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: Now That’s a Little Weird

A craaaaazy breast implant complication.

September 25th, 2019 — 3:19pm

I use my blog to share some of the interesting stuff I see in medical journals and this is one of weirdest case reports I have ever seen.  This is from PRS Global Open (from about a year ago) which is the International Open Access Journal of the American Society of Plastic Surgeons. See the original article here.

This is a 65 year old lady with 31 year old silicone gel breast implants.  She presented with massive swelling of her left breast. She first noted the three years previously following a car accident.  Apparently she initially sought treatment but because of insurance issues did not receive definitive care.  Her MRI scan showed rupture of her implant with extrusion of implant material outside the scar capsule (a so-called extracapsular rupture) and fluid and a mass.  Since this looked so creepy and suspicious for cancer, a biopsy was done with came back consistent with organized hematoma which is a benign collection of old blood usually secondary to trauma.

She was taken to the OR and she was found to have ruptured breast implants (not unexpected given their age) and a large blob of old partially solidified blood on the left side.  She had removal of the implants and blood blob and also had some skin reduction done on the left side.  From this seasoned plastic surgeon point of view, she has an absolutely stellar result.  She also had some silicone removed from her left upper arm.  It no doubt migrated there either during or shortly after the car accident.  It had not caused any problems but was a palpable mass.  It hard to believe that this lady had to live with for 3 years because of her insurance company dragging their feet!

Anyway, it’s always something and I’m grateful to the plastic surgery department from Duke University for sharing this really weird and really interesting case with a very happy ending!

Thanks for reading and I would be so happy for you to follow me on Instagram @sowdermd and @breastimplantsanity.  Dr. Lisa Lynn Sowder

Breast Implant Removal, Breast Implants, Now That's a Little Weird

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.

Driver’s side skin damage. Check this out!

June 8th, 2017 — 8:12am

Got sunscreen in your glove box?  You should!

 This is an ABC news report written by Serena Marsh and edited for length by me.  This was originally posted in 2012.

Sunny Side Old: Pic Reveals Sun’s Aging Effects

William (Bill) Edward McElligott is two different ages, 66 and 86 yeaars old. 

If you look at McElligott from the right, he looks like any 66-year-old would expect to, but from the left, wrinkles and sagging skin place him far beyond his years. He is a living demonstration of the importance of protecting your skin from the sun.

“It would take me an hour to drive to work and an hour to come home,” McElligott said. “It was a semi route, I’d have six to eight stops. … 6 a.m. to 3 p.m. on the road.”

For almost 30 years, McElligott drove a truck during prime sun hours throughout the city of Chicago delivering milk to stores and gas stations.

“My left arm was always more tan than my right, because a lot of the time I had the window open (since) we didn’t have A.C.,” McElligott said.

The 66-year-old truck driver suffers from unilateral dermatoheliosis or photo-aging, which was caused by repeated, long-term exposure to UVA rays of the sun.

It was 15 years before he noticed any difference between the two sides of his face, but McElligott ignored it, that is until his grandchildren’s questions got the best of him.

Dr. Jennifer Gordon a dermatology resident at UT Southwestern saw McElligott while on a rotation at Northwestern in Chicago and submitted his case study, which was featured in the April edition of the New England Journal of Medicine.

“It was very stark,” Gordon said. “We are used to seeing photo damage, photo aging every day, (but) for it to be so one sided? We were taken aback.”

Gordon explained that since McElligott spent so much time in his car, his left side was exposed to UVA rays that can penetrate glass and cause the majority of photo-aging, unlike UVB rays, which cause sunburns.

“We think its because it (UVA) can penetrate more deeply into the skin than UVB and affect your collagen and elasticity,” she said. “When you destroy those that’s what gives you the aging appearance that we see.”

Dr. Mitchell Chasin, a dermatologist who did not treat McElligott, says it is extremely common to see patients that come in with more damage to their left side than their right.

“Most people are completely unaware and most people who come in to have sun damage treated, they often times will point to their left side saying they see more spots, more wrinkles, more aging, but never put two and two together,” said Chasin.

Chasin says that whenever people are outdoors, even when covered from the sun directly or on a cloudy day, they should be aware they are not safe from the reflected rays of the sun and should wear sunscreen.

“Sun block is the answer, really, for someone 365 days a year, whether it’s cloudy whether it’s sunny, whether someone is outdoors, in the car, or at the beach,” Chasin said. “If someone wants to age as best they can, sun protection is a daily regimen no matter what you are doing. Put sun block on before you leave the house.”

With summer approaching and vacations and road trips, it’s important to make sure your sunblock has protection against both UVA and UVB rays.

Last year the FDA demanded sunscreen manufacturers update their labels to offer protection for both UVA and UVB, as well as to stop the use of misleading claims such as waterproof. The agency recently extended the deadline to December for manufacturers to comply.

For McElligott sunscreen with UVA and UVB protection has become a daily fixture.

“When I’m out in the sun, when I’m going to be driving, I have sunscreen on,” he said. “I always carry it with me.”

Thanks for reading.  And do you have a favorite sunscreen?  Send me an email and let me know.

Dr. Lisa Lynn Sowder

Follow me on Instagram: @sowdermd and @breastimplantsanity


Aging Issues, General Health, Now That's a Little Weird, Skin Care, sun damage

Placebo and Nocebo Effect : The Power of Positive and Negative Thinking

February 6th, 2017 — 12:18pm

The Placebo Effect and its evil twin, the Nocebo Effect.

I’ve been doing some interesting reading lately on the mind/body connection in preparation for a presentation I am giving at the annual meeting of the Northwest Society of Plastic Surgeons this month.  I have been reading up on the “Nocebo Effect” which is the evil twin of the much studied and celebrated “Placebo Effect.”  Any one who has kissed a child’s owie is well acquainted with the placebo effect.

The nocebo effect is a more recently studied phenomenon.  One nocebo effect study involved giving a fake lactose solution to a group of participants which included lactose tolerant and lactose intolerant individuals.  44% of the lactose intolerant and 26% of the lactose tolerant reported gastrointestinal distress after ingesting the sham lactose.  The study participants were told that the solution was know to cause gastrointestinal symptoms.   The nocebo effect can be disruptive when it comes to new drug trials.  In some cases almost 10% of the participants in the placebo arms of clinical trials have to drop the study because of adverse effects.  I have come to view the nocebo effect as the Power of Negative Thinking.  We humans are very susceptible to suggestion.

I had a patient recently who came in for removal of her surgical drains after a breast reduction.  She was just a nervous wreck and was clearly bracing herself for the most painful thing ever.  I asked her about her anxiety and she told me she had seen a YouTube video of a young man who had had a gynecomastia procedure getting his drains removed.  He apparently was howling like an injured wolf.  He must have either had a very low pain threshold or maybe he was a drama student?   Anyway, while chatting with my patient, I slipped out her first drain in about 3 seconds.   Then I slipped out the other one.  She was pleasantly surprised at how quick and easy it was.  Yes, it stung a little but no need for howling.  The howling wolf video she saw was the nocebo effect at work.  The nocebo effect is one reason I implore my patient to avoid surgery horror stories before and after their procedures.  For every horror story out there are likely 10,000 undocumented stories of uneventful surgery and recovery.  But uneventful isn’t nearly as interesting as a howling wolf.

Thanks for reading and beware the nocebo effect.   Dr. Lisa Lynn Sowder.



Breast Implant Illness, General Health, Now That's a Little Weird, Postoperative Care

Dude, when you get off the bike, put on your fig leaf.

June 21st, 2015 — 11:23am

Seattle Plastic Surgeon and mother of a 14 year old daughter implores the naked cyclist at the Fremont Summer Solstice Fair to put a fig leaf on it. 

blog fremont fairI have been attending the Fremont Summer Solstice Fair for many years.  I live just a few  blocks away from Fremont, the self designated “Center of the Universe”.  The fair is a fun and funky and freaky celebration of Seattle’s short but wonderful summer and just about anything goes.  But this year, either I’m getting old and cranky or maybe the anything goes has gone too far.

Saturday’s parade has for years included a posse of nude cyclists who seem to appear from nowhere, weave through the parade and crowds and then disappear.  And we all cheer for their naughtiness.   But this year, after the parade, many of the cyclists just hung out, really hung out with nary a loin cloth.  I felt like I was in a urology clinic.  My daughter was having a hard time knowing where to look because everywhere she looked, there was another one.

So dudes, next year make sure you look for me.  I will be the middle aged lady handing out free fig leaves for those of you who forgot yours.

Thanks for reading!  Dr. Lisa Lynn Sowder




Now That's a Little Weird, Wardrobe Observations

Are the planets aligned for your surgery?

January 16th, 2015 — 1:12pm

Is there an astrologer in the house?

blog planets alligned

How are those planet lining up for your day of surgery?

Today I saw a lovely lady who is a great candidate for tummy tuck and fat transfer to the breasts.   She’s done with babies, her youngest is out of diapers and she is ready to reclaim a little bit of her babehood.  She’s also got some help lined up and some time off work available and now all she needs to do is check with her astrologer to make sure planetary alignment is just right!

Back when I was a smarty pants young surgeon, I would have dissed this lady’s belief in astrology but now that I have been around the block a time or two, I recognize that many people believe in things that I don’t and vice versa.  So if I need to tweek my schedule a little bit to get in alignment with her planets, I’ll do my best to do so.

Thanks for reading and by the way, I’m an Aries.  That explains everything, huh?  Dr. Lisa Lynn Sowder

Mommy Makeover, Now That's a Little Weird

Archaeology and Plastic Surgery

August 1st, 2014 — 12:39pm

Seattle Plastic Surgeon feels like an archaeologist while removing 42 year old silicone gel implants. 

blog archeology

Dr. Sowder, breast implant archaeologist.

Recently I saw a lovely woman in my office who wanted removal of her breast implants and replacement with new ones.  This is a common procedure in my practice.  What made this case really memorable was the age of her implants.  They were 42 years old!  This patient was one of the breast implant pioneers and here she was, all those years later finally ready for an upgrade.

Her old implants were as hard as rocks and upon removing them, the reason why was immediately evident.  The scar tissue around the implants (this is called the capsule) were very thick and  had calcified.  The capsules had literally turned to rock.

Paradoxically, the thicker and harder the capsule, the easier it is to remove and I was able to remove the  implants and capsules in two tidy pieces with zero spillage of silicone gel.  Remarkably, when I opened the capsule to reveal the implants, the implants were not ruptured but they had oozed a lot of silicone gel into the surrounding capsule.  The capsule and calcification was the body’s response to the oozed silicone gel.   The gel implants currently on the market are much sturdier and do not have the same degree of rupture or gel ooze and these old ones did.

I inserted some brand new silicone gel implants under her chest muscle, stitched her up and she is thrilled to have a chest that doesn’t look and feel like there are two tennis balls under her skin.  As for her husband, I can’t wipe the smile off of his face.

Have I told you lately that I really dig my job?  Thanks for reading!  Dr. Lisa Lynn Sowder

Breast Implant Removal, Breast Implants, Now That's a Little Weird

The IKEA Effect

February 7th, 2013 — 10:59am

Seattle Plastic Surgeon discusses the IKEA Effect.

blog Ikea effect

It may be crooked but I love it because I built it.

The IKEA effect refers to the phenomenon of how we are apt to like or even love something that required a lot of work on our part even if that something is flawed.

Take this crooked chair.  You would never buy this at a store but if you bought it at IKEA and did a lousy job of assembling it, you may very well be satisfied with it or even in love with it because it was the fruit of your labor.

So what does this have to do with plastic surgery?  Quite a bit actually.  It is very common for plastic surgeons to cling to a technique, procedure or device that they themselves developed even if something better comes along.     Also, it can be difficult to accept that a patient is unhappy with a result that the surgeon really sweated over.  We can sometimes deny that the result could have been better because we had to work so hard to get the result we did.

I recently saw a patient who had  minor asymmetry after breast surgery and I really thought she should be thrilled with her result but she was not.  I finally “gave in” and did a revision and now she is beyond thrilled and I am thrilled that she is thrilled.  Looking back  I see now that I had fallen victim to the IKEA Effect.

Thanks for reading and keep and open mind!  Dr. Lisa Lynn Sowder

My Plastic Surgery Philosophy, Now That's a Little Weird, Surgical Eductaion, Uncategorized

The rolling pin test for breast sagging.

November 1st, 2012 — 4:43pm

Seattle Plastic Surgeon shares a great patient story about sagging breasts.

One thing I just love about being a plastic surgeon is all of the great stories I hear from my patients.  Some of the stuff they tell me is better than anything I could make up.  Here’s one:

Last week I had a patient come in who was interested in breast surgery.   As we were chatting, she told me that she had passed the rolling pin test.  I had certainly heard of the pencil test but not the rolling pin test.  Just to refresh your memory, the pencil test is done by placing a pencil under your breast.  It the pencil stays put when you let go, you just may need the services of a plastic surgeon. 

Will your breasts hold up this rolling pin?

Well, my patient passed the rolling pin test.  Yes, it is true;  her breasts were so saggy and heavy that they could hold up a rolling pin. 

But not for long.  She has signed up for a breast reduction which always includes a breast lift.  I am certain that she will be thrilled with her result but what about her rolling pin?  It probably appreciated the attention.

Thanks for reading!  Dr. Lisa Lynn Sowder


Breast Contouring, Breast Lift, Breast Reduction, Now That's a Little Weird

Botox for Bunny Lines

September 21st, 2012 — 12:32pm

 Seattle Plastic Surgeon discusses “Bunny Lines”

I saw a patient today who wanted treatment for those funny little horizontal wrinkles on the nose that we plastic surgeons refer to as bunny lines.  She was surprised that I recommended Botox instead of a filler.

Botox works very well for bunny lines because these creases are caused by the underlying procerus muscle.  This muscle allows for that expression that people have when they smell something really, really bad.  Botox weakens the muscle and the wrinkles smooth out over several weeks after injection. 

Filler, such as Juvederm or Restylane could be used to fill in these creases but filler woud not treat the underlying cause and could make the bridge of the nose look a little bulky. 

Botox and fillers are both “injectables” but they treat wrinkles in completely different ways. 

Thanks for reading.  Dr. Lisa Lynn Sowder

Botox, Now That's a Little Weird

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