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

There’s nothing that makes me wanna holler much more than an anatomically perfect patient for tummy tuck who smokes!

Last week I saw two patients in one day who were both absolutely anatomically perfect patients for tummy tucks.  They were both done with child bearing, they were both thin and both had abdominal muscle separation and loose jelly belly skin and they both had c-section scars.  This kind of patient makes me almost droll at the thought of how straight forward their surgery would be, how much improvement they would have and, most of all, how happy theywould be with their surgical result.

That was the ectacsy part of the consultation and now for the agony part.  Both of these patients were long time and dedicated smokers.  And that made them very, very poor candidates for tummy tuck regardless of their favorable anatomy.

The issue with smoking is the damage that smoking does to blood vessels.  With many procedures such as tummy tuck, face lift, breast lift and some body lifts, the blood supply of the skin is stressed because the skin must be peeled up for a distance either to remove extra skin or to alter structures under the skin.  Peeling the skin up cuts many, many small vessels that provide circulation to the peeled up area and that area is then dependent on a secondary blood supply for post-operative healing.   In a smoker, that secondary blood supply is not reliable and the chance for the peeled up skin dying is much higher than a non smoker.  We surgeons have a fancy name for things that die – necrosis and it’s a word I loath using in describing a post surgical wound in my post-operative notes.

So I had to deliver the two smokers that bad news that I could not operate on them until they were non smokers for at least three months and even then, they are still at increased risk for healing problems.   I am sure I am not the first doctor to tell them they should quit smoking but maybe, just maybe, if they want than tummy tuck enough, they will finally find the strength to kick the habit.

Seattle Plastic Surgeon’s hunch confirmed by recent report – body lifting is in demand.

I really, really like doing body contouring procedures on patients after massive weight loss.   There are many, many types of lifts that are done below the neck.  They include:  lower body lift, flank lift, mons lift, brachioplasty (upper arm lift), thigh lift, breast lift, buttock lift and tummy tuck which is sorta kinda a lift. 

These procedures make such a huge difference in both how the patients look and feel.  Many of these patients, despite being at or close to their ideal weight, still feel obese because of all of the excess skin and sags and bags.

It’s a good thing I like doing these procedures because according to the American Society of Plastic Surgeons, these sorts of lifts have increased 600% over the past 10 years.  The reason, of course, is the obesity rates have gone up as thus the incidence of formerly obese patients has gone up.  

 About 1/2 of my massive weight loss patients have had weight loss surgery.  The other half have accomplished their weight loss through huge and profound permanent lifestyle changes usually with the help of a peer support group such as Weight Watchers or Overeaters Anonymous. 

I feel very, very privileged to help these patients finally achieve their personal best after they have suffered so much from their obesity and have worked so very, very hard to improve their health and their appearance.  I say, keep ‘em coming! 

Thanks for reading.  Dr. Lisa Lynn Sowder

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 is seeing some very nice results from fat transfer to the breast.

Left side : before fat transfer. Right side : 3 months after fat transfer. She has gone from a B to a C cup.

It takes quite a bit to get me enthusiatic about “new stuff” because “new stuff” pops up every day and more often than not, the reality does not begin to live up to the hype.  This tends to make one (me, for instance) a bit skeptical. 

As discussed on my website and previous blogs, fat transfer to the breast is a new procedure that I am now offering to very carefully selected patients.   And now I am starting to get some sort of longish term follow-up and I am starting to get, well, a little bit excited.

This lovely mother of two darling boys had her fat transfer last fall and her size is holding steady.  She was a B cup before transfer and a C cup three weeks after transfer and today is a C cup three months after transfer.  She is thrilled and so am I. 

She not only has no implant to maintain, she has virtually no scars on her chest and she has a subtle improvement in her breast shape.  No, she’s not going to stop traffic with this chest but that was never her intent. 

And another cool thing about fat transfer – it’s really a twofer.  In this patient’s case, I took the fat off of her posterior hips and she is much slimmer in that area and with the increase in her breast volume, is much better balanced between her upper and lower body.  SWEET!

Thanks for reading!  Dr. Lisa Lynn Sowder

Seattle Plastic Surgeon decides she needs to get out more often.

I had one of those humbling moments recently at our monthly staff meeting when I felt like I had been living under a rock for a decade or so.  We were discussing the importance of placing ice packs to areas injected with filler immediately after the procedure to decrease swelling and bruising. 

Our ice packs are in our freezer down the hall and our staff puts lots of miles in  making this trip.  I was wondering about a small freezer in each exam room to make things more efficient ………………but my up-to-date and very hip staff had a better idea :  Jack Frost Instant Ice Packs.

This most wonderful invention works sorta like the “Hot Feet” packs I use when skiing, but instead of getting hot, they get cold - very, cold.  Apparently Jack Frost Instant Ice Packs have been around FOREVER.  Our first order of packs came in today and they work great!  So no freezers taking up space in the exam rooms and no wearing a path in the carpet going to fetch ice packs. 

So now I am up to date on the latest ice pack technology and next I am sure someone will explain to me why Lady Gaga wears dresses made of pork chops.

Thanks for reading.  Dr. Lisa Lynn Sowder

Seattle Plastic Surgeon finds (and fixes) umbilical hernias in about 20% of her tummy tuck patients. 

I do a lot of abdominoplasties a.k.a. tummy tucks and I fix a lot of umbilical hernias. 

It's not an "outie'. It's a hernia but I'm here to help.

Here’s how I approach this very common problem:

During surgery, I carefully exaimine the umbilicus (that’s belly button in normal speech) to feel if there is any weakness in the abdominal wall.  Sometimes the weakness is obvious like in the photo, but often it is not.  If I think there is a hernia, I will incise the umbilicus from the center to the 6:00 position and take a look at the abdominal wall underneath.  If there is a hernia, it shows up as a little or not-so-little blob of fat that is poking out from the inside to the outside.  I coax the little fat blob back into the inside and put 1 – 3 permanent sutures in to repair the small hole in the abdominal wall.  Then I stitch up the belly button incision and proceed with the rest of the surgery. 

Easily amused Seattle Plastic surgeon shares a cool surgery word.

I just finished taking my annual OSHA test online (I scored 100% !) and came across this example of doffing gloves.   Surgeons use some pretty weird words and the words for putting gloves on and taking them off are don and doff respectively.  Why do I share this information?

The reason I share don and doff is that few people have heard the word doff and it could potentially be useful in a savage, down to the single digits game of Scrabble.  Imagine this.  You’re down to your last two letters:  d and f.  If you can play them both and go out first, you’ll win by a few points.  If you can play only one letter, your opponent will go out first and you will lose and will have to put up with his gloating for the next week since you are married to said opponent.  You survey the board and yes, yes, there is:  an “of” sitting right there with room on either side.  You play “doff”  and win.

Or better yet; your over-confident, English PhD  (but doff-naive) opponent challenges you thinking that you are bluffing with a non-word.  The dictionary is consulted and yes, yes, yes, it is there and you not only win but the over-confident opponent is humiliated by his linguistic ignorance.  And you are the one who gets to gloat for a week.   As you may have guessed, this is one of my many Scrabble fantasies.

Thanks for reading and remember;  tonight when you take off your clothes to go to bed, you are doffing your clothes and donning (or not) your jammies and may you have sweet dreams of winning your next game of Scrabble.  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 blogs about needing a crystal ball to answer many of her patients’ questions.

How will your breasts look 20 years after your surgery? Let me look into my crystal ball.

I had one of those days today where every patient asked me to predict the future.  

• Will I be able to drive a week after a tummy tuck? 

• Will these implants look okay after I have children? 

•  Will I get fat on my hips if I have liposuction on my abdomen?

•  How long will a face lift “last”? 

• Will my breasts grow back after a reduction? 

• Will I gain weight when I go through menopause?

My honest answer to all of those questions is this:  I DON”T KNOW. 

I am always very, very happy to share what I have learned from being in practice for over twenty years and what most of my patients have experienced but I cannot predict the future for any given patient!  I am an optimist by nature but that being said, I am not one to sugar coat the realities of postoperative discomfort, postoperative scars, the effects of gravity, the physical and mental price of childbearing, or the horrors of menopause. 

So if any of you wonderful readers out there have a crystal ball, please let me know when Seattle is going to have the “BIG ONE” meaning our long over due devastating earthquake.  I want to be visiting my mom in Spokane when it hits.

Thanks for reading and sorry about being a little prickley.  It’s been a long day and I still have another hour of paperwork!  Dr. Lisa Lynn Sowder