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

Coffee Headaches can be a problem after surgery.

April 24th, 2012 — 3:59pm

Head ache the day after surgery? It's probably a "coffee headache".

Seattle Plastic Surgeon advises coffee drinker patients to have a cup of coffee ASAP after surgery. 

I did surgery on a vigorously healthy middle aged lady yesterday and today she was doing fine except for a really, really bad headache.  My very astute nurse told her to drink two cups of coffee and see if that helped.  Sure enough, a little caffeine in the system and the headache disappeared. 

Coffee headaches are pretty common after surgery because patients cannot eat or drink anything the morning of surgery so regular coffee drinkers miss out on that dose of caffeine and they often don’t feel like a cup of coffee for a few days after surgery.

So, if you had a tummy tuck yesterday and your head hurts more than your tummy, you just may have a coffee headache and the cure is a nice hot cup of coffee.   Bottoms up!

Thanks for reading!   Dr. Lisa Lynn Sowder

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

Get out of the rain and into the Moisture Festival!

March 19th, 2012 — 4:48pm

Seattle Plastic Surgeon is a big fan of this very Seattle-ish tradition.

Every late winter/early spring, when the city of Seattle is just about ready to move to Phoenix the Moisture Festival saves the day.

This quirky vaudevillian celebration of human weirdness runs for several weeks at various venues in Seattle.  It showcases jugglers, comedians, contortionists (my husband’s favorites), aerialists, musicians, unicyclists, bubble masters and even a guy who makes sandwiches with his feet and then gets members of the audience to eat them.   What is not to loooooove?   All of this for $20!!!

Soooo, if you need a few laughs, check out a show.  The Comedy/Variety shows are PG rated and fine for the kids.   (My daughter loves the Moisture Festival and wants to be an contortionist when she grows up).  The over 18 shows are for adults only and showcase Seattle healthy burlesque scene and, although I do not have proof, probably some nice plastic surgery work!

Thanks for reading.  Dr. Lisa Lynn Sowder


I Love Seattle!, Now That's a Little Weird, Now That's Cool

The Cautionary Tale of Gertrude McFuzz

February 6th, 2012 — 7:09pm

Seattle Plastic Surgeon Tells the Tale of a Tail – It’s a great story about greed.


This in Gertrude after discovering the secret of a bigger tail.

Gertrude McFuzz is a wonderful Dr. Seuss story, one of three in his book Yertle the Turtle and Other Stories.

All three stories involve hubris and/or greed.

Here’s the Cliff Notes of Gertrude McFuzz:

  1. Gertrude is a plain little bird with a one feather tail.  She seethes with jealously when she see’s La La Lee Lou, a bird with a two feathered tail fly buy.

  2. She visits her uncle with her woe of inadequacy and he tells her about the berries on a special bush that will make her tail grow.

  3. She eats one berry and finds that her tail is just an nice as La La Lee Lou’s tail.  But of course, she cannot stop at two and she eats all the berries.  Her tail explodes over the next few hours in a show of lavish feathers and fronds and Gertrude is  thrilled.  Her tail is sooooo much better than La La’s.

  4. Then she tries to fly home to show off her beautiful tail but finds she cannot fly with the weight and drag of her magnificent appendage.

  5. Her whimper for help reaches her Uncle who sends out a flock of birds to help Gertrude home.  Once home, she is plucked back to her one feather status.  OUCH!

  6. She is so happy to be able to fly again with her one feather tail.

I think of Gertrude every time I see or hear of a patient who has a nice result from breast augmentation and wants to “go bigger”, especially if she wants to be as big as “fill in the blank with the name of a friend or celebrity”.   Breast implant problems are much more common in patients with big implants, especially when the implants are too big for the patient’s frame and/or life style.

A lot of patients and their plastic surgeons belong to the “GO BIG OR GO HOME CLUB” but this plastic surgeon has read Gertrude McFuzz a jillion times to her children, nieces and nephews and this tale of a tail always pops into my brain when I hear the words, “these are really, really great but can’t I go just a little bigger?”

Buy Yertle the Turtle and Other Stories even if you have no young kids to read to.  You will enjoy and learn from it!   I personally think every plastic surgeon would benefit from reading about Yertle and his ego run riot.  That’s another blog.   Thanks for reading.  Dr. Lisa Lynn Sowder


Breast Contouring, Breast Implants, Children, My Plastic Surgery Philosophy, Now That's a Little Weird, Patient Beware, Plastic Surgery

Do your earlobes need a little attention before that big job interview?

December 28th, 2011 — 9:19pm

Seattle Plastic Surgeon gives some unsolicited advise on earlobe interview etiquette.

These earlobes are not interview ready.

This year I received many a Christmas card with the family photo and I am always amazed at how fast all of our kids grow up.  I also am amazed at the various hairdos and facial adornments my friends’ children seem to come up with as they reach young adulthood.    I am so thankful that I have promised each of my children $$$$$ for a no above- the-collar-bone- mutilation or tattto prior to college graduation and/or real job.   This job market  has to be brutal for new  grads, especially new  grads with earlobe issues like a few of my friends’ offspring now have.

 About 6 months ago I interviewed a lovely young lady who I really though might be the total package for the position we were filling until I saw her earlobes.  They peaked out from her tidy and stylish coif and screamed at me “CLUELESS”, “POOR JUDGEMENT” or “I DON’T GIVE A RIP“.  Black metal gauges the size of a faucet washer do not make it in a plastic surgery office.  Sorry, but looks matter.  They matter a lot.  That’s what keeps me in business.   A teeny, tiny nose stud or eyebrow stud —– maybe, just maybe but not this True Value Hardware look.  I don’t care about Honor Roll or Phi Beta Kappa.  This was a deal breaker.

 So if you are out looking for a real job, a real career, where you will be treated and paid like a real grown up and you have earlobe issues, you might want to look into earlobe repair.  The vast majority of stretched earlobes can be fixed and made to pass for normal with a little plastic surgery.  Cost, scars and recovery will vary with the damage that has been inflicted.  Give me a call.  I’m here to help you with that job interview.

 Thanks for reading.  Dr. Lisa Lynn Sowder

Earlobes, Now That's a Little Weird, Plastic Surgery

Meet the Tooth Fairy’s cousin – the Scab Fairy

December 20th, 2011 — 6:09pm

Seattle Plastic Surgeon tells the story of the Scab Fairy, a story that every parent needs to know.

Seattle Plastic Surgeon's scab fairy
This is the Scab Fairy. She’ll leave you a little something if you put that scabby Band-aid under you pillow.

Last week I had the opportunity to take care of a delightful little boy in the emergency room.  He had a classic childhood injury:  forehead vs coffee table.  The table won (it always does) and he needed a half dozen sutures to sew up the deep, jagged gash in his forehead. 

When he came to my office for suture removal, his suture line was scabby and crusty and this can make it hard to remove the teeny, tiny sutures.  Now little kids do not like having anyone mess with their scabs but once I told him about the Scab Fairy, he became much more enthusiastic about the whole thing.  

 You see, the Scab Fairy visits every night looking for scabby Band-aids that good little children have placed under their pillow.  Usually the Scab Fairy leaves something like a Hershey’s Kiss or even a little money.  Once one of my children scored a Pop Tart!   Once my little patient heard this, he was fine with me gently removing the Band-aid and underlying scab.  I made sure to send this home with him in a little baggie. 

 So,  all of you parents out there with active children:  There will be scabs and you need to make friends with the Scab Fairy.

 Thanks for reading!   Dr. Lisa Lynn Sowder.

Children, General Health, Now That's a Little Weird, Plastic Surgery, Postoperative Care, Trauma

“Hand Lift” – What a BAD Idea

December 13th, 2011 — 10:33pm

Top shows the back of the hand before fat transfer. Bottom shows the back of the hand after fat transfer.

Seattle Plastic Surgeon just can’t keep her opinion about this poorly thought out procedure to herself. 

I read several plastic surgery journals every month and more often than not I think, “Now there is a good idea”.  But this month I read an article about using a “hand lift” for hand rejuvenation and I thought, “Now there is a really, really bad idea”.

 A “hand lift” involves excising some of the loose skin at the level of the wrist and pulling the skin on the back of the hand tighter.  Yikes!  This not only leaves a significant scar on a very visible area of the wrist but also makes the skin too tight when making a fist.  And it doesn’t help the quality of the skin itself. 

The problem with the idea of a “hand lift” is that it does not address the real problems with aging of the hands.

So what was this plastic surgeon thinking when he thought up this operation?????   My guess is that he did not know how to perform fat transfer to the hand which is a procedure that I think is really, really great.  Fat transfer addresses some of the real problems with aging of the hands: deflation because of loss of fat and deterioration in skin quality. 

With fat transfer to the hand, fat is harvested from the patient where there is a relative excess (usually the belly or the hips).  The fat is purified and then injected into the back of the hand in teeny, tiny parcels.  The fat does a couple of things.  First of all, it plumps up the hand that has lost fat over the years and second, it really improves the quality of the skin.  Just take a look at these close up photos.  Not only are the veins less prominent after fat transfer, the fine lines are much, much smoother and the color of the skin is better.  These changes are likely due to the stem cells that are in the fat.  This change in skin quality is seen in other areas when fat is transferred to the layer just under the skin.   This stem cell effect is a very, very hot topic and is being investigated by several large plastic surgery institutions.

Soooo, if you don’t like the way your aging hands look, don’t get a “hand lift” but consider fat transfer instead.  There are no long scars and recovery is usually quite rapid and almost painless and the improvment is long lasting.

Thanks for reading!  Dr. Lisa Lynn Sowder


Aging Issues, Fat Injection, Hand Surgery, New Technology, Now That's a Little Weird, Now That's Cool, Plastic Surgery

Stitch abscesses – a postoperative bump in the road.

October 24th, 2011 — 10:25pm

Seattle Plastic Surgeon blogs about spitting stitches a.k.a stitch abscesses a.k.a. a real pain for both patient and surgeon

Healing after surgery in most cases is uneventful.  (Uneventful is a good thing when it comes to surgery and flying.)  But sometimes uneventful healing can be interrupted by a stitch abscess which always looks way worse than it actually is.

Spitting stitches can occur whenever stitches are left in after surgery.  In plastic surgery, we often close incisions just under the surface of the skin with stitches that dissolve over several months.  If one of these stitches is a little too close to the skin surface, or works its way up towards the surface, it can cause a stitch abscess which is the skin’s reaction to a foreign substance (in this case the stitch).  This is a lot like having a splinter in your foot or finger.  It won’t get better until the splinter is removed.  The same for a stitch abscess.  It won’t get better until the stitch is removed.   If you have had surgery and have a little area like in the photo above, give your surgeon a call and make an appointment to be seen.  In the meantime, put some warm, moist compresses on the area and don’t freak out!  It will be okay!

In most cases, a gentle probing with some sterile tweezers locates the offending stitch and it can be easily removed and the abscess resolves quickly.  Sometimes, I will put a patient on antibiotics for a week or so if the inflammation is pretty wide spread or the patient feels lousy and/or is running a fever. 

Back in the old days when silk and cotton sutures were used in the deep layers, patients could spit a stitch decades after surgery.  Fortunately that is really rare these days although I have had a few patients myself spit permanent stitches years after surgery.  It’s just one of those things that can happen but once the suture is removed, healing occurs quickly.  Learn more here.

Thanks for reading.  Dr. Lisa Lynn Sowder

Now That's a Little Weird, Plastic Surgery, Postoperative Care

Do you want to keep this?

July 11th, 2011 — 4:40pm

This Seattle Cosmetic Plastic Surgeon has plastic surgery on the brain even when dropping her car off at the repair shop.

Early this morning, I dropped off my poor 20+ year old car off at Seattle’s wonderful Fat City.  This place just loves German automobiles (as do I).    They had not yet opened so I filled out the intake form with my concerns (sorta like my new patient intake form) and was asked to check a box if I wanted them to save any replaced parts for me.

This, of course, got me thinking about plastic surgery and what I  do if when a  patient requests that we save their “parts”.

Plastic surgery involves a lot of restoring, repairing, and refining but it also involves a lot of removing.  Eyelid surgery removes skin and fat, face lift surgery removes a little skin and sometimes some fat, liposuction obviously involves removal of fat, breast reduction removes breast tissue and abdominoplasty removes abdominal skin and fat.   These are but a few examples.

Some of the parts I remove go to pathology so they can be examined for disease.  This is routine for breast tissue and for many skin lesions.  But some of the parts are just discarded.  And this may shock you, gentle reader, but all the stuff I remove from perfectly healthy and morally upright citizens is considered “hazardous waste”.  The stuff I remove is disposed of in an OSHA compliant fashion.  So ……… no, you cannot take your 4 liters of fat home in a jar to store in your refrigerator as a gentle reminder.

So you can’t take it with you but I am happy to take a photo of your parts if you want me to.    Just ask!    An 8 x 10 color glossy on your refrigerator door may work just fine.

Thanks for reading!

Dr. Lisa Lynn Sowder,   your easily amused plastic surgeon.

Now That's a Little Weird, Plastic Surgery

What can dog toys teach us about obesity?

June 22nd, 2011 — 6:45pm

Meet Henrietta and Earl

Seattle Plastic Surgeon shares her dog toy wisdom.

My aussie/border collie/snapping turtle, Stella, just loves her Henrietta and Earl chew toys.  Henrietta emits a high pitched squeal when chewed.  Earl produces a realistic flatus-like sound.  Stella, Henrietta and Earl make for some great hilarlity – for about 30 seconds.

Henrietta and Earl do, however, have some redeeming qualities in that they are very useful for obesity education.

Henrietta has a problem with external obestiy.  Her excess fat is mostly external and distributed kind of all over – her hips, back, chest, upper thighs and tummy.  This fat is unsightly but not much of a health issue.

Earl, on the other hand, has the dreaded internal belly fat.  Earl, who has an inappropriately elevated level of self esteem, will say, “It’s muscle, not fat.  Feel it, baby, it’s hard.”  Well, it’s not muscle, Earl.  It’s belly fat and it puts Earl at risk for diabetes, high blood pressure, stroke, heart attack, etc.

Henrietta’s fat is best addressed with weight loss but it can also be addressed with breast and body contouring surgery.  Earl’s fat on the other hand can only be addressed with weight loss.  Surgery cannot remove Earl’s internal fat although Stella is doing her best to chew it off.

Thanks for reading!  Easily asmused Seattle Plastic Surgeon, Dr. Lisa Lynn Sowder

Body Contouring, General Health, Now That's a Little Weird, Now That's Cool, Obesity, Patient Safety

Yuck! What are these things?

June 14th, 2011 — 5:27pm

Seborrheic Keratosis – looks bad but is totally harmless

Seattle Plastic Surgeon discusses icky but harmless skin lesions.

I just finished treating a lovely middle aged lady with about 20 of these unsightly skin lesions on her back.  Since she turned 50,  they have been popping up like mushrooms in our wet Seattle. 

These nasty looking lesions are seborrheic keratoses and despite their looks, they are totally harmless. 

Most patients who develop seborrheic keratoses are over 50 and most have a family history.  They usually develop in sun exposed areas but not always. 

There are several ways to treat these.  My treatment of choice is to numb up the area with local anesthetic and then scrape the lesions off with a curette and then zap any little areas of oozing with an electric needle.  It takes about 7 – 10 days for the areas to heal, depending on the size of the kertosis.  The really nice thing about treating these is that the treated area usually heals with minimal scarring.  Removal of seborreic keratoses does not require going all the way through the skin layers.  Usually I just have to go into the middle layer of the skin and that accounts for the fairly rapid and scarless healing. 

One big work of caution.  Do not have these treated unless you can spend a couple of months without sun exposure to the area.  UV radiation can turn the healing area brown and then you just end up with a brown scar where the brown spot used to be.  Rather counterproductive.  The lady I treated today won’t be exposing her back until next winter when she goes to Hawaii.  Perfect timing.

SOOOO – if you have some of these nasty little spots that bother you (or anyone who has to look at them), give my office a call and we can set up a time to remove them.  Fall is the best time because then you have a whole 6 – 9 months before any worry about sun exposure. 

Thanks for reading!  Dr. Lisa Lynn Sowder

Aging Issues, General Health, Now That's a Little Weird, Plastic Surgery, Skin Care

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