Do you have a child with severe acne???  An ounce of treatment now is worth a ton of scar revisions later.

Left: Before a bazillion procedures. Right: After a bazillion procedures.

I have two children in high school and I often am asked for advice regarding acne.  I am not a dermatologist nor do I play one on T.V. so do not expect any advice as to the latest therapies for acne.  I do have advice, however, on whether or not one should seek therapy.   So here goes.

If the zits are small and superficial, there will likely be no lasting damage and whether or not to seek anything other than over-the-counter treatment is really a matter of how much the zits bother your child.  BUT if the zits are deep (so called cystic acne), your child needs to get treatment YESTERDAY. 

 The problem with cystic acne is that it causes inflammation deep under the skin and can result in very bad scarring that can be devastating and permanent.   And it’s not just the scarring that is an issue.  The inflammation can also cause atrophy of the fatty layer under the skin and cause sinking in of the face. 

 The example on the right shows both superficial scarring and also some deeper scarring and atrophy.  This is a mild case.  If this were a man, he probably would not have sought treatment but this is a young, beautiful, fine featured woman and this post acne scarring affects her self esteem and also results in her spending a lot of time every morning trying to cover this up.   

She an I got to know each other very, very well over about two years of procedures that included fat grafting, skin resurfacing, excisional scar revision and filler injection.  It was a long process but worth it for both of us.  She can now get on with her day without the prolonged fussing with cover-up and I just loved the bright smile on her face at her last visit. 

 Not all plastic surgeons are well suited to treat these patients because it involves a lot of patience (which I for some reason have in abundance) and a lot of hand holding. 

 But the real message here is that if you know someone with deep, cystic acne who is not under the care of a dermatologist, do what you can to get them proper care.  What seems like just a minor, cosmetic issue can be a major, difficult to treat problem later. 

Thanks for reading!  Dr. Lisa Lynn Sowder

Seattle Plastic Surgeon blogs about the lessons learned in the play, Pygmalion, now playing at Seattle’s Intiman Theater.

Mark Anders as linguist Henry Higgins and Jennifer Lee Taylor as Eliza Doolittle. Her décolleté is so lovely, he dare not look!

Last night I soooo enjoyed attending Pygmalion at Seattle’s Intiman Theater.  There is something about live human beings on stage telling a story through words and action that just touch my soul so much more than film or television ever does. 

Pygmalion, as most of you probably know, refers to the story of the artist who fell in love with his own sculpture of the “perfect woman”. 

The play, written by George Bernard Shaw and made into the musical My Fair Lady, tells the story of Linguist Henry Higgins turning the gutter snipe Eliza Doolittle into a Duchess.  In the end of course, he learns as much from her as she does from him.  It’s a great story of class and money and manners and empathy and for the plastic surgeon in the audience, the importance of sun protection on the ever important  décolleté .  

The  décolleté  is so often exposed to the sun and, unlike the face, is not amenable to deep chemical peels or laser treatments to treat the sun damage.  Therefore, prevention is paramount.  I recommend adding quick spray of Neutrogena spray-on sun block every morning to the décolleté  to every woman’s morning skin care routine.  It takes but a second or two and helps maintain skin health in this most important female landscape. 

I also highly recommend seeing this delightful play!

Thanks for reading.  Dr. Lisa Lynn Sowder

Seattle Plastic Surgeon shows off a GREAT NON-SURGICAL RESULT – take a look at this.

And take a look at these photos.  Her skin quality is so much better and the shape of her jaw line and chin is so improved and her wrinkles —- what wrinkles?????  

Fill ‘er up even if it means saving up some hard earned $$$.

Seattle Plastic Surgeon, Dr. Lisa Lynn Sowder blogs about patient satisfaction with HA fillers such as Restylane, Perlane, Prevelle and Juvederm. 

I’ve been using these fabulous new facial fillers for many years now and have come to really, really love the way they rejuvenate the face without looking fake or tight or overdone. 

Here is one thing I have learned over the years:  patient satisfaction is directly proportional to how full their tank is filled.  The tank is your face and the fuel is the filler. 

Some patients will get to full with one syringe and some will require a half dozen.  It just depends on how many creases a patient has, how deep the creases are and how much fullness would benefit the patient.   And I am not talking freak show fullenss here.  This is Seattle.  I’m from Spokane.   I don’t do freak show. 

The big issue, of course, is the cost and these magical fillers are pricey.   Many patients are reluctant to spend the money ($2800 for 6 syringes!)  especially considering that these fillers are temporary.  But …….. it has also been my experience that these temporary fillers can often last 18 – 24 months even though they are advertised as lasting 6 months.  And ……….. patient’s who fill ‘er up usually need much less volume for subsequent “maintenance”  injections. 

“Fill ‘er up” patients are almost always thrilled and I know they will be back for more.  The patients who settle for just partial correction are rarely impressed and often don’t come back for repeat injections.

So if you need a lot to ”fill ‘er up”, save up and let me really do it right!  Thanks for reading!  Dr. Lisa Lynn Sowder

Seattle Plastic Surgeon, Dr. Lisa Lynn Sowder blogs about patient satisfaction. 

I can usually tell when a patient really, really likes the result of their breast or body contouring surgery, at least if they have had any sun lately.  I just take a look at their tan lines!  (Those of you who read this blog regularly know that I am totally anti-tan and I am not advocating any activity that causes tan line nor do I advocate non-tan line nude sunbathing!)

Sometimes I’ll have a patient who is super picky about a very minor imperfection but who has tan lines that tell me he/she is comfortable not wearing much at the beach or pool.   Once I had a tummy tuck patient, well into her 50s, that was upset that her string bikini didn’t cover her bikini line scar.  That is what I call a happy problem!

Hey, thanks for reading and stay away from those tanning beds.  More on that in an upcoming blog.  Dr. Lisa Lynn Sowder

Lip enhancement can be subtle. It doesn’t have to be bizarre.

Seattle Plastic Surgeon is thrilled to share news of the FDA approval of Restylane for lip enhancement and/or augmentation.  It’s about time!

Earlier this month the FDA approved the hyaluronic acid filler Restylane for lip enhancement.  This puts what is sort of like the Good Housekeeping Seal of Approval on a procedure that I have been doing for several years.

Lip enhancement/augmentation gets a really bad rap in the popular media because it is so overdone in many high profile individuals.  But really, it doesn’t have to be that way.  No Donald Duck lips are necessary.  The enhancement can be really lovely and subtle like the lady in the photo.  She had just 1 cc of filler placed in her lips with most of it going to her lower lip.  Nice, huh?   This is yet another thing I love about practicing plastic surgery in Seattle.  Patients want lovely and subtle, not LOOK AT ME.

Most lip enhancement/augmentation patients can go about their usual business and social lives the day after injection.  The bruising and swelling is usually pretty minimal if the patient is careful not to take any medication that can encourage bruising (aspirin and ibuprofen are the most common offenders) for a week before injection and is vigilant about icing the area for a few hours after injection. 

So from now on when you hear lip ehancement/augmentation/enlargement etc., don’t think bizarre Donald Duck lips ala the First Wives Club.  Think lovely and subtle and now FDA approved!

Thanks for reading.  Seattle Plastic Surgeon, Dr. Lisa Lynn Sowder

Seattle Plastic Surgeon implores patients not to fall for “Botox on Sale”.

Occasionally I have patients come in for Botox or fillers who have flitted around from doctor to doctor looking for the “best price”.   I hear statements like  ”the last Botox didn’t work” , “the Restylane didn’t last”, “I’m not sure what she used but I didn’t like it”, and this is my favorite, “it was on sale but it didn’t last”.

This flitting around in seach of a “deal” makes it very hard for a hardworking plastic surgeon (moi, for example) to figure out what, where and how much injectable to inject.  In my practice, we keep very accurate records of all of the above so I can judge what works best for any given patient.   And believe me, every patient is different.

Sometimes I think just because it is “cosmetic”,  patients don’t take these treatments seriously enough.  I cannot imagine anyone shopping around for the “best” price on, say, steroid injections into a bum shoulder or the “best” price for an hour of psychotherapy!

Usually continuity of care provides the best value of all, even if the prices are not bargain basement.  So for injectables, find a good doctor and stick (nice pun, huh?) with him/her.

Thanks for reading.  Seattle Plastic Surgeon, Dr. Lisa Lynn Sowder

Seattle Plastic Surgeon, Dr. Lisa Lynn Sowder is smitten with an old fashioned parasol.

I saw a patient recently who was carrying a lovely, old fashioned parasol.  I commented on her very cool accessory and got the whole story.

She had a large bald spot just above her anterior hair line where, several years ago, a melanoma had been excised and her scalp reconstructed with a skin graft.  Her hair was already quite thin and she was uninterested in any sort of hair grafting or scalp rearranging procedure to rid her of her bald spot.  She opted to keep her hair super short and wear a very high quality wig.  (I would have never known had she not told me.)

The down side of the wig is that it is hot and she cannot bear to wear a hat in the summer.  Being a melanoma survivor, she is very, very careful about sun exposure.  Thus the parasol which she uses in addition to a good sunscreen.  She is smart and oh so stylish.

Seattle has a very cool umbrella and parasol store, Bella Umbrella,  located in the Ballard neighborhood.  If you live around here, you ought to check it out.  A pretty parasol might be just the summer accessory you are looking for.

Thanks for reading!  Dr. Lisa Lynn Sowder

Seattle Plastic Surgery, Dr. Lisa Lynn Sowder blogs about her newest obsession and Seattle’s lousy summer.

Last weekend my daughter and I went to Swanson’s, which is a lovely nursery in north Seattle.  We had a light lunch at the cafe and then went browsing.  (Now that I am most definitely a woman of a certain age, I would rather cruise a nursery than a boutique).

Marie and I saw it as the same instant, just sitting there like a beautiful young orphan, so tiny and out of place with the much taller quotidian deciduous ornamental trees.  And we fell hard for this Japanese Umbrella Pine.  I put it on our cart and found a staff member to ask about it.  He could have said you need to water it with sterile thrice deionized water 4 times a day and apply platypus feces as a side dressing in the spring and fall and I would have still purchased this beauty.  Actually all he said was that it will grow to 20 feet over 20 years and I can’t let it dry out.

And drying out won’t likely be a problem, at least this summer.  While the rest of the nation is sweltering and frying, Seattle is experiencing the coldest and wettest summer in any one’s memory.  But this is good for my sweet, beautiful Japanese Umbrella Pine.  It is native to the rain forests of Japan and I’m sure I can keep it happy in the rain forest of Seattle.

So what does this have to do with plastic surgery?  Okay, how’s this?

• Just because it’s cloudy, you still need sunscreen!
• And the real reason I do plastic surgery is to support my gardening habit.

Thanks for reading!  Seattle Plastic Surgeon and Plant Freak, Dr. Lisa Lynn Sowder

Yesterday the Food and Drug Adminstration issues new rules on the labeling of sun protection products.  These rules have been many years in the making with many stakeholders involved.  This news  is welcome to me and my patients as is any regulation that promotes accurate information and truth in advertising.

Only sun protection products that protect against a broad spectrum of ultra- violet rays can claim protection against skin cancer and skin aging.  No product can call itself a sunblock.  Strong sunscreen, yes but sunblock, no.  The SPF system will be redone to give patients a more accurate way to measure protection.  No longer will we see promotions of SPF 100 which really does not exist (SPF 100 means you can spend 1500 minutes or 25 hours in the sun without getting much more than a little “color”).    Also, sweatproof and waterproof labels will disappear.

So expect some better information on sun protection products’ packaging and remember:  It only works if you use it.

Here’s wishing you a great and tan free summer.  Thanks for reading.  Seattle Plastic Surgeon, Dr. Lisa Lynn Sowder