Seattle Plastic Surgeon blogs about the influence of body type on body contouring procedures.

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

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

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!

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

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.

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!

Like most plastic surgeons, I just love shopping for new instruments and gizmos but like most plastic surgeons, I am also quite skeptical of stuff that seems too good to be true – especially very expensive stuff that doesn’t work very well (VES-DW, for short). Behold, on the left, the lastest sales brochure occupying my in-box.

This brochure might make someone like me (a plastic surgeon who would love to deliver abdomens like the one on the left to my patients) buy a “coolsculpting” system for a couple hundred grand. If the “coolsculpting” system delivered the aforementioned abdomen, I suspect there would be a line outside my office door extending down 16 flights of stairs and out onto the street. But alas; there is the inside of the brochure. See my next blog for the “results”.