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: My Plastic Surgery Philosophy

Should you travel for breast explant surgery ?????

August 29th, 2019 — 2:00pm

This post is based on a phone consultation from earlier this week.  I’ve changed a few unimportant details to protect patient privacy.

That bag is gonna be a killer to get into the overhead bin after surgery!

This lady has smooth, saline implants that are about 10 years old.  She is part of the Pacific Northwest Breast Implant Illness (BII) Facebook group and she thinks her implants are making her ill.  Her augmentation was done by the (IMHO) very best plastic surgeon in her state who lives and practices in the patient’s hometown.  She has seen her plastic surgeon for explant and her plastic surgeon has agreed to do her explant and remove as much capsule as can be safely done.  So why, I ask, does this patient want to come see me???  Am I an explant expert?   Well, sort of in that I have done about a bajillion explants (mostly reasons other than BII) over the 28+ years I’ve been in practice.

But……………….explant and capsulectomy is not specialized surgery.  This is a procedure that just about any plastic surgeon who does a lot of breast surgery is capable of doing.  Now, I would not expect, say, a craniofacial surgeon to have any great expertise (or interest) in this but most “general” plastic surgeons are very capable of doing this.  Promoting myself for explant and capsulectomy is sort of like Gordon Ramsey promoting himself as the ultimate chef for grilled cheese sandwiches.

So how about the fabulous explant experts who can guarantee an “en bloc” and offer “detox” products?  Well…………………………….I’m not gonna throw anyone whom I have never met under the bus.  But I will say this:  There is zero, nada, zilch, nichts, niet, nula, noll, odo evidence that an en bloc resection is absolutely necessary or that detox does anything other than slim down your bank account.  It’s super nice (and sort of fun) to do an en bloc in cases of silicone gel rupture but there is no evidence in peer reviewed surgical literature that there is any difference in clinical outcome.  The same goes for cases of BIA-ALCL.  Would I recommend a careless surgeon who is not thorough or does not endeavor to keep things as clean as possible?  Of course not but I must say the vast majority of plastic surgeons are pretty damn thorough and meticulous.  It’s in our DNA.

We plastic surgeons are always ragging on surgical tourism and espousing the danger of going to a distant land for el cheapo plastic surgery but we should also be ragging on traveling within the United States for routine procedures.  Travelling adds a lot of complexity to the whole surgical process from initial evaluation to final follow up.

There are plastic surgeons being promoted as some sort of super experts by the breast implant illness activists.  I have zero evidence that money is changing hands but isn’t it a little weird that this sisterhood, who should want what is best for other women, to recommend traveling hundreds and sometimes thousands of miles for a routine surgical procedure?  Oh, and waiting sometimes up to a year to have their toxic bags of death removed?  And as for detox?  Zero evidence of necessity or efficacy. You can get your detox package from your local woo woo health provider who is happy to lighten your wallet.

So think global, buy local and support your probably very capable local plastic surgeon!  Just make sure your plastic surgeon is the real meal deal and certified by the American Board of Plastic Surgery.

Thanks for reading and I would be thrilled if you followed me on Instagram @sowdermd and @breastimplantsanity.

Dr. Lisa Lynn Sowder

Breast Implant Illness, Breast Implant Removal, Breast Implants, My Plastic Surgery Philosophy, Patient Safety, Plastic Surgery

Spectators in the OR

June 18th, 2018 — 10:30am

Occasionally I have a request from a patient’s friend or family member to come into the OR to “watch the surgery.”  Many times they tell me that they have seen it on T.V. or on YouTube and just think it will be cool to see it in person.  The answer is always no and here is why.  In the OR, what may look like a relaxed and even fun atmosphere is actually a very carefully planned and executed choreography with several participants front stage and more in the wings.  There is me and the scrub tech at the table and sometimes one of the 6th year plastic surgery residents from the University of Washington.  Then there is the anesthesiologist keeping the patient asleep and safe and then there is the circulating nurse who helps the anesthesiologist and also opens equipment and  supplies as needed.  There really isn’t any extra room for a spectator and that spectator really isn’t going to see much because the surgical field is surrounded on all sides by anesthesia, the Mayo stand with the instruments and people on both sides of the table.  And we keep OR “traffic” to a minimum because of infectious issues.  The more people in and out of the OR the greater chance of contaminating the surgical field.  And a lay person has very little concept of the sterile field and probably has not even heard the term “sterile conscious.”  Don’t take it personally but we surgery types think lay people are just walking talking fomites.

“Jesus Christ! I think you are doing that wrong!”

And then there is “going to ground” factor.  Even the most hardened lay person or even a doctor or nurse may react very differently to the sight of blood when that blood is that of a close friend or a loved one.  If that person goes to ground, then we have another patient to take care of!

I have to tell just one little story about a would be OR spectator from my residency days.  I was rotating at Children’s Hospital in Salt Lake City and doing an infant hernia case with the Chief of Pediatric Surgery, the wonderful Dr. Dale Johnson.  One could not imagine a more competent and kind and ethical surgeon than Dr. Johnson.  He was and even after retirement is a deity in surgery circles.  We scrubbed our hands and arms and went into the OR for gowning and gloving.  He noticed an extra person in the OR with a clipboard. (Surgeon’s have a visceral distrust of people with clipboards).  Dr. Johnson politely asked this lady who she was and why was she here.  She told Dr. Johnson that she was a “patient advocate” there for the patient’s protection.  Dr. Johnson politely asked her from whom she was protecting the patient and if she was going to let him know if he was doing something wrong.  She became flustered and just left the OR and I have never seen or heard of such a “patient advocate” since then.  It was very strange and makes me think if a patient or patient’s parent think they need an advocate in the OR other than their operating surgeon, maybe they should choose another surgeon.

So go ahead and ask to be an observer but just be prepared to hear “no” in the nicest possible way.

Thank you for reading and I would be honored if you followed me on Intragram @sowdermd and @breastimplantsanity.  Dr. Lisa Lynn Sowder

My Plastic Surgery Philosophy, Patient Safety, Plastic Surgery

Did you know that I am “Woman of Year in Medicine and Healthcare” and that “Seattle’s #1 Ranked Plastic Surgeon” is not a plastic surgeon?

May 17th, 2018 — 12:20pm

Seattle Plastic Surgeon ponders the meaning of all of these awards than just seem to arrive in the mail along with a place for credit card information.  

Dr. Sowder, you are really are the best.

Dr. Sowder, you are really are the best.

I was dejunking my office this week and came across a bunch of letters and a few emails informing me how fabulous I am and inviting me to order various plaques and trophies (prices range from $99 – $530) so I can spread the news of my fabulousness.

Over the past few years I have been named one of “America’s Top Surgeons”, one of  “America’s Top Plastic Surgeons” (with honors of distinction and excellence), one of the “Leading Physicians of The World”, one of the “Best Doctors in America”, one of “Washington State’s Best Doctors”, “the 2015 Best Business of Seattle in the category of Cosmetic Surgeons”, “One of the 10 Best Plastic Surgeons for Washington”, “Top 100 Health Professionals – 2018”, and (my favorite), “Woman of the Year in Medicine and Healthcare.”

I have to say that I am honored and humbled by all of these accolades but I have a sneaking suspicion that these “associations” really don’t know anything about me or my practice and just want my money.  I’m pretty cheap so you won’t see any this stuff hanging on my wall.

But …………… I am not at all shy about letting the world know about the fabulous awards I actually have received without having to fork over a dime.  Going way, way, way back – here they are, at least the ones I can remember:

  • Tidiest camper at Camp Sweyolaken as a Campfire Girl.  You would laugh at this if you could see my desk right now.
  • Best Book Week Poster – 5th grade, Hutton School, Spokane, Washington (Mom was so proud).
  • First Place Beginner Dog Obediance (shared with Mickey, the wonderdog), Spokane Canine Club.
  • Best Undergraduate Research Paper, University of Washington, 1978 (I got $400 which back then was a boat load of money.  Actually it still is a boat load of money).
  • Phi Beta Kappa – University of Washington, 1978.
  • Alpha Omega Alpha – University of Washington School of Medicine, 1983.
  • Best Paper, Senior Plastic Surgery Residents’ Conference, 1991.
  • Golden Hands Award for the best cosmetic surgery case, Washington Society of Plastic Surgeons, 2005.
  • “The Dom”. a.k.a. best presentation, Northwest Society of Plastic Surgeons, 2009.  It’s called “The Dom” because the prize is a bottle of Dom Perignon.

Oh, and this just in:  There is a new doctor in town who claims on his home page that he is ranked the #1 Plastic Surgeon in Seattle.  And his home page is cluttered with the aforementioned fake plastic surgeon awards.  Problem is that he has not spent one day in an approved plastic surgery residency, is not certified or eligible to be certified by the American Board of Plastic Surgery (the only real plastic surgery board), and is not a member of the American Society of Plastic Surgeons, the American Society for Aesthetic Plastic Surgery, the Washington Society of Plastic Surgeons or the Northwest Society of Plastic Surgeons.  In other words, he is not a plastic surgeon!!!  Is he a good non-plastic surgeon?  Don’t know.  I do know that he is not an honest surgeon.

Thanks for reading and be careful out there when picking a plastic surgeon.  Make sure you pick a real one.  Check your surgeon’s credentials by visiting the American Board of Plastic Surgery 

Thanks for reading, (Multiple Award Winning) Dr. Lisa Lynn Sowder

I would be honored if you followed me on Instagram @sowdermd and @breastimplantsanity.


My Plastic Surgery Philosophy, Now That's a Little Weird, This Makes Me Cranky.

Portion control in breast augmentation.

October 3rd, 2017 — 5:32pm

This cartoon is by the late, great B. Kliban. His book, “Never Eat Anything Bigger Than Your Head” is a treasure. Get your hands on one if you can. You’ll laugh until you cry.

Portion control is very important for maintaining a healthy weight and it becomes more and more difficult as restaurants, especially fast food restaurants, keep increasing the size of the offerings.  There is a Mexican place in Seattle that  has a poster of one of its burritos next to a new born baby.  They are the same size. So sick in so many ways, huh?

I would like to introduce portion control for breast implants.  There is a condition that we plastic surgeon’s call breast greed.  Those with breast greed want to go a little larger and then a little larger and then a little larger.  This results in the eager to please plastic surgeon putting a too big implant into a too little woman.  Supersized implants have an increased chance of having implant problems.  Big implants cause thinning of the breast tissue and skin and over-stretching of the pectoralis muscle if they are submuscular.  They are more likely to result in the dreaded unaboob or extend into the underarm area.  And, in my humble opinion, they look really, really bizarre.

Fortunately I do not get many patients looking for that super top heavy look.  Implant patients self select surgeons who feature these jumbo implants on their website or social media accounts.  You won’t fine many of those attached to my name.

Thanks for reading and if you want to supersize your chest, don’t come to me!  Dr. Lisa Lynn Sowder

Follow me on Instagram @sowdermd and @breastimplantsanity.


Breast Implants, My Plastic Surgery Philosophy

Can these procedures be combined?

October 13th, 2016 — 1:05pm

Seattle Plastic Surgeon answers another

It is common to combine surgical procedures and often makes a lot of sense to do so.  Combining procedures saves a trip to the operating room, saves some money and consolidates recovery time.  Procedures often done in combination include breast lift with a tummy tuck and face lift with blepharoplasty.

There are some procedures, however, that I will not combine.  Here is an example:  Posterior hip liposuction and facial surgery.  Why?  Liposuction involves some heavy physical labor.  I work up a sweat with most major liposuction cases.  That heavy large muscle effort leaves me with a fine tremor for about an hour or so and I don’t want to do fine facial surgery with a fine tremor.  So can’t I do the facial surgery first?  No that won’t work either.  The posterior hip liposuction requires the patient to be face down on the OR table.  Positioning a patient who has just had facial surgery face down is NOT a good idea.  Another example:  Brachioplasty (upper arm lift) and tummy tuck is not a good combination.  A tummy tuck really leaves the patient without core strength for several weeks so the patient is very reliant on the arms to move around in bed or get up from lying or sitting down.  Arms that are fresh from a brachioplasty are very sore and should not engage in heavy work.

So, when patients are looking at more than one procedure, sometimes it makes sense to combine them but sometimes it doesn’t.  Oh, and one other factor is surgeon fatigue.  Yes, even badass surgeons like me get tired.  More about that in another blog post.

Thanks for reading!  Dr. Lisa Lynn Sowder

My Plastic Surgery Philosophy, Plastic Surgery

Manual labor

June 8th, 2016 — 3:08pm

I recently returned from a 12 day stay in Vaison La Romaine, France where my husband taught his yearly Travel, Food and Wine Writing class.  Blog winery workerThis class combines some excellent sight seeing, lots and lots of eating and, of course, some winery tours.  On one of the tours, I skipped the usual sniffing, sipping and spitting routine and just wandered around the winery a little bit.  That is when I came across this photo on the wall which just delighted me.  You see, I have this thing about manual labor maybe because beneath all the fancy surgeon stuff, I am, like all surgeons, a manual laborer.  And I, like all surgeon, prefer it that way.  I cannot imagine spending most of my work week sitting at a desk.

I just love this image of this young winery worker hosing herself down after a long day of turning grape juice into wine.  Don’t think for one minute that I need to hose down after a long bloody case because the procedures I do are really very controlled, quite tidy and, thanks to the electric scalpel, not very bloody.  But there are days when I have labored all day, on my feet, in a warm O.R. under bright lights and I feel like need a good hosing down.  I just take a shower instead.

Thanks for reading!

Dr. Lisa Lynn Sowder


It's All About Me., My Plastic Surgery Philosophy, Now That's Cool

Patient selection and surgeon selection. We have to like each other!

February 2nd, 2016 — 12:38pm
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“And I feel the same way about you.”

Recently I saw a patient who I just did not like.  I did my best to be professional and courteous but there were some very important health issues that he was unwilling to discuss.  It was sort of like he thought I was a technician who could just do what he told me he wanted done.  He had had several body contouring operations by other surgeons over the years to treat his weight problem.  He was unhappy with his surgical result, had had some significant postoperative complications (which he blamed on his surgeons) and he just wanted me to “fix things”.  I wanted to explore his weight issues which included secondary serious medical issues but he would have none of it.  I also wanted to know more about his previous surgery and he wanted none of that either.  He refused to allow me to obtain records of his previous surgery.  I wasn’t being nosy I was doing my job.  After about 10 minutes (seemed much longer) of this back and forth, he decided he didn’t like me and left.  I honestly cannot remember the last time this happened and I felt bad that I was unable to establish rapport with a patient.  But I am really, really glad he and I decided to dislike each other before I had a chance to operate on him!  Operating on someone is kind like going steady for several months.  Love my not be necessary but like certainly is!

Thanks for reading!  Dr. Lisa Lynn Sowder

My Plastic Surgery Philosophy, Plastic Surgery, This Makes Me Cranky., Uncategorized

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.

HRT and plastic surgery

April 2nd, 2015 — 2:36pm

HRT and Plastic Surgery:  Insight from a menopausal plastic hot flash

It is well know that hormone replacement therapy can increase the risk of postoperative deep vein thrombosis (DVT).  Some surgeons just recommend to “just stop taking your HRT medication for two weeks before and two weeks after surgery.”   I take a different approach.  “Just stop taking your HRT” means different things to different women.  Some women would just have to put up with a few night sweats but other women (yours truly included) would have a thermo nuclear meltdown.  And adding thermo nuclear meltdown to your list of preoperative and postoperative issues is not very appealing, is it?

My recommendations for women on HRT depends on their menopausal symptoms, their general health and the type of surgery they are having.  In most cases, if a woman has several risk factors for DVT and is one of the thermo nuclear types, I will put keep her on her HRT and put her on Lovenox, a low dose blood thinner for a week after surgery.  Lovenox is injected just under the surface of the skin and, thanks to very friendly packaging and a teeny tiny needle,  even the most squeamish patients and caregivers can inject it.   And, knock on wood, I have yet to see serious bleeding issues with this medication.

Thanks for reading and keep cool.  Dr. Lisa Lynn Sowder


My Plastic Surgery Philosophy, Patient Safety, Postoperative Care, Preoperative Care

Male Plastic Surgery – Easy Does It!

December 1st, 2014 — 4:48pm

Seattle Plastic Surgeon dials it down a few notches for dudes.

blog male plastic surgery.

The Dude is a good example of a man who just keeps getting better with age.

I’ve been doing quite a few cases on men lately.  Almost all of my male facial plastic surgery patients are eager to tell me what they don’t want.  Names like Mickey Rourke, Bruce Jenner, Kenny Rogers and Burt Reynolds come up frequently.   All of these men have obviously had “a little work” done over the years and I don’t think I would be going out on a limb to say they they have had “a little too much work” done.

The procedures we do to rejuvenate the face are for the most part feminizing.  We raise the brow, we trim the eyelids, we lift the face, we smooth the skin.  And when these procedures are done on men in the same way they are done on women, the result can be, well, a bit disturbing.  A really ruggedly handsome middle aged or older guy can end up looking not quite the way a guy of any age should look.

When I operate on men’s faces, I dial it down a notch or two.  I don’t want that brow to high or those eyelids too trim or that jawline too tight.  And neither do my male patients.

Thanks for reading.  Dr. Lisa Lynn Sowder

For Men Only, Male Plastic Surgery, My Plastic Surgery Philosophy

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