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: Liposuction

Do you have armpit cleavage? I’m here to help!

January 25th, 2012 — 11:00pm

Seattle Plastic surgeon offers help for a common problem – ARMPIT CLEAVAGE

Most women have a little bit of breast tissue and fat just in front of the arm pit.  This is called the axillary tail of the breast.    This is all normal.

But some ladies, even slender ladies, have more than a little bit of breast tissue and fat in this area and I have heard it called many thing;  armpit cleavage, pit boobs, waddies, etc.  Whatever you want to call it, it can be an annoyance especially with some type of clothing.

The good news is that it is usually treatable with liposuction and this can usually be done at the same time as another breast procedure .   The excess fat and tissue is quite fibrous and therefore  a little tough to suction out.  Also, this area stays firm and sometimes lumpy for several months.  But when it’s all done and the swelling is down and the tissues softened up, it can be a really, really nice improvement.

I occasionally have to actually excise the area if it is quite large or saggy.  That incision is usually pretty easy to tuck up in the underarm area and it usually heals with a thin white line.

So if you have this annoying problem, I’m here to help.  If you get you surgery done by St. Patrick’s Day, you will be more than ready for summer clothes by Summer Solstice.

Take a look at this patient below.  She had a periareolar breast lift to lift her nipple and improve the shape of her breasts and also liposuction of her armpit cleavage.  She is shown about 3 months after surgery with a nice result.  She’ll look even better at six months as her scar around her areola fades.

Thanks for reading!  Dr. Lisa Lynn Sowder

This patient wants her nipples lifted a little and the shape of her breast improved with the least possible surgery. She also wants to get rid of her armpit cleavange.

Here she is 3 months after a periareolar lift and liposuction of her armpit cleavage. She only took a couple of days off of work. She's pleased with her result as am I.


Body Contouring, Breast Contouring, Liposuction

The mathmatics (arthmetic really) of body contouring surgery.

November 2nd, 2011 — 9:54pm

Seattle plastic surgeon blogs about the arithmetic of body contouring surgery.

Okay, here’s a question I get all the time from my body contouring patients:  “Will the fat come back?”  And my answer is always:  “New fat will accumulate if you gain weight after surgery and I cannot predict where the new fat will go but I can almost guarantee it won’t go where you want it to go!”. 

And then I review a little simple arithmetic with them.  For example:

  • Their preoperative weight is 146 pounds.
  • I removed a total of 7 pounds of fat with liposuction and a tummy tuck.
  • Their new preoperative weight is 139 because I removed 7 pounds of fat with surgery.
  • If they come back three months later at 146, unless they have been weight training like a fiend, they have gained 7 pounds of fat.
  • 146 – 7 + 139 and 139 + 7 = 146.

And then I tell them my story of a patient I did liposuction on over 15 years ago.  She was a very fit and lean distance runner who had some stubborn fat on her lateral thighs (so-called saddle bags).  I did liposuction on her and she had a great result.  She can back a couple of years later having gained about 30 pounds after some personal issues including a knee injury that precluded her running.  She had the weirdest shaped thighs.  She had caved-in  lateral thighs where the fatty layer remained thin when the surrounding area’s fat pad had increased in thickness.  Yikes!   All I could tell her was that is she got back down to her healthy weight it would get better and in fact she did and it did. 

So this is why liposuction is about shape and spot reduction.  It is not about weight loss!

Body Contouring, Liposuction, Obesity, Tummy Tuck

It’s never too early to plan ahead

July 13th, 2011 — 10:32pm

Got cankles? Liposuction can usually help.

This Seattle Cosmetic Plastic Surgeon tells it like it is!   There are a few procedures I do that come close to immediate gratification but treatment of “cankles” is not one of them.

This week I saw a patient who wanted to have ankle liposuction ASAP so she could look really great for her upcoming  highschool reunion at the end of August.

The good news:  Ankle liposuction can  help most patients with heavy ankles (a.k.a. cankles) and/or calves.

The bad news:  Ankle and/or calf liposuction requires a long recovery period and patients need to wear heavy support hose for 3 to 6 months following the surgery.   Because the ankles are so dependent (meaning they are way below the level of the heart), they hang onto post liposuction swelling longer than, say, the area under the chin or even the upper thighs.  ( If you ever come across a doctor who wants to lipo your ankles who tells you otherwise, he/she is either ignorant and/or deceptive and you should run the other way.)

So my advice to this really, really lovely young woman:

  1. Find a great pair of slimming summer slacks that almost touch the ground when she is wearing a fab pair of high heeled sandals.
  2. Make the most of her lovely shoulders with a halter top.
  3. Book her ankle liposuction for October.

Next summer she can show off her nice ankles with a photo on her Facebook page.

Thanks for reading!

Seattle Cosmetic Plastic Surgeon, Dr. Lisa Lynn Sowder

Body Contouring, Liposuction, Postoperative Care

Laser Liposuction? No Thanks.

February 21st, 2011 — 8:15pm

Seattle Plastic Surgeon Discusses the Risks of                         Laser Liposuction.

blog subdermal plexus 2I just returned from the annual meeting of the Northwest Society of Plastic Surgeons. The best presentation was a panel on new technologies – when, how and why or adopt them or, in many cases, not adopt them. A very interesting statistic was presented. Ninety-five percent of new technologies – meaning the latest and greatest, gotta have it, cannot survive without it – did not exist 5 to 6 years after it’s introduction. Wow, what a number. Laser liposuction was one of the featured new technologies that this panel of plastic surgeons did not think would make the cut. In fact, a recent survey of fully trained (as opposed to the imitation) plastic surgeons who had used laser liposuction, over 96% did not like it. This is the first time that I have heard that 96% of any kind of surgeons agree on anything.

One of the panel members, arguably the most laser friendly plastic surgeon on the planet, summed up laser liposuction with this comment: “Last time I checked, the subdermal plexus still existed.”

Stay with me; You are about to learn something important. Take a look at the illustration of your largest organ (the skin) above. See where the pink (skin) turns yellow (fat). That is the subdermis and that is the target of the laser in laser liposuction. After removing fat, the laser is used to heat up the subdermis in an effort to get the skin to shrink. I always get the image of bacon frying for some reason. Well, it’s not nice to heat this layer because the blood vessles that supply the skin live here. If a large enough area of blood vessles is fried, the skin will die. Dead skin is a very, very bad thing.

Non-laser liposuction spares most of the blood vessels because the intruments used (cannulas) are blunt and push the vessels aside rather than damage them. Because most skin has some elastic quality, the overlying skin usually shrinks to some degree once the underlying bulk is reduced.

I have seen my share of skin necrosis in patients who have heard the siren song of laser liposuction thinking it would spare them the necessity of a truly skin tightening procedure such as tummy tuck. I remain sooooo glad that I did not invest in one of these very, very expensive gizmos. It would be keeping our old furniture in our basement storage unit company.

Body Contouring, Liposuction, My Plastic Surgery Philosophy, Obesity, Patient Beware


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

Back to top