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


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

Visualize Liposuction

March 26th, 2013 — 11:20am

Seattle Plastic surgeon teaches patients to visualize liposuction volumes and weights using butter.

Seattle Liposuction

One pound of butter = one pound of fat.

One of the most frequently asked questions in my office is “how much fat will you remove?”  The answer usually ranges somewhere between 1 – 10 pounds.

So how much is 1 – 10 pounds?  This can be hard to visualize.  I recommend thinking of excess fat as sticks of butter.  One stick of butter is 1/4 of a pound.  A box of butter – 4 sticks- is 1 pound.  Ten  boxes of butter – 40 sticks – is 10 pounds.  That’s a lot of butter and a lot of fat!

Liposuction results in targeted weight loss which is why liposuction is so useful in patients with uneven fat distribution – think of the lady with a narrow waist but heavy thighs.  She would have to starve herself to see much slimming of her thighs.  Liposuction could remove several pounds – think several boxes of butter – of fat from each thigh.

Liposuction is not so useful in patients who are significantly overweight all over.   It is not possible to safely remove an extra thirty pounds with liposuction.  That weight needs to be lost through lifestyle changes.   Once a healthier weight is reached and if there are still areas of recalcitrant fat, then liposuction will likely be indicated.

Thanks for reading!  Dr. Lisa Lynn Sowder

 

Body Contouring, Liposuction

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

Do you have armpit cleavage? I’m here to help!

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

The mathmatics (arthmetic really) of body contouring 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

It’s never too early to plan ahead

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:

  1. Find a great pair of slimming summer slacks that almost touch the ground when she is wearing a fab pair of high heeled sandals.
  2. Make the most of her lovely shoulders with a halter top.
  3. 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

It’s Tank Top Season

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

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