giving them expectations about sound,” says Keith Petrie, who researched the power of the mind in relation to wind turbine syndrome. When Petrie and colleagues exposed people to both infrasound and sham infrasound (silence), they found it wasn’t the sound itself, but their expectations—or what’s known as the nocebo effect—that produced adverse physiological reactions. Witnessing another person with symptoms can create an even stronger response, as can the perceived cause.

“When we gave them a plausible, biological explanation,” says Petrie, “it increased their symptoms the next time they were exposed to sound. When we gave them a nocebo explanation—and both explanations were equally credible—their symptoms decreased.”

On the surface, studies like this make it easy to agree with the Marco Rubio line of thinking that sufferers are just faking it. But the people who were told there was a medical reason for the hearing loss are not just imagining the resulting symptoms—they are physiologically real, “medically verifiable,” and cause deep distress, even if they resolve quickly, as most do.
“People suffering from mass psychogenic illness are not hypochondriacs and they’re not all making it up,” says Bartholomew. “It is a real condition with real symptoms. It could happen to anybody.”

There is real crossover between the condition’s mental origin and physical manifestation.
Research into the nocebo effect has been hampered by the ethics of subjecting people to it, but a picture of the mechanisms is emerging. And one important factor is “abnormally focused attention,” as neurologist Jon Stone puts it.

“As human beings, we’re more prone to these phenomena than we like to think,” says Stone, co-editor of Functional Neurological Disorders. “The rate of functional symptom experiences in the general population is very high. People have these symptoms a lot and just normalize them. We’re never very far from a functional disorder.”

What were once known as conversion disorders (meaning the conversion of a mental problem into a physical one) are now referred to as functional disorders. The old terms like psychosomatic or even psychogenic imply a purely mental origin, but the current parlance reflects the more complicated picture, that there is real crossover between the condition’s mental roots and physical manifestation. A “functional disorder means something has gone wrong with the network, the connections, the pathways, as opposed to the physical structure of the brain. And when these functions go wrong, normal sensations like tiredness, dizziness, or pain can grow much worse and become persistent.

One of the findings in Cuba that reporters seized on was the assertion that victims had suffered some kind of head trauma. As Rosenfarb put it, there were “clinical findings of some combination similar to what might be seen in patients following mild traumatic brain injury or concussion.” Here, he appears to be talking about abnormalities in the patients’ white matter, but a concussion isn’t the only thing that can have that effect. White matter changes with experience and learning, and becomes more robust in response to using a given pathway repeatedly. If those pathways are related to a disorder, it may appear in “diffusion tensor imaging” scans as anomalies.

“Diffusion tensor imaging,” says Stone, “is a technique that shows abnormalities in patients not only with minor brain injuries, but also with chronic pain, anxiety, depression, you name it. This is not a mark of brain injury. It’s a mark of brain dysfunction. It’s evidence that they’re ill.”

One problem in understanding the reality of a functional disorder is that most of us, when we are ill, look for a single cause, a simple chain of events that starts with an event, or a germ, and ends with our own misery. But functional disorders don’t work in this linear fashion. They are recursive and multifactorial, a feedback loop between our expectations, emotions, and physiology. According to Mark Hallett, a senior investigator at the National Institute of Neurological Disorders and Stroke, a picture of how they work is beginning to emerge, in a sense that, “when the so-called limbic system of the brain [the part of the brain that drives instinct, mood, and emotion] is overactive, it might induce the different symptoms that arise.”

Which is to say that if we fixate on our naturally occurring experiences and feelings, they can become amplified, particularly if the limbic system is overactivated by fear and anxiety. This creates a kind of loop between mind and body that it can be difficult to get out of, and which can make these conditions difficult to treat.

“It’s very powerful,” says Petrie. And often underestimated. “From the comments I read by the physician associated with the [embassy attacks], it was interesting how he dismissed this explanation” Petrie says. “He didn’t seem to understand how easily this can happen.”

Most people don’t. That includes just about everyone involved in the Cuban attacks. Mass psychogenic illnesses are not as intuitive to grasp as cold or a flu, but they are just as serious, and should be treated as such. In Cuba, they have not been. Instead, a fixation on secret weapons has obscured a real illness with real consequences, one which can not only be “medically verified,” but which regularly afflicts people across the world, and to which anyone with a functioning brain is vulnerable.

Thank you for reading!  Dr. Lisa Lynn Sowder

I would be honored if you followed me on Instagram @sowdermd and @breastimplantsanity

Breast Implant Illness, General Health, Uncategorized

Brazilian Butt Lift a.k.a. Fat Grafting to the Buttocks: Let’s make this safer.

January 31st, 2018 — 12:18pm

Brazilian Butt Lift a.k.a. fat grafting to the buttocks is getting a lot of needed attention considering the comparatively high mortality rate of this procedure.   Several surgical societies have come together to study these deaths and have come up with these following guidelines.  Hopefully this procedure will become safer.  I applaud those who did the heavy lifting and came up with these recommendations.  If you or someone you love (or even don’t love) is thinking about this procedure, make sure their surgeon is aware of and compliant with these guidelines.  A big booty isn’t worth dying for.

Multi-Society Gluteal Fat Grafting Task Force issues safety advisory urging practitioners to reevaluate technique

Dear Colleagues,

An Inter-Society Gluteal Fat Grafting Task Force** has analyzed deaths from gluteal fat injection (“Brazilian Butt Lift” or “BBL”) and offers the following advisory statement:

Not worth dying for.

The death rate of approximately 1/3000 is the highest for any aesthetic procedure. In 2017, there were three deaths in the state of Florida alone. Every surgeon performing BBLs should immediately reevaluate his or her technique.

Some patients have died when their surgeon said they had injected into the subcutaneous fat layer, but all autopsies of deceased BBL patients have had these findings in common: 1) fat in the gluteal muscles; 2) fat beneath the muscles; 3) damage to the superior or inferior gluteal vein; 4) massive fat emboli in the heart and/or lungs. No post mortem has yet shown a case of death with fat only in the subcutaneous space; this means that surgeons have injected more deeply than they had intended. The mechanism of death is presumed to be high pressure extravascular grafted fat entering the circulation via tears in the large gluteal veins with subsequent embolization to the heart and lungs.

The task force, therefore, offers these suggestions*:

1.Stay as far away from the gluteal veins and sciatic nerve as possible. Fat should only be grafted into the superficial planes, with the subcutaneous space considered safest. If the aesthetic goal requires more fat than can be placed in the subcutaneous layer the surgeon should consider staging the procedure rather than injecting deep.
2.Concentrate on the position of the cannula tip throughout every stroke to assure there is no unintended deeper pass, particularly in the medial half of the buttock overlying the critical structures.
3.Use access incisions that best allow a superficial trajectory for each part of the buttock; avoid deep angulation of the cannula; and palpate externally with the non-dominant hand to assure the cannula tip remains superficial.
4.Use instrumentation that offers control of the cannula; avoid bendable cannulas and mobile luer connections. Vibrating injection cannulas may provide additional tactile feedback.
5.Injection should only be done while the cannula is in motion in order to avoid high pressure bolus injections.
6.The risk of death should be discussed with every prospective BBL patient.
These are links to three helpful articles:

Research projects overseen by the task force and funded by The Plastic Surgery Foundation (PSF), Aesthetic Surgery Education and Research Foundation (ASERF) and International Society of Aesthetic Plastic Surgery (ISAPS) are underway. They will correlate deep and topographical anatomy, define danger zones, and try to understand the mechanism of embolization. The ability to safely perform this procedure in the future is dependent upon this research.

Members of the task force have also assisted coroners during autopsies, and this has provided invaluable safety information. If you become aware of a fatality, immediately contact the task force co-chairs care of Keith Hume, executive director of The PSF, at khume@plasticsurgery.org.

Your societies will keep you updated with all developments.

Sincerely,

Dan Mills, MD

Gluteal Fat Grafting Task Force co-chair

J. Peter Rubin, MD

Gluteal Fat Grafting Task Force co-chair

Renato Saltz, MD

Gluteal Fat Grafting Task Force co-chair

Thanks for reading and did you know that skating (roller, ice or skis) can really build up your gluteal muscles?  Just check out the Olympic skaters and skier this winter!  Dr. Lisa Lynn Sowder

 

Uncategorized

Ten common misconceptions about liposuction

January 30th, 2018 — 9:33am

If you look like this, you don’t need liposuction!

Taken from an article by Dr. Wayne Carman for online American Society of Plastic Surgeons from January 30, 2108

Liposuction is one of the most frequently performed cosmetic surgical procedures in the United States and around the world. This is somewhat surprising, considering how many misunderstandings about it persist. Listed below are the ten most common liposuction misconceptions we hear as plastic surgeons, and what the actual facts are.

Liposuction can help you lose weight

The reality is that most patients only lose about two to five pounds in total. The best candidates, in fact, are generally within 30 percent of a healthy weight range and have localized fat pockets they would like to reduce.

Liposuction can treat cellulite

Cellulite is not simply an irregular pocket of fat – it occurs when subcutaneous fat pushes connective tissue bands beneath the skin, causing those characteristic dimples and bumps. Because liposuction is only able to remove soft, fatty tissue (and does not directly affect the skin or other tissues), the fibrous connecting bands causing cellulite are not altered.

Liposuction is not for “older” people

Any patient who is in good health and has had a positive medical examination may safely receive liposuction. A lack of firmness and elasticity (both of which commonly decrease with age) may compromise the skin’s ability to re-drape over newly slimmed, reshaped contours. Poor skin quality is one of the main contraindications to liposuction.

Liposuction is dangerous

While every surgery carries an element of risk, liposuction techniques have become increasingly sophisticated. If performed by an experienced and board-certified plastic surgeon, and if the patient follows all appropriate postsurgical instructions, liposuction can be as safe and successful as any other surgical procedure.

Liposuction will fix lax skin

The appearance of a double chin or a heavy tummy may involve some degree of sagging skin with reduced elasticity, as well as excess fat. In such cases, your surgeon may recommend a skin tightening procedure instead of (or in conjunction with) liposuction, as liposuction alone may result in a deflated appearance.

Fat deposits removed will return after liposuction

Liposuction is “permanent,” in that once the fat cells are suctioned out, they will not grow back. However, there will still be some remaining fat cells that can grow in size and expand the area if one’s calorie intact is excessive. The best way to prevent this is to maintain a healthy diet and exercise regimen.

Liposuction is the “easy way out”

As mentioned earlier, liposuction is not a weight loss method, and maintaining ideal postsurgical results should include a general commitment to a healthy lifestyle. Liposuction (or any other body contouring method, for that matter) is targeted to streamline and contour localized areas – ideally, in someone who is within a healthy weight range.

You can get back to your routine right after liposuction

While relatively safe and frequently performed on an outpatient basis, every surgical procedure entails a recovery period, and liposuction is no exception. The most common after-effects include swelling, bruising, and soreness at and around the treatment areas. While the healing process varies from patient to patient, most should plan to take at least a week off work to rest and recover. It may be four to six weeks before a patient can resume strenuous activity or exercise.

Liposuction is only for women

Men frequently request liposuction – in fact, it was one of the top five most popular cosmetic surgeries American men received this past year, according to ASPS statistics. Common areas for treatment include the abdomen, love handles and chest.

Liposuction is always the answer to belly fat

Liposuction targets only subcutaneous fat – the kind that is located below the skin and above the muscle. An abdomen that protrudes due to fat under the muscle and around the internal organs (known as visceral or intra-abdominal fat) will not be improved with liposuction. Appropriate exercise and diet are the only effective methods to combat visceral fat.

Thanks for reading.  Follow me on Instagram @sowdermd and @breastimplantsanity.

Dr. Lisa Lynn Sowder.

Body Contouring, Liposuction

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