Blog — Notes of a Plastic Surgeon

Welcome to my blog. I am a plastic surgeon in Seattle and have been in private practice since 1991. I've seen more than a few interesting faces and cases through my years spent in the exam room, the operating room and the emergency room. And I have an opinion on just about everything relating to plastic surgery (and a lot of unrelated stuff). If you like my blog, let me know. Thanks for reading! Lisa

Lessons Learned (and Confirmed) on my Rim to Rim Grand Canyon Backpacking Adventure

November 21st, 2021 — 5:55pm

I am still basking in the afterglow of last month’s Grand Canyon adventure.  Early in the pandemic, I came across an article on backpacking in Grand Canyon in one of the travel magazines my husband, Nick O’Connell, occasionally writes for. This article planted a little seed, or maybe a wild hair, in my head to do a 4 day/3-night backpacking trip down into the depths of Grand Canyon and then back out. Although I am an avid day hiker, I had not backpacked since college so this was a stretch for me at the ripe age of 65.  Floating this idea to my family, I soon had two enthusiastic partners in this adventure, my husband and one of our sons, Daniel.

Me with my husband and son soon after our arrival on the South Rim of Grand Canyon.

Although my husband is an experienced outdoorsman, I pushed to use a guide mainly to get a permit (not an easy thing), arrange transportation from Flagstaff (another not so easy thing), plan the food (no thanks) and hopefully maintain marital and familial harmony (it did).  We went with Wildland Trekking out of Flagstaff.

Within days of making a deposit the emails started arriving about preparing for this adventure. There was no sugar coating. Training for this was essential if the experienced was to be enjoyed rather than just endured.  About 4 months before our trip, right after I retired, I started training in earnest.  This involved a lot of walking up and down the hills of Seattle with a pack that started at about 5 pounds and increased to 30 pounds as I got stronger. (My training was curtailed for a few weeks following a harrowing car accident – not my fault! – which left my beloved stick shift purple Mini Cooper totaled and me bruised and sore from the airbag and seat belt.  That’s another blog.  Stay tuned.)  Nick and I also did at least one hike a week in the Cascade mountains near Seattle with full packs.  I also upped my weight training and yoga, drank protein supplements and slimmed down about 5 pounds.

We arrived at the North Rim and being a sea level dweller, I felt the altitude – 8,297 feet.  Once I donned my 30-pound pack, I really felt the altitude.  Carrying a pack uses all kinds of muscles that, at least with my day-to-day activities, don’t get used much.  I was very, very grateful for all those hours and miles of schlepping that increasingly heavy pack all over Seattle and the Cascades.  Our awesome guide, Karla Kennedy had many stories of clients and their mistaken belief that distance running, swimming, Cross Fit, weight training, Zumba, etc. would be enough.  As the early emails from the guiding company had stated, the best training for schlepping a pack is schlepping a pack.  So that was lesson number one.  Train!  Train right!

Karla, a 40 something biologist by training and experienced Grand Canyon guide, had an amazing depth and breadth of knowledge about back country trekking, botany, geology, and history relating not just to our endeavor at hand but life in the outdoors in general.  Her hard skills were surpassed only by her soft skills. Within minutes of our departure from the North Rim, she established a hierarchy within our group. My husband, who is the nicest guy on the planet, likes to be in charge on the trail.  After all, he’s summited Mt. Rainier many times, summited Denali once, has trekked in the Himalayas, has ice climbed in B.C., backcountry skied all over the United States and Europe and lived to write about it. He knows what he’s doing.  But……………..Karla, without Nick even noticing, assumed the alpha role with authority laced with good cheer.  So that was lesson number two.  Someone needs to be in charge and hierarchy, which has gotten a bad rap in the Woke World, serves an important purpose in serious endeavors.

Fortunately for my oxygen needs, but unfortunately for my quads, the first day was a steep downhill 8 miles to a breathable altitude of 4049 feet.  We soon got into a rhythm and I was very grateful for the pacing imposed on our group by our wonderful guide. Normally, when I hike with Nick, it’s a grueling blast to the top of the peak.  Just get there.  That usual M.O. would not have worked on this trip. Just when I was feeling really, really fatigued and cranky, Karla would read my mind (I never once complained, really) and we would take a break.  Off with the packs.  Another sip of water and then a hearty snack.  We had oodles of snacks, Karla’s orders.  My favorites were Cliff Bars with Megan Rapino or Venus Williams, two of my favorite badasses, on the wrappers.  Enjoy the view, enjoy the moment, regroup, eat up, feel that blood glucose level inching up and hey, look at these fossilized lizard foot prints on this rock. They are one bajillion years old.  Then back with the pack and onto the trail.  This was our routine for the 4 days of the trip.  Lesson number three.  It’s okay to rest and snack!

And now that I’m back home and working on my memoir (working title is The Human Condition: Sometimes It Isn’t Pretty), I think about my long career in surgery and how these lessons did or did not apply.  The first one certainly did. There is no way to learn to be a surgeon except to operate. You start slow and small and with a lot of supervision.  You build on your skills and learn new ones.  There is no substitute for putting in the time and getting those case numbers.  Attention medical students looking at surgery residencies:  Go for the programs with high volumes.  All the academic yada, yada, yada in the world will not make up for time not spent in the operating room.

The second lesson of hierarchy has been under attack in medicine for most of my career. (And do not confuse hierarchy with assholery.  There is no place for assholes in medicine.)  While it is important for all members of a surgical team to be heard and respected, the surgeon remains, as he or she must, the captain of the ship.  Any misadventure in the operating room, regardless of the cause of such misadventure, becomes the surgeon’s problem.  The forgotten epinephrine in the liposuction tumescence solution?  Umm.  The nurse forgot but it’s the surgeon who must deal with the bleeding and explain to the patient why the case was not completed as planned.  The pregnant nurse tripping over the IV pole and sending it crashing onto an asleep patient’s face?  Umm.  It’s the surgeon who assures the patient and his family that nothing was broken and those bruises should fade in a couple of weeks.  That piece of belly button fuzz (ewwwww) missed during the surgical prep?  Umm.  That postoperative wound infection will be the surgeon’s problem.  Thus, the person with the responsibility, the surgeon in the OR and Karla on the trail, must be the person with authority.

The third lesson?  Rest and snacks.  Geeze, I wish I had embraced that concept during my career.  It’s not unusual for a surgeon to operate 4, 6, or even 8 hours without taking break.  It’s truly crazy to work that way considering that a quick break to stretch, down a Megan Rapino or Venus Williams Cliff Bar and a glass of water and a quick trip to the ladies (or gentleman’s) room would only take, really, about 6 minutes assuming there are no fossilized lizard tracks to contemplate. Then, back the surgeon could come to the OR, refreshed and strong.  I’m convinced it would actually speed up the completion of a case.  Typically in a long case, the nurses, techs and anesthesiologist get spelled but not the surgeon. So why, why, why?  It’s a culture thing mostly.  And honestly, it took this backpacking adventure to even put the idea of planned breaks in my head.  If you are a surgeon, young or old or in between, consider taking a break during those long cases.  It won’t make you less badassy than you already are.  Just tell the staff that it’s Karla’s orders.

Thanks for reading!  Dr. Lisa Lynn Sowder (blissfully retired)

I’d be honored if you followed me on Instagram @lisalynnsowder, @sowdermd and @breastimplantsanity.

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Meet Dr. Hakim Said!

May 23rd, 2021 — 8:58am

My last day of surgery was last Friday (5/21/21) and my very last day of practice is June 1st.  My 30 years of private practice have been a pleasure and a privilege.  I thank all of my wonderful patients and my wonderful staff for a great run.

I am very pleased that Dr. Hakim Said will be joining the practice on June 2nd.  He is currently offering consultations and I highly recommend you consider him for your plastic surgery.

My web site will be undergoing a radical pruning in the coming weeks.  I plan to trim it down to my blog which I plan on continuing.  Stay tuned for a wide variety of blog posts now that I have time to pursue my many non-medical interests!

I also plan on continuing my Instagram accounts – @lisalynnsowder, @sowdermd and @ breastimplantsanity.

Onward.  Dr. Lisa Lynn Sowder

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To everything there is a season………………………

December 1st, 2020 — 10:46am

It is with mixed feelings I am announcing my retirement this June, after 30 years of practice.  I know it’s cliche to say that time as flown but it really, really has.  Plastic surgery has offered me everything in a career that I could have asked for.  It allowed a biology geek like me to embrace the science of medicine and surgery and also kept my very restless physical self moving and allowed me the ultimate joy of working with my hands, all while serving a wonderful group of patients and working with incredibly talented staff and colleagues.

Sooo……..if you are a current or past patient, I will be doing my last case in the OR sometime in mid-May.  The office I share with Dr. Shahram Salemy, Madison Tower Plastic Surgery, will be welcoming another plastic surgeon.  This individual will be well trained and experienced and likely taller and much younger and maybe even nicer than me.  Madison Tower Plastic Surgery will maintain all patient records should past patients need access to them.

What about this glorious web site? I know my website is short on style and bells and whistles but have been told many times how helpful the content is.  I have been nurturing my web site for 20 years and it is almost like a child to me. Yeah, I know that’s weird.   I am making the tough decision to whittle my web site down to include only my blog – Notes of a Plastic Surgeon.  I will continue to post on this blog from time to time about all kinds of topics. I suspect my range of topics will expand mightily once I have the time to pursue many interests that have been sidelined during my medical training and career.  I am also planning on keeping my Instagram accounts – @sowdermd, @breastimplantsanity and @lisalynnsowder.

So what’s next for me?  Hmmmmm. I’ll keep you up to date on my blog!

I thank each and every one of you who have supported me in this glorious career!

Dr. Lisa Lynn Sowder

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Happy Thanksgiving

November 24th, 2020 — 10:17am

 

’tis the season of Thanksgiving. 

Here are a few things that this plastic surgeon is thankful for……….

  • Modern Anesthesia.  This makes for painless surgery.  And the surgeon can take her time to do a really, really nice job.  During the Pilgrims’ time, the main qualification for being a surgeon was to be really, really, really fast. Yikes!
  •  The Germ Theory and Antibiotics.  Surgery used to mean infection.  Now surgical infections are rare.  Not rare enough, but rare.
  • The Bovie.  This is the electrical gizmo that seals blood vessels as it cuts.  This is why you don’t need a blood transfusion when I do your Mommy Makeover.
  • Surgical Scrubs.  It’s like working all day in my pajamas.
  • My Dansko Clogs.  It’s like working all day in my slippers.
  • Surgical Loupes.  These are my silly looking magnifying glasses that allow me to see important teeny tiny things like nerves and blood vessels.  They also come in handy for reading the newspaper when I can’t find my reading glasses.
  • My Battery Powered LED Surgical Headlight.  Now I don’t have to be attached to the light source by a fiberoptic tube (which is how my dog must feel on her leash).
  • Power Assisted Liposuction a.k.a. PAL.  This PAL is a true friend.  It makes liposuction so much better for the patient and the surgeon. 
  • My Wonderful Staff and Colleagues.  They keep me on my toes.
  • My Wonderful Patients.  They are why I love coming to work!
  • My Wonderful Husband and Children and Dog and Cat.  They make my life complete, especially the cat.
  • My Freakishly Good Health.  I’m 64 and still running, skiing, biking, and playing tennis.    I’d like to take full credit for this but really I think I’m just lucky. 

Thanks for reading!  Dr. Lisa Lynn Sowder

Now That's Cool, Plastic Surgery

Eddie Van Halen – R.I.P. and thanks for the memories.

October 8th, 2020 — 3:04pm

Eddie Van Halen died  few days ago at the ripe old age of 65.  I’m 64 so that’s hitting pretty damn close to home although his odometer was considerably higher than mine.

I was a resident in general surgery from 1983 until 1988 when Van Halen ruled the airways, even in Salt Lake City where I was living at the time.  Back in those days, it was normal, or even expected, to listen to loud music while operating and Van Halen was the often the band of choice.  And think about what that meant.  There were no smart phones, no iPods, no Pandora or Spotify or even Napster.  In order to rock out to Eddie and the gang one needed a portable CD player and Van Halen CDs.  It took a little effort to set this up but Van Halen was worth that effort.  And don’t think we were all playing air guitar and not paying attention to the task at hand.  There have been studies that have shown that listening to music does not adversely effect surgical outcomes.   I think music actually contributes to the high energy OR vibe, that is unless it is opera which just makes me want to turn that scalpel on myself.

These days I’m older, suffer from tinnitus and listen mostly, on low volume,  to what would be called Roots or Americana but for my OR day tomorrow, we’re gonna stream Van Halen.

Thanks for reading and I would be honored if you followed me on Instagram @sowdermd and @breastimplantsanity.

Stuff I love

From the Wall Street Journal, June 10, 2020

June 11th, 2020 — 10:10am

Thank you for reading.  Be kind.  Stay strong. Dr. Lisa Lynn Sowder

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Breast Lift at the Time of Breast Implant Removal : Is It Safe???

June 1st, 2020 — 9:30am

I saw a patient recently who would benefit a lot from having a breast lift at the time of implant removal and that was what I recommended.  She had read on Dr. Facebook that it was safer to delay the lift.  This launched me into a discussion about the blood supply to the breast, which to a layperson, is a pretty arcane topic.  I had to reveal myself for the lousy visual artist that I am and draw out a diagram of the blood supply to the breast with and without implants.  Later I was able to find a pretty good diagram of the breast with and without an implant and add some red squiggles of my own representing blood vessels.

Let’s walk though it:  The unoperated breast has a very rich blood supply with vessels traveling from the chest wall, through the pec and straight into the breast tissue and also blood vessels traveling more superficially, about 1 cm under the skin surface from the periphery of the breast.

A breast that has an implant or had and implant has a much altered blood supply.  The placement of the implant necessitates division of the centrally located vessels and thus results in a breast that is dependent on the peripheral vessels.  This is not to be regarded as a terrible thing; it’s just a trade off and many surgical procedures also disrupt blood vessels and change the pattern of blood supply (tummy tuck and face lift are two examples).

Trouble arises when a surgeon does not recognize the altered blood supply.  The most common procedure I do which requires deep appreciation of this altered anatomy is when I do a breast lift following removal of a breast implant.  I use a very different technique than I use when doing a lift on a breast that has never had an implant.  See this blog for a step by step explanation of a regular breast lift.  When an implant has been removed, the peripheral vessels must be preserved or the breast tissue, including the nipple, will lose its blood supply and necrose which is a nice way of saying it will die.  When I have just removed an implant, I am on HIGH ALERT in regards to blood supply and also in a position to select the layer of breast tissue that is safe to undermine in order to shape the breast.  This sounds creepy but I can place one hand in the implant pocket and the other on the surface of the breast and judge the thickness of the breast tissue and location of the blood vessels.  In a delayed case where I wait several months for the breast to heal, I cannot do this because the pocket where the implant had been has disappeared and thus there is no way for me to do the one hand in and one hand on trick.  In delayed cases, there will also likely be some scarring and tethering of the tissues that can make safe dissection difficult as well.   The very worse case scenario is if a patient who has had implant removed has a lift by surgeon who is not really mindful of this altered anatomy.  Using a normal breast lift technique would have a very high risk of tissue necrosis.

so, IMHO, doing a lift at the same time of implant removal has some real advantages.  I hope this blog and my fabulous illustration add some clarity. Thanks for reading and I would be honored if you followed me on Instagram @sowdermd and @breastimplantsanity.

Dr. Lisa Lynn Sowder

Breast Contouring, Breast Implant Removal, Breast Implants, Breast Lift

Returning to Elective Surgery in the New World Order of COVID-19.

May 11th, 2020 — 12:41pm

 Washington State is starting to open up following our stay-at-home order.  I am really looking forward to getting back to what I love – taking care of patients.  We have worked very hard along with our national societies and governmental agencies to put in place procedures to keep ourpatients and ourselves as safe as possible.  I am over 60 as are three of our four anesthesiologist and our nurse manager and you will find us here, doing our jobs.  We would be foolish to pretend that there is no increased risk during these times. 

SMALL BUT NASTY

We have put together the following informed consent form for patients during this time.  Like all informed consent forms, it is meant not to frighten but to rather inform patients and remind them that surgery, even elective plastic surgery, is never risk free.  All patients undergoing surgery during this pandemic will be given this form and be required to sign off on it.  And remember, me and my staff are signing off on this increased risk every day we show up for work.  Should you have questions about our protocols, don’t be afraid to ask!  

 

 COVID-19 RISK INFORMED CONSENT

 I                                               (patient name) understand that I am opting for an elective treatment/procedure/surgery that is not urgent and may not be medically necessary.

I also understand that the novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. I further understand that COVID-19 is extremely contagious and is believed to spread by person-to-person contact; and, as a result, federal and state health agencies recommend social distancing.  I recognize that Dr. Shahram Salemy and Dr. Lisa Sowder and all the staff at Madison Tower Plastic Surgery and Madison Tower Surgery Center are closely monitoring this situation and have put in place reasonable preventative measures aimed to reduce the spread of COVID-19. However, given the nature of the virus, I understand there is an inherent risk of becoming infected with COVID-19 by virtue of proceeding with this elective treatment/procedure/surgery. I hereby acknowledge and assume the risk of becoming infected with COVID-19 through this elective treatment/procedure/surgery, and I give my express permission for Dr. Shahram Salemy and Dr. Lisa Sowder and all the staff at Madison Tower Plastic Surgery  and Madison Tower Surgery Center to proceed with the same.

I understand that, even if I have been tested for COVID and received a negative test result, the tests in some cases may fail to detect the virus or I may have contracted COVID after the test. I understand that, if I have a COVID-19 infection, and even if I do not have any symptoms for the same, proceeding with this elective treatment/procedure/surgery can lead to a higher chance of complication and death.

I understand that possible exposure to COVID-19 before/during/after my treatment/procedure/surgery may result in the following: a positive COVID-19 diagnosis, extended quarantine/self-isolation, additional tests, hospitalization that may require medical therapy, Intensive Care treatment, possible need for intubation/ventilator support, short-term or long-term intubation, other potential complications, and the risk of death. In addition, after my elective treatment/procedure/surgery, I may need additional care that may require me to go to an emergency room or a hospital.

I understand that COVID-19 may cause additional risks, some or many of which may not currently be known at this time, in addition to the risks described herein, as well as those risks for the treatment/procedure/surgery itself.

I have been given the option to defer my treatment/procedure/surgery to a later date. However, I understand all the potential risks, including but not limited to the potential short-term and long-term complications related to COVID-19, and I would like to proceed with my desired treatment/procedure/surgery.

 

Thanks for reading and I would be grateful if you followed me on Instagram @sowdermd and @breastimplantsanity.  Dr. Lisa Lynn Sowder

 

 

 

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A must read article about COVID-19

March 19th, 2020 — 1:52pm

Please read this article for some excellent information of COVID-19.  

My office and ambulatory surgery center is shutting down for at least a month.  We will have a skeleton staff answering the phone and I will be available in person for only those who really need a face to face with me.  I am 63 and thus at high risk despite enjoying excellent health and feeling and sometimes acting like I’m 14.  I thank all my patients who have had to reschedule their surgery and I thank everyone who takes this seriously.  And for those who don’t, get a clue already.

Stay safe, stay strong, stay sane, and stay in touch.

Dr. Lisa Lynn Sowder.   Follow me on Instagram @sowdermd and @breastimplantsanity.

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Can Surgery Be A Placebo?????

February 21st, 2020 — 11:45am

A few weeks ago I listened to an excellent Hidden Brain Podcast about placebos and not just the sugar pill kind of placebo.  This podcast recounted an amazing clinical trial done way back in 2002 which put the very common procedure of arthroscopic knee surgery for osteoarthritis to the test.  I will summarize that study here but I really encourage everyone to listen to the podcast.  There are also some links to the original paper published in the New England Journal of Medicine.

In this controlled trial involving patients with osteoarthritis of the knee, the outcomes after arthroscopic lavage or arthroscopic débridement were no better than those after a placebo procedure.

So here we go with my summary:  180 patients with osteoarthritis of the knee were randomly assigned to one of three groups.  The assignments were controlled for severity of disease.

Group 1 : Routine arthroscopic surgery to wash out and clean up any irregularities in the knee joints

Group 2:  The incision was made, the arthroscope was inserted and the knee joint washed out (lavaged) but nothing else was done.

Group 3:  An incision was made but the arthroscope was never inserted.

The patients did not know which group they were in nor did their families or the nurses who cared for them after surgery.   The surgeon and the operating team did not know which procedure the patient would have until the patient was on the OR table and anesthetized and the randomization envelope was opened.  For groups 2 and 3, a video of standard knee surgery was played and the OR team sort of faked the movements of the surgery and the time in the OR was the same for all groups.  One surgeon did all of the cases.  Group 1 is the real operation, Group 2 is the lavage group and Group 3 is the sham procedure.     Now some commentary on this study.  These patients had honest to goodness osteoarthritis of the knee confirmed by history, exam and X-Rays.  This was not a group of patients with ill defined and subjective complaints.  These were patients with objective disease. .

Follow up at two years showed no statistically significant difference in relief of symptoms as reported by the patients or function as measured by walking and climbing stairs between Group 1 (real surgery), Group 2 (lavage only) and Group 3 (sham surgery).   Think about this for a moment……….An arthroscopic clean out of the knee joint had no more effect than a superficial skin incision.  

I remember the reaction to this study when it was published.  At that time I did a lot of my surgery at Seattle Surgery Center and I had the opportunity to hob nob with a lot of orthopedic surgeons.  The ortho bros often teased me for all the unnecessary surgery I do.  Yeah, it’s true.  The vast majority of cases I do are unnecessary.  This study allowed me to tease them about their “scoping for dollars” practices.  I think a lot of scoping for dollars still goes on (mostly because patients request it) but maybe a little less since this paper smacked everyone upside the head.

Isn’t it just amazing what the human mind can do?  It can convince the body that the sugar pill was the real thing or even that the sham surgery was the real thing!

Thanks for reading and really you should listen to this podcast!   And as usual, I would be honored if you followed me on Instagram @sowdermd and @breastimplantsanity.  Dr. Lisa Lynn Sowder

 

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