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: Obesity


FAQ: If I gain weight after liposuction, where will the fat go?

September 2nd, 2016 — 9:43am

Seattle Plastic Surgeon answers common Liposuction FAQ:  Where will the fat go if I gain weight?

Before hip liposuction, after hip liposuction, after significant weight gain. It's not pretty.

Before hip liposuction, after hip liposuction, after significant weight gain. It’s not pretty.

This is one of the great plastic surgery mysteries because in any given patient, I cannot really predict where the fat will go if a patient gains weight after liposuction.  I can say with confidence that it won’t likely go to the area(s) liposuctioned and it will likely go somewhere the patient does not want it.

So here’s the deal.  Liposuction removes unwanted fat cells.  Weight gain, at least short term weight gain,  makes existing fat cells fatter.  Soooo, if I remove, say, one half of the thickness of the fat pad of your lateral thighs and you gain weight, there are only half the previous fat cells in that area to get larger.  So the area may get a little thicker but not as much as the surrounding areas where fat cells were not removed.

And the same goes for other types of body contouring like tummy tucks (a.k.a. abdominoplasty), body lifts and breast reduction.  And this is why I am so adamant about patients having body or breast contouring when they are at a healthy and reasonable weight (did you notice I did not say ideal weight).  And then after surgery, their healthy and reasonable weight is their pre-op weight minus the weight removed surgically.  So if I removed 5 pounds doing a tummy tuck, my 145 pound patient should end up weighing (after recovery of course), 140 pounds.  See this blog on the Arithmetic of Body Contouring.  And see this blog on Predicting Patient Satisfaction after Body Contouring.

Thanks for reading!  Dr. Lisa Lynn Sowder

Body Contouring, Liposuction, Obesity, Tummy Tuck

FAQ: Should I lose or gain weight before surgery?

October 21st, 2014 — 2:21pm

What’s the ideal weight for plastic surgery?

Which Oprah will do best with surgery? Probably the one in the red dress!

I get this question a lot from patients who are thinking about having breast and/or body contouring.  It’s an important question and I am always glad to hear it because it tells me that the patient understands that weight fluctuations can make a difference in surgical outcome.  Take Oprah for example.  There have been times in her life where her weight has yo-yoed all over the place.  Operating on her during these times would be like operating on a moving target.  A great result seen two weeks after surgery could turn into a lousy or even bizarre result a few months hence if her weight went up or down 30 – 40 pounds.

Sooo……patients should be at a stable and sustainable and healthy weight prior to surgery.  Did you notice that I did not say ideal?  Ideal weight may be achievable for some patients but unless it is sustainable, I would rather operate on a patient who is a little bit or even quite a bit over their ideal as long as they are healthy.

Healthy is the key word here.  If a patient is carrying a lot of excess weight and has type 2 diabetes, high blood pressure and has trouble walking up a flight of stairs, that person is not healthy and should not be having elective surgery.  That is the type of patient I will refer to a weight loss specialist.  If on the other hand, the patient is carrying extra weight and does not have diabetes, high blood pressure and plays an hour of pickle ball every day, I have no problem doing elective surgery on them.  And at the other end of the weight spectrum there are issues with being too thin.  I screen carefully for patients with eating disorders such as anorexia nervosa or bulimia.  Those conditions are serious illnesses and patients need evaluation, care and support – not plastic surgery.  Thin patients who are well nourished and weight stable usually make excellent surgical candidates.

So as you can see, it’s not about the number on the scale or the BMI or the dress size.  It’s about being healthy.

Thanks for reading!  Dr. Lisa Lynn Sowder

Body Contouring, Breast Contouring, Obesity

More on BELLY FAT

April 9th, 2014 — 11:10am

Seattle Plastic surgeon shows why belly fat cannot be treated with liposuction (with a little help from Oprah and Dr. Oz).

This, folks, is belly fat. It is inside the abdomen, deep to the abdominal muscles. It cannot be removed with liposuction or tummy tuck (abdominoplasty). Losing weight will make it shrink.

I saw a patient a couple of years ago who was requesting abdominal liposuction.  I did my usual body contouring evaluation and had the unenviable task of informing him that he was a really lousy candidate for liposuction or an abdominoplasty (tummy tuck).  His abdominal girth was caused by belly fat a.k.a. intrabdominal fat a.k.a. visceral fat a.k.a. beer belly fat.   The way I could determine this was to have him lay down on the exam table.  His belly did not flatten out.  See photo on the right.

The omentum from a deceased obese person vs. the omentum from a deceased slender person.

 

 

 

 

 

 

Belly fat collects in the mesentary, which is the structure that carries blood vessels to the abdominal organs, and the omentum, which is an apron like structure that hangs off the stomach.   In an obese person, they are very, very thick.  In a lean person, the mesentary and omentum are very thin and translucent.   Here is Dr. Oz holding the omentum of a fat person and Oprah holding the omentum of lean person.  There is NO WAY a fat omentum can be sucked down to a thin omentum.  The only way to reduce an omentum is to lose weight.  I referred the patient to Dr. Richard Lindquist at Swedish Medical Center Weight Loss Services.

I asked him to follow-up with me but I haven’t heard from him.  And he never went to Dr. Lindquist.  I hope he did not find a surgeon ignorant or desperate enough to do surgery on him.  If he did, my guess is that he is sorely disappointed with his result.

Thanks for reading!  Dr. Lisa Lynn Sowder

Body Contouring, Liposuction, Obesity, Tummy Tuck

Downton Abbey – those corsets remind me of tummy tuck surgery

March 11th, 2013 — 11:16am

Seattle Plastic Surgeon riffs on how those Downton Abbey women stay so slim and what it all has to do with the modern day tummy tuck.

A tummy tuck is a little like having an internal corset.

A tummy tuck is a little like having an internal corset.

The ladies of Downton Abbey spend a lot of time having their corsets laced up by their maids – and it’s always right before they go down for dinner.  No wonder they all stay so slim.  Who can overeat when laced up tight?

And this brings me to a recent study about weight loss in ladies who have had a tummy tuck.  This is a common observation in my practice but I had never before seen it reported in the plastic surgery literature.  It seems that the internal corset that is part of most tummy tuck operations results in automatic portion control just like an old fashioned corset does.

Just another great thing about tummy tuck.  You get to wear your corset 24/7 and you don’t even need a maid!

Thanks for reading!  Dr. Lisa Lynn Sowder

Body Contouring, Now That's Cool, Obesity, Tummy Tuck, Wardrobe Observations

Fat Necrosis: it looks and sounds worse that it really is.

August 24th, 2012 — 9:52am

Seattle Plastic Surgeon explains fat necrosis.

Fat necrosis often gets much, much better with a little tincture of time and usually does not require reoperation.  It occurs most frequently in overweight patients who have a thick layer of fat.

     Recently I re-operated on an abdominoplasty patient of mine for fat necrosis.  The term, fat necrosis, sounds so awful that I am compelled to blog about this uncommon and totally manageable problem that can occur after any surgery that removes and/or rearranges fat. 

     Fat necrosis occurs when the blood supply to the fat is inadequate.  The fat cells die and as they die they release fatty acids and other chemicals that causes inflammation and swelling and sometimes pain.  Usually fat necrosis presents as a non-tender lump but in my patient’s case, the area was quite painful. 

     Fat necrosis can look a lot like a wound infection to the patient.  Diagnosis is made by evaluating the patient for other signs of infection such as fever or chills and examination of the surgical site.   Fat necrosis has a very doughy texture.   It feels just like bread dough under the skin and is rarely very tender.

    In most cases the lump shrinks over time and ends up as a firm little lump that many patients just ignore,  If it is a bother, the lump can be excised under a local anesthetic through a small incision.  

       The lady I re-operated on had an area of fat necrosis the size of a small plum.  Two days after removal, she felt like a million bucks and is on her road to a quick recovery from this “lump in the road”. 

    

  Thanks for reading.  Dr. Lisa Lynn Sowder

Body Contouring, Breast Reduction, Obesity, Postoperative Care, Tummy Tuck

Happy Belated Birthday to the Rolling Stones

July 13th, 2012 — 11:29am

Seattle Plastic Surgeon wishes Happy B-Day to those ageless boys of the Rolling Stones.

It’s hard to believe that the orginal Bad Boys of Rock ‘n’ Roll first went  had their first gig fifty years and one day ago.  Several years ago, Marianne Faithful wrote Memories, Dreams and Reflections about her high times with the band and rumor has it that Keith Richards gave her a call to tell her he didn’t really care what she wrote about him but to be sure to let her readers know how much fun they had.  Further proof that time flies when your having fun.  I haven’t read Marianne’s memoir but I’ve read Keith’s.    It’s a good read, especially about the early days in post WW II England and how he gets that unmistakable sound on his guitar. 

I’m not sure I would call the Stones examples of graceful aging but they have sure made it look much better than the alternative which of course is dying young and leaving a good looking corpse.  One thing they all have in common is that they DID NOT GET FAT.  Not many dudes can fit into their circa 1962 jeans but these dudes can.  Staying lean is obviously not good for the face but  that’s what fillers are for. 

My favorite Stone’s song is Gimme Shelter but Satisfaction is my all time favorite party sing-along song.  It’s so fun to play that opening riff and seeing everyone (well, I guess almost everyone) perk up and start tapping their feet.  What’s your favorite Stone’s song???  Let me know.

Thanks for reading!  Dr. Lisa Lynn Sowder

 

 

 

 

 

Aging Issues, Facial Fillers, Obesity

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

Predicting Patient Satisfaction With Liposuction – Here’s The Math.

June 11th, 2012 — 11:06am

Seattle Plastic Surgeon blogs about predicting patient satisfaction following liposuction.

Later this month, I am giving a talk to the Washington Society of Plastic Surgeons on Plastic Surgery and the Overweight or Obese Patient.  This is a very prickly topic and a difficult one to discuss, especially with the overweight or obese patient.  I do my best to be straight forward and honest about what body contouring can accomplish in this patient population and try to educate patients about realistic expectations.

While researching this topic, I came across this very helpful diagram.  This was published by Dr. Rod Rohrich and associates at the University of Texas Southwestern.  They looked at the effect of post liposuction weight changes on long term satisfaction .  They came up with this very helpful chart.  I am going to start using this chart for all my body contouring patients, regardless of their weight.

Thanks for reading!  Dr. Lisa Lynn Sowder

 

 

 

 

 

 

 

 

 

 

Body Contouring, Liposuction, Obesity

A Surgical Cure for Type 2 Diabetes?

April 13th, 2012 — 2:23pm

Seattle Plastic Surgeon shares some great news about Type 2 Diabetes.

For years it has been observed that obese patients with Type 2 diabetes have a dramatic improvement in their diabetes after gastric bypass surgery.   And this improvement is seen almost immediately after surgery, long before the patient loses significant weight.  Now there is something more that just anecdotal reports of this finding.

Recently the results of a randomized, prospective study of 150 obese, type 2 diabetic patients treated with  surgery or intensive medical therapy was released.  This study was carried out at the Cleaveland Clinic and took a look at the blood sugars of patients one year after surgery vs. one year after intensive medical treatment. 

The surgery patients blew the medical patients out of the water with their blood sugars going down, way down, despite stopping their diabetes medications. 

This study confirms the many anecdotal reports of the past decade or so.  Could it be that the first line of treatment for this devastating disease that afflicts so many obese patients will be major surgery?   It’s too soon to tell but as these types of surgical weight-loss procedures become safer and safer, that just may end up being the case. 

Now we just need a fix for obesity that triggers most cases of Type 2 diabetes.    Send me your ideas for this.  I’d love to be in on it. 

Thanks for reading!  Dr. Lisa Lynn Sowder

General Health, New Technology, Now That's Cool, Obesity

600% Increase in Body Lifts in the Past Decade

March 10th, 2012 — 1:12am

Seattle Plastic Surgeon’s hunch confirmed by recent report – body lifting is in demand.

I really, really like doing body contouring procedures on patients after massive weight loss.   There are many, many types of lifts that are done below the neck.  They include:  lower body lift, flank lift, mons lift, brachioplasty (upper arm lift), thigh lift, breast lift, buttock lift and tummy tuck which is sorta kinda a lift. 

These procedures make such a huge difference in both how the patients look and feel.  Many of these patients, despite being at or close to their ideal weight, still feel obese because of all of the excess skin and sags and bags.

It’s a good thing I like doing these procedures because according to the American Society of Plastic Surgeons, these sorts of lifts have increased 600% over the past 10 years.  The reason, of course, is the obesity rates have gone up as thus the incidence of formerly obese patients has gone up.  

 About 1/2 of my massive weight loss patients have had weight loss surgery.  The other half have accomplished their weight loss through huge and profound permanent lifestyle changes usually with the help of a peer support group such as Weight Watchers or Overeaters Anonymous. 

I feel very, very privileged to help these patients finally achieve their personal best after they have suffered so much from their obesity and have worked so very, very hard to improve their health and their appearance.  I say, keep ’em coming! 

Thanks for reading.  Dr. Lisa Lynn Sowder

Body Contouring, Brachioplasty, Breast Contouring, Breast Lift, Obesity, Tummy Tuck

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