Seattle Plastic Surgeon’s hunch confirmed by recent report – body lifting is in demand.

I really, really like doing body contouring procedures on patients after massive weight loss.   There are many, many types of lifts that are done below the neck.  They include:  lower body lift, flank lift, mons lift, brachioplasty (upper arm lift), thigh lift, breast lift, buttock lift and tummy tuck which is sorta kinda a lift. 

These procedures make such a huge difference in both how the patients look and feel.  Many of these patients, despite being at or close to their ideal weight, still feel obese because of all of the excess skin and sags and bags.

It’s a good thing I like doing these procedures because according to the American Society of Plastic Surgeons, these sorts of lifts have increased 600% over the past 10 years.  The reason, of course, is the obesity rates have gone up as thus the incidence of formerly obese patients has gone up.  

 About 1/2 of my massive weight loss patients have had weight loss surgery.  The other half have accomplished their weight loss through huge and profound permanent lifestyle changes usually with the help of a peer support group such as Weight Watchers or Overeaters Anonymous. 

I feel very, very privileged to help these patients finally achieve their personal best after they have suffered so much from their obesity and have worked so very, very hard to improve their health and their appearance.  I say, keep ‘em coming! 

Thanks for reading.  Dr. Lisa Lynn Sowder

Seattle Plastic Surgeon warns women of a certain age:  Breast implants that made you look voluptuous 20 years ago may  be making you look matronly today. 

I think she has crossed the line to matronly. Implant removal and a breast lift can take a lot of bulk off the chest and years off the postmenopausal figure.

 Recently I have had several ladies come in with implants that are no longer enhancing their figures.  These ladies are all  several years postmenopausal and even without overall weight gain, have added a cup size or two to their chests.  This is often how weight redistributes after menopause.  Don’t ask me why.  It just happens. 

In these cases, it is often beneficial to remove the breast implants and do a breast lift.  Many, many of these patients have enough breast tissue to leave them with a B, C or even D cup.  And to think that they started out flat chested so many years ago!  Crazy, huh?

Doing implant removal and a lift unloads the chest and makes the torso look much slimmer (much the way a breast reduction does in a lady who carries some extra weight around the middle).  These patients are often just thrilled to look slimmer and have their breast be “the real thing” after having implants for so many years. 

Also, since implants don’t last forever, removing them provides a lot of peace of mind.  Very few ladies over 60 relish having a new set of implants and then thinking about another new set at 80!

Now if I could just figure out a cure for the postmenopausal weight redistribution, I could retire and buy that little island in the Caribbean. 

Oh, never mind.  I love my job and I’m sure I would be bored to death.

Thanks for reading.  Dr. Lisa Lynn Sowder

Seattle Plastic Surgeon assures her breast lift patients that the nipple never leaves the breast.  It would be impossible to drop it on the floor.

I saw a patient today who was worried about what could happen to her nipple during a breast lift.  She thought we actually removed the nipple from the breast and then sutured it back into a higher position.  This is a very common misunderstanding of how a breast lift works.  Take a look at these illustrations that show how the nipple (actually the nipple areaola complex or NAC) stays attached to the breast tissue.

Preoperative markings for a vertical breast lift.

The outer layer of skin around and below the NAC (nipple areolar complex) is removed.

The breast tissue is loosened up from the overlying skin. The NAC stays attached to the breast tissue.

This is the "Stuff" step in what I call my "Stuff and Tuck" breast lift. The NAC is still happily attached to the breast.

This is the tuck part of the "Stuff and Tuck" Vertical Breast Lift

The incisions are closed and the nipple is inset with stitches. The skin has shifted and the breast tissue has shifted carrying the NAC with it. The NAC has stayed attached to the breast tissue the entire time. Most of the nerves and blood vessels to the NAC are undisturbed.

 So there you have it; the “Stuff and Tuck” Vertical Breast Lift.  So no more worries about the nipple being dropped, thrown away by mistake, mixed up with the other nipple, etc.  It never leaves the breast just like my fingers never leave my hands.  I know these illustrations make it look kind of easy but I don’t advise that you try this procedure at home.

Kudos to Dr. Michael J. Brown of Virginia for these awesome illustrations.  They are the best I have seen.

Thanks for reading!  Dr. Lisa Lynn Sowder

Permanent weight loss – here’s what I’ve learned from my patients

How to lose weight for good according to Dr. Lisa Lynn Sowder’s weight loss patients.

I am a bit of an expert on weight loss, not because I have ever had major weight loss, but because I know so many patients who have and have been able to maintain their weight loss.  These are patients who come to me for body contouring procedures such as abdominoplasty, breast lift, upper arm lift, thigh lift, flank lift, lower body lift and so forth.   

I always ask them how they managed to finally lose the weight and keep it off.   I ask them to go into some detail.  This is not because because I want to write the next “diet bestseller” and buy a small island in Greece (although that would be nice) but because I want to pass on their secrets of success to other patients who struggle.

About 40% of my weight loss patients have undergone weight loss surgery.  That’s another blog.  The other 60% have done it through life style changes. Here is what that 60% have told me:

• Without exception, they have all sworn off sweets and refined carbohydrates.
• Many have embraced a very low carb diet – think Adkins -  diet.
• Almost all have maintained regular aerobic exercise – walking and biking are the most popular with my patients.
• Many of my patients have been helped with support groups such as Overeaters Anonymous, TOPS, and Weight Watchers.
• A few of my patients have been helped with nutritional guidance from a physician or nutritionist.
• I cannot remember a patient who mentioned a prepackaged food or liquid diet system. 

And here are a few patients I will never forget:

• One gentleman lost 60 pounds when he quit drinking with the help of Alcoholics Anonymous.
• One lady was able to stay 180 pounds overweight despite her gastric bypass through continuous and careful overeating.  She finally dropped her weight 150 pounds when she addressed her emotional issues with a psychologist and the help of Overeaters Anonymous.
• One lady lost over 100 pounds by jogging.  She started really, really slow and got faster and faster as she lost weight.   She became addicted to a runners high which I guess is better than most addictions.
• Several of my patients were able to slim down only after leaving a dysfunctional relationship.
• One teenager lost 40 pounds just by giving up soda.
• One lady in her 60′s lost 100 pounds after having bilateral knee replacements.  She had been very, very sendentary and once pain free,  became more active.

So there you have it folks; Dr. Sowder’s  Guide to Slow, Deliberate, Difficult, Soul Searching, Sweating, Hungry but Long Term Weight Loss.    Just think, I could have written that best seller and here I am just giving it away.

Thanks for reading.  Dr. Lisa Lynn Sowder

Seattle Plastic Surgeon, Dr. Lisa Lynn Sowder blogs about patient satisfaction. 

I can usually tell when a patient really, really likes the result of their breast or body contouring surgery, at least if they have had any sun lately.  I just take a look at their tan lines!  (Those of you who read this blog regularly know that I am totally anti-tan and I am not advocating any activity that causes tan line nor do I advocate non-tan line nude sunbathing!)

Sometimes I’ll have a patient who is super picky about a very minor imperfection but who has tan lines that tell me he/she is comfortable not wearing much at the beach or pool.   Once I had a tummy tuck patient, well into her 50s, that was upset that her string bikini didn’t cover her bikini line scar.  That is what I call a happy problem!

Hey, thanks for reading and stay away from those tanning beds.  More on that in an upcoming blog.  Dr. Lisa Lynn Sowder

Seattle Plastic Surgeon, Dr. Lisa Lynn Sowder finds breast lift and augmentation to be a difficult operation of opposing forces.

I saw a patient yesterday who needs a breast lift and wants an augmentation.  If I just do an augmentation, she will have  weirdly shaped and still saggy breasts and if I just do a lift, she won’t be as large as she desires.  She needs both operations and I was obligated to explain to her how tricky it is to do both an augmentation and a lift at the same time.

This challenge is one of opposing forces.  Placing a breast implant makes the breast tight and we want the tissues to loosen up and stretch some.  Doing a lift makes the breast tight and we want it to stay tight.  The weight and pressure of the implant can make a lift loosen up.  And, to make it even more tricky, every patient reacts a little differently to the forces of the implant and gravity, depending on her breast and skin elasticity and whether or not she spends any time in the International Space Station (no gravity there!).

My revision rate for patients undergoing and augmentation and simultaneous lift is pretty high, about 20%.  In most cases the revision involves re-tightening the lift and this can sometimes be done under just a local anesthetic but some patients need major revision, sometimes using $trattice or another acellular dermal matrix which acts like an internal bra.    Every patient is different.

I must confess that I have no control over a patient’s breast and skin elasticity and certainly have no control over gravity (I wish!)  And I must confess that I do not have a crystal ball to predict which patients will do great and which ones will need a revision.

If anyone out there has a crystal ball for sale (one that really works), let me know.  I’d love to buy one!

Thanks for reading, Dr. Lisa Lynn Sowder

"I like these."

Seattle is a very high tech city and I often have patients requesting breast implants bring in photos they have found on the internet. Internet photos can be very helpful IF the woman on the internet is in the same ball park as the patient in my exam room as far as age, height, weight, breast shape, breast size, nipple position, nipple size, skin elasticity and rib cage anatomy. Finding your breast doppelganger on the internet can be a very, very time consuming task.

Several years ago I had a 50 something lady bring in a Playboy centerfold as her desired look. That consultation required a rather difficult conversation about what plastic surgery can and cannot do and also the fine art of photographic lighting and airbrushing.

So click away on those before and after photos but keep in mind that what you end up with has a lot to do with what you and I start with!

One thing that is easy to find on the Internet are examples of what a patient does not want. Those photos are very, very valuable and help determine if the patient and I are “on the same page”.

I saw a patient recently that brought this cartoon to mind. She was requesting breast surgery and knew just what she wanted to look like; like a playboy centerfold. The problem was that she was over 50, a little overweight, and a lot saggy. I had to tell her in the nicest possible way that there was no way I could make her look 20 something, nulliparous (meaning not having given birth), naturally gorgeous and, to top it off, airbrushed! We plastic surgeons call this “deflation of expectations”. I have a jillion before and after photos of patients I have operated on and I arrange them by age and by body mass index. When I see a patient for surgery, I show them examples of patients who resemble them, not some idealized nymph. If I don’t do this little reality check, I can be assured that the patient will be unhappy with their outcome and unhappy with me and behind every unhappy plastic surgery patient is an unhappy plastic surgeon.

Ah, the joys of motherhood! I can wax eloquently about fat little feet, apple cheeks, wet baby kisses and so on but one of the joys I did not expect was a boost in my Plastic Surgery practice, especially my “mommy makeover” patients. Since becoming a mother myself, I speak “mommy” really well. I know first hand the glorious details of feeding, bathing, changing, and schlepping the baby. I can recite the stages of the toddler, the preschooler, the gradeschooler, the tween and currently I am becoming an expert on the tableau of horror called puberty.

Being familiar with all that being a mother requires makes me much better at counseling patients about the process and timing of a “mommy makeover”.

“Mommy makeovers” usually combine breast surgery (augmentation and/or lift or reduction) with body surgery (usually abdominoplasty and/or liposuction). Most women are healthy enough to have a combination of procedures during one operative session. It is, however, the first couple of post operative weeks that are the most challenging for the patient.

Mommy is used to taking care of everyone but herself. After surgery the Mommy needs to take of only herself. She needs to be “Queen for a Week or Two” and resist the urge to cook, clean, change, wipe, mop, vacuum, load, unload, fold, etc. And if her youngest weighs over 20 pounds, she may not pick him/her up for at least two weeks if breast surgery was done and for at least six weeks if an abdominoplasty was done. The little one can crawl into Mommy’s lap for a cuddle but NO HEAVY LIFTING for Mommy. This also applies to the dog.

It’s very important to for patients to discuss these issues with their families. I’ve had a few ladies who have underestimated their recovery time, have done too much too soon and have turned what should be a relatively comfortable and relaxing recovery into a very sore and frustrating one.

So, calling all mothers interested in a “mommy makeover”: Plan ahead and get your husband and your children and your friends on board. Make a sign for your bedroom door. “DO NOT DISTURB – MOMMY RECOVERING”.

“Dr. Sowder, what is you favorite procedure?” That is a question patients frequently asked. The answer, hands down, is breast lift a.k.a. mastopexy. I really love doing breast lifts because the patients get a lot of benefit for little risk and very minimal pain and suffering and for most patients, it’s affordable.

I often see ladies who think they need implants but really they just a little boost to improve the position of the nipple, decrease the diameter of the areola (it makes the breast look bigger) and tighten the skin and raise the breast mound.

After all the healing is done, the breasts look a little bigger and oh so perky. And there is no implant to maintain.

Implants are great for ladies who are really small busty but lots of ladies are plenty big but they just don’t realize it.

I also love the breast lift patients. They are usually middle aged moms who are so happy to get a few days off from family demands in addition to their new look. It’s a win, win, win.

For more about breast lift, check out my web site http://www.sowdermd.com/