June 19th, 2012 — 11:11am
Seattle Plastic Surgeon shares an article in last Saturday’s Wall Street Journal that takes on the problem of food addiction in women.
I am a bit of an expert on the subject of overeating. I’ve been in practice over 20 years and many of my patients are women with “food issues.” I always try to gently probe for any eating disorders in women who are over or underweight or who have a history significant weight fluctuations. Eating disorders, especially compulsive overeating, are always difficult to talk about but it’s very, very important, especially in patients who are coming in for breast and/or body contouring.
This weekend, I came across an article in the Wall Street Journal that addresses the problem of food addiction in women. It’s painful to read but I think it is spot on for many of my patients who have confided in me about the emotional work they had to go through before they could really address this lowest ranking of addictions and finally get on track to better self care. Check it out here and let me know what you think.
Thanks for reading, Dr. Lisa Lynn Sowder
body contouring, breast contouring, Liposuction, Mommy makeover, Obesity, tummy tuck
June 11th, 2012 — 11:06am
Seattle Plastic Surgeon blogs about predicting patient satisfaction following liposuction.
Later this month, I am giving a talk to the Washington Society of Plastic Surgeons on Plastic Surgery and the Overweight or Obese Patient. This is a very prickly topic and a difficult one to discuss, especially with the overweight or obese patient. I do my best to be straight forward and honest about what body contouring can accomplish in this patient population and try to educate patients about realistic expectations.
While researching this topic, I came across this very helpful diagram. This was published by Dr. Rod Rohrich and associates at the University of Texas Southwestern. They looked at the effect of post liposuction weight changes on long term satisfaction . They came up with this very helpful chart. I am going to start using this chart for all my body contouring patients, regardless of their weight.
Thanks for reading! Dr. Lisa Lynn Sowder
body contouring, Liposuction, Obesity
March 8th, 2012 — 6:13pm
Seattle Plastic Surgeon blogs about the influence of body type on body contouring procedures.
Short waisted on the left and long waisted on the right.
It is super important for your plastic surgeon to be aware of body type when he or she undertakes a body contouring consultation. A lovely hourglass waistline is on every patient’s wish list but sometimes it is not possible to achieve with body contouring.
Patients who are short waisted have a rib cage that almost abuts their pelvis. There is very little vertical room for a waistline. Those with long waists have a lot of vertical room between the rib cage and the pelvis and are move likely to get that lovely hourglass figure with body contouring.
But take heart, you short waisted women out there (I am one of your tribe). We usually have nice long legs where as our hourglass sisters usually have shorter legs.
The lesson here is, of course, to make the most of what you are blessed with. And choose a plastic surgeon who will give you a realistic idea of what sort of results you can expect.
Thanks for reading. Dr. Lisa Lynn Sowder
body contouring, Liposuction, Mommy makeover, Plastic surgery, Seattle plastic surgery, tummy tuck
January 25th, 2012 — 11:00pm
Seattle Plastic surgeon offers help for a common problem – ARMPIT CLEAVAGE
Most women have a little bit of breast tissue and fat just in front of the arm pit. This is called the axillary tail of the breast. This is all normal.
But some ladies, even slender ladies, have more than a little bit of breast tissue and fat in this area and I have heard it called many thing; armpit cleavage, pit boobs, waddies, etc. Whatever you want to call it, it can be an annoyance especially with some type of clothing.
The good news is that it is usually treatable with liposuction and this can usually be done at the same time as another breast procedure . The excess fat and tissue is quite fibrous and therefore a little tough to suction out. Also, this area stays firm and sometimes lumpy for several months. But when it’s all done and the swelling is down and the tissues softened up, it can be a really, really nice improvement.
I occasionally have to actually excise the area if it is quite large or saggy. That incision is usually pretty easy to tuck up in the underarm area and it usually heals with a thin white line.
So if you have this annoying problem, I’m here to help. If you get you surgery done by St. Patrick’s Day, you will be more than ready for summer clothes by Summer Solstice.
Take a look at this patient below. She had a periareolar breast lift to lift her nipple and improve the shape of her breasts and also liposuction of her armpit cleavage. She is shown about 3 months after surgery with a nice result. She’ll look even better at six months as her scar around her areola fades.
Thanks for reading! Dr. Lisa Lynn Sowder
This patient wants her nipples lifted a little and the shape of her breast improved with the least possible surgery. She also wants to get rid of her armpit cleavange.
Here she is 3 months after a periareolar lift and liposuction of her armpit cleavage. She only took a couple of days off of work. She's pleased with her result as am I.
body contouring, breast contouring, Liposuction
December 8th, 2011 — 10:02pm
Seattle Plastic Surgeon has been waiting almost 18 years for some additional real research on laser-assisted liposuction.
I recently read a letter to the editor in Cosmetic Surgery Times. This glossy “journal” arrives in my mailbox monthly and is often fodder for this blog, especially when I am exposing misleading before and after photos.
This month’s edition included a great letter from Dr. Peter Fodor about a multicenter clinical study of laser-assisted liposuction he and several other plastic surgery colleagues did way back in 1994. They performed liposuction on a bajillion patients and used traditional liposuction (TL) on one side and Laser-assisted liposuction (LAL) on the opposite side and then, after healing, had the results assessed by a neutral observer and the patient, neither of whom knew which side was the TL side and which side was the LAL side. This was a well designed blinded and controlled study.
The results: “The investigators came to the unanimous conclusion that LAL was not an advantageous trade for TL. The results were not superior, while the expense, learning curve and cumbersome nature of the procedure were rather steep. The company wisely withdrew the device from large-scale commercial distribution.”
Fast forward to 2011: Currently availiable LAL devices include SmartLipo, CoolLipo, ProLipo/Plus, LipoForm, Lipotherme, SlimLipo, LipoPulse, Gold Lipo, SmoothLipo, and AccuSculpt. Have any of these devices undergone the scrutiny of that LAL device from 1994? Noooooooooo. Are these newer devices being aggressively marketed to every sort of doctor who wants a piece of the liposuction action (and sometimes marketed directly to prospective patients)? Yesssssssss. And are these devices and their often inexperienced users responsible for most of the poor and often untreatable liposuction outcomes? Yessssssss.
Dr. Fodor reminds us that: ”Just as in playing tennis, other sports or music, it is not the racquet, musical instrument or surgical device that plays the primary role in the quality of the performance, it is the person in control that matters the most.”
Thanks for reading. Dr. Lisa Lynn Sowder
body contouring, Laser liposuction, Liposuction, New technology, patient beware, Plastic surgery, Seattle plastic surgery
November 2nd, 2011 — 9:54pm
Seattle plastic surgeon blogs about the arithmetic of body contouring surgery.
Okay, here’s a question I get all the time from my body contouring patients: “Will the fat come back?” And my answer is always: “New fat will accumulate if you gain weight after surgery and I cannot predict where the new fat will go but I can almost guarantee it won’t go where you want it to go!”.
And then I review a little simple arithmetic with them. For example:
- Their preoperative weight is 146 pounds.
- I removed a total of 7 pounds of fat with liposuction and a tummy tuck.
- Their new preoperative weight is 139 because I removed 7 pounds of fat with surgery.
- If they come back three months later at 146, unless they have been weight training like a fiend, they have gained 7 pounds of fat.
- 146 – 7 + 139 and 139 + 7 = 146.
And then I tell them my story of a patient I did liposuction on over 15 years ago. She was a very fit and lean distance runner who had some stubborn fat on her lateral thighs (so-called saddle bags). I did liposuction on her and she had a great result. She can back a couple of years later having gained about 30 pounds after some personal issues including a knee injury that precluded her running. She had the weirdest shaped thighs. She had caved-in lateral thighs where the fatty layer remained thin when the surrounding area’s fat pad had increased in thickness. Yikes! All I could tell her was that is she got back down to her healthy weight it would get better and in fact she did and it did.
So this is why liposuction is about shape and spot reduction. It is not about weight loss!
body contouring, Liposuction, Obesity, tummy tuck
July 13th, 2011 — 10:32pm
Got cankles? Liposuction can usually help.
This Seattle Cosmetic Plastic Surgeon tells it like it is! There are a few procedures I do that come close to immediate gratification but treatment of “cankles” is not one of them.
This week I saw a patient who wanted to have ankle liposuction ASAP so she could look really great for her upcoming highschool reunion at the end of August.
The good news: Ankle liposuction can help most patients with heavy ankles (a.k.a. cankles) and/or calves.
The bad news: Ankle and/or calf liposuction requires a long recovery period and patients need to wear heavy support hose for 3 to 6 months following the surgery. Because the ankles are so dependent (meaning they are way below the level of the heart), they hang onto post liposuction swelling longer than, say, the area under the chin or even the upper thighs. ( If you ever come across a doctor who wants to lipo your ankles who tells you otherwise, he/she is either ignorant and/or deceptive and you should run the other way.)
So my advice to this really, really lovely young woman:
- Find a great pair of slimming summer slacks that almost touch the ground when she is wearing a fab pair of high heeled sandals.
- Make the most of her lovely shoulders with a halter top.
- Book her ankle liposuction for October.
Next summer she can show off her nice ankles with a photo on her Facebook page.
Thanks for reading!
Seattle Cosmetic Plastic Surgeon, Dr. Lisa Lynn Sowder
body contouring, Liposuction, Postoperative care
June 6th, 2011 — 9:43pm
These arms are NOT the result of plastic surgery!
Seattle Plastic Surgeon discusses options for upper arms.
The thermometer in Seattle is finally hitting 70 degrees after the most wretched sping in recorded weather history and I’m getting a lot of questions about upper arm enhancement.
The First Lady’s arms are the result of good arm genes and a great personal trainer. Also, she has not yet entered the menopausal years (more about that in a future post). For those without Mrs. Obama’s genes or trainer, there are a few procedures that can be done to improve the upper arm. Which procedure is the most appropriate is dictated by several factors:
- Skin tone
- Thickness of the fat layer
- Condition of the underlying muscles
- Scar history
Patients with a thin layer of fat and poor skin tone are usually older and thin. The only procedure that will improve the upper arm is a brachioplasty. This procedure involves removing the excess skin of the upper and inner arm. This always leaves a scar from the axilla (arm pit) to the elbow. I strive to keep this scar on the surface that is hidden against the side when the arms are down. The question patients must ask them selves is: “Am I willing to trade these bat wings for a scar?” In patients who heal well and the scar is narrow and light, the answer is usually “yes” but I do have one brachioplasty patient who has a lovely arm shape and excellent scars who is still too self-conscious to go sleeveless. I may have hit a surgical home run with her but I don’t consider the case a complete success.
Patients with chubby upper arms and good skin tone are great candidates for the CAST procedure. This procedure involves circumferential treatment of the arm with very careful tumescense power- assisted liposuction. The fat removal is limited to the outer arm where the excess fat resides but the inner arm is also treated with undermining the skin with the blunt liposuction cannula off of suction to stimulate shrinkage and tightening of the skin. Patients wear a compression bolero to help the skin tighten postoperatively.
Patients who are “in between” are often candidates for a combination procedure where the incision and resultant scar can be confined to the axilla and the very, very upper inner arm where the sun hardly ever shines.
So if you want perfect Mrs. Obabma’s arms, sorry it’s not likely to happen. But is you want better arms, there is likely something I can do to get you to your personal best.
Thanks for reading!
Seattle Plastic Surgeon, Lisa Lynn Sowder, M.D.
body contouring, Brachioplasty, Liposuction, Plastic surgery, Seattle plastic surgery
February 21st, 2011 — 8:15pm
Seattle Plastic Surgeon Discusses the Risks of Laser Liposuction.
I just returned from the annual meeting of the Northwest Society of Plastic Surgeons. The best presentation was a panel on new technologies – when, how and why or adopt them or, in many cases, not adopt them. A very interesting statistic was presented. Ninety-five percent of new technologies – meaning the latest and greatest, gotta have it, cannot survive without it – did not exist 5 to 6 years after it’s introduction. Wow, what a number. Laser liposuction was one of the featured new technologies that this panel of plastic surgeons did not think would make the cut. In fact, a recent survey of fully trained (as opposed to the imitation) plastic surgeons who had used laser liposuction, over 96% did not like it. This is the first time that I have heard that 96% of any kind of surgeons agree on anything. http://www.abplsurg.org/
One of the panel members, arguably the most laser friendly plastic surgeon on the planet, summed up laser liposuction with this comment: “Last time I checked, the subdermal plexus still existed.”
Stay with me; You are about to learn something important. Take a look at the illustration of your largest organ (the skin) above. See where the pink (skin) turns yellow (fat). That is the subdermis and that is the target of the laser in laser liposuction. After removing fat, the laser is used to heat up the subdermis in an effort to get the skin to shrink. I always get the image of bacon frying for some reason. Well, it’s not nice to heat this layer because the blood vessles that supply the skin live here. If a large enough area of blood vessles is fried, the skin will die. Dead skin is a very, very bad thing.
Non-laser liposuction spares most of the blood vessels because the intruments used (cannulas) are blunt and push the vessels aside rather than damage them. Because most skin has some elastic quality, the overlying skin usually shrinks to some degree once the underlying bulk is reduced.
I have seen my share of skin necrosis in patients who have heard the siren song of laser liposuction thinking it would spare them the necessity of a truly skin tightening procedure such as tummy tuck. I remain sooooo glad that I did not invest in one of these very, very expensive gizmos. It would be keeping our old furniture in our basement storage unit company.
body contouring, Liposuction, My Plastic Surgery Philosophy, Obesity, patient beware
October 26th, 2010 — 10:36am
Seattle Plastic Surgeon discusses the limitations of some of the newest, most expensive and most advertized gizmos.
Take a look at this “before” and “after”.
As promised, here’s the inside of the brochure that shows the “results” and you can be sure these are the best results the company could come up with. The “CoolSculpting” gizmo is promoted as a non-invasive body contouring procedure. I would say non-invasive and ineffective.
Most of the doctors that will purchase this device or one of the dozens similar to it are non-surgeons. These doctors do not know how to do an abdominoplasty (tummy tuck) so they offer this instead. I’m sure they go into it with high hopes but how can they not be disappointed at such a “result’? Once they have paid the $$$$$$ for the gizmo, they need to promote it to make sure they get a decent return on investment.
If any of my abominoplasty patients had a result like this, they would feel ripped off. I suspect the doctors using “CoolSculpting” are going to have some unhappy patients. Geez, everyone could have saved all that time, money and gnashing of teeth by referring those patients to me!
body contouring, Ineffective, Laser liposuction, Liposuction, New technology, patient beware, Plastic surgery, tummy tuck