Head ache the day after surgery? It's probably a "coffee headache".

Seattle Plastic Surgeon advises coffee drinker patients to have a cup of coffee ASAP after surgery. 

I did surgery on a vigorously healthy middle aged lady yesterday and today she was doing fine except for a really, really bad headache.  My very astute nurse told her to drink two cups of coffee and see if that helped.  Sure enough, a little caffeine in the system and the headache disappeared. 

Coffee headaches are pretty common after surgery because patients cannot eat or drink anything the morning of surgery so regular coffee drinkers miss out on that dose of caffeine and they often don’t feel like a cup of coffee for a few days after surgery.

So, if you had a tummy tuck yesterday and your head hurts more than your tummy, you just may have a coffee headache and the cure is a nice hot cup of coffee.   Bottoms up!

Thanks for reading!   Dr. Lisa Lynn Sowder

Seattle Plastic Surgeon suffers from self inflicted post-surgical complication.

Seattle Plastic Surgeon tells the story of the Scab Fairy, a story that every parent needs to know.

This is the Scab Fairy. She’ll leave you a little something if you put that scabby Band-aid under you pillow.

Last week I had the opportunity to take care of a delightful little boy in the emergency room.  He had a classic childhood injury:  forehead vs coffee table.  The table won (it always does) and he needed a half dozen sutures to sew up the deep, jagged gash in his forehead. 

When he came to my office for suture removal, his suture line was scabby and crusty and this can make it hard to remove the teeny, tiny sutures.  Now little kids do not like having anyone mess with their scabs but once I told him about the Scab Fairy, he became much more enthusiastic about the whole thing.  

 You see, the Scab Fairy visits every night looking for scabby Band-aids that good little children have placed under their pillow.  Usually the Scab Fairy leaves something like a Hershey’s Kiss or even a little money.  Once one of my children scored a Pop Tart!   Once my little patient heard this, he was fine with me gently removing the Band-aid and underlying scab.  I made sure to send this home with him in a little baggie. 

 So,  all of you parents out there with active children:  There will be scabs and you need to make friends with the Scab Fairy.

 Thanks for reading!   Dr. Lisa Lynn Sowder.

How to give the gift of plastic surgery.

Looking for the perfect gift this holiday season?   That perfect gift may just be a plastic surgical procedure.  Here are a few tips if you are considering this most thoughtful and personal of presents.

• Only consider this if your loved one has confided in you that he/she is considering “doing something” or that he/she just wishes that he/she could just “get rid of this ______(fill in the blank)”.  Remember, it’s about him/her, not about you.
• Make sure the lucky recipient is a good candidate for surgery.  Good candidates for surgery are in good heath (physically and mentally) and are in a socially stable place in their life.   If in doubt, shoot me an email and I can probably make an educated guess.  Do not, I repeat, do not give the gift of liposuction as a substitute for weight loss.  Need convincing that doing so is a bad idea?  Check out my blogs on obesity.
• Make sure that you can afford the surgery!  You wouldn’t want to have to back out because of sticker shock.  I have a lot of ball park prices posted on my web site.  Or feel free to shoot me an email and I can give you a financial idea of how much this could set you back.
• Make sure that lucky guy/gal will be able to take enough time off of work and/or household duties to recover.  It’s misery to try to get back to work too soon.  You want your gift to be a positive experience.  I have recovery times listed for most procedures on my web site.  Or shoot me an email.
• Make sure you have nice package to present.   You can’t wrap up a tummy tuck or eyelid lift, but you can wrap up something they might love to wear or use after all the discomfort and bruising is gone.  Maybe a nice pair of pj’s from Betsey Johnson for that mommy makeover patient or a pair of beautiful Firefly earrings for that face lift patient.  Or for that dude of yours, how about a nice pair of pink cammo boxer shorts?  You can include one of my practice brochures and a procedure brochure.  Oh, I can just hear the shrieks of joy now! 

And just think, your gift of plastic surgery will last years, even decades.  You and your loved one will be enjoying the benefits much longer than a new car or television or laptop.  Do the math.  It could end up being a great value as well as a great gift!   

HAPPY SHOPPING AND THANKS FOR READING!  Dr. Lisa Lynn Sowder

Seattle Plastic Surgeon empathises with those who itch after surgery.

I’m a naturally itchy type.  I keep a back scratcher on my bed side stand.  I’m one of those types who gets prickly heat with 5 minutes exposure to sun and every ten years or so get hives for no apparent reason.  So if you are itching after surgery, I feel your itch and your pain. 

Itching is no laughing matter.  Itching sensation is carried by the same nerve fibers (so called c-fibers) that cause pain.  I personally, on any given day, rather hurt than itch.

Post-operative itching of incisions is absolutely normal.  It is cause by the chemical histamine, which is present in healing wounds.  It is also present in nettles.  Some patients find a lot of relief in just knowing it is a sign of healing and will diminish.   Others find even more relief in an over the counter antihistamine such as Zyrtec, Afrin or Allegra which are good for daytime use or Benedryl which is great at bed time because it also has some sedation qualities.   There are also prescription medications for recalcitrant itching. 

Post-operative all over itching is usually a reaction to a post operative medication.  Narcotics such as Percocet and Vicodin also cause histamine release and often an antihistamine helps or changing medication can help.  Also, some antibiotics cause itching if a patient is sensitive.  In these cases, changing antibiotics usually takes care of the problem.

Another thing that I have found helpful is a topical cream called Caladryl which is a combination or Camomile and Benadryl Cream.   Caladryl kept me from going crazy during a hive outbreak about 20 years ago.   Don’t put it on your incisions unless you get the okay from the doctor but you can slather it on itchy areas away from the incisions.

Don’t itch and suffer in silence.  There is almost always something that can help.

Thanks for reading.  Now I’m feeling a little itchy.  Dr. Lisa Lynn Sowder

Seattle Plastic Surgeon tells it like it is for obese women seeking breast surgery.

A recent article published in The Journal of Plastic & Reconstructive Surgery caught my attention.  This article looked at breast surgery outcomes in  7982 patients (that would be almost 16,ooo breasts!!!!) and divided the patients in obese and non-obese.  Their results were not surprising to me but they may be surprising to you.  The obese patients had a nearly 12 fold increase in postoperative complications when compared to non-obese patients. 

Breast reduction is the most common breast operation performed in obese women.  That operation has a nearly 9 fold increase in postoperative complication in obese women compared to the non-obese. 

This is not news for those of us who do a lot of reductions.  The sort of problems that obese women tend to have are fluid  collections (seroma), bleeding, delayed healing and infection.  These complications sometimes require a trip back to the operating room and they always require many, many postoperative visits.  Despite a rocky postoperative recovery, many obese women are still glad they had a reduction after everything is healed up. 

So what’s the big deal?  All’s well that ends well, right?    Let’s look at this from an few different points of view.  If insurance pays for the reduction, they don’t want to see more bills for a hospital readmission to stop postoperative bleeding or a bajillion office visit bills to treat an infected wound.   And insurance companies are looking more closely at surgical outcomes and costs and using this information to rate surgeons.  

If the reduction is private pay, the surgeon is unlikley to bill for increased postoperative visits which can run into 10 – 20 additional visits during recovery.  This can get very time consuming and expensive.  

And for the patient it is no picnic having to pack an area along the suture line that either became infected or fell apart.  Post operative complications are just a total bummer all around, especially when the surgery is totally elective. 

And here another issue.  Let’s say an obese lady has 5 pounds of breast tissue (which is 99% fat) removed and her weight drifts back up to her preoperative weight which almost always happens.  This means that she has gained 5 pounds of fat.  If that fat is just external fat, say on her hips, it’s not a big health issue but if it is intraabdominal fat a.k.a. belly fat a.k.a. visceral fat, it is a huge health risk.  Her breasts may no longer be killing her neck and back but her belly fat may literally be killing her.

So what am I really trying to say here.  Obese patients need to understand that breast reduction has a high rate of complications and that a reduction may actually make them less healthy if they gain back their weight as belly fat. 

So this is a real sticky wicket.  Obese reduction patients are usually helped with back and neck pain with a breast reduction but weight loss would also help those back and neck pain issues.  Non surgical weight loss has no surgical risk and is accompanied by a host of improvements in a patients health.  Think high blood pressure, type 2 diabetes, arthritis, high cholesterol, etc.

So if you are obese and want a breast reduction from me, you will get a little weight loss lecture from me and may get turned down for surgery until you are able to shape up and slim down a little.    You may be willing to accept a high risk for a postoperative complication but I may not be. 

Thanks for reading.  And if you have a quick, easy way to lose weight, please let me know.  I’m all ears. 

 Dr. Lisa Lynn Sowder

Seattle Plastic Surgeon, Dr. Lisa Lynn Sowder recalls a Halloween to remember.

A couple of years ago around Halloween I had a patient play a very, very mean trick on me.  She had had some major body contouring following her major weight loss and she had a few areas of her incision that festered because of spitting stitches.  (Spitting stitches deserves it’s own blog so here is a link.)

These spitting stitches were a problem for several months after surgery but finally, we thought she had done all the spitting she was going to do. 

Then, a year later, I saw her on my schedule and figured she had come in to explore her next “round” of surgical self improvement.  I entered the exam room and she slipped down her slacks and said, “I think it’s another problem stitch”.  She had a big dark and inflamed spot on her incision line and I just wanted to cry until upon closer inspection I saw it was a wound tattoo.  Boy, she really had me for a few agonizing moments.  We both had a good laugh (her more than me) and she sweetly gave me some fake wound tattoos that really, really look like the real thing.  You may want to check these out in time for Halloween.  Put on a few before your visit with your plastic surgeon.  You just may give him/her a little trick and then a treat when he/she realizes it’s just a joke.

Happy Halloween and thanks for reading!  Dr. Lisa Lynn Sowder

Seattle Plastic Surgeon blogs about spitting stitches a.k.a stitch abscesses a.k.a. a real pain for both patient and surgeon

Healing after surgery in most cases is uneventful.  (Uneventful is a good thing when it comes to surgery and flying.)  But sometimes uneventful healing can be interrupted by a stitch abscess which always looks way worse than it actually is.

Spitting stitches can occur whenever stitches are left in after surgery.  In plastic surgery, we often close incisions just under the surface of the skin with stitches that dissolve over several months.  If one of these stitches is a little too close to the skin surface, or works its way up towards the surface, it can cause a stitch abscess which is the skin’s reaction to a foreign substance (in this case the stitch).  This is a lot like having a splinter in your foot or finger.  It won’t get better until the splinter is removed.  The same for a stitch abscess.  It won’t get better until the stitch is removed.   If you have had surgery and have a little area like in the photo above, give your surgeon a call and make an appointment to be seen.  In the meantime, put some warm, moist compresses on the area and don’t freak out!  It will be okay!

In most cases, a gentle probing with some sterile tweezers locates the offending stitch and it can be easily removed and the abscess resolves quickly.  Sometimes, I will put a patient on antibiotics for a week or so if the inflammation is pretty wide spread or the patient feels lousy and/or is running a fever. 

Back in the old days when silk and cotton sutures were used in the deep layers, patients could spit a stitch decades after surgery.  Fortunately that is really rare these days although I have had a few patients myself spit permanent stitches years after surgery.  It’s just one of those things that can happen but once the suture is removed, healing occurs quickly.  Learn more here.

Thanks for reading.  Dr. Lisa Lynn Sowder

She must be feeling better. She’s putting on lipstick.

Seattle Plastic Surgeon, Dr. Lisa Lynn Sowder blogs about lipstick.

I saw a patient today who exhibited a classic “positive lipstick sign”. She had surgery last week and today was feeling good enough to put on some lipstick for her appointment.  It is always a happy day for a surgeon to see his/her patients with lipstick because it always means that the patient is feeling better and is actually getting to that point where they are no longer saying to themselves, “Why in the world did I think this was a good idea?”

For facial surgery, the positive lipstick sign usually appears within a week but for major body surgery such as abdominoplasty, it can take up to two weeks.

Recovery is a fact of life with plastic surgery and a big part of my job is to be a postoperative  cheerleader and assure my patients that “this, too, shall pass”.  The “positive lipstick sign” is always reassuring to this plastic surgeon that the patient is “on her way”.

By the way, the male counter part for this is the freshly shaved face.
Thanks for reading!  Dr. Lisa Lynn Sowder

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