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: Facial Fillers


Feeling a little Grinchy? I’m here to help!

November 11th, 2017 — 7:00pm

Seattle Plastic Surgeon recommends Botox and Restylane for the GrinchAll he needs is a little Botox and Juvederm (and a heart enlargement).

The Grinch Who Stole Christmas is one of my most beloved Christmas stories.  This tale of epiphany and redemption always gets me in the right mood for the Holidays.   I make sure this book is handy as soon as I see the stores put out their Christmas displays.  Christmas displays before Halloween make me feel really Grinchy.

The Grinch is an excellent example of an individual who would benefit a lot with two of the most popular non-operative procedures I do:  Botox and HA fillers.

Botox injected into the creases between his eyebrows would wipe that scowl right off his face.  And it just might make him feel better.  I have found that Botox for my scowl makes me feel less Grinchy.  It is sort of like how smiling makes you feel happy.  Non-scowling makes me feel non-Grinchy.

Mr. Grinch looks really old and haggard, partly because of his nasolabial folds – those creases that go from his nose to the corners of his mouth.  Plumping those up with one of the many HA fillers (Juvederm, Volbella, Voluma, etc.) would take years off his face.  Filler could also take care of that downturn at the corner of his mouth to give him a little friendlier expression.

So, of course, the Grinch needs the love and forgiveness of Whoville for redemption of his rotten soul but his face needs a little visit to the plastic surgeon.

Thanks for reading!  Dr. Lisa Lynn Sowder and follow me on Instagram @sowdermd and @breastimlantsanity.

Botox, Facial Fillers

Fillers that I don’t like. I hope they don’t take it personally.

September 21st, 2017 — 2:10pm

Seattle Plastic Surgeon blogs about fillers she does not like and does not use.  

I’ve written many blogs on the miracles of fillers for facial aging.  I think they are the best thing for facial maintenance since sunscreen.

Facial silicone gone bad. Really, really bad.

Facial silicone gone bad. Really, really bad.

The fillers I really like and use a lot are Voluma, Juvederm, Restylane, and Perlane which are all hyaluronic acid (HA) fillers.   The thing I love about HA fillers is their ease of use, safety, and their reversibility when a rare patient (1 every five years or so) does not like the result.  The HA fillers can be reversed by injecting an enzyme which dissolves the filler within 24 hours.

I also use fat as a facial filler in some cases. The thing I like about fat is that there is usually an abundant supply and it is often very, very long lasting and sometimes permanent.

There are other fillers out there.  Here’s my list of fillers that I just don’t like or use.  Full disclosure here:  this is based solely on my (sometimes very limited) experience, hearsay, prejudice and my risk adverse nature.  Some of my colleagues use these regularly and successfully but these fillers just give me the creeps.

  • Collagen:  It is sooooo yesteryear.  Even when it was the only legit filler out there, I didn’t like it.  Patients needed a skin test 30 days prior to using Collagen.  The results were fleeting and even a detail freak like me had trouble getting a nice smooth result.  Oh, it also had to be refrigerated and shelf life was very limited.  Oh, one more thing, it comes from cows.
  • Radiesse:  This is used quite a bit in the Seattle area but it gives me the creeps.  It’s made of teeny, tiny spheres of calcium hydroxylapatite and provides a scaffold for connective tissue growth.   It is quite thick and can fill in deep creases nicely but can also result in nodule formation.  Radiesse lasts 1 -2 years which is great (unless you are one of the unlucky ones who develops nodules).   I used it a few times years ago in a a few  employees who volunteered (really, they did) to be my training subjects.  All three of them bruised really, really badly and I felt like a worm until their bruising resolved.   I don’t have a cajones to try it again.
  • ArteFill:  Yikes.  This is a scary one.  This is a permanent filler which is made up of teeny, tiny spheres of polymethylmethacrylate.  They elicit a “foreign body response” which walls off the little spheres with collagen.   It also requires a skin test 30 days before injection because the sphere are carried in liquid collagen.  My training subjects this time were two pals of mine.  Both had negative skin tests.  My first patient did fine and is still my pal.  The second patient, who was from out of state,  had to delay her injection because a family illness prevented her from traveling.  Four months later, she had a rip-roaring inflammatory reaction to the little spot on her forearm where I had injected the test dose.  It was by the grace of a good and loving God I had not injected her face.  She is still one of my very best pals.  I have also seen many case reports and a couple of patients with poor results from ArteFill.  The only way to get rid of it is to surgically remove it.
  • Sculptra:  Sculptra stimulates dermal fibrosis and thickens the skin.   This is filler was first introduced about 10 years ago for use in patients with HIV.  The medications that many HIV patients rely upon to stay healthy have the side effect of facial wasting.  This filler is made of poly-L-lactic acid, the same chemical that a common suture, Vicryl, is made of.  I use Vicryl a lot.  It is easy to sew with.  It provides strength and support for a couple of months while an incision heals and then the body absorbs sit.  But once in awhile, a patient has an inflammatory reaction to the suture.  I have had maybe a dozen patients over 20 + years of practice who have “spit” every single stitch.  There are many case reports of disfiguring inflammatory reactions to Sculptra and all I have to do is think of one of my Vicryl “allergic” patients and I break out into a cold sweat.  Am I a wimp or what?
  • Silicone:  This is the Queen Mother of Bad Fillers (in my humble opinion).  It has been used for decades and is responsible for the permanent disfiguration of many, many patients.  I will never forget a lecture I attended when I was a surgery resident on the treatment of a bizarre condition called Romberg’s disease.  This disease causes profound atrophy of facial fat.  Way back when, these patients were injected with medical grade silicone and initially it was beneficial.  But fast forward 10, 20 even 30 years and many of these patients went on to develop severe inflammatory reactions that were more disfiguring than the original disease.  I know of a plastic surgeon in Hawaii who used this stuff on his wife’s lips.  Yikes.

So there is my personal rogue gallery of “no thanks” fillers.  All of these (I think) are still in the good graces of the F.D.A. but you won’t find them on my shelf.

Hey, thanks for reading.  That was a slog, wasn’t it?  Dr. Lisa Lynn Sowder

 

 

Facial Fillers, Fat Injection

Happy Valentine’s Day – Pucker Up!

February 14th, 2017 — 7:00am

Seattle Plastic Surgeon loves doing subtle and artful lip augmentation with Hyaluronic Acid fillers. 

Are they real or plumped up with filler? It should be impossible to tell with a nice and artful lip augmentation.

I am always amazed at how much my practice has evolved after being in practice for over 20 years now.  

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.   And a relatively new filler, Volubella lasts 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

Facial Fillers, Fat Injection, Lip Enhancement and Augmentation, Non-invasive, Plastic Surgery, Uncategorized

Botox and Facial Filler for the Grinch Who Stole Christmas

December 16th, 2016 — 12:28pm

Seattle Plastic Surgeon knows how to make the Grinch look a little less grinchy.

Botox Restylane Juvederm Seattle

It’s those glabellar frown lines and nasolabial folds that make this Grinch look soooo grinchy.

Take a look at the Grinch.  What is it that makes him look so old and cranky?  It’s his glabellar from lines between his eyes that make him look like he’s having a pretty bad day and it’s his nasolabial folds (those creases that go from the sides of the nose to the corners of the mouth) that make him look a billion years old. All he needs to do to work himself up into a really bad mood is to look in the mirror every morning.  No wonder he has such a bad attitude.

If the Grinch were to come into my office, here is what I would recommend:

His forehead creases would be softened and smoothed out with Botox.  He looks like he needs a pretty large dose, maybe 60 units.  The injection would sting but would be quick and he would see a remarkable improvement within 3 days or so.  Also, he would feel so much more relaxed.  If he wanted to scowl at his poor little dog, he would be unable to!  Smile, yes but scowl, no.  This amount of Botox would set him back $900 and would last at least 3 months.  If he kept coming back for treatment, his dose would likely drop considerably.

His nasolabial folds could be filled in with one of the hyaluronic facial fillers that I inject almost every day of the week.  They are terrific for treating the area around the mouth that is such a problem in some people and is hard to treat with other methods.  Even a full face lift doesn’t help this area very much.  I would use 2 or 3 syringes to get as full of correction as possible.  It’s been my experience that patients who opt for just partial correction (to keep the cost down) are not nearly as satisfied as those who just go for it.  Three syringes of a filler such as Juvederm would set him back about $1600.  Juvederm lasts at least six months and I have many patients who have had nice lasting improvement for up to two years.

Do what about the redemption of his rotten soul?  I’ll leave that up to the transcendent love and forgiveness of Whoville. But he’s got to save his face for me.

Thanks for reading!  Dr. Lisa Lynn Sowder

Botox, Facial Fillers, Nasolabial Folds, Non-invasive

Trout Pout – Let’s Not Go There

September 5th, 2014 — 11:22am

Seattle Plastic Surgeon cajoles patient not to go with the Trout Pout look.

pinterest trout pout

Mona Lisa’s lips were NOT done by me!

I recently saw a patient of mine who I have been injecting with hyaluronic acid fillers for a couple of years.  She comes in about every 6 to 12 months for topping off.  This time she wanted “just a little more” to her already quite voluptuous lips and I just had to say “no”.  Another syringe of filler or even half a syringe of filler would have pushed her over the edge into a trout pout.

It very common for patients to think if something is good, more of that something is better but sometimes it just isn’t.  I see this mostly with breast augmentation patients and lip enhancement patients.  They loose their perspective.  One tool I use for these patients is their pre-operative or pre-injection photos.   Once they see these photos and realize where they were and where they are now, they are more likely to appreciate their nice, tasteful, “it could have occurred in nature on a very good day” result and less likely to try to twist my arm to do something that I do not think is in their best interest.

So if you see a woman with gigantic breast implants and lips to match, I can guarantee you that I am not her plastic surgeon!

Thanks for reading!  Dr. Lisa Lynn Sowder

 

Facial Fillers, Lip Enhancement and Augmentation

Voluma. I think I’m going to really, really like this new HA filler.

March 11th, 2014 — 1:32pm

Seattle Plastic Surgeon is happy to add Voluma to her toolbox.

Those who know me well know that I take a long hard look at new technology, products, procedures, etc.  I think that new is not enough.  It has to be better, safer, easier or less expensive that the technology, product or procedure it is gunning to replace.  I’m always so tickled when something new really does turn out to live up to its claims.

Seattle Voluma

My very brave first Voluma patient. Before injection on the left and after injection on the right. Note how her fuller cheekbones enhance her entire face. Oh, the eye makeup doesn’t hurt either.

Voluma is the new thing that floats my boat.  Here’s why.  Voluma is another hyaluronic acid (HA) filler, similar to other HA fillers such as Restylane, Juvederm, Prevelle, Perlane, etc.  What makes it different is that it was developed for deep injection onto the bone or in the fatty layer of the mid face.  Voluma allows for nonsurgical enhancement of the cheekbone area which in turn can improve the contour of the lower eyelids and also the nasolabial folds.

Other procedures that can enhance this area include fat transfer, cheek implants and vertical face lifts.  Of course, these all have down time whereas our Voluma patient on the left went to work about 10 minutes after her injection.  And she said it hardly hurt although maybe she was just being nice.

Voluma lasts about 2 years, much longer than the other HA fillers.

The cost for this new filler is twice that of the standard HA fillers but often less can be used because it is so “volumizing”.  A little bit goes a long way.

So this is another tool in my toolbox and one that I think I will pull out often.  Oh, and by the way, the makers or Voluma do not pay me to promote their product.  In fact, no one pays me anything to promote their products.  I prefer it that way and you should too!

Thanks for reading!  Dr. Lisa Lynn Sowder

 

Facial Fillers, New Technology, Stuff I love

Botox and Facial Filler for the Grinch Who Stole Christmas

November 27th, 2013 — 10:42am

Seattle Plastic Surgeon knows how to make the Grinch look a little less grinchy.

Botox Restylane Juvederm Seattle

It’s those glabellar frown lines and nasolabial folds that make this Grinch look soooo grinchy.

Take a look at the Grinch.  What is it that makes him look so old and cranky?  It’s his glabellar from lines between his eyes that make him look like he’s having a pretty bad day and it’s his nasolabial folds (those creases that go from the sides of the nose to the corners of the mouth) that make him look a billion years old. All he needs to do to work himself up into a really bad mood is to look in the mirror every morning.  No wonder he has such a bad attitude.

If the Grinch were to come into my office, here is what I would recommend:

His forehead creases would be softened and smoothed out with Botox.  He looks like he needs a pretty large dose, maybe 60 units.  The injection would sting but would be quick and he would see a remarkable improvement within 3 days or so.  Also, he would feel so much more relaxed.  If he wanted to scowl at his poor little dog, he would be unable to!  Smile, yes but scowl, no.  This amount of Botox would set him back $900 and would last at least 3 months.  If he kept coming back for treatment, his dose would likely drop considerably.

His nasolabial folds could be filled in with one of the hyaluronic facial fillers that I inject almost every day of the week.  They are terrific for treating the area around the mouth that is such a problem in some people and is hard to treat with other methods.  Even a full face lift doesn’t help this area very much.  I would use 2 or 3 syringes to get as full of correction as possible.  It’s been my experience that patients who opt for just partial correction (to keep the cost down) are not nearly as satisfied as those who just go for it.  Three syringes of a filler such as Juvederm would set him back $1450.  Juvederm lasts at least six months and I have many patients who have had nice lasting improvement for up to two years.

I hope the Grinch comes into my office this holiday season and leaves those poor Whos in Whoville alone.

Thanks for reading!  Dr. Lisa Lynn Sowder

Botox, Facial Fillers, Nasolabial Folds, Non-invasive

Let’s Make a Deal!

April 17th, 2013 — 12:40pm

Let’s Make a Deal is great entertainment but has no place in a doctor’s office.

Plastic surgery deals

Not in my office, please!

I used to love watching Let’s Make a Deal as a kid when I was home sick from school.  It was just so fun to see the contestants win something really cool like a car and so funny to see the look on their face when their chosen door opened to reveal a donkey or some other outrageous booby prize.

Despite my fond memories of Let’s Make a Deal, I don’t play this game with my pricing of goods and services.  I recently had an inquiry about discounting my price for Juvederm, one of the hyaluronic acid fillers, for a woman and her 4 sisters.  I didn’t see the logic in discounting my price.  I spend the same care and time with each patient and the same amount of Juvederm and sometimes seeing a group of patients can turn into a bit of a three ring circus or a game show.

So I like to keep it professional, my services and my prices.  Otherwise I am crossing the line from doctor to used care salesman or a game show host.

Thanks for reading!  Dr. Lisa Lynn Sowder

Facial Fillers, My Plastic Surgery Philosophy, Uncategorized

Stem Cell Face Lift

April 10th, 2013 — 3:15pm

Seattle Plastic Surgeon discusses the promotion of stem cell face lifts by ethically challenged physicians.

Stem Cell Face Lift

Pssstttt …. I’ve got a Stem Cell Face Lift for sale.

Recently I have had several inquiries about “stem cell face lifts” and whether or not I perform them.  There must be someone out there promoting this as the latest and greatest fountain of youth.   That someone  is probably deceptively promoting him or herself as a plastic surgeon with a magic wand.

A little background on stem cells:  These are little baby cells that can differentiate into almost any adult tissue.  Research on stem cells is one of the hottest areas of biology and with good reason.  Figuring out how to turn on the right genes in a population of stem cells could lead to tissue and organ engineering and amazing advances in the treatment of human disease and injury.

Adult fat tissue has a lot of stem cells.  Cool, huh?  Who would have thought that Mother Nature would pack away these tiny powerhouses of potential in our blubber?  Stem cells can be isolated from fat tissue in the laboratory using very sophisticated equipment .  This equipment  is not something available to physicians working in a clinical setting.   Stem cells are not being isolated from fat and injected into human faces.

So what’s the deal? Fat transfer for facial rejuvenation has been around for 20 + years and is becoming more and more popular as we understand the aging process better and also get better with the very fussy techniques required for successful fat transfer.  I’ve been doing fat transfer for facial rejuvenation for 15 years.  Fat transfer does something that is very obvious:  it plumps up a deflated face and makes it more youthful appearing.  It also does something else that has been observed by those of us who do fat transfer:  it improves the quality of the overlying skin.  And this qualitative improvement is likely the effect of stem cells that come along for the ride with the fat.  So the “stem cell face lift” practitioners are doing fat transfer but are promoting it as something new and unique.   It’s a little like calling a jelly donut a new type of fruit serving.

Check out this article in the New York Times. 

Thanks for reading and if you find a jelly donut that really is a fruit serving, please let me know.  Dr. Lisa Lynn Sowder

Face Lift, Facial Fillers, Fat Injection, Uncategorized

Fillers may reverse skin aging????? WOW.

December 27th, 2012 — 12:17pm

Seattle Plastic Surgeon shares some very interesting research on fillers and skin aging.  Check it out.

Fountain of youth

Could fillers be the Fountain of Youth?

I read with interest today an article from Dermatology Times e news.  To my knowledge, this is the first study looking at the anti-aging effects of off the shelf fillers.  Here it is:

Ann Arbor, Mich. — It may be possible to slow down the skin’s aging process by boosting support of the dermal extracellular matrix, a new study finds.

As the skin ages, the extracellular matrix, which acts as a scaffold for skin cells, becomes fragmented, according to researchers with University of Michigan Medical School, Ann Arbor. Fibroblasts shrink and less collagen is produced causing the support structure to decline, Newswise.com reports.

The researchers found that injecting the space between the skin cells with a filler enhances the structural support of the extracellular matrix.

Investigators injected a dermal filler into the facial skin of 21 volunteers over age 70 during a three month period. Data indicated that the filler stimulated fibroblasts to begin producing more collagen and boosted the support structure of the extracellular matrix. This increased support, the researchers noted, appeared to further stimulate the proliferation of fibroblasts and increase epidermal thickness, according to the abstract. The entire layer of skin grew thicker with more blood vessels, which nourished the cells, according to Newswise.com.

“By altering the matrix using an external filler and increasing the internal pressure, we’ve shown that we can essentially trigger a signal for cells to wake up,” a researcher said. “This shows that skin cells in elderly people have the capacity to respond robustly in a very positive way to alterations in the mechanical property of their environment. We still need to know more about how cells sense their environment, but in general it appears we have made a real difference in the structural integrity of skin.”

The findings were published in the October issue of the Journal of Investigative Dermatology.

Thanks for reading!  Dr. Lisa Lynn Sowder

Aging Issues, Facial Fillers, Now That's Cool, Skin Care

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