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: Ineffective


Correct diagnosis is the cornerstone of proper treatment.

June 15th, 2015 — 1:27pm

blog correct diagnosisI saw a patient this week that really drove home the importance of diagnosis before treatment.  In plastic surgery, diagnosis is usually very straight forward and can be made from across the exam room or sometimes even from across the street.  Common diagnoses in my practice include large breasts, saggy breasts, small breasts, asymmetrical breasts, saggy abdomen, big saddlebags, jowls, saggy eyelids …… you get the idea.  But sometimes I will see a patient whose diagnosis requires something more than a history and physical examination.

This particular patient was a lady in her early 60’s who had a breast lift some 15 years previously.  She presented with an ulcerated area on her right nipple that had been present for over 6 months.  She was convinced it had something to do with her breast lift surgery although the ulcerated area was well away from any of her well healed and almost invisible breast lift scars.  I am convinced that her ulceration is a rare and treatable form of breast cancer called Paget’s disease.

She had seen a half dozen alternative provides who all offered some sort of treatment be it supplements, special salt baths or special ointments.  Guess what?  Nothing worked and none of these providers had a diagnosis.  They were treating an unknown problem with ineffective therapy.  If you know me well, you know that this sort of thing makes me really, really cranky.  This lady had spent a lot of money and delayed a definitive diagnosis by 6 months.

I referred this patient to a breast cancer surgeon for a biopsy which will reveal her diagnosis and allow her to get proper treatment.  I never cease to be amazed by the hubris of some members of the “alternative” medical community.  They don’t know what they don’t know.

Thanks for reading.  Dr. Lisa Lynn Sowder

General Health, Ineffective, My Plastic Surgery Philosophy, This Makes Me Cranky.

Too good to be true??? Yes!!!

February 28th, 2011 — 9:21am

Seattle Plastic Surgeon Uncovers Some Really, Really Misleading Before and After Photos.

scan0043I am really on a roll here, or maybe it’s a rampage. It’s too soon to tell. Here is another “before and after” from yet another liposuction gizmo that is supposed to sculpt the fat layer and tighten the skin layer, all without surgery!

Take a close look at these photos. They are pretty impressive, don’t you think? But take a really close look. Mentally drop a straight line down from the point where her nose meets her upper lip. Then take a look at her chin. Her chin (AS IN CHIN BONE) has been moved forward. This ad thus implies that this non-surgical fat sculpting and skin tightening gizmo can actually move a chin and jaw bone. Maybe this lady’s chin and jaw were moved but if so, it was done using an orthognathic surgical procedure and it involved a bone saw and some metal screws and plates. Not exactly non-surgical or minimally invasive. Or maybe the ad folks just used Photoshop. Either way, this ad is more than highly misleading. It is fraudulent.

And again, the wretched thing is that these gizmos are heavily marketed to those without full training in Plastic Surgery. And those wannabe “plastic surgeons” who may be saying, “Wow, what a great result. I must have one of these!” don’t even know what orthognathic surgery is. I sure didn’t know it existed until I did my plastic surgery training.

Orthognatic surgery, by the way, is a field of plastic surgery and maxillofacial surgery which involves moving the bones of the face, usually the upper and/or lower jaw. And it’s not done with a “minimally invasive”, one bazillion dollar, fraudulently advertised gizmo with a “doesn’t know any better” doctor pushing the button.

Ineffective, Jawline, New Technology, Non-invasive, Patient Beware

Look carefully, very carefully

February 23rd, 2011 — 6:17pm

Seattle Plastic Surgeon Reveals Some Very Shady             Before and After Photos.

I get buried in advertisements for the newest, latest, greatest, you gotta have it, gizmos that are supposed to make my practice and my results and my life in general even better that they already are. Of course, these gizmos average about $100,000 and – this is what really fries me – they are rarely available for demo prior to purchase. This is sort of like buying a fancy new car without a test drive.

Another thing that fries me is some of the very, very misleading advertisements that many of the manufacturers try to pass off as real results. Here is an example. This is from an ad for a non-invasive fat removal system that uses energy that passes through the skin and is directed at the fat layer. Wow, what a difference until you look carefully. (Plastic surgeons are trained to look carefully.) In the photo on the right, Mr. Sixpack is pinching a fat roll that starts above his bellybutton and in the photo on the right, he’s pinching a fat roll that starts below his bellybutton. So obviously the more fat pinched, the thicker the roll. I can do this myself – big fat roll and little fat roll. I bet you can do it too!

Okay, and just one more thing that fries me, and then I’ll stop, at least until my next blog entry: Most of these new technologies are marketed heavily to non-plastic surgeons. The family practice doc or gynecologist or even (I’m not making this us) ophthalmologist who may want a little piece of the cosmetic surgery action may see this ad and go, “Wow, I must have one of these!” These docs are not experienced with liposuction or other body contouring and may not look at these photos as carefully as a real plastic surgeon. So these non-plastic surgeons buy one, it doesn’t work very well but they have to keep promoting it and using it and in some cases, giving patients a really raw deal because they have already dropped $100,000 on it and they can’t sell it because after a while, everyone knows it doesn’t work very well. So beware of non-plastic surgeons using the “latest technology”. They likely just don’t know any better.

Ineffective, New Technology, Non-invasive, Plastic Surgery

FEELING A LITTLE RIPPED OFF?????

October 26th, 2010 — 10:36am

Seattle Plastic Surgeon discusses the limitations of some of the newest, most expensive and most advertized gizmos.

scan0005Take a look at this “before” and “after”.

As promised, here’s the inside of the brochure that shows the “results” and you can be sure these are the best results the company could come up with. The “CoolSculpting” gizmo is promoted as a non-invasive body contouring procedure. I would say non-invasive and ineffective.

Most of the doctors that will purchase this device or one of the dozens similar to it are non-surgeons. These doctors do not know how to do an abdominoplasty (tummy tuck) so they offer this instead. I’m sure they go into it with high hopes but how can they not be disappointed at such a “result’? Once they have paid the $$$$$$ for the gizmo, they need to promote it to make sure they get a decent return on investment.

If any of my abominoplasty patients had a result like this, they would feel ripped off. I suspect the doctors using “CoolSculpting” are going to have some unhappy patients. Geez, everyone could have saved all that time, money and gnashing of teeth by referring those patients to me!

Body Contouring, Ineffective, Laser Liposuction, Liposuction, New Technology, Patient Beware, Plastic Surgery, Tummy Tuck

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