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: Government and Politics


Required reading for election season.

August 15th, 2012 — 1:14pm

Seattle Plastic Surgeon recommends reading this book and getting through the election season without losing friends or your sanity.

“Can we talk?”

While on vacation last week, I read a book that I highly recommend during this political season, preferably before the GOP and Democratic conventions:  The Righteous Mind:  Why Good People are Divided by Politics and Religion by Jonathan Haidt.   Haidt, an accademic moral psychologist does a great job of explaining why and how individuals can have such differing opinions on really important issues.  He focuses mainly on the conflicts between liberals and conservatives and explains the different value systems that make some  think cleaning your bathroom floor with an old American flag isa little weird but no big deal and others think it is an abomination.  He also explains why just about everyone thinks it wrong to have sex with a dead chicken prior to roasting it.  Now I’ve got your attention.

So get the book and read it.  Some of it is a bit of a slog through the various ways psychological research is done but the slog is well worth the effort.  I learned a lot about why some of my dearest friends are such commie pinkos when it comes to political debate.   And I’ve recommended the book to them so they can understand why I’m such a fascist. 

Thanks for reading and did I tell you to read this book?  Dr. Lisa Lynn Sowder

Government and Politics

Ban the Tan?

July 23rd, 2012 — 11:57am
 

Pasty white Seattle Plastic Surgeon shares her view on tanning bed restrictions.

What’s wrong with this picture???

My daughter is a competative Irish step dancer and if you don’t what that involves, you must rent the documentary “Jig”.  The Irish dancing subculture is an interesting mix of athletic, artisitic and beauty competition.   I have attended many a competition and have seen that part of the “look”, for some of the girls, includes deeply  tanned legs. 

Some of the girls have spray on tanned legs but some of them have obviously been spending time in an indoor tanning salon and, as a physician, it drives me nuts. 

 The incidence of Malignant Melanoma has been going up, up, up in the past couple of decades and it’s rising the fastest in the same group that spends the most time in indoor tanning salons – young women. 

 Many countries and some states have placed age restrictions on indoor tanning.  Brazil has an outright ban on indoor tanning.  I’m not one to advocate a nanny state, but I do think that we need to protect children from their own bad choices when the stakes are very, very high.  Isn’t that why we don’t sell children cigarettes and alcohol? 

 What do you think?  Should a 12 year old be able to waltz into a tanning salon to spend her allowance on a tanning session?  Should I say something to the parents of these tanned girls?   Should I spray paint my daughter’s legs?????

 Thanks for reading!  Dr. Lisa Lynn Sowder

 

 

 

 

General Health, Government and Politics, Irish Step Dancing, Skin Cancer, Skin Care, sun damage

David Sedaris explains why America spends so much on heath care.

March 30th, 2012 — 6:24pm

Seattle Plastic Surgeon loves David Sedaris’ account of his experiences with Socialized Medicine in the heart of Old Europe.

American Humorist David Sedaris

This week’s New Yorker Magazine has a hilarious piece by humorist David Sedaris.  Mr. Sedaris now lives in Paris and I squeal with delight every time I read one of his essays on his French experiences.   Here is his take on French medicine.  This is just an excerpt and you  should really pick up the April 2, 2012 New Yorker to read the entire essay. 

I was lying in bed and found a lump on my right side, just below my rib cage.  It was like a devilled egg tucked beneath my skin.  Cancer, I thought.  A phone call and twenty minutes later, I was stretched out on the examining table with my shirt raised. 

 “Oh, that’s nothing,” Dr. Medioni said.  “A little fatty tumor.  Dogs get them all the time.”

I thought of other things dogs have that I don’t want:  Dewclaws, for example.  Hookworms.  “Can I have it removed?”

“I guess you could , but why would you want to?”

He made me feel vain and frivolous for even thinking about it.  “Your right,” I told him.  “I’ll just pull my bathing suit up a little higher.”

When I asked him if the tumor would get any bigger, the doctor gave it a little squeeze.  “Bigger?  Sure, probably.”

“Will it get a lot bigger?”

“No.”

“Why not?” I asked.

And he said, sounding suddenly weary, “I don’t know.  Why don’t trees touch the sky?”

This conversation would never happen in my office.  The conversation would go something like this.

Me:  It’s probably a lipoma, a fatty tumor.  They are very common.  (I’d leave the dog reference out).  It could be something else but I am almost certain it’s a lipoma.

David:  Can I have it removed?

Me:  Sure.  I would send it to pathology to make sure it wasn’t something more serious and that would take care of it.  These lipomas can get pretty big.  I could remove it next week in the office.  I would inject some local anesthetic and remove it though a small incision.  You could drive yourself home.  It will leave a scar but the scar won’t be as noticable as the lipoma.

David:  Will my insurance pay for it?

Me:  Maybe, it depends on your insurance.  I’ll have you pay me, then I will send the information to your insurance company and they might reimburse you. 

David:  How much will it cost?

Me:  I’ll have my patient care coordinator give you a price quote and get you on my schedule.  Make sure you don’t take any aspirin between now and next week

So here’s the difference:  I’m happy to take the lipoma out.  I like doing surgery and that’s how I pay my bills.  Also, I want to make sure it is a lipoma.  If it is something horrible like a fibro-fatty cancerous horrindoma and Mr. Sedaris has a delayed diagnosis because of me, he will sue me for a bazillion dollars.   I, like all American doctors, practice defensive medicine.   In America, defensive medicine is the standard of care.  Also, this conversation takes place between two Americans.  American patients  like to get things fixed and American doctors like to fix things.   Even minor things.  So there will be about $500 changing hands because of Mr. Sedaris’  lipoma, $250 for the use of the operating room and $250 for my time and skill.    In France, $50 changes hands because  Dr. Medioni is dismissive about Mr. Sedris’ lipoma and is not worried about being sued even with the 0.1% chance his clinical impression is wrong.  And  Mr. Sedaris lives with his lipoma and pulls his bathing suit up a little higher. 

This, folks, is why American Health care is so expensive.

Thanks for reading!  Dr. Lisa Lynn Sowder

 

General Health, Government and Politics, Health Care Costs, Plastic Surgery, Uncategorized

This just in …………………

January 18th, 2012 — 12:10am

Here’s some news I have been waiting for since 2004.  Woo, hoo! 

OH HAPPY DAY

This is from Plastic Surgery News online:

New Jersey repeals cosmetic tax

New Jersey Gov. Chris Christie today signed legislation calling for the elimination of the state’s 6 percent tax on cosmetic surgery procedures, which was enacted in 2004. Assembly Bill 3646/Senate Bill 1988 requires the tax to be reduced to 4 percent in the first quarter of this year; to 2 percent on July 1; and rescinded completely on July 1, 2013.

“This is great news – we’re all thrilled,” says New Jersey Society of Plastic Surgeons (NJSPS) President Chris Godek, MD. “All ASPS members should be ecstatic to learn this tax has been rescinded – not just NJSPS members, but all ABPS-certified plastic surgeons in our country. We’re happy to finally have erased a tax that was unfair on several different levels – including bias against women – and which caused major unforeseen problems, such as the flight of residents across state borders for procedures.”

Dr. Godek says ASPS, as well as Bev Lynch and A.J. Sabath of the Advocacy Management Group, were instrumental in reversing the onerous tax.

“The NJSPS should be congratulated for its tenacity in fighting to repeal the New Jersey cosmetic tax,” says ASPS President Malcolm Roth, MD. “In addition, this repeal has been a top priority for the national Stop Medical Taxes Coalition, which includes several national medical specialty groups and industry partners – they’ve committed significant time and resources to fight alongside us on this issue over the past several years. In particular, we want to acknowledge our industry partner, Allergan, for its support and leadership in seeking the repeal.”

The original law, which was enacted in 2004, imposed a gross receipts tax on procedures including cosmetic surgery, cosmetic injections and fillers, dermabrasion, laser hair removal and hair transplantation, among others.  Estimates put the actual revenue at $10 million annually – half of what the state’s Legislature anticipated – one reason behind calls that reach back to 2006 from the bill’s sponsor, Assemblyman Joseph Cryan, to eliminate the tax.

The New Jersey Assembly in 2006 had passed similar legislation to rescind the tax, but then-Gov. Jon Corzine vetoed the measure.

 

New Jersey Gov. Chris Christie today signed legislation calling for the elimination of the state’s 6 percent tax on cosmetic surgery procedures, which was enacted in 2004. Assembly Bill 3646/Senate Bill 1988 requires the tax to be reduced to 4 percent in the first quarter of this year; to 2 percent on July 1; and rescinded completely on July 1, 2013.

“This is great news – we’re all thrilled,” says New Jersey Society of Plastic Surgeons (NJSPS) President Chris Godek, MD. “All ASPS members should be ecstatic to learn this tax has been rescinded – not just NJSPS members, but all ABPS-certified plastic surgeons in our country. We’re happy to finally have erased a tax that was unfair on several different levels – including bias against women – and which caused major unforeseen problems, such as the flight of residents across state borders for procedures.”

Dr. Godek says ASPS, as well as Bev Lynch and A.J. Sabath of the Advocacy Management Group, were instrumental in reversing the onerous tax.

“The NJSPS should be congratulated for its tenacity in fighting to repeal the New Jersey cosmetic tax,” says ASPS President Malcolm Roth, MD. “In addition, this repeal has been a top priority for the national Stop Medical Taxes Coalition, which includes several national medical specialty groups and industry partners – they’ve committed significant time and resources to fight alongside us on this issue over the past several years. In particular, we want to acknowledge our industry partner, Allergan, for its support and leadership in seeking the repeal.”

The original law, which was enacted in 2004, imposed a gross receipts tax on procedures including cosmetic surgery, cosmetic injections and fillers, dermabrasion, laser hair removal and hair transplantation, among others.  Estimates put the actual revenue at $10 million annually – half of what the state’s Legislature anticipated – one reason behind calls that reach back to 2006 from the bill’s sponsor, Assemblyman Joseph Cryan, to eliminate the tax.

The New Jersey Assembly in 2006 had passed similar legislation to rescind the tax, but then-Gov. Jon Corzine vetoed the measure.

 Thanks for reading and consider sending Gov. Christie some flowers.  Dr. Lisa Lynn Sowder

Government and Politics, Plastic Surgery

Michael Jackson, Conrad Murray, the Moon Walk and Scope of Practice

November 8th, 2011 — 7:42pm

The Moon Walk, not everyone should try this.

Seattle Plastic Surgeon weighs in on the Dr. Conrad Murray verdict.

I remember clearly the day that Michael Jackson died.  I was operating at Seattle Surgery Center and the news went around the O.R. quickly as did speculation of his cause of death.  Drugs was at the top of my list.

As the story unfolded, we in medicine were blown away by the bizarre circumstances of Jackson’s death.  Propofol overdose.  What?  Propofol given by his private physician in his home.  You have got to be kidding.  How nuts is that???

This very sad story at least allows for some education of the public on the topic of Scope of Practice.   It is not a well known fact that there are no federal scope of practice laws and no state scope of practice laws in California, Washington (where I practice) or in most states.

What this means is that physicians with a medical license are not restricted as to what type of medicine they practice.  In the case of Dr. Murray, he was practicing anesthesia without training, experience or certification in anesthesia.  Yikes, huh?

The formally trained and board certified anesthesiologist with whom I work use Propofol all the time but they use it in an operating room with monitoring of the patient, control of the patients airway and with resuscitation equipment at hand.  Those essential ingredients were not available at Michael Jackson’s home.  Another thing lacking was Dr. Murray’s judgment.  It took him 20 minutes to call for help.

Something in plentiful supply was hubris.  Dr. Murray was in way, way over his head but did not recognize or admit his folly.    Hubris is also plentiful in “cosmetic surgery”.  Over the past 20 years there has been a flood of non plastic surgeons physicians entering the field of “cosmetic surgery” through the back door.  These physicians have formal residency training in fields from radiology to ophthalmology to obstetrics/gynecology to emergency room medicine.  There are no laws that prevent these physicians from calling themselves cosmetic surgeons.

One reason for this flood is financial.   Twenty years ago there was a sea change in medical reimbursement and physicians have been squeezed financially by third party payers to the point where many physicains honestly can barely make it.   The “easy money” of “cosmetic surgery” is tempting.   Take a weekend course on liposuction or breast augmentation or buy this fancy, dancy laser!   But honestly, there is absolutely nothing easy about cosmetic surgery.  Many of these physicians (and their cosmetic patients) learn this the hard way.

Also, more and more surgery is being on in the private office setting.  One does not need hospital operating room privleges to operate in their own private O.R.  And even most state and federal regulations of outpatient operating rooms do not have requirements about the training and board certification of the physicans using the operating room.  The regulators are more concerned with the facility that the physicians who use it!  And in some states, an operating room can “fly under the radar” of all regulation because they use only local anesthesia.  And that topic is worth a whole blog of its own.

And, it gets even darker.  There are also at least a dozen “boards” and organizations that a physicain can join to give them credibility with potential patients.  Confusing?  Oh yeah.  On purpose?  Oh yeah.

So if you are looking for a plastic surgeon for a cosmetic procedure, don’t settle for a “cosmetic surgeon”.  If that surgeon were fully trained and boarded in plastic surgery, believe me, they would call themselves a plastic surgeon.   You can check to see if your” cosmetic surgeon” is a board certified plastic surgeon here.

 I know that I don’t know how practice radiology, opthalmology or ob/gyn or emergency medicine and I don’t try.  And I certainly know I don’t know how to Moon Walk.

Thanks for reading.  R.I.P. Michael.  Dr. Lisa Lynn Sowder

General Health, Government and Politics, Patient Beware, Patient Safety, Plastic Surgery

The FDA approves Restylane for lip augmentation and/or enhancement.

October 28th, 2011 — 6:18pm

Lip enhancement can be subtle. It doesn’t have to be bizarre.

Seattle Plastic Surgeon is thrilled to share news of the FDA approval of Restylane for lip enhancement and/or augmentation.  It’s about time!

Earlier this month the FDA approved the hyaluronic acid filler Restylane for lip enhancement.  This puts what is sort of like the Good Housekeeping Seal of Approval on a procedure that I have been doing for several years.

Lip enhancement/augmentation gets a really bad rap in the popular media because it is so overdone in many high profile individuals.  But really, it doesn’t have to be that way.  No Donald Duck lips are necessary.  The enhancement can be really lovely and subtle like the lady in the photo.  She had just 1 cc of filler placed in her lips with most of it going to her lower lip.  Nice, huh?   This is yet another thing I love about practicing plastic surgery in Seattle.  Patients want lovely and subtle, not LOOK AT ME.

Most lip enhancement/augmentation patients can go about their usual business and social lives the day after injection.  The bruising and swelling is usually pretty minimal if the patient is careful not to take any medication that can encourage bruising (aspirin and ibuprofen are the most common offenders) for a week before injection and is vigilant about icing the area for a few hours after injection.

So from now on when you hear lip ehancement/augmentation/enlargement etc., don’t think bizarre Donald Duck lips ala the First Wives Club.  Think lovely and subtle and now FDA approved!

Thanks for reading.  Seattle Plastic Surgeon, Dr. Lisa Lynn Sowder

Facial Fillers, Government and Politics, Lip Enhancement and Augmentation, Skin Care

Mistakes were made

September 9th, 2011 — 5:04pm

Seattle Plastic Surgeon., Dr. Lisa Lynn Sowder shares a worthy article on physician errors.  Please check it out.

I was doing a little surfing today and came across this excellent article on physician error.  It discusses how difficult it is, or at least used to be, for physicians to discuss their errors with patients or with other members of the health care team.

In the past few years, physicians have been more willing to openly discuss errors with patients and their family members because these “I’m sorry” discussions are no longer considered admissible in  medical malpractice litigation.

Isn’t it just nuts that something so basic as a from-the-heart apology had to get a legislative green light?  This shows just how messed up our present medical malpractice system is.

Sorry for yet another depressing blog topic.  Thanks for reading.  Dr. Lisa Lynn Sowder

Government and Politics, Patient Safety

A doctor’s take on the Medicare scrum.

September 8th, 2011 — 5:15pm

A very ugly graph

Seattle Plastic Surgeon, Dr. Lisa Lynn Sowder, blogs about Medicare.

I just can’t help but comment on the current national discussion regarding the future of Medicare. To understand how some doctors (me, for example) feel about Medicare, it may be enlightening  to look at this graph.

This ugly graph shows what doctors in private practice (me, for example) have experienced since 2000. Our practice costs keep going up while our payments from Medicare just keep dropping. I think anyone would agree after looking at these numbers that it is not unreasonable for a doctor in private practice (me, for example) might consider dropping Medicare.

In fact, I did drop Medicare about 5 years ago. I was losing money on every Medicare patient I saw and as the saying goes “you can’t make up for that in volume”.   In fact, none of the 4 surgeons in my office accept Medicare.

Talks of  further cuts in physician reimbursement is being discussed as a way to “save” Medicare but is it worth saving if fewer and fewer doctors are accepting it?   A Medicare card in your wallet is worthless if no doctors take it.  This is what is know as coverage without access.

In all of this talk of Medicare, I haven’t heard any politician discuss the fact that many doctors are choosing not to take Medicare. It is the sick old elephant in the living room.

Sorry for such a depressing topic.  Next entry, I’ll try to lighten it up.

Thanks for reading!  Dr. Lisa Lynn Sowder

Financial Issues, Government and Politics

Groupons for plastic surgery? Nope and here’s why.

July 27th, 2011 — 7:22pm

Hip Seattle Plastic Surgeon does not offer Groupon for services.  Shocking, huh?

Groupon for medical services is considered fee splitting and it’s illegal.

I know, I know – Groupon is just the best thing since sliced bread but you won’t be finding it in my office, at least not until the laws change.

Yeah, it would be kinda fun to get a bajillion people to give Botox a try so they can see how fabulous it is and maybe turn them into life long Botox patients but the downside for me is that it is illegal.  You see, when a person buys a Groupon, the Groupon folks take a cut and that cut is called fee splitting and for medical services, it’s illegal.

The law does not look at this any differently than me paying another doctor for sending patients my way.  That sort of bad doctor behavior is taken very, very seriously.

So Botox Groupons just isn’t going to be something I offer.  Although, I would likely get some much needed rest behind bars, I think my family and my practice might miss me.

Thanks for reading!  Dr. Lisa Lynn Sowder

Government and Politics, Health Care Costs

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

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