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

Full length mirrors in the plastic surgeon’s office.

July 1st, 2014 — 9:08am

Seattle Plastic Surgeon and seamstress thinks of plastic surgery while shopping for fabric.

blog britex 2In April I attended the annual meeting of the American Society for Aesthetic Plastic Surgery (ASAPS) in San Francisco.  I sat in on many presentations, took a couple of workshops and spent lots of time comparing notes with colleagues.  As per usual, I learned a lot and have tweeked a few of my procedures based on new found knowledge.

But I have to admit, I did skip a session on practice management so I could check out Britex Fabrix, a legendary four story fabric store a stone’s throw from the meeting venue.

This store had everything from fine Italian cotton the weight of tissue paper to the newest neoprene prints to a bajillion buttons and trims.  And of course their collection of feather boas was amazing.  I could have spent a week there.

Every floor had a full length mirror or two so customers could see the whole effect of holding a length of fabric and assessing the drape, the texture, the pattern, the color and this, of course, reminded me of plastic surgery.

A full length mirror is essential in any plastic surgery exam room because so much of the surgery we do is about balance and harmony.  This is especially true with breast and body contouring.  Changes made in one area can influence how another area will look.  For example, larger breasts can make the waistline and hipline seem smaller.  A tummy tuck can leave a patient with a flat tummy but may make her generous hips more noticeable.  Even facial surgery comes into play.  A face lift may really benefit a lady who has taken great care of her body over the years.  Conversely,  a really heavy lady may actually look odd after aggressive neck liposuction.

So fear not that full length mirror in my office.  It’s useful for both the patient and the plastic surgeon to see the whole picture.

Thanks for reading and next time you are in San Francisco, check out Britex Fabrix.  Dr. Lisa Lyn Sowder

My Plastic Surgery Philosophy

Another reason why surgeons love the operating room.

April 8th, 2014 — 12:30pm

Seattle Plastic Surgeon explains why one of many reasons why she just loves the operating room.

Scrubs. It’s a uniform we all love.

There are many reasons that surgeons love to spend the day in the operating room.

We consider the operating room our nest and those with whom we work in the operating room our tribe.  It really is our home away from home.  And it is kind of a sacred space.  Others are loath to interrupt an operation with trivial questions like “does anyone remember who the bass player for Herman’s Hermits was?”

And surgeons like to operate.  That is why we spend the better part of our young adulthood in training so we can learn our craft.  As one of my co-residents used to say when we were weary from working such long hours, “Lisa, you gotta love it!”

Another  reason we love the OR is the operating room uniform – scrubs.  Ah, scrubs.  They are as comfortable as pajamas and we get to work in them!  And we get to wear a surgical cap which comes in very, very handy on a bad hair day.  And we get to wear really comfortable operating room clogs.  No high heals allowed in the operating room.

And here is the best part about scrubs.  At the end of the day, we take them off and put them in a magic laundry hamper.  A few days later, they appear all clean and folded in the scrub cabinet.  I sure I wish I had a magic laundry hamper at home.

Thanks for reading!  Dr. Lisa Lynn Sowder



My Plastic Surgery Philosophy, Stuff I love, Wardrobe Observations

No need to be a nervous wreck the day of surgery.

March 24th, 2014 — 4:31pm

Seattle Plastic Surgeon gets an inside view of the surgery check in process at a famous Seattle hospital.

Recently I helped a much loved family member check into a famous hospital in Seattle for some orthopedic surgery.  He is by nature a pretty calm person and had great confidence in his surgeon and was really, really looking forward to playing soccer again.   But still, he was about to undergo the knife.

We arrived in the parking garage, went up the elevator and came to a gorgeous, modern, clean surgery reception area.  The lady at the front desk was very nice and courteous but there was so much stuff she had to do.  There were forms to fill out, papers to sign, phone numbers to give, prescriptions to fill, ID to show and yada, yada, yada, yada.  My loved one rolled with it but I could see he was getting a more than a little nervous.

This got me to thinking about much better we do it in our office operating room.  Our patients come in for a pre-operative visit usually about 2 weeks before the surgery date.  At this visit, we leisurely go over the operative plan, review consent forms and instructions, fill out the history and physical exam and anethesia forms, get all necessary signatures, get all the financial business taken care of and write the patient their prescriptions for them to fill before the day of surgery.  This way, when the patient comes in for their surgery, all of this necessary yada, yada, yada has been done.

I know this preoperative visit makes the day of surgery go a lot smoother for me and I think it also makes the day of surgery a lot easier and calmer for our patients.  I think the preoperative visit is time very, very well spent.

Thanks for reading.  Dr. Lisa Lynn Sowder







My Plastic Surgery Philosophy, Preoperative Care

Is it wrong to worship an operating room?

March 4th, 2014 — 10:53am

Seattle Plastic Surgeons does her first case in her new operating room.  It was a religious experience.

blog worship

Operating Room Worship: is it wrong?

Today I did three cases in our brand new operating room which is part of the brand new Madison Tower Surgery Center in Seattle.  And it was a great day.  Our new OR has plenty of space, natural light in addition to two powerful overhead lights, a new anesthesia machine and tons of storage space so that there is a place for everything and, so far, everything has been in its place.

Our old operating room was perfectly functional but was small and cramped and sometimes it felt like we were always bouncing off each other or a piece of equipment that didn’t really have a home.  And there were no windows which meant that a day in the operating room felt a little bit like working in a cave with good lighting.

Building out this new facility was a labor of love and money and I owe a lot to my associate Dr. Shahram Salemy for his vision and persistence in making it all happen.  It’s a great place to spend the day which is good because  I am going to be stepping up my schedule  to help pay for it!

Thanks for reading!  Dr. Lisa Lynn Sowder

My Plastic Surgery Philosophy, New Technology, Patient Safety

Can I guarantee an all female surgical team? Sorry. No can do.

February 12th, 2014 — 4:52pm

Seattle Plastic Surgeon discusses why she cannot guarantee an all female surgical team. blog no boys

Recently a prospective patient contacted me and wanted to know if I could guarantee and all female surgical staff.  If I could not guarantee this, she would seek care with another doctor.  Well, that’s one I had to let go.  You see, I cannot guarantee an all female staff because our operating team has one female surgeon (moi), one male surgeon, two female nurses, one male nurse, two female surgical techs, two male anesthesiologists and one female anesthesiologist.  It may be logistically possible to request that a female only crew staff the operating room on any given day but what if our female anesthesiologist has to stay home with a sick child or if one of the female nurses is needed to assist my male associate at another surgical facility that day?  Do we cancel the surgery?  Do we scramble to find a fill in?  Do we call a temp agency and say “send us someone, anyone,  with two X chromosomes.”

And then there are the employment laws.  I cannot not discriminate based on gender or even on gender identity.  I have to give equal consideration to a male nurse, a female nurse with a unibrow and soul patch, and a cross dressing nurse of either gender.   You see, the gender or gender identity is not of consequence for taking good care of patients.  As long as an individual is professional and competent, a patient’s discomfort with a particular gender is (well, sorry about this), the patient’s problem.

Believe me, I have been on both ends of patient discomfort many times.  I trained in surgery in the 80’s when women surgeons were a bit on an oddity.  And I did my general surgery training in Utah.  I distinctly remember during one of my rotations in the surgical intensive care unit helping the nurses with an elderly Mormon gentleman who was crashing fast.  I was cleaning his pubic area in preparation to insert a catheter into his bladder.  He looked at me and said “Dr. Sowder, I’ll give you 20 minutes to stop that.”  I’ll never forget this nice man’s little joke and how it relieved my discomfort.

So, no I cannot guarantee an  all female surgical team.  But I can guarantee a team of professionals who come to work every day wanting to make your surgical experience as comfortable and pleasant as possible.  And if anyone feels a little embarrassed, don’t take it personally.  We won’t.

Thanks for reading!  Dr. Lisa Lynn Sowder

My Plastic Surgery Philosophy, Plastic Surgery

Next step?

October 2nd, 2013 — 10:32am

Do you have lots of questions about plastic surgery?  Come on in for a consultation!

Interested in a consultation? What's the next step?

Interested in a consultation? What’s the next step?

I get about a bajillion emails every day from prospective patients and I try very hard to answer them the best I can but…………………………there is a limit to how much information I can provide without actual the laying on of eyes and hands.

Plastic surgery is such an individual and personal undertaking that I really, really need to see a patient in the office before I can come up with a detailed plan.  No two patients are alike – not even identical twins!

I usually spend about 45 minutes with a new patient, getting to know them and their concerns, taking a detailed medical history and then examining their area of concern.  After an in-person evaluation, I can answer specific questions, provide useful information to help patients make decisions regarding surgery and my patient care coordinator can provde detailed information about costs and scheduling.

So…………………… the best way to take the next step is to call my office at 206 464-0873 and a real, live person will answer the phone and set you up for a consultation.  We can check each other out and I’ll answer just about every question you can throw at me!

Thanks for reading and hey, go ahead and call for a consulation!

Dr. Lisa Lynn Sowder

My Plastic Surgery Philosophy, Plastic Surgery

“I want to look natural.” Really?

April 25th, 2013 — 11:54am

Seattle Plastic Surgeon riffs on the “natural look”.

Natural look

This is a really, really natural look (except for the tats).

I practice in Seattle and many if not most of my patients come in saying they want a “natural look”.

Simply by making an appointment  with a plastic surgeon tells me that their idea of a natural look and my idea of a natural look may differ a bit.  To me, the lady on the left has a really, really natural look, except for her tats.  And if my patients looked like this lady after surgery, I would not be very busy.  I am not, in any way, dissing this lady.  I rather admire her chutzpah in letting it all hang out.

I try very, very hard to understand exactly what my patients mean by “looking natural” and in most cases what they really mean is that they want it to look like it “could have, just maybe, just possibly, on a really, really good day, occurred in nature”.  Another term I like is “as good for my age as possible”.

So ………… “like it could have occured in nature” and “as good for your age as possible” are two looks that are in my realm of reality and two looks that I strive for in my plastic surgery practice.

Thanks for reading!  Dr. Lisa Lynn Sowder

Aging Issues, My Plastic Surgery Philosophy

Let’s Make a Deal!

April 17th, 2013 — 12:40pm

Let’s Make a Deal is great entertainment but has no place in a doctor’s office.

Plastic surgery deals

Not in my office, please!

I used to love watching Let’s Make a Deal as a kid when I was home sick from school.  It was just so fun to see the contestants win something really cool like a car and so funny to see the look on their face when their chosen door opened to reveal a donkey or some other outrageous booby prize.

Despite my fond memories of Let’s Make a Deal, I don’t play this game with my pricing of goods and services.  I recently had an inquiry about discounting my price for Juvederm, one of the hyaluronic acid fillers, for a woman and her 4 sisters.  I didn’t see the logic in discounting my price.  I spend the same care and time with each patient and the same amount of Juvederm and sometimes seeing a group of patients can turn into a bit of a three ring circus or a game show.

So I like to keep it professional, my services and my prices.  Otherwise I am crossing the line from doctor to used care salesman or a game show host.

Thanks for reading!  Dr. Lisa Lynn Sowder

Facial Fillers, My Plastic Surgery Philosophy, Uncategorized

I am such a Girl Scout!

April 12th, 2013 — 12:34pm

Seattle Plastic Surgeon discusses the difference between reconstructive and cosmetic surgery and what that has to do with April 15th and the Girl Scouts of America.

Seattle Plastic Surgeon

I am such a Girl Scout. Please don’t ask me to fudge about the medical necessity of cosmetic procedures.

This time of year I get numerous requests from patients who want to “write off” plastic surgical procedures for tax purposes.    I am always happy to provide my clinic notes and operative reports and billing information for patients to use as they wish but I will not call a cosmetic procedure medically necessary.  Here are the definitions I use for the different categories of plastic surgery:

  • Reconstructive surgery includes those procedures that address an abnormal body structure to return to it normal or near normal appearance and/or function.
  • Cosmetic surgery include those procedures which address a normal body structure to improve appearance and/or function.

So both reconstructive and cosmetic surgery improve appearance and/or function.  The difference resides in starting point.  Was the body structure normal prior to surgery?  And, of course, the plot thickens because normal for a 65 year old is not normal for a 25 year old.  And to add more confusion, what is the function of the face?  The breast?  The nose?

Is the function of the face to provide a place for smell, breathing, taste, vision, hearing, speaking and eating?  How about the function of the face as our visual calling card?  And the breast:  Is the only function of the breast lactation or is the breast a visual calling card for femininity?

And then there is the issue of medical necessity.  What exactly does that mean?  Clearly, treatment of acute appendicitis is medically necessary.  But is it medically necessary to reconstruct a breast lost to cancer?  That reconstructed breast will never lactate.  Is it mecially necessary to treat  post-menopausal hot flashes with hormone replacement therapy or  how about replacing an arthritic hip in a 60 year old who wants to continue to play tennis?  Insurance will cover all of those above treatments but only the acute appendicitis is life threatening.

As you can see,plastic surgery is often not black and white but sometimes it is.  In those in between cases, I am happy to provide an opinion.   But I won’t stretch the truth on cases that are clearly cosmetic.

Don’t you just love it that your plastic surgeon is a Girl Scout?

Thanks for reading and have a happy tax day!  Dr. Lisa Lynn Sowder




Financial Issues, My Plastic Surgery Philosophy

Body Dysmorphic Disorder

March 28th, 2013 — 9:47am

Seattle Plastic Surgeon explains why plastic surgery should be avoided in those who suffer from Body Dysmorphic Disorder.

Plastic Surgery will not relive the suffering of Body Dysmorphic Disorder.

Plastic Surgery will not relieve the suffering of Body Dysmorphic Disorder.

I saw a young man recently who suffers from Body Dysmor-phic Disorder (BDD). Those who suffer from BDD become obsessed with a minor or imaginary physical flaw.  They may withdraw from society because of their perceived defect and spend hours a day checking the perceived defect.  And they may very well end up in a plastic surgeons office.

Plastic surgery may remove the tiny flaw but it does not help the patient with BDD.  If the defect is a mole that I can barely see without my magnifying glasses and I remove it successfully, the BDD patient will then obsess over the tiny scar or another tiny flaw.  Plastic surgery cannot cure BDD because BDD is a mental illness, not a physical condition.

It is very important for plastic surgeons to be aware and on the look out for patients with Body Dysmorphic Disorder.  Operating on one of these unfortunate patients will undoubtedly set up a cycle of dissatisfaction and disappointment for both the patient and the surgeon.  These patients need a referral to a mental health specialist.

Read more about Body Dysmorphic Disorder.

Thanks for reading!  Dr. Lisa Lynn Sowder


General Health, My Plastic Surgery Philosophy, Plastic Surgery

Back to top