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

Happy Thanksgiving

November 15th, 2017 — 8:49am


’tis the season of Thanksgiving. 

Here are a few things that this plastic surgeon is thankful for……….

  • Modern Anesthesia.  This makes for painless surgery.  And the surgeon can take her time to do a really, really nice job.  During the Pilgrims’ time, the main qualification for being a surgeon was to be really, really, really fast. Yikes!
  •  The Germ Theory and Antibiotics.  Surgery used to mean infection.  Now surgical infections are rare.  Not rare enough, but rare.
  • The Bovie.  This is the electrical gizmo that seals blood vessles as it cuts.  This is why you don’t need a blood transfusion when I do your Mommy Makeover.
  • Surgical Scrubs.  It’s like working all day in my pajamas.
  • My Dansko Clogs.  It’s like working all day in my slippers.
  • Surgical Loupes.  These are my silly looking magnifying glasses that allow me to see important teeny tiny things like nerves and blood vessels.  They also come in handy for reading the newspaper when I can’t find my reading glasses.
  • My Battery Powered LED Surgical Headlight.  Now I don’t have to be attached to the light source by a fiberoptic tube (which is how my dog must feel on her leash).
  • Power Assisted Liposuction a.k.a. PAL.  This PAL is a true friend.  It makes liposuction so much better for the patient and the surgeon. 
  • My Wonderful Staff and Colleagues.  They keep me on my toes.
  • My Wonderful Patients.  They are why I love coming to work!
  • My Wonderful Husband and Children.  They are why I love going home in the evening.

Thanks for reading!  Dr. Lisa Lynn Sowder

Now That's Cool, Plastic Surgery

Feeling a little Grinchy? I’m here to help!

November 11th, 2017 — 7:00pm

Seattle Plastic Surgeon recommends Botox and Restylane for the GrinchAll he needs is a little Botox and Juvederm (and a heart enlargement).

The Grinch Who Stole Christmas is one of my most beloved Christmas stories.  This tale of epiphany and redemption always gets me in the right mood for the Holidays.   I make sure this book is handy as soon as I see the stores put out their Christmas displays.  Christmas displays before Halloween make me feel really Grinchy.

The Grinch is an excellent example of an individual who would benefit a lot with two of the most popular non-operative procedures I do:  Botox and HA fillers.

Botox injected into the creases between his eyebrows would wipe that scowl right off his face.  And it just might make him feel better.  I have found that Botox for my scowl makes me feel less Grinchy.  It is sort of like how smiling makes you feel happy.  Non-scowling makes me feel non-Grinchy.

Mr. Grinch looks really old and haggard, partly because of his nasolabial folds – those creases that go from his nose to the corners of his mouth.  Plumping those up with one of the many HA fillers (Juvederm, Volbella, Voluma, etc.) would take years off his face.  Filler could also take care of that downturn at the corner of his mouth to give him a little friendlier expression.

So, of course, the Grinch needs the love and forgiveness of Whoville for redemption of his rotten soul but his face needs a little visit to the plastic surgeon.

Thanks for reading!  Dr. Lisa Lynn Sowder and follow me on Instagram @sowdermd and @breastimlantsanity.

Botox, Facial Fillers

Will the real plastic surgeon please stand up.

November 1st, 2017 — 1:31pm

Is he certified by the American Board of Plastic Surgery? It would be in a patient’s best interest to check!

Real Seattle Real Plastic Real Surgeon blogs about the difference between a real plastic surgeon and a wannabe.

I participate in a physician only message and discussion board called Sermo.  Lately there have been many discussions about the dangers of plastic surgery performed by doctors who are either poorly trained or, in some cases, not trained at all in surgery.  These doctors may be trained in pediatrics, ophthalmology, family practice, radiology, OB-gyn or even occupational medicine.  The things these doctors do have in common is that they have not completed formal and rigorous training in plastic surgery and they do not have hospital privileges for plastic surgery.  They do their procedures under local anesthetic (this way they do not have to have their facility inspected or accredited) and they don’t know what they don’t know.   It’s that “don’t know what they don’t know” that really scares me.  It should also scare you.

Before signing up for surgery, check to make sure your doctor has hospital operating privileges and is certified by the American Board of Plastic Surgery – the only plastic surgery board recognized by the American Board of Medical Specialties.  Accept no substitute!

Thanks for reading, Dr. Lisa Lynn Sowder, certified by the American Board of Plastic Surgery.  Follwow me on Instagram @sowdermd and @breastimplantsanity.

Patient Beware, Plastic Surgery

Autumn Is the Best Season for Liposuction

October 23rd, 2017 — 12:07pm

Thinking about liposuction?  Autumn is the time to come in for a consultation.

blog atumn

When the leaves start to fall, think of body contouring surgery.

I love this time of year.  The air is crisp.  The leaves are a riot of color.   And best of all – my children are back in school!  Autumn is a great time to curl up with a nice cat and a good book and savor the season.

Autumn is also a great time to have body contouring and here is why:  Body contouring procedures always require wearing post surgical compression garments for several weeks after surgery.  And one area in particular – the calves and ankles -require compression stockings for up to three months after surgery.  See this previous blog on cankle liposuction.

The compression garments we use are fairly comfortable and patients get used to them (or sometimes even fall in love with them in a kind of Stockholm Syndrome way) but they are warm and wearing these garments in the summer is something I do not recommend.  Yes, patients have body contouring surgery in the summer but they can be pretty uncomfortable even in temperate Seattle.

So if you are thinking of looking better in those spring and summer fashions, plan ahead and consider having your body contouring surgery now.  Call for a consultation:  206 467-1101.

Thanks for reading!  Dr. Lisa Lynn Sowder

Body Contouring, Liposuction

Price Transparency (or lack thereof) in Healthcare

October 16th, 2017 — 10:29am

Recently my head almost exploded over a price quote from the great big gigantic medical center (GBGMC) across the street.  I have surgical  privileges at the GBGMC but do almost all of my surgery cases in my office ambulatory surgery center (ASC).  My ASC is fully certified, much more convenient and private for patients and much more affordable.  But it took a few phone calls yesterday to the GBGMC to realize how much more affordable my ASC was for private pay patients.

I have a prospective tummy tuck patient who is a little borderline for doing in my ASC because of her age and a few medical issues.  I would kind of like to do her in the GBGMC with an overnight stay.

My patient care coordinator spent two days trying to get a tight price estimate for the 4 hour tummy tuck.  So here are the 4 different quotes we got from various employees of the GBGMC for facility fee which means the use of the operating room.  These quotes did not include anesthesia and do not include my surgeons fee.   Are you ready?  $41,650, $53,550, $70,000 and $90,000. I am not making this up.  Anesthesia costs were real steal at about $13,000.  Hmmm – that means the anesthesiologist is charging way, way more for the anesthesia than I am for the surgery. And the anesthesiologist provides zero follow up care.

Now these prices are just mind blowing but the other thing that drives me nuts is that we got 4 different quotes.  How on earth can a patient budget for surgery when the price could vary by over 100%?

So does the GBGMC really rake in $90,000 for a 4 hour surgery.  Well, maybe from a private pay patient who happens to be a member of the Saudi royal family, but never from an insurance company.  You see, the GBGMC charges this but the insurance companies have cut a deal with the GBGMC and they pay a steeply discounted rate.  This, gentle readers, is one of the things that is really, really dysfunctional in our heath care system.  Nobody really knows how much things really cost, unless of course you are paying out of pocket at a clinic like mine where we put everything in writing and I even post price ranges on this website.

As for my sweet patient who, by the way, is not a member of the Saudi royal family.  I think I will do her in my ASC and have her hire a home nurse for a day or two.  Geeze, for the facility fee of the GBGMC, we could hire a home nurse for a year!

Thanks for reading and when you go in for a medical procedure, ask how much it is going to cost.  This will not be a welcome question but I think the more pressure applied to the health care industrial complex for price transparency, the more likely we will see a change in how the big business of health care is done.

Thanks for reading and follow me on Instagram @sowdermd and @breastimplantsanity.  Dr. Lisa Lynn Sowder


Is the ideal female breast of the future smallish? Yes, according to Blade Runner 2049.

October 10th, 2017 — 2:11pm

K (Ryan Gosling) and the very evil Luv (Sylvia Hoeks) stroll among the newly finished small breasted replicants.

My husband and I went to Blade Runner 2049 this past weekend at Seattle’s wonderful Majestic Bay Theater.  I am a big fan of the original Blade Runner thus the bar was very, very high for 2049.  IMHO, Blade Runner 2049 was too frenetic, too convoluted and the only characters I really cared much about was Rick Deckard (the still handsome and wiley Harrison Ford) and his big ass shaggy mongrel doggie.  I shed a tear when the doggie is shown peering out of a shattered building, wagging his tail just a bit, wondering where his human went.  I’m tearing up now just remembering that scene.

One thing I found interesting throughout the movie was the relatively smallish breasts of all of the female characters.  Hardly any cleavage at all – a real change for Hollywood.  K’s (played by a deliciously disheveled Ryan Gosling) made-to-order AI concubine Joi (Anade Armas) and her human side kick, Mariette (Mackenzie Davis) with whom she mind and body melds, were both small chested.  The LAPD’s Madame played by the ever wonderful Robin Wright was lean and mean and small chested.  The still-under-construction and just “born” female replicants would all measure into an A or B cup bra.    Even the gigantic virtual reality pleasure girl with the pastel hair was small breasted.  The only bouncing breasts seen in the movie was in the cocktail lounge hologram dancing girls of the distant past.  They contrasted nicely with Deckard and K beating the bejesus out of each other.

So maybe this return to a natural sized breast will be the next not-so-big thing for the ever scrutinized female figure?

Thanks for reading and if you haven’t seen the original Bland Runner, you are missing out on a great movie.  Follow me on Instagram @sowdermd and @breastimplantsanity.  Dr. Lisa Lynn Sowder

Breast Contouring, Now That's Cool, Stuff I love

Tummy tuck t-incision.

October 9th, 2017 — 9:39am

This patient had more muscle laxity that skin laxity. Here she is at 3 months with a very flat tummy. Her scar will fade with time.

I just love doing tummy tucks because this procedure allows me to tighten skin, fix muscle position, remove fat and improve a belly button in one operation.   Usually this can be done with an incision that is admittedly quite long but is where the sun doesn’t usually shine.  But sometimes, maybe 10% of cases, it is necessary to leave a scar in the lower mid-line.  Sometimes a patient really needs a full tummy tuck to correct muscle separation but doesn’t have quite enough skin laxity of remove all of the skin between the pubis and the belly button and in those cases a “t-incision” is necessary.  In most cases, I have a pretty good idea before surgery if I am going to need a t-incision but once in a while I cannot quite get that skin to stretch enough and have to leave a t-incision without prior warning to the patient.   This occurred recently and I had a husband hopping mad at me for the extra scar.  The alternative would have been to make the abdominal skin closure so tight that the patient would never be able to stand up straight again or position the really long horizontal scar quite high which would probably look worse than a nicely healed t-incision.

These intraoperative decisions are very, very difficult and sometimes, quite frankly, agonizing.  I am hoping that this particular patient heals well and her vertical scar becomes a non-issue as is usually the case.  And sometimes I just wish patients and their families could spend a day in my operating room clogs.  It’s not so easy!

Thanks for reading and letting me get that one off my chest!  Dr. Lisa Lynn Sowder

Follow me on Instagram @somdermd and @breastimplantsanity

Body Contouring, Tummy Tuck

Portion control in breast augmentation.

October 3rd, 2017 — 5:32pm

This cartoon is by the late, great B. Kliban. His book, “Never Eat Anything Bigger Than Your Head” is a treasure. Get your hands on one if you can. You’ll laugh until you cry.

Portion control is very important for maintaining a healthy weight and it becomes more and more difficult as restaurants, especially fast food restaurants, keep increasing the size of the offerings.  There is a Mexican place in Seattle that  has a poster of one of its burritos next to a new born baby.  They are the same size. So sick in so many ways, huh?

I would like to introduce portion control for breast implants.  There is a condition that we plastic surgeon’s call breast greed.  Those with breast greed want to go a little larger and then a little larger and then a little larger.  This results in the eager to please plastic surgeon putting a too big implant into a too little woman.  Supersized implants have an increased chance of having implant problems.  Big implants cause thinning of the breast tissue and skin and over-stretching of the pectoralis muscle if they are submuscular.  They are more likely to result in the dreaded unaboob or extend into the underarm area.  And, in my humble opinion, they look really, really bizarre.

Fortunately I do not get many patients looking for that super top heavy look.  Implant patients self select surgeons who feature these jumbo implants on their website or social media accounts.  You won’t fine many of those attached to my name.

Thanks for reading and if you want to supersize your chest, don’t come to me!  Dr. Lisa Lynn Sowder

Follow me on Instagram @sowdermd and @breastimplantsanity.


Breast Implants, My Plastic Surgery Philosophy

Nipple reduction and a breast lift can make the breasts look fuller.

September 27th, 2017 — 11:55am

Check out this case.

This lady initially came in for breast augmentation.  She wanted to look a little fuller but was a worried about the impact of larger breasts on her competitive tennis game.  After chatting with her and examining her, I came up with the plan of a lift and a nipple reduction.  These procedures would give the illusion of fuller breasts without actually increasing the volume.

A small and saggy breast with a long stretched-out nipple looks – I’m gonna say it – a little pathetic.  Once the breast skin is tightened up and the nipple shortened, the breast looks almost the way it did before babies, breast feeding, gravity, general aging, etc.  And a procedure like this is maintenance free.  It should last a lifetime.  But remember to wear a bra most of the time when upright.  Gravity never sleeps.

Thanks for reading!  Dr. Lisa Lynn Sowder

Follow me on Instagram @sowdermd and @breastimplantsanity.

Breast Contouring, Breast Lift, Mommy Makeover, Nipples

Get your flu shot already!

September 26th, 2017 — 7:12am

Not a good time to be having that eyelid lift.

Seattle Plastic Surgeon nags because she cares.

It’s that time of year again.  Roll up your sleeve and get your flu shot already.  Why should a “surgical sub-specialist” like me care about whether or not you’ve had your flu shot?  First of all, I’m a physician and it is my duty promote good health.  Second of all, I don’t want any of my patients coming down with the flu.  If a patient falls sick before surgery, we have to cancel and then reschedule the case which is hard on us meaning surgeons, anesthesiologists, surgical techs and nurses and it is also really hard on the patient because he/she has to carve more time out of a busy schedule and many times arrange for child care,  not only for surgery but for recovery.

If a patient comes down with the flu in the early postoperative period, he/she may end up wishing they had never been born.  That would make for a less than excellent plastic surgery experience and could also be down right dangerous.

And we tend to think of the flu as just an inconvenience with a little misery added but really, the flu can be very, very serious.  I am old enough to remember the Hong Kong Flu of 1968.  I was sicker than a dog and missed a week of school but was not one of unlucky million or so who died.  And then there was a Spanish Flu of 1918 that killed 50 (!) million mostly healthy, young people.  Sorry to be such a fear monger but I really want you to get a flu shot.

Thanks for reading!  Dr. Lisa Lynn Sowder

P.S.  Get your flu shot.  Today.

General Health

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