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

Category: Aging Issues

I’m so sad about Nora Ephron.

June 27th, 2012 — 4:32pm

Seattle Plastic Surgeon wonders how she will survive the rest of her “aging journey” without Nora Ephron. 

I am so sad to hear of Nora Ephron’s death.   I wonder how I am going to survive the next few decades of life without having another pithy Nora Ephron book to make me laugh out loud about the adventures and misadventure of making the transition from youth to middle age to older to old.   I am hoping to hear in the next few days that Nora was finishing her book about the ultimate transition at the time of her death.  If anyone could make that funny, it would be Nora. 

I’ve enjoyed Nora’s writing for decades, but it’s really been since I became a “woman of a certain age” myself that I have truly appreciated her wonderful take on this journey of life and her wise wit (or maybe it’s witty wisdom).

I Feel Bad About My Neck and I Remember Nothing are her most recent books and I devoured both of them in one sitting.  I read I Remember Nothing on a flight from Seattle to Boston and I’m sure the dudes on either side of  me thought I was off my meds.  Can anything other than a Nora Ephron book  make flying coach, middle seat, so much fun?  I think not.

Rest in peace Nora and thank you for the laughs and tears and your amazing humor and humanity.  I’m going to load all your books onto my Kindle and read them – again. 

Lisa Lynn Sowder, M.D.

Aging Issues, Highly Recommended Reading

Fear not the big black snake.

April 2nd, 2012 — 2:08pm

Are you over 50?  Have you had your colonoscopy?  If you answer “yes” to the first question but “no” to the second, you need a good spanking.

Today I saw a patient in my office for a cosmetic procedure.  I couldn’t help but notice in his health history that he had had colon surgery.  I asked him about the details and here’s his story.

He knew he should get a screening colonoscopy at age 50 but he kept putting it off – and off – and off.  Finally at age 54 he succumbed to his wife’s “nagging” and finally went in.  Guess what the doctor found?  A couple dozen polyps and a rectal cancer.  He had been totally without symptoms despite having a half dollar sized cancer just beyond the reach of a finger during his yearly rectal exam. 

He had part of his rectum removed but did not need a colostomy and now 5 years later is disease free.  Had he procrastinated another year or two, his outcome could have been much, much worse. 

I’m here to tell you, it’s not that bad.  The preparation is a little unpleasant and I was famished by the time they were starting my IV to knock me out but really, it was just one day off of work and a full ten years of peace of mind.  I also had several weeks of basking in my handsome doctor’s praise of my  “absolutely pristine”  colon.

Read more here about early dectection of colorectal cancer and fear not the big black snake (my term of endearment for the colonoscope).  There are things you should fear a whole lot more – colorectal cancer come to my mind.

Thanks for reading!   Dr. Lisa Lynn Sowder

Aging Issues, General Health

Breast implant removal and breast lift – one of my favorite ways to spend a morning.

January 24th, 2012 — 10:23pm

Seattle Plastic Surgeon warns women of a certain age:  Breast implants that made you look voluptuous 20 years ago may  be making you look matronly today. 

I think she has crossed the line to matronly. Implant removal and a breast lift can take a lot of bulk off the chest and years off the postmenopausal figure.

 Recently I have had several ladies come in with implants that are no longer enhancing their figures.  These ladies are all  several years postmenopausal and even without overall weight gain, have added a cup size or two to their chests.  This is often how weight redistributes after menopause.  Don’t ask me why.  It just happens. 

In these cases, it is often beneficial to remove the breast implants and do a breast lift.  Many, many of these patients have enough breast tissue to leave them with a B, C or even D cup.  And to think that they started out flat chested so many years ago!  Crazy, huh?

Doing implant removal and a lift unloads the chest and makes the torso look much slimmer (much the way a breast reduction does in a lady who carries some extra weight around the middle).  These patients are often just thrilled to look slimmer and have their breast be “the real thing” after having implants for so many years. 

Also, since implants don’t last forever, removing them provides a lot of peace of mind.  Very few ladies over 60 relish having a new set of implants and then thinking about another new set at 80!

Now if I could just figure out a cure for the postmenopausal weight redistribution, I could retire and buy that little island in the Caribbean. 

Oh, never mind.  I love my job and I’m sure I would be bored to death.

Thanks for reading.  Dr. Lisa Lynn Sowder

Aging Issues, Breast Contouring, Breast Implant Removal, Breast Implants, Breast Lift, Plastic Surgery

For middle aged dudes with mustaches – looking younger almost instantly.

January 13th, 2012 — 12:12am
Mustache dye job seen by Seattle Plastic Surgeon

No surgery, no pain, and the cost of a few lattes.

Anyone for immediate gratification?  Seattle Plastic Surgeon discovers youth in a bottle for middle aged dudes with mustaches. 

Okay, check this out.

This is a gentleman who came in for a scar revision on his forehead.  When he came in for his post-surgical photos, I was stunned with how much younger he looked.  It took looking at his pre surgical-photos for me to put a finger on what was different.

It was his mustache.  He had dyed it with the help of his girlfriend and honestly, I think it took a good ten years off of him.

I wish I could have attributed his youthful visage to my fabulous surgical skills but could not.  It was his resourceful and clever lady friend and the patient’s openness to this little over the counter tweek.  Good for both of them.

My husband sports nothing but a 5:00 shadow but if he ever grows out his salt and pepper stubble, I know what I will be recommending!

Thanks for reading!  Dr. Lisa Lynn Sowder.


Aging Issues, For Men Only, Non-invasive, Now That's Cool

Agressive Skin Care + Enough Filler = GREAT RESULTS

December 14th, 2011 — 10:25pm

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

Seattle Plastic Surgeon, Facial filler, skin careTop photo before treatment. After photo is after agressive skin care and HA filler over a nine month period.

I saw this patient recently who I have been treating with aggressive skin care and HA fillers (eg Restylane, Juvederm, Perlane, Prevelle) over about 9 months.  She has been very, very dedicated to her skin care program and I’ve been very, very dedicated to injecting her with filler where she needs it and, as mentioned in a previous blog, using enough to really filler ‘er up.

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?????

Fat transfer followed by a deep chemical peel could have achieved this result but no face lift, I repeat, no face lift could have achieved this sort of improvement.

Yes, she will need continued skin care and will need to come in every year or so for some more filler but remember, this is all with no down time and very, very little pain and suffering.

And just remember all of those things we do that also need maintenance – hair, nails, legs, bikini line (ouch),  eyebrows, etc.  Oh yeah, and how about getting your teeth cleaned every 6 months.  No down time but talk about pain and suffering!

Thanks for reading!  Dr. Lisa Lynn Sowder

Aging Issues, Facial Fillers, Facial Rejuvenation, Non-invasive, Skin Care

“Hand Lift” – What a BAD Idea

December 13th, 2011 — 10:33pm

Top shows the back of the hand before fat transfer. Bottom shows the back of the hand after fat transfer.

Seattle Plastic Surgeon just can’t keep her opinion about this poorly thought out procedure to herself. 

I read several plastic surgery journals every month and more often than not I think, “Now there is a good idea”.  But this month I read an article about using a “hand lift” for hand rejuvenation and I thought, “Now there is a really, really bad idea”.

 A “hand lift” involves excising some of the loose skin at the level of the wrist and pulling the skin on the back of the hand tighter.  Yikes!  This not only leaves a significant scar on a very visible area of the wrist but also makes the skin too tight when making a fist.  And it doesn’t help the quality of the skin itself. 

The problem with the idea of a “hand lift” is that it does not address the real problems with aging of the hands.

So what was this plastic surgeon thinking when he thought up this operation?????   My guess is that he did not know how to perform fat transfer to the hand which is a procedure that I think is really, really great.  Fat transfer addresses some of the real problems with aging of the hands: deflation because of loss of fat and deterioration in skin quality. 

With fat transfer to the hand, fat is harvested from the patient where there is a relative excess (usually the belly or the hips).  The fat is purified and then injected into the back of the hand in teeny, tiny parcels.  The fat does a couple of things.  First of all, it plumps up the hand that has lost fat over the years and second, it really improves the quality of the skin.  Just take a look at these close up photos.  Not only are the veins less prominent after fat transfer, the fine lines are much, much smoother and the color of the skin is better.  These changes are likely due to the stem cells that are in the fat.  This change in skin quality is seen in other areas when fat is transferred to the layer just under the skin.   This stem cell effect is a very, very hot topic and is being investigated by several large plastic surgery institutions.

Soooo, if you don’t like the way your aging hands look, don’t get a “hand lift” but consider fat transfer instead.  There are no long scars and recovery is usually quite rapid and almost painless and the improvment is long lasting.

Thanks for reading!  Dr. Lisa Lynn Sowder


Aging Issues, Fat Injection, Hand Surgery, New Technology, Now That's a Little Weird, Now That's Cool, Plastic Surgery

Fill ‘er up for higher patient satisfaction.

November 16th, 2011 — 12:48am
Seattle Plastic Surgeon recommends full tank for HA fillers

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

Aging Issues, Facial Fillers, Lip Enhancement and Augmentation, Nasolabial Folds, Non-invasive, Plastic Surgery, Skin Care

Let’s hear it for late bloomers!

August 17th, 2011 — 5:35pm

Seattle Plastic Surgeon Blogs About Trees and Mommy Makeovers – Again.

I returned from my two weeks away on Sunday night after dark.  The next morning as I was getting into my car, I caught the most lovely scent wafting across my drive way.  Lo and behold, our harlequin glorybower tree had bloomed while I was away.  This lovely little late bloomer does a good impression of being dead until late spring and then slowly leafs out and just when everything else in the garden is looking a little boring, tah dah, it bursts into bloom with the most lovely pink blossoms that then turn this otherworldy red and colbalt blue.  It  scent is heavenly for weeks. Come late fall, the leaves turn a purpilish orange  and if you crush them, they smell like peanut butter!

So what on earth does this have to do with plastic surgery?

Well, my first day back I saw a lady who described herself  as a late bloomer.    She’s forty-something and just sent her youngest off to college.  After years of taking care of her family, she’s ready to do a little something for herself, in this case a mommy makeover.  This is something she has wanted to do for years but with a busy household to run,  never had the time for the surgery or the recovery.    Now she’s finally has the time to bloom.

Thanks for reading,  Dr. Lisa Lynn Sowder

Aging Issues, Body Contouring, Gardening, Mommy Makeover, Plastic Surgery

Can’t call it “Sunblock” anymore.

June 15th, 2011 — 9:42pm

Seattle Plastic Surgeon discusses sun block and sun screen lingo.

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.  Dr. Lisa Lynn Sowder

Aging Issues, Government and Politics, Skin Care, sun damage

Yuck! What are these things?

June 14th, 2011 — 5:27pm

Seborrheic Keratosis – looks bad but is totally harmless

Seattle Plastic Surgeon discusses icky but harmless skin lesions.

I just finished treating a lovely middle aged lady with about 20 of these unsightly skin lesions on her back.  Since she turned 50,  they have been popping up like mushrooms in our wet Seattle. 

These nasty looking lesions are seborrheic keratoses and despite their looks, they are totally harmless. 

Most patients who develop seborrheic keratoses are over 50 and most have a family history.  They usually develop in sun exposed areas but not always. 

There are several ways to treat these.  My treatment of choice is to numb up the area with local anesthetic and then scrape the lesions off with a curette and then zap any little areas of oozing with an electric needle.  It takes about 7 – 10 days for the areas to heal, depending on the size of the kertosis.  The really nice thing about treating these is that the treated area usually heals with minimal scarring.  Removal of seborreic keratoses does not require going all the way through the skin layers.  Usually I just have to go into the middle layer of the skin and that accounts for the fairly rapid and scarless healing. 

One big work of caution.  Do not have these treated unless you can spend a couple of months without sun exposure to the area.  UV radiation can turn the healing area brown and then you just end up with a brown scar where the brown spot used to be.  Rather counterproductive.  The lady I treated today won’t be exposing her back until next winter when she goes to Hawaii.  Perfect timing.

SOOOO – if you have some of these nasty little spots that bother you (or anyone who has to look at them), give my office a call and we can set up a time to remove them.  Fall is the best time because then you have a whole 6 – 9 months before any worry about sun exposure. 

Thanks for reading!  Dr. Lisa Lynn Sowder

Aging Issues, General Health, Now That's a Little Weird, Plastic Surgery, Skin Care

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