Check out these tips from the Washington State Medical Association and the American Heart Association.  And guess what, doing all of these things also helps your looks!  Who says beauty is only skin deep?

7 Simple Steps to Improve Your Heart Health

The American Heart Association is a great place for information on heart health. You will find ways to improve your lifestyle, manage weight and stress, and eat healthy—all steps to lower your risk of heart disease and stroke. The American Heart Association has a program called “Life’s Simple 7″—7 easy steps to improve your health. Check it out at mylifecheck.heart.org where you will find detailed information on each step, tips and motivation, and success stories. The 7 steps include:   1. Get active 2. Control cholesterol 3. Eat better 4. Manage blood pressure 5. Lose weight 6. Reduce blood sugar 7. Stop smoking

Know Your Risk

The Polyclinic has posted a simple quiz to help you determine your risk of heart disease. Knowledge is power, as they say. Take the quiz and find out your risk.

Recommended Screenings/Risk Factors for Heart Disease

Recommended screening How often? Starting when? Cholesterol (fasting lipoprotein profile to measure total HDL, LDL, and triglycerides) Every 5 years for normal-risk people. More often if your numbers are not in normal range or you have risk factors for heart disease or stroke. Age 20 Blood pressure At least once every two years if blood pressure is less than 120/80 mm Hg Age 20 Blood glucose test Every 3 years Age 45 Weight/Body Mass Index (BMI) Each regular healthcare visit Age 20 Waist circumference As needed to help evaluate cardiovascular risk Age 20 Discuss smoking, physical activity and diet Each regular healthcare visit Age 20

(from the American Heart Association)

Coronary Heart Disease Risk Factors

Major risk factors that cannot be changed: Increasing age: The vast majority of people who die of coronary heart disease are age 65+.   Gender (male): Men have a greater risk of heart attack than women and they have attacks earlier in life.   Heredity (including race): Children of parents with heart disease are more likely to develop it themselves.

Major risk factors that can be changed: Smoking: Smokers’ risk of developing coronary heart disease is 2-4x that of non-smokers.   High blood cholesterol: As cholesterol rises, so does the risk of heart disease.   High blood pressure: High blood pressure increases the heart’s workload, causing the heart to thicken and become stiffer.   Physical inactivity: An inactive lifestyle is a risk factor for heart disease.   Obesity and overweight: People who have excess body fat— especially if a lot of it is at the waist—are more likely to develop heart disease and stroke.   Diabetes: Diabetes seriously increases your risk of developing coronary heart disease.

Other factors that increase cardiovascular risk: Stress: Individual response to stress may be a contributing factor to heart disease.   Alcohol: Limit alcohol consumption to no more than 2 drinks per day for men and no more than 1 drink per day for women.   Diet and nutrition: A healthy diet is one of the best weapons to fight heart disease.

(from the American Heart Association)

6 Simple Steps to a Heart Healthy Diet

A heart-healthy diet is one that limits saturated fat, trans fat and dietary cholesterol while adding heart-healthy foods in an attempt to lower your blood cholesterol levels and reduce your risk of heart disease.   Eat a diet rich in vegetables, fruits, whole grains, and fiber Eat fish at least twice a week. Limit how much saturated fat, trans fat, and cholesterol you eat. Only 30% of your daily calories should come from fat, with very little of that from saturated fats. Select fat-free, 1% fat, and low-fat dairy products. Cut back on foods containing partially hydrogenated vegetable oils to reduce trans fat in your diet. Limit your salt intake.

Thanks for reading!  Dr. Lisa Lynn Sowder

Back in 1991 when I first hung my shingle, lip enhancement was done with collagen injections or with a procedure where a strip of skin above and below the lip vermilion border was excised and the lips expanded out.  I wasn’t enthusiastic with either procedure.  The collagen was often lumpy and the excision procedure left a scar and sometimes a funny shape. 

Then along came fat transfer and I liked this much better in that it lasted, sometimes for years and years and years, and it looked and felt natural.  But is was unpredictable in that some patients had resorption of the fat over time and needed repeat procedures.  And the recovery from fat transfer is a couple of weeks looking like the love child of Mick Jagger and Angelina Joli. 

Then along came lip implants, Softform Implants, that worked okay in some patients but in others distorted the lips with smiling or puckering.

Then along came HA (hyaluronic acid fillers) and oh happy day.  These fillers make lip augmentation predictable, natural and easy on the patient because down time is in hours or days at most.  The longevity of the fillers varies from filler to filler and from patient to patient but most patients get a good 3 – 6 months benefit and some even a year or more. 

I used to kind of cringe when I would see “lip enhancement” on my schedule.  With the new HA fillers, I love seeing this on my schedule because I know the patient will likely be pleased and that always makes my day.

Thanks for reading!  Dr. Lisa Lynn Sowder

Today I had a patient ask me discuss a worst-case scenario for her surgical recovery.  Yikes, what a depressing topic!   I tried to educate her without scarring the whatever out of her.  Here’s my spiel on this topic.

Worst-case scenario:  The BIG ONE (as in earthquake) hits Seattle when I am removing her stitches and we all die together in a heap of rubble.  Or, North Korea drops a nuclear bomb on Seattle while I am removing her stitches and we all fry together.  Or, any other number of terrible things in which we all die together.

Now for more likely bad-case scenarios:  Postoperative bleeding, infection, dehydration, fecal impaction, severe nause and vomiting, uncontrollable diarrhea, deep vein thrombosis, pulmonary embolus, wound dehiscense, heart attack, stroke, psychotic break, etc.   Are these common?  NO!  I wouldn’t be doing this for a living if they were!  But……..they could  happen. 

If they happen, proper and prompt treatment is in order to avoid a bad outcome.  That may mean a trip to the Emergency Room or even admission to the hospital and – er – who pays THAT bill??????

I have been covering my patients with Cosmetassure for about 10 years.  This is sort of like travel insurance.  If anything bad happens (that is realted to the surgery) during the postoperative “trip” (defined here as 30 days), Cosmetassure will cover it.  

I signed up with Cosmetassure after a postoperative complication almost did me and a very nice patient in.  I had done an uneventful tummy tuck on her and she contracted a very, very bad case of diarrhea a couple of weeks after surgery.  She got sicker than a dog but did not want to seek medical care because she thought her regular insurance would not cover the cost because she was recovering from cosmetic surgery.   She became so dehydrated and weak that I finally said, “You check into the hospital today or I am calling 911.”

Her hospital admission labs showed early kidney failure from the dehydration!!!  YIKES!   I got an excellent internist involved in her care and she had a quick and uneventful recovery, kidneys and all, after intravenous fluid and medications.  And the diagnosis was a viral infection unrelated to her surgery and her insurance covered her hospital costs.  My recovery from this horrible post-operative experience was not so quick and uneventful.  I was a wreck for weeks thinking that I could have lost this sweet and wonderful (although a little stubborn) lady! 

So now, I make sure my patients are covered by Cosmetassure.  I never, ever again want a patient resisting needed care because they are concerned about the out-of-pocket expense.  I sleep better and I think my patients do too.

Thanks for reading and stay healthy!  Dr. Lisa Lynn Sowder

Did ya know why SmartWool socks aren’t itchy?  It’s because the type of wool that is used is very, very fine and flexible compared to normal wool which is thick, stiff and poky.   I don’t itch at all in these sock and I am a very, very itchy gal by nature.   In fact, I am sitting here right now thinking how itchy my boiled wool jacket is.   And you know how that makes me feel?  Well, it rhymes with itchy.

So check out some pink SmartWool socks for Valentines Day.  And no, no, no, I do not get a dime or even a free pair of socks for this blog. 

Thanks for reading.  Dr. Lisa Lynn Sowder

This in Gertrude after discovering the secret of a bigger tail.

Gertrude McFuzz is a wonderful Dr. Seuss story, one of three in his book Yertle the Turtle and Other Stories.

All three stories involve hubris and/or greed.

Here’s the Cliff Notes of Gertrude McFuzz:

1. Gertrude is a plain little bird with a one feather tail.  She seethes with jealously when she see’s La La Lee Lou, a bird with a two feathered tail fly buy. 

2. She visits her uncle with her woe of inadequacy and he tells her about the berries on a special bush that will make her tail grow. 

3. She eats one berry and finds that her tail is just an nice as La La Lee Lou’s tail.  But of course, she cannot stop at two and she eats all the berries.  Her tail explodes over the next few hours in a show of lavish feathers and fronds and Gertrude is  thrilled.  Her tail is sooooo much better than La La’s. 

4. Then she tries to fly home to show off her beautiful tail but finds she cannot fly with the weight and drag of her magnificent appendage. 

5. Her whimper for help reaches her Uncle who sends out a flock of birds to help Gertrude home.  Once home, she is plucked back to her one feather status.  OUCH!  

6. She is so happy to be able to fly again with her one feather tail.   

I think of Gertrude every time I see or hear of a patient who has a nice result from breast augmentation and wants to “go bigger”, especially if she wants to be as big as “fill in the blank with the name of a friend or celebrity”.   Breast implant problems are much more common in patients with big implants, especially when the implants are too big for the patient’s frame and/or life style. 

A lot of patients and their plastic surgeons belong to the “GO BIG OR GO HOME CLUB” but this plastic surgeon has read Gertrude McFuzz a jillion times to her children, nieces and nephews and this tale of a tail always pops into my brain when I hear the words, “these are really, really great but can’t I go just a little bigger?”

Buy Yertle the Turtle and Other Stories even if you have no young kids to read to.  You will enjoy and learn from it!   I personally think every plastic surgeon would benefit from reading about Yertle and his ego run riot.  Thanks another blog.   Thanks for reading.  Dr. Lisa Lynn Sowder

Good, good, good, good vibrations. Come on, sing along now!

I’ve been experimenting with using skin vibration to reduce the pain of injections for a few months now and recently I have read a study supporting this practice.   in the Aesthetic Surgery Journal.  I’m sold on this little trick.

Here’s what I do: 

• I tell you fabulous the Botox and/or filler injection is going to be while I put on gloves and get the injection ready.
• I have you put a cold pack to the area while I am yakking.
• I wash off the injection area with some alcohol to clean the skin while continuing to yak about how great it’s going to be.
• I put my left index finger, which is wearing my little vibration gizmo, just next to the area I am going to inject.
• I inject the Botox (really fast) and/or the filler (much slower) and yak some more about how great it’s going to be and how much I empathise because I’ve been on the receiving end the needle many times.  Yak, yak, yak.   If you are still showing signs of discomfort, I start singing the Beach Boys Good Vibrations and ask you to harmonize with me.  Let this last bit be a warning for you not to show signs of discomfort.
• I put pressure on the Botox area and/or run the filler area as necessary.  And say “Now that wasn’t so bad, was it?”.  And then I tell you how much you are going to love it.

Thanks for reading and if you haven’t listened to Good Vibrations lately, do so.  It’s an amazing song.  Dr. Lisa Lynn Sowder

Check out Opening Night at the Northwest Flower and Garden Show. It’s like stepping into Spring, if only for an evening.

This  past weekend it rained and rained and rained.  It was so soggy, even in the mountains, that my daughter’s ski lesson was cancelled.  It was even too soggy to work in the garden.  Oh, winter in Seattle.  What a prescription for Seasonal Affective Disorder.

BUT next week, we get a reprieve for the wet and dreary weather with the Northwest Flower and Garden Show.  This event makes escape into a Spring Wonderland possible.  There’s only one problem:  Every other soggy, mossy, trench foot suffering soul is also there and the crowds can be as oppressive as the weather. 

My solution for the last 10 years has been to attend the Opening Night Preview Show.  This year it is Tuesday, February 7th.   It costs $75 for non-members and $65 for members like me and it is soooooooo worth it.  There are complimentary light bites and beverages and uncrowded access to a dozen or so stunning display gardens and the chance to chat with the show garden designers.  And, I actually save money by attending this event.  None of the vendors are open  until the next morning so I cannot buy anything!  All I can take home is wonderful ideas and the feeling that I’ve had a lovely Spring evening. 

So consider joining me, my daughter and my fellow garden freak neighbor, Mary, and a bunch of us who love this show but not the crowds it attracts.  You can purchase tickets here.

Thanks for reading and happy gardening.  Dr. Lisa Lynn Sowder

Abdominoplasty a.k.a. tummy tuck is a BIG operation and it is in every ones best interest to do everything possible to make sure that the surgery is safe and effective.  Careful patient selection is the key.

Abdominoplasty does several things:

• Tightens the muscle layer by pulling the two rectus muscles together in the midline.
• Removes the excess skin of the abdomen.
• Removes the excess fat between the skin and the muscle.
• Fixes a ventral or umbilical hernia (if present).

One really important thing that abdominoplasty does not do:

• Remove the excess fat inside the abdominal cavity, so called visceral or belly fat.

Take a look at this before and after photo.  Depressing, huh?  BTW – this is NOT my patient!

My guess is that this patient is not very satisfied with her result.

This patient had mostly visceral fat and this fat resides inside the abdomen.  It surrounds the intestines, infiltrates the liver and collects in a structure called the omentum.  The only way to reach this fat is to go inside the abdomen.

Even if the surgeon were really, really aggressive and went inside the abdomen, it still would not be possible to remove this fat.  The structures that collect the fat are either vital organs or carry the blood vessels to vital organs.

So how does one get rid of belly fat?  Not with surgery but rather with weight loss.  As a patient loses weight, the belly fat melts away and the abdomen becomes flatter and flatter.  If there is a lot of excess and loose skin left after the weight loss, then the patient likely is a  candidate for abdominoplasty.  Here’s a patient of mine that shows it very well.

In the first photo, most of this patient’s fat is visceral fat.  She wanted an abdominoplasty and I told her that she would have a lousy result and needed to loose weight first.  (This is NEVER what a patient wants to hear but it is what they need to hear from a doctor.)  She worked very,very hard to change her lifestyle and came back a year later having lost almost all of her excess weight.  She looked and felt like a million bucks.  I could not have wiped the smile off her face.  She was now the perfect patient and I did an abdominoplasty and a breast lift on her and she got a really, really nice result.  We were both thrilled.  She is a great success story and has kept her weight off.  She really has a whole new life.

I can take credit for about 10% of her new life.  She did 90% through diet, exercise and changing her whole lifestyle.  She not only looks so much better, she feels better and is in much better health.

So when I say “no”, and believe me, saying “no” is hard to do, it is because I don’t want a patient to go through the expense, time, discomfort and risk for a really, really mediocre result that they will likely be unhappy with.

Thanks for reading.  Dr. Lisa Lynn Sowder.

The tuberous breast is characterized by “puffy” and enlarged areolas, a pointy shape with a constricted breast base. They can come in any size, from extra small to really large. Also, breast asymmetry is very common in patients with tuberous breasts.

I do a lot of breast surgery and I spend a better part of my day looking at breasts.  Just like my patients, breasts come in all shapes and sizes. 

One breast issue that I see from time to time is called tuberous breast deformity.  I have also heard it called tubular breast deformity.  This problem does not become apparent until a girl starts developing with puberty.  It is not uncommon for pubertal girls to be very, very modest and embarrassed with their development, even with sisters, friends and mothers.  So many young women with tuberous breasts haven’t shared their problem with anyone and have just managed to choose clothing, bras and swimsuits that hide their tuberous breasts.  I have seen young women in their 20′s and even 30′s with this “secrete” and I have seen the psychological damage that tuberous breasts can cause. 

Tuberous breasts is a problem that gets very little attention in the popular culture or even the medical culture and often patients with tuberous breasts feel very isolated and think that they are the “only one” with this deformity.  That is until they come in and see me and I can tell them that I see this condition many times a year and that they are, in fact, not alone.

Treatment of this condition is always surgical and treatment varies depending on the severity of the deformity, the size of the breasts and the patient’s desires.  I have never seen a tuberous breast that I could not make a lot better.  Not perfect, but a lot better. 

The surgery usually consists of treating the deficient base of the breast with an implant or fat transfer and then addressing the pointy and droopy shape and the puffy areola with some type of breast lift.  In some cases, only a lift is needed to rearrange the breast tissue and reshape the nipple. 

My tuberous breat patients are some of my most gratifying patients.  It is so wonderful to see these women actually enjoy shopping for a bra or swim suit.  I have seen some young women go from being very, very shy and self conscience to being confident and happy with their bodies. 

I just wish that this problem would get a lot more attention.  Maybe this blog will go viral?  Who knows.  Spread the word and thanks for reading.  Dr. Lisa Lynn Sowder

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.