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: Body Contouring


Brazilian Butt Lift – A Dire Warning.

July 19th, 2018 — 9:29am
This is an email I received last week.  I want to share it here.  Please pass it along to anyone who may be considering a Brazilian Butt Lift:

Not worth dying for.

URGENT WARNING TO SURGEONS
PERFORMING FAT GRAFTING TO THE BUTTOCKS
(Brazilian Butt Lift or “BBL”)
This urgent advisory is in response to the alarming number of deaths still occurring from the Brazilian Butt Lift (BBL).The Multi-Society Task Force for Safety in Gluteal Fat Grafting (ASAPS, ASPS, ISAPS, IFATS, ISPRES), representing board-certified plastic surgeons around the world, recently released a practice advisory). Additionally, the Task Force is conducting anatomic studies to develop specific technical safety guidelines.Since the release of the practice advisory, deaths from this procedure continue to be reported. The unusually high mortality rate from this cosmetic procedure is estimated to be as high as 1:3000, greater than any other cosmetic surgery.

The cause of mortality is uniformly fatal fat embolism due to fat entering the venous circulation associated with injury to the gluteal veins. In every patient who has died, at autopsy, fat was seen within the gluteal muscle.

In no case of death has fat been found only in the subcutaneous plane.

The Task Force has therefore concluded that: FAT SHOULD NEVER BE PLACED IN THE MUSCLE. FAT SHOULD ONLY BE PLACED IN THE SUBCUTANEOUS TISSUE.

If the desired outcome might require another procedure, then manage the patient’s expectations and discuss the possibility of staging (as often done with fat injections, hair transplants, etc.)

IT IS EASY TO UNINTENTIONALLY ENTER THE MUSCLE DURING SUBCUTANEOUS INJECTION.

Therefore, stay mentally focused, alert, and aware of the cannula tip at every moment; be vigilant about following the intended trajectory with each stroke and feel the cannula tip through the skin. Consider positioning that can favor superficial approaches, such as table jackknife. Use cannulas that are resistant to bending during injection and recognize that Luer connectors can loosen and bend during surgery.

The risk of death should be discussed in your informed consent process, along with alternative procedures (such as gluteal implants or autologous flap augmentation).

No published series of BBLs done with intramuscular injections is large enough to demonstrate it can be done without the risk of fat embolism.

The subcutaneous plane has not been linked to pulmonary fat embolism. Until and unless data emerges that intramuscular injections can be done safely, the subcutaneous plane should remain the standard.

Fat injected into the subcutaneous space cannot cross the superficial gluteal fascia and migrate into the muscle; therefore, any intramuscular fat found at autopsy can be concluded to be the result of injection into the muscle.

Surgeons wishing to continue performing this procedure should strictly adhere to these guidelines. The Task Force is actively performing anatomic studies. and more specific technical guidelines will be forthcoming. We need to dramatically improve patient safety with this procedure through careful technique, or reconsider whether the procedure should still be offered. Patient safety is the number one goal of board certified plastic surgeons across the globe.

Sincerely,

 

Dan Mills, MD
Gluteal Fat Grafting Task Force co-chair
J. Peter Rubin, MD
Gluteal Fat Grafting Task Force co-chair
Renato Saltz, MD
Gluteal Fat Grafting Task Force co-chair
Co-Chairs
Multi-Society Task Force for Safety in Gluteal Fat Grafting* The information in this Advisory Statement while setting forth the strong recommendations of the Task Force, should not be considered inclusive of all methods of properly performing buttock augmentation with fat transfer or as a statement of the standard of care or as a mandate to strictly follow the recommendations of the Task Force.This Advisory Statement is not intended to substitute for the independent professional judgment of the treating plastic surgeon nor for the individual variation among patients.The Members of the Multi-Society Task Force and the participating societies assume no responsibility or liability for injury arising out of any use of the information contained in this Advisory Statement.** The Inter-Society Gluteal Fat Grafting Task Force represents leading clinical plastic surgery societies, including the American Society of Plastic Surgeons (ASPS), the American Society for Aesthetic Plastic Surgery (ASAPS), and the International Society of Aesthetic Plastic Surgeons (ISAPS). Additionally, two scientific societies, the International Society of Plastic & Regenerative Surgeons (ISPRES) and the International Federation for Adipose Therapeutics and Science (IFATS) are represented and provide scientific support. The efforts of the Task Force build upon a foundation of important work by the Aesthetic Surgery Education and Research Foundation (ASERF), the American Society of Plastic Surgeons (ASPS) Regenerative Medicine Committee, and the International Society of Aesthetic Plastic Surgery (ISAPS) Patient Safety Committee. The Task Force is an unprecedented collaborative effort to address a major patient safety concern, investigate factors that lead to increased risk with gluteal fat grafting, perform scientific studies to improve safety, and educate plastic surgeons.

 

I have been a member of the American Society of Plastic Surgeons (ASPS) and the American Society for Aesthetic Plastic Surgery (ASAPS) for many, many years and do not recall any advisory with the strong wording of this one.  I abandoned intramuscular injection a couple of years ago when the news of deaths from this procedure came trickling in.  I suspect all ASPS and ASAPS members will follow this advisory.  My concern is that many surgeons who do this procedure are not board certified plastic surgeons and therefore not eligible for ASPS and ASAPS membership.  I hope they get this message and change their techniques.  I have seen a few Instagram posts and videos of butts being pumped up to the max that make my head spin and my backside ache.  The only true way to put this dangerous procedure in the rear view mirror is for patients to stop asking for it.  There are docs (and non-docs) out there who will do just about anything if the patient is willing to take the risk.  That Kim Kardashian butt is not worth dying for!

Thanks for reading and please follow me on Instagram @sowdermd and @breastimplantsanity.  

Dr. Lisa Lynn Sowder

Body Contouring, Fat Injection, Patient Beware, Patient Safety

The truth about plastic surgery chains.

March 22nd, 2018 — 9:57am

I came across this well written article by plastic surgeon Jennifer Greer on www.Kevinmd.com.  I think it provides some good information about plastic surgery chains like Lifestyle Lift (out of business for a few years now) and SonoBello which appears to be expanding.  If you haven’t heard the SonoBello jingle you must never listen to the radio.  According to a recruiting letter I received from them today, SonoBello spends $75K – $100K per month on TV infomercials, radio ads and internet marketing in each market.  That is one ginormous advertising budget!  Anyway I don’t work for any of these chains mainly because I think they provide less personalized and inferior care compared to a private office like my own and I have a visceral disgust of high-pressure sales tactics.  Oh, and I’ve reviewed the records of three SonoBello deaths in the Pacific Northwest, one for a news organization and two for attorneys.   Anyway, the author of this article works both for herself and for a couple of years worked for a chain that sounds like SonoBello.  Here is her advice to prospective patients based on her experience.

One day? Really? I don’t think there is a single procedure I do where patients look their best after one day.

 Over 17 million cosmetic surgery and minimally invasive procedures were performed in the U.S. in 2016. With the increasing popularity of cosmetic procedures, it seems nearly everyone is out to get a bite of the apple.

Cosmetic surgery chains are growing in size and popularity in an attempt to cash in on this market. Examples include: LifeStyle Lift in the U.S., which declared bankruptcy in 2015 and Transform in the U.K. With this growing popularity, consumers should ask themselves whether having surgery at a cosmetic surgery chain is a good idea. Today, I’m going to explain what to look for during your cosmetic surgery consultation and what you should stay far away from.

The first red flag to watch out for is high-pressure sales tactics. If you check websites such as ConsumerAffairs.com and the Better Business Bureau, you’ll find this is a common complaint about cosmetic surgery chains. High-pressure sales tactics may include:
  • Requiring you to put money down before you ever meet a physician.
  • Pressuring you to make a decision that day.
  • Insisting on applying for a loan at your initial consultation.
  • Offering a special “limited time” discount.

High-pressure sales can occur at both a private practice and at a cosmetic surgery chain. Regardless of where you encounter them, they are a huge red flag. As a consumer, you want a doctor who is focused on providing the best care possible, not on meeting a revenue goal. Focusing on money over patient care can lead to some scary medical decisions, like operating on people who really aren’t healthy enough to have surgery.

The second red flag to watch out for is misleading statements about pain during and after surgery. LifeStyle Lift had many complaints that their advertising gave the impression the procedure was quick and the recovery painless. In reality, the procedure lasted three hours or longer, and the downtime afterward was about two weeks. When you see a surgeon for a consultation, she or he should tell you what the average experience is like, as well as best and worst-case scenarios for recovery time. If this part is glossed over in your consultation, alarm bells should be going off in your head.

The third red flag you should watch out for is a surgery center or physician that only offers a very limited number of procedures. The center I worked at did liposuction, but no tummy tucks or skin removal. So if you were looking for a flatter stomach, they would only be able to offer you liposuction, even if you would get a better result with a tummy tuck. This is where the high-pressure sales comes into play again as well; if you have a sales person who needs to meet sales goals, that person is highly motivated to sell you his or her product, regardless of whether it’s actually the best option for you.

The fourth and final red flag to watch out for is the safety of the facility. Hospitals have the strictest oversight for patient safety, followed by surgery centers. But if surgery is performed with only oral medication, it can legally be done in an office that has no type of accreditation. This doesn’t mean having surgery isn’t necessarily safe, but you do want to ask what happens if there is an emergency, and how the staff are trained to deal with that. You also want to ask your surgeon if he or she has privileges to do your surgery in a hospital; non-plastic surgeons usually cannot get privileges to perform cosmetic surgery procedures such as liposuction in a hospital because they don’t have the training. If your surgeon only operates in an office or surgery center, this is a red flag that he or she is not board-certified in plastic surgery.

In my experience working for a cosmetic surgery chain, I was able to give patients some fantastic results. And I myself had a safe procedure by a surgeon I trust. But I think there is a huge difference in the mindset between a physician in private practice and a corporation. Physicians go into medicine because we want to help people, first and foremost.

Corporations exist to make money. Although there are certainly exceptions in both groups, I hope you can use the information I’ve given you to ensure you have a safe surgery experience wherever you go.

Jennifer Greer is a plastic surgeon and can be reached at Greer Plastic Surgery and on Twitter @greerplastics.

Thank you Dr. Greer for giving us a little inside view and some very good advice.  Dr. Lisa Lynn Sowder

Body Contouring, Liposuction, Patient Beware, This Makes Me Cranky.

Silicone injections are deadlier than ever.

March 13th, 2018 — 2:34pm

Silicone has quietly become beauty’s own modern-day scourge. Here’s what you need to know about the infamous injectable.

From Haper’s Bazaar, January 30, 2018 by

We often write about—and unapologetically enjoy receiving—popular cosmetic injections, like line-relaxing Botox and hyaluronic acid fillers. Thankfully for our foreheads and lips, the FDA has deemed these injectables safe and effective. And we trust our board-certified dermatologists and plastic surgeons to administer these treatments 100 percent appropriately.

Marilyn Reed is spending 8 years in prison for her buttock enhancements done with industrial grade silicone and a calking gun. Her patients didn’t get off so easily.

But a disturbing number of news reports have surfaced detailing unlicensed providers injecting all kinds of life-threatening stuff—from industrial silicone to lamb fat—with the goal of Kardashianizing women on the cheap. The FDA issued a safety alert late last year warning the public of the catastrophic risks involved with liquid silicone injections in particular.

All over the country, “people are dying from these shots,” said Beverly Hills liposuction surgeon Aaron Rollins, echoing statements in the FDA alert. Silicone, a permanent synthetic substance, is not FDA-approved for cosmetic purposes, but since it was greenlighted in the 1990s for certain uses in ophthalmology (serious stuff, like retinal detachment), injecting it into the skin to plump and fill lips, breasts, and butts is technically considered “off-label”—i.e. not illegal.

Still, the insidious goo is an infamous troublemaker. “I wouldn’t touch it with a ten-foot pole,” adds Rollins. “It may look good at first, but over time, the body forms scar tissue around it, so the injected area keeps growing and growing, as the silicone weaves its way into your tissues, becoming lumpy and hard, and nearly impossible to remove.”

Subtract an experienced injector from the equation, and silicone goes from dicey to deadly. “You hear about these so-called pumping parties at hotels, where unlicensed doctors visiting from other countries are injecting patients with massive doses of silicone,” says Dr. Clyde Ishii, president of the American Society for Aesthetic Plastic Surgery (ASAPS). “They’re literally buying it from Home Depot or Lowe’s,” he explains, “because it’s so much cheaper and easier to get than medical-grade silicone.” To lower their cost even more, some of these unlicensed doctors mix in toxic filler-type materials, like cement and motor oil, says Miami dermatologist Manjula Jegasothy. “Even in Beverly Hills,” notes Rollins, “there are people using caulk guns to inject stuff into women’s bodies, and tragic things are happening.”

It’s not uncommon for these unlicensed practitioners—inexperienced with human anatomy—to inadvertently shoot silicone into a blood vessel. And when they do, it can travel to the heart or lungs, blocking blood flow, and causing sudden heart attacks and strokes. The risk is especially high when injecting the vascular buttocks. Yet, for some, silicone’s price tag is just too good to pass up. According to Atlanta plastic surgeon Wright Jones, “Silicone butt injections may cost a tenth of the price of a legal gluteal enhancement using one’s own fat”—which is currently regarded as the most effective way to boost a backside. A Brazilian Butt Lift, using liposuction and fat transfer, can cost upwards of $10,000.

In light of the recent wave of silicone horror stories, and with butt augmentation fast becoming one of the most popular plastic surgery procedures in the U.S., not to mention a burgeoning business for untrained injectors, the Aesthetic Surgery Education and Research Foundation (a division of ASAPS) felt compelled to publish a safety protocol for gluteal fat grafting in the current issue of the Aesthetic Surgery Journal.

That’s not to say fat is the only safe solution for a shapeless bottom. Many dermatologists and surgeons do use FDA-approved cosmetic fillers “off-label” here— to either produce an immediate, yet temporary, lift from hyaluronic acid gels; or a gradual, long-term improvement from the collagen-stimulating Sculptra (which is currently only approved to soften the appearance of nasolabial folds). But such shots can be wildly expensive.
Which brings us back to silicone and its unfortunate recipients, many of whom are millennials, says Jones. At age 22, Heather*, a model in Los Angeles, visited a Koreatown medical spa for silicone butt injections. “I was booked to do a big photo shoot, and wanted my bum to look perkier,” she says.

About six months later, she noticed several golf ball-size lumps in her bottom, a common side effect of silicone. On the advice of a trusted friend, Heather says she went to see Rollins, who was able to camouflage the hills and valleys by liposuctioning fat from her arms and injecting it into her butt—an $8,000 fix.

Lips have long been another hot spot for silicone. Tired of having to draw on a juicer pout each morning, Madeline paid $50 to have her lips injected with silicone in a salon basement in Queens when she was 26 years old. Now 40, she says, “I feel like I messed up my mouth for the rest of my life.”

The size and shape of her lips change daily, often with the weather. “Usually in summer [the silicone] lays okay, but in the colder months, it moves around a lot, and concentrates in one area, bulging out.” To have her smile repaired will cost roughly $10,000, she’s been told, and surgeons can’t promise a total improvement.

Cosmetic injections should only be performed by board-certified dermatologists or plastic surgeons. If your injector is not, ask thorough questions about their training and experience. How many years have they been injecting patients? What formula are they using? If you’ve found the injector through a bargain website or coupon—the deal is likely too good to be true. The bottom line: Heed the warnings. “Don’t allow silicone into your body—ever,” says Rollins. At best, “you’ll be buying a problem for the rest of your life.”

Now a word from Dr. Sowder:  The above article is very well written and is not, I repeat, is not alarmist.  People are dying from these injections and others are being maimed for life.  I have taken care of a couple of ladies who had silicone injected into their breasts in Asia and cleaning this up is such a mess.  Whenever I hear about another silicone injection disaster, usually done by a non-physician in some hotel room, I just shake my head.  I mean, really, how dumb can you be?  I do not endorse blaming the victim but in cases like this I think the person allowing a charlatan to inject their butt or breast with silicone bears some responsibility.  Those on the other end of the calking gun need to go to jail and many in fact have.  The lesson here is that you get what you pay for.

Kudos to Ms. Edgar for a cautionary tale and to Harper’s for publishing it.  Thanks for reading and don’t let anyone get near you butt or breast with a calking gun!  Dr. Lisa Lynn Sowder

 

Body Contouring, General Health, Patient Beware, Patient Safety, Plastic Surgery, This Makes Me Cranky.

Ten common misconceptions about liposuction

January 30th, 2018 — 9:33am

If you look like this, you don’t need liposuction!

Taken from an article by Dr. Wayne Carman for online American Society of Plastic Surgeons from January 30, 2108

Liposuction is one of the most frequently performed cosmetic surgical procedures in the United States and around the world. This is somewhat surprising, considering how many misunderstandings about it persist. Listed below are the ten most common liposuction misconceptions we hear as plastic surgeons, and what the actual facts are.

Liposuction can help you lose weight

The reality is that most patients only lose about two to five pounds in total. The best candidates, in fact, are generally within 30 percent of a healthy weight range and have localized fat pockets they would like to reduce.

Liposuction can treat cellulite

Cellulite is not simply an irregular pocket of fat – it occurs when subcutaneous fat pushes connective tissue bands beneath the skin, causing those characteristic dimples and bumps. Because liposuction is only able to remove soft, fatty tissue (and does not directly affect the skin or other tissues), the fibrous connecting bands causing cellulite are not altered.

Liposuction is not for “older” people

Any patient who is in good health and has had a positive medical examination may safely receive liposuction. A lack of firmness and elasticity (both of which commonly decrease with age) may compromise the skin’s ability to re-drape over newly slimmed, reshaped contours. Poor skin quality is one of the main contraindications to liposuction.

Liposuction is dangerous

While every surgery carries an element of risk, liposuction techniques have become increasingly sophisticated. If performed by an experienced and board-certified plastic surgeon, and if the patient follows all appropriate postsurgical instructions, liposuction can be as safe and successful as any other surgical procedure.

Liposuction will fix lax skin

The appearance of a double chin or a heavy tummy may involve some degree of sagging skin with reduced elasticity, as well as excess fat. In such cases, your surgeon may recommend a skin tightening procedure instead of (or in conjunction with) liposuction, as liposuction alone may result in a deflated appearance.

Fat deposits removed will return after liposuction

Liposuction is “permanent,” in that once the fat cells are suctioned out, they will not grow back. However, there will still be some remaining fat cells that can grow in size and expand the area if one’s calorie intact is excessive. The best way to prevent this is to maintain a healthy diet and exercise regimen.

Liposuction is the “easy way out”

As mentioned earlier, liposuction is not a weight loss method, and maintaining ideal postsurgical results should include a general commitment to a healthy lifestyle. Liposuction (or any other body contouring method, for that matter) is targeted to streamline and contour localized areas – ideally, in someone who is within a healthy weight range.

You can get back to your routine right after liposuction

While relatively safe and frequently performed on an outpatient basis, every surgical procedure entails a recovery period, and liposuction is no exception. The most common after-effects include swelling, bruising, and soreness at and around the treatment areas. While the healing process varies from patient to patient, most should plan to take at least a week off work to rest and recover. It may be four to six weeks before a patient can resume strenuous activity or exercise.

Liposuction is only for women

Men frequently request liposuction – in fact, it was one of the top five most popular cosmetic surgeries American men received this past year, according to ASPS statistics. Common areas for treatment include the abdomen, love handles and chest.

Liposuction is always the answer to belly fat

Liposuction targets only subcutaneous fat – the kind that is located below the skin and above the muscle. An abdomen that protrudes due to fat under the muscle and around the internal organs (known as visceral or intra-abdominal fat) will not be improved with liposuction. Appropriate exercise and diet are the only effective methods to combat visceral fat.

Thanks for reading.  Follow me on Instagram @sowdermd and @breastimplantsanity.

Dr. Lisa Lynn Sowder.

Body Contouring, Liposuction

Autumn Is the Best Season for Liposuction

October 23rd, 2017 — 12:07pm

Thinking about liposuction?  Autumn is the time to come in for a consultation.

blog atumn

When the leaves start to fall, think of body contouring surgery.

I love this time of year.  The air is crisp.  The leaves are a riot of color.   And best of all – my children are back in school!  Autumn is a great time to curl up with a nice cat and a good book and savor the season.

Autumn is also a great time to have body contouring and here is why:  Body contouring procedures always require wearing post surgical compression garments for several weeks after surgery.  And one area in particular – the calves and ankles -require compression stockings for up to three months after surgery.  See this previous blog on cankle liposuction.

The compression garments we use are fairly comfortable and patients get used to them (or sometimes even fall in love with them in a kind of Stockholm Syndrome way) but they are warm and wearing these garments in the summer is something I do not recommend.  Yes, patients have body contouring surgery in the summer but they can be pretty uncomfortable even in temperate Seattle.

So if you are thinking of looking better in those spring and summer fashions, plan ahead and consider having your body contouring surgery now.  Call for a consultation:  206 467-1101.

Thanks for reading!  Dr. Lisa Lynn Sowder

Body Contouring, Liposuction

Tummy tuck t-incision.

October 9th, 2017 — 9:39am

This patient had more muscle laxity that skin laxity. Here she is at 3 months with a very flat tummy. Her scar will fade with time.

I just love doing tummy tucks because this procedure allows me to tighten skin, fix muscle position, remove fat and improve a belly button in one operation.   Usually this can be done with an incision that is admittedly quite long but is where the sun doesn’t usually shine.  But sometimes, maybe 10% of cases, it is necessary to leave a scar in the lower mid-line.  Sometimes a patient really needs a full tummy tuck to correct muscle separation but doesn’t have quite enough skin laxity of remove all of the skin between the pubis and the belly button and in those cases a “t-incision” is necessary.  In most cases, I have a pretty good idea before surgery if I am going to need a t-incision but once in a while I cannot quite get that skin to stretch enough and have to leave a t-incision without prior warning to the patient.   This occurred recently and I had a husband hopping mad at me for the extra scar.  The alternative would have been to make the abdominal skin closure so tight that the patient would never be able to stand up straight again or position the really long horizontal scar quite high which would probably look worse than a nicely healed t-incision.

These intraoperative decisions are very, very difficult and sometimes, quite frankly, agonizing.  I am hoping that this particular patient heals well and her vertical scar becomes a non-issue as is usually the case.  And sometimes I just wish patients and their families could spend a day in my operating room clogs.  It’s not so easy!

Thanks for reading and letting me get that one off my chest!  Dr. Lisa Lynn Sowder

Follow me on Instagram @somdermd and @breastimplantsanity

Body Contouring, Tummy Tuck

MOMMY MAKEOVER A.K.A. MATERNAL RESTORATION

May 14th, 2017 — 7:00pm

motherhoodSeattle Plastic Surgeon Discusses Mommy Makeover on Mother’s Day

Ah, the joys of motherhood! I can wax eloquently about fat little feet, apple cheeks, wet baby kisses and so on but one of the joys I did not expect was a boost in my Plastic Surgery practice, especially my “mommy makeover” patients. Since becoming a mother myself, I speak “mommy” really well. I know first hand the glorious details of feeding, bathing, changing, and schlepping the baby. I can recite the stages of the toddler, the preschooler, the gradeschooler, the tween, the teenager and currently I am becoming an expert on the joys of being the mother of young adults.  

Being familiar with all that being a mother requires makes me much better at counseling patients about the process and timing of a “mommy makeover”.

“Mommy makeovers” usually combine breast surgery (augmentation and/or lift or reduction) with body surgery (usually abdominoplasty and/or liposuction). Most women are healthy enough to have a combination of procedures during one operative session. It is, however, the first couple of post operative weeks that are the most challenging for the patient.

Mommy is used to taking care of everyone but herself. After surgery the Mommy needs to take of only herself. She needs to be “Queen for a Week or Two” and resist the urge to cook, clean, change, wipe, mop, vacuum, load, unload, fold, etc. And if her youngest weighs over 20 pounds, she may not pick him/her up for at least two weeks if breast surgery was done and for at least six weeks if an abdominoplasty was done. The little one can crawl into Mommy’s lap for a cuddle but NO HEAVY LIFTING for Mommy. This also applies to the dog.

It’s very important to for patients to discuss these issues with their families. I’ve had a few ladies who have underestimated their recovery time, have done too much too soon and have turned what should be a relatively comfortable and relaxing recovery into a very sore and frustrating one.

So, calling all mothers interested in a “mommy makeover”: Plan ahead and get your husband and your children and your friends on board. Make a sign for your bedroom door. “DO NOT DISTURB – MOMMY RECOVERING”.

Body Contouring, Breast Contouring, Breast Implants, Breast Lift, Breast Reduction, Mommy Makeover, Plastic Surgery

FAQ: If I gain weight after liposuction, where will the fat go?

September 2nd, 2016 — 9:43am

Seattle Plastic Surgeon answers common Liposuction FAQ:  Where will the fat go if I gain weight?

Before hip liposuction, after hip liposuction, after significant weight gain. It's not pretty.

Before hip liposuction, after hip liposuction, after significant weight gain. It’s not pretty.

This is one of the great plastic surgery mysteries because in any given patient, I cannot really predict where the fat will go if a patient gains weight after liposuction.  I can say with confidence that it won’t likely go to the area(s) liposuctioned and it will likely go somewhere the patient does not want it.

So here’s the deal.  Liposuction removes unwanted fat cells.  Weight gain, at least short term weight gain,  makes existing fat cells fatter.  Soooo, if I remove, say, one half of the thickness of the fat pad of your lateral thighs and you gain weight, there are only half the previous fat cells in that area to get larger.  So the area may get a little thicker but not as much as the surrounding areas where fat cells were not removed.

And the same goes for other types of body contouring like tummy tucks (a.k.a. abdominoplasty), body lifts and breast reduction.  And this is why I am so adamant about patients having body or breast contouring when they are at a healthy and reasonable weight (did you notice I did not say ideal weight).  And then after surgery, their healthy and reasonable weight is their pre-op weight minus the weight removed surgically.  So if I removed 5 pounds doing a tummy tuck, my 145 pound patient should end up weighing (after recovery of course), 140 pounds.  See this blog on the Arithmetic of Body Contouring.  And see this blog on Predicting Patient Satisfaction after Body Contouring.

Thanks for reading!  Dr. Lisa Lynn Sowder

Body Contouring, Liposuction, Obesity, Tummy Tuck

It’s Tank Top Season

June 9th, 2015 — 2:00pm

These arms are NOT the result of plastic surgery!

Seattle Plastic Surgeon discusses options for upper arms.

The thermometer in Seattle is finally hitting 70 degrees after the most wretched sping in recorded weather history and I’m getting a lot of questions about upper arm enhancement.

The First Lady’s arms are the result of good arm genes and a great personal trainer.  Also, she has not yet entered the menopausal years (more about that in a future post).  For those without Mrs. Obama’s genes or trainer, there are a few procedures that can be done to improve the upper arm.  Which procedure is the most appropriate is dictated by several factors:

  • Skin tone
  • Thickness of the fat layer
  • Condition of the underlying muscles
  • Scar history

Patients with a thin layer of fat and poor skin tone are usually older and thin.  The only procedure that will improve the upper arm is a brachioplasty.  This procedure involves removing the excess skin of the upper and inner arm.  This always leaves a scar from the axilla (arm pit) to the elbow.  I strive to keep this scar on the surface that is hidden against the side when the arms are down.  The question patients must ask them selves is: “Am I willing to trade these bat wings for a scar?”  In patients who heal well and the scar is narrow and light, the answer is usually “yes” but I do have one brachioplasty patient who has a lovely arm shape and excellent scars who is still too self-conscious to go sleeveless.  I may have hit a surgical home run with her but I don’t consider the case a complete success.

Patients with chubby upper arms and good skin tone are great candidates for the CAST procedure.  This procedure involves circumferential treatment of the arm with very careful tumescense power- assisted liposuction.  The fat removal is limited to the outer arm where the excess fat resides but the inner arm is also treated with undermining the skin with the blunt liposuction cannula off of suction to stimulate shrinkage and tightening of the skin.  Patients wear a compression bolero to help the skin tighten postoperatively.

Patients who are “in between” are often candidates for a combination procedure where the incision and resultant scar can be confined to the axilla and the very, very upper inner arm where the sun hardly ever shines.

So if you want perfect Mrs. Obabma’s arms, sorry it’s not likely to happen.   But is you want better arms, there is likely something I can do to get you to your personal best.

Thanks for reading!

Seattle Plastic Surgeon, Lisa Lynn Sowder, M.D.

Body Contouring, Brachioplasty, Liposuction, Plastic Surgery

FAQ: Should I lose or gain weight before surgery?

October 21st, 2014 — 2:21pm

What’s the ideal weight for plastic surgery?

Which Oprah will do best with surgery? Probably the one in the red dress!

I get this question a lot from patients who are thinking about having breast and/or body contouring.  It’s an important question and I am always glad to hear it because it tells me that the patient understands that weight fluctuations can make a difference in surgical outcome.  Take Oprah for example.  There have been times in her life where her weight has yo-yoed all over the place.  Operating on her during these times would be like operating on a moving target.  A great result seen two weeks after surgery could turn into a lousy or even bizarre result a few months hence if her weight went up or down 30 – 40 pounds.

Sooo……patients should be at a stable and sustainable and healthy weight prior to surgery.  Did you notice that I did not say ideal?  Ideal weight may be achievable for some patients but unless it is sustainable, I would rather operate on a patient who is a little bit or even quite a bit over their ideal as long as they are healthy.

Healthy is the key word here.  If a patient is carrying a lot of excess weight and has type 2 diabetes, high blood pressure and has trouble walking up a flight of stairs, that person is not healthy and should not be having elective surgery.  That is the type of patient I will refer to a weight loss specialist.  If on the other hand, the patient is carrying extra weight and does not have diabetes, high blood pressure and plays an hour of pickle ball every day, I have no problem doing elective surgery on them.  And at the other end of the weight spectrum there are issues with being too thin.  I screen carefully for patients with eating disorders such as anorexia nervosa or bulimia.  Those conditions are serious illnesses and patients need evaluation, care and support – not plastic surgery.  Thin patients who are well nourished and weight stable usually make excellent surgical candidates.

So as you can see, it’s not about the number on the scale or the BMI or the dress size.  It’s about being healthy.

Thanks for reading!  Dr. Lisa Lynn Sowder

Body Contouring, Breast Contouring, Obesity

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