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: Mommy Makeover

Rectus Diastasis Explained

September 18th, 2012 — 10:45am

Seattle Plastic surgeon thinks a picture is worth a thousand words in explaining what she does with the muscle during an abdominoplasty a.k.a. tummy tuck.  

Check out these drawings of the abdominal wall.  The one on the left shows what I see during an abdominoplasty a.k.a. tummy tuck.  The white area in the middle is the fascia (it looks and feels like packing tape) connecting the two rectus muscles on either side.  With pregnancy and sometimes weight gain, the muscles get separated and the mid-line becomes very weak and the abdominal tone decreases.  This separation is called rectus diastasis which translates into separation of the rectus.

During abdominoplasty a.k.a. tummy tuck, the surgeon peels up the fat and skin layer and exposes this stretched out area.  Then stitches are placed in the fascia where it meets the rectus muscles and used to pull the edges  back together.  These stitches accomplish what exercise really cannot.  Exercise may strengthen the muscle but it does not move the muscle back into a normal position.   

Maybe this explains why I prefer the term adominoplasty to tummy tuck.  The former acknowledges the repair and reshaping that takes place with this operation.  The latter makes it sound like just a quick nip and tuck.   It’s not!  It’s a real operation but one well worth the recovery for the vast majority of patients.

Thanks for reading.  Dr. Lisa Lynn Sowder

Body Contouring, Mommy Makeover, Tummy Tuck

Pregnancy after tummy tuck?

August 28th, 2012 — 10:19am

Seattle Plastic Surgeon discusses one of life’s little surprises.

I have seen 2 patients in the past week who had babies after having had a tummy tuck.  These were surprise pregnancies and both patients had been concerned about 1) the effect of their surgery on their baby and 2) the effect of their baby on their surgery. 

The post tummy tuck abdomen is perfectly capable of s-t-r-e-t-c-h-i-n-g and there is no evidence that the tightened abdomen  interferes with pregnancy. 

If after delivery, the abdomen does not return to a satisfactory shape, re-tightening can be done but in my two patients, their tummies snapped back into shape after a couple of months and a lot of crunches and no re-tightening was needed.    

Soooooo……………………if you have a tummy tuck and then get a little surprise, make an appointment to see me a couple months after delivery and I’ll take a look and let you know if re-tightening is indicated.  Make sure to bring the little surprise package in with you.  We all love babies in my office!

Thanks for reading!  Dr. Lisa Lynn Sowder

Body Contouring, Mommy Makeover, Tummy Tuck

Overeating – the addiction of choice for “carers”

June 19th, 2012 — 11:11am

Seattle Plastic Surgeon shares an article in last Saturday’s Wall Street Journal that takes on the problem of food addiction in women.

I am a bit of an expert on the subject of overeating.  I’ve been in practice over 20 years and many of my patients are women with “food issues.”  I always try to gently probe for any eating disorders in women who are over or underweight or who have a history significant weight  fluctuations.  Eating disorders, especially compulsive overeating, are always difficult to talk about but it’s very, very important, especially in patients who are coming in for breast and/or body contouring. 

This weekend, I came across an article in the Wall Street Journal that addresses the problem of food addiction in women.  It’s painful to read but I think it is spot on for many of my patients who have confided in me about the emotional work they had to go through before they could really address this lowest ranking of addictions and finally get on track to better self care.  Check it out here and let me know what you think.

Thanks for reading, Dr. Lisa Lynn Sowder

Body Contouring, Breast Contouring, Liposuction, Mommy Makeover, Obesity, Tummy Tuck

Smoking and tummy tucks – a bad combination that makes me wanna holler.

March 13th, 2012 — 6:42pm

There’s nothing that makes me wanna holler much more than an anatomically perfect patient for tummy tuck who smokes!

Last week I saw two patients in one day who were both absolutely anatomically perfect patients for tummy tucks.  They were both done with child bearing, they were both thin and both had abdominal muscle separation and loose jelly belly skin and they both had c-section scars.  This kind of patient makes me almost droll at the thought of how straight forward their surgery would be, how much improvement they would have and, most of all, how happy theywould be with their surgical result.

That was the ectacsy part of the consultation and now for the agony part.  Both of these patients were long time and dedicated smokers.  And that made them very, very poor candidates for tummy tuck regardless of their favorable anatomy.

The issue with smoking is the damage that smoking does to blood vessels.  With many procedures such as tummy tuck, face lift, breast lift and some body lifts, the blood supply of the skin is stressed because the skin must be peeled up for a distance either to remove extra skin or to alter structures under the skin.  Peeling the skin up cuts many, many small vessels that provide circulation to the peeled up area and that area is then dependent on a secondary blood supply for post-operative healing.   In a smoker, that secondary blood supply is not reliable and the chance for the peeled up skin dying is much higher than a non smoker.  We surgeons have a fancy name for things that die – necrosis and it’s a word I loath using in describing a post surgical wound in my post-operative notes.

So I had to deliver the two smokers that bad news that I could not operate on them until they were non smokers for at least three months and even then, they are still at increased risk for healing problems.   I am sure I am not the first doctor to tell them they should quit smoking but maybe, just maybe, if they want than tummy tuck enough, they will finally find the strength to kick the habit.

Body Contouring, General Health, Mommy Makeover, Patient Safety, Plastic Surgery, Tummy Tuck, Uncategorized

Are you short or long waisted?

March 8th, 2012 — 6:13pm

Seattle Plastic Surgeon blogs about the influence of body type on body contouring procedures.

Short waisted on the left and long waisted on the right.

It is super important for your plastic surgeon to be aware of body type when he or she undertakes a body contouring consultation.  A lovely hourglass waistline is on every patient’s wish list but sometimes it is not possible to achieve with body contouring. 

Patients who are short waisted have a rib cage that almost abuts their pelvis.  There is very little vertical room for a waistline.  Those with long waists have a lot of vertical room between the rib cage and the pelvis and are move likely to get that lovely hourglass figure with body contouring.

But take heart, you short waisted women out there (I am one of your tribe).  We usually have nice long legs where as our hourglass sisters usually have shorter legs. 

The lesson here is, of course, to make the most of what you are blessed with.   And choose a plastic surgeon who will give you a realistic idea of what sort of results you can expect. 

Thanks for reading.  Dr. Lisa Lynn Sowder

Body Contouring, Liposuction, Mommy Makeover, Plastic Surgery, Tummy Tuck

It’s not an “outie”. It’s an umbilical hernia.

March 6th, 2012 — 12:48am

Seattle Plastic Surgeon finds (and fixes) umbilical hernias in about 20% of her tummy tuck patients. 

I do a lot of abdominoplasties a.k.a. tummy tucks and I fix a lot of umbilical hernias. 

It's not an "outie'. It's a hernia but I'm here to help.

Here’s how I approach this very common problem:

During surgery, I carefully exaimine the umbilicus (that’s belly button in normal speech) to feel if there is any weakness in the abdominal wall.  Sometimes the weakness is obvious like in the photo, but often it is not.  If I think there is a hernia, I will incise the umbilicus from the center to the 6:00 position and take a look at the abdominal wall underneath.  If there is a hernia, it shows up as a little or not-so-little blob of fat that is poking out from the inside to the outside.  I coax the little fat blob back into the inside and put 1 – 3 permanent sutures in to repair the small hole in the abdominal wall.  Then I stitch up the belly button incision and proceed with the rest of the surgery. 

Most of these little hernias are asymptomatic meaning they do not bother the patient.  So why do I fix them?  Abdominoplasty increases the pressure inside the abdomen just as a tightening procedure would be expected to.  This increased pressure can make the hernia worse and an previously asymptomatic hernia can become a problem.  The other reason is that patients usually prefer an “innie” and fixing the hernia turns an “outie” into an “innie”. 
Now you know yet another one of my secrets.  But don’t try it at home.  Thanks for reading.  Dr. Lisa Lynn Sowder

Body Contouring, Mommy Makeover, Tummy Tuck

Mini Tummy Tuck – Proceed With Caution

January 5th, 2012 — 8:47pm

Seattle plastic surgeon blogs about the lessons she has learned (the hard way, of course) about Mini Tummy Tuck.

Indications for a Mini Tummy Tuck are few and far between.

Sometimes a procedure just seems too good to be true and that is often the case for Mini Tummy Tuck.  It seems that every week I get a question about this procedure from a patient who thinks she may be the perfect candidate.

The appeal of the Mini Tummy Tuck is really easy to understand.  A short scar just above the pubis (like a C-section scar) and a quick recovery.  Sweet, huh?

The problem with this procedure is that it is often done with a dose of wishful thinking on the part of both the surgeon and the patient.  This procedure only addresses issues in the lower abdomen and cannot be expected to help upper abdominal issues of skin laxity or muscle weakness.  So it is not unusual for a Mini Tummy Tuck patient to be disappointed with the result.  The lower abdomen may end up nice and tight and smooth and then the untreated upper abdomen looks worse when compared to the lower abdomen.  Also, the longevity of the procedure may not be so great.  I have had several ladies who had a Mini Tummy Tuck come back years later for a full tummy tuck because of the toll that aging took on the upper abdomen.  Contrast that with a close to zero rate of repeating a full tummy tuck.

So if I tell a patient that she is not a good candidate for a Mini Tummy Tuck, it’s not because I want her to have a longer scar and recovery and I want  me to have a larger surgeon’s fee.  It’s because I am using my experience as my guide.  And, as I say almost every day, I learned this the hard way!

Thanks for reading!  Dr. Lisa Lynn Sowder

Body Contouring, Mommy Makeover, Patient Beware, Plastic Surgery, Tummy Tuck

Tan lines and patient satisfaction

November 7th, 2011 — 10:11pm

Seattle Plastic Surgeon, Dr. Lisa Lynn Sowder blogs about patient satisfaction. 

I can usually tell when a patient really, really likes the result of their breast or body contouring surgery, at least if they have had any sun lately.  I just take a look at their tan lines!  (Those of you who read this blog regularly know that I am totally anti-tan and I am not advocating any activity that causes tan line nor do I advocate non-tan line nude sunbathing!)

Sometimes I’ll have a patient who is super picky about a very minor imperfection but who has tan lines that tell me he/she is comfortable not wearing much at the beach or pool.   Once I had a tummy tuck patient, well into her 50s, that was upset that her string bikini didn’t cover her bikini line scar.  That is what I call a happy problem!

Hey, thanks for reading and stay away from those tanning beds.  More on that in an upcoming blog.  Dr. Lisa Lynn Sowder

Body Contouring, Breast Contouring, Breast Implants, Breast Lift, Breast Reduction, Mommy Makeover, Plastic Surgery, Skin Care, sun damage, Tummy Tuck

Let’s hear it for late bloomers!

August 17th, 2011 — 5:35pm

Seattle Plastic Surgeon Blogs About Trees and Mommy Makeovers – Again.

I returned from my two weeks away on Sunday night after dark.  The next morning as I was getting into my car, I caught the most lovely scent wafting across my drive way.  Lo and behold, our harlequin glorybower tree had bloomed while I was away.  This lovely little late bloomer does a good impression of being dead until late spring and then slowly leafs out and just when everything else in the garden is looking a little boring, tah dah, it bursts into bloom with the most lovely pink blossoms that then turn this otherworldy red and colbalt blue.  It  scent is heavenly for weeks. Come late fall, the leaves turn a purpilish orange  and if you crush them, they smell like peanut butter!

So what on earth does this have to do with plastic surgery?

Well, my first day back I saw a lady who described herself  as a late bloomer.    She’s forty-something and just sent her youngest off to college.  After years of taking care of her family, she’s ready to do a little something for herself, in this case a mommy makeover.  This is something she has wanted to do for years but with a busy household to run,  never had the time for the surgery or the recovery.    Now she’s finally has the time to bloom.

Thanks for reading,  Dr. Lisa Lynn Sowder

Aging Issues, Body Contouring, Gardening, Mommy Makeover, Plastic Surgery


September 29th, 2010 — 3:38pm

Seattle Plastic Surgeon discusses her very favorite operation.

breasts - 2“Dr. Sowder, what is you favorite procedure?” That is a question patients frequently asked. The answer, hands down, is breast lift a.k.a. mastopexy. I really love doing breast lifts because the patients get a lot of benefit for little risk and very minimal pain and suffering and for most patients, it’s affordable.

I often see ladies who think they need implants but really they just a little boost to improve the position of the nipple, decrease the diameter of the areola (it makes the breast look bigger) and tighten the skin and raise the breast mound.

After all the healing is done, the breasts look a little bigger and oh so perky. And there is no implant to maintain.

Implants are great for ladies who are really small busty but lots of ladies are plenty big but they just don’t realize it.

I also love the breast lift patients. They are usually middle aged moms who are so happy to get a few days off from family demands in addition to their new look. It’s a win, win, win.

For more about breast lift, check out my web site

Breast Contouring, Breast Lift, It's All About Me., Mommy Makeover, Plastic Surgery

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