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

Category: Liposuction


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.

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

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

FAQ: If I gain weight after liposuction, where will the fat go?

September 2nd, 2016 — 9:43am

Seattle Plastic Surgeon answers common Liposuction FAQ:  Where will the fat go if I gain weight?

Before hip liposuction, after hip liposuction, after significant weight gain. It's not pretty.

Before hip liposuction, after hip liposuction, after significant weight gain. It’s not pretty.

This is one of the great plastic surgery mysteries because in any given patient, I cannot really predict where the fat will go if a patient gains weight after liposuction.  I can say with confidence that it won’t likely go to the area(s) liposuctioned and it will likely go somewhere the patient does not want it.

So here’s the deal.  Liposuction removes unwanted fat cells.  Weight gain, at least short term weight gain,  makes existing fat cells fatter.  Soooo, if I remove, say, one half of the thickness of the fat pad of your lateral thighs and you gain weight, there are only half the previous fat cells in that area to get larger.  So the area may get a little thicker but not as much as the surrounding areas where fat cells were not removed.

And the same goes for other types of body contouring like tummy tucks (a.k.a. abdominoplasty), body lifts and breast reduction.  And this is why I am so adamant about patients having body or breast contouring when they are at a healthy and reasonable weight (did you notice I did not say ideal weight).  And then after surgery, their healthy and reasonable weight is their pre-op weight minus the weight removed surgically.  So if I removed 5 pounds doing a tummy tuck, my 145 pound patient should end up weighing (after recovery of course), 140 pounds.  See this blog on the Arithmetic of Body Contouring.  And see this blog on Predicting Patient Satisfaction after Body Contouring.

Thanks for reading!  Dr. Lisa Lynn Sowder

Body Contouring, Liposuction, Obesity, Tummy Tuck

It’s Tank Top Season

June 9th, 2015 — 2:00pm

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

More on BELLY FAT

April 9th, 2014 — 11:10am

Seattle Plastic surgeon shows why belly fat cannot be treated with liposuction (with a little help from Oprah and Dr. Oz).

This, folks, is belly fat. It is inside the abdomen, deep to the abdominal muscles. It cannot be removed with liposuction or tummy tuck (abdominoplasty). Losing weight will make it shrink.

I saw a patient a couple of years ago who was requesting abdominal liposuction.  I did my usual body contouring evaluation and had the unenviable task of informing him that he was a really lousy candidate for liposuction or an abdominoplasty (tummy tuck).  His abdominal girth was caused by belly fat a.k.a. intrabdominal fat a.k.a. visceral fat a.k.a. beer belly fat.   The way I could determine this was to have him lay down on the exam table.  His belly did not flatten out.  See photo on the right.

The omentum from a deceased obese person vs. the omentum from a deceased slender person.

 

 

 

 

 

 

Belly fat collects in the mesentary, which is the structure that carries blood vessels to the abdominal organs, and the omentum, which is an apron like structure that hangs off the stomach.   In an obese person, they are very, very thick.  In a lean person, the mesentary and omentum are very thin and translucent.   Here is Dr. Oz holding the omentum of a fat person and Oprah holding the omentum of lean person.  There is NO WAY a fat omentum can be sucked down to a thin omentum.  The only way to reduce an omentum is to lose weight.  I referred the patient to Dr. Richard Lindquist at Swedish Medical Center Weight Loss Services.

I asked him to follow-up with me but I haven’t heard from him.  And he never went to Dr. Lindquist.  I hope he did not find a surgeon ignorant or desperate enough to do surgery on him.  If he did, my guess is that he is sorely disappointed with his result.

Thanks for reading!  Dr. Lisa Lynn Sowder

Body Contouring, Liposuction, Obesity, Tummy Tuck

Gynecomastia patient shows what surgery and exercise can do.

April 4th, 2014 — 10:14am

Seattle gynecomastia patient shows what can happen once a guy is comfortable going to the gym.  It’s a beautiful thing.

Top photo shows a guy embarrassed to take off his shirt.  Bottom photo shows a guy who feels and looks great after gynecomastia surgery and working out.

Top: Before surgery and some serious gym time. Bottom: After surgery and some serious gym time.

I find it very gratifying to help patients achieve their personal best through plastic surgery.  And I find it super gratifying when plastic surgery really helps a patient make a commitment to better self care.

This patient is a middle-aged guy who felt embarrassed about his pudgy chest.  He has a mild case of gynecomastia but a serious case of self consciousness.  I performed a  gynecomastia reduction on him.  I used my standard technique in this type of gynecomastia.  I removed the excess fat from his chest with power assisted tumescence liposuction and excised the little bit of excess glandular tissue though an incision under his nipple.  This technique leaves teen tiny scars that are almost imperceptible.  I am always careful to preserve a disc of breast tissue under the nipple.  This keeps the nipple from caving in.

He was well-enough healed at about 3 weeks to start  going to the gym for some weight training and before long, he was feeling really, really good about his chest.   Not all of my patients get this inspired but I sure love it when they do.  They provide me with some really, really nice before and after photos!

Thanks for reading!  Dr. Lisa Lynn Sowder

For Men Only, Gynecomastia, Liposuction, Male Plastic Surgery, Stuff I love

Overeating – the addiction of choice for “carers”

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

Predicting Patient Satisfaction With Liposuction – Here’s The Math.

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

Are you short or long waisted?

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, Tummy Tuck

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