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: Patient Beware


Another fake top surgeon racket.

October 28th, 2014 — 2:28pm
blog top breast surgeon

You too, for some $$$, can hang one of these on your wall. No qualification necessary. Just $$$. You can send an email to daniel@americastopbreastsurgeons.com to arrange for payment.

Yet another bogus TOP DOC award I could hang on my wall but won’t. 

Here is the cut and paste of an email I received today from one Daniel Singh.

“You Have Been Nominated – Join the Top Breast Surgeons in America

Only 5 Plastic Surgeons will be chosen per state to be showcased
www.AmericasTopBreastSurgeons.com

Please reply back to this email and we will have detailed information sent to you regarding this exciting opportunity to showcase your practice as one of the Best of the Best in Breast augmentation and reconstruction.

Thank you for your time in advance.
www.AmericasTopBreastSurgeons.com

AmericasTopBreastSurgeons.com is not a credentialing organization.  It is not a surgery association.  It is nothing but a website to promote their bogus awards that are sold to doctors to display in their offices to impress unsuspecting patients.   Do I seem cranky today?  I am because this kind of nonsense makes me cranky.  Check out this blog for more of Cranky Dr. Sowder.
Thanks for reading!  Dr. Lisa Lynn Sowder

 

Patient Beware, This Makes Me Cranky.

Is your plastic surgeon’s in-office OR certified? You should ask!

June 27th, 2014 — 1:20pm

Seattle Plastic Surgeon is off to Spokane to inspect an in-office operating for the American Association for Accreditation of Ambulatory Surgery Facilities, Inc.  (AAAASF)

cc inspector

Inspector Dr. Lisa Lynn Sowder

I am off to my hometown, Spokane, this weekend both to visit family but also to inspect the in-office operating room of one of Spokane’s plastic surgeons for AAAASF.  I’ll be snooping around and looking not only at the facility’s physical space and equipment and medical supplies, I will be scrutinizing their policies and procedures, staff education and certification and looking through about a dozen patient charts.  It’s a very comprehensive evaluation for what is considered by many (me included) the Gold Standard in Accreditation.

One very important thing that sets AAAASF apart from some other accreditation authorities is that AAAASF not only looks at the facility and patient care, they look closely at surgeon qualifications.

In many states including Washington State, anyone with an MD license can play surgeon.  In fact, all MD  licenses from the Washington State Department of Health state “Physician and Surgeon” even if the MD has not set foot in an operating room since medical school.  There are no restrictive “scope of practice” laws in Washington.  Crazy, huh?  Oh, and a little scary.

Fortunately AAAASF thinks that surgery should be performed by surgeons, meaning those of us who have formal training and board certification in surgery.  AAAASF even requires that the procedures done in an in-office OR be within the scope of practice of the surgeons board certification.  And by board certification they mean a board which is recognized by the American Board of Medical Specialties (ABMS) and not some self-designated board.  The American Board of Plastic Surgery is recognized by ABMS whereas the self-designated American Board of Cosmetic Surgery is not.

Also, AAAASF requires that the surgeons using the in-office OR have hospital operating privileges for the procedures performed in the in-office OR in an accredited hospital within 30 minutes of the in-office OR.  It may be shocking to some, but some franchise cosmetic surgery businesses fly non-plastic surgeons in from out of state  to do liposuction for a few days and fly them back home.

So if you are looking into having a procedure done in an in-office operating room, it would be prudent to check to see if they are accredited by AAAASF.  If they aren’t, why not???

Thanks for reading and be sure to do your homework!  Dr. Lisa Lynn Sowder

 

Government and Politics, Patient Beware, Patient Safety, Plastic Surgery

DO YOUR HOMEWORK WHEN CHOOSING A PLASTIC SURGEON!

March 25th, 2014 — 9:26am

“I’ll double check to see if she is certified by the American Board of Plastic Surgery.”

Seattle Plastic Surgeon advises patients to do their homework when choosing a plastic surgeon.  Make sure that “cosmetic surgeon” is the real meal deal.

Today I saw a patient for follow-up after her Botox injection.  She was thrilled with how well the injection worked for her frown lines.  Prior to seeing me, she had been injected at her dentist’s office and had had very little improvement.

Some non-invasive procedures seem so trivial that anyone can do them.  Right?  Well, not really.  It is vital to know the anatomy of the area you are injecting and surgeons know their anatomy really, really well.  Also, I think it is important to have a lot of tools to treat any given problem so if a problem is best treated with surgery, surgery can be recommended as a better alternative.  I doubt if most dentists know their forehead anatomy well or are well versed in the various types of browlift to treat forehead issues.

I cannot imagine offering dental services to my patients and I am always surprised when other health care provides wander far from their core areas of practice.  For more on this issue, check out this article in the NEW YORK TIMES.

Thanks for reading and remember to do your homework.  Dr. Lisa Lynn Sowder

Patient Beware, Patient Safety, Plastic Surgery

Plastic surgery wannabes* have their knickers in a knot over this billboard in Utah.

October 4th, 2013 — 12:10pm

Seattle Plastic Surgeon loves this billboard in Utah.

billbordThis is a billboard in Utah that has a bunch of plastic surgeon wannabes’* knickers in a knot.  Why?  Because the billboard implies that plastic surgery ought to be performed by plastic surgeons.  Shocking, huh?

So what’s a wannabe* to to?  Take it to court, of course.  Well, the U.S. District Court in Utah recently ruled that the billboard does not constitute violation of the Sherman Antitrust Act.    See the report here.

*  wan·na·be

/ˈwɒnəˌbi, ˈwɔnə‐/ Show Spelled [won-uh-bee, waw-nuh‐]

noun, plural wan·na·bes. Informal.

one who aspires, often vainly, to emulate another’s success or attain eminence in some area.

Origin: 1980–85; derivative of ( I ) wanna be…         (from Dictionary.com)
Thanks for reading!  Dr. Lisa Lynn Sowder – a wannabe blues singer/songwriter but a real honest-to-God-fully- trained-8-years-of post-medical-school-residency-board-certified-real-meal-deal plastic surgeon.

 

Patient Beware, Patient Safety, Plastic Surgery

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

Anesthesia Smackdown!

January 20th, 2012 — 11:56pm

Seattle Plastic Surgeon blogs about the MYTH of local anesthesia being safer than general anesthesia.

Lisa Sowder blogs about the types of anesthesia

General Anesthesia vs Local Anesthesia. The winner is???????????????

I would  like to dispel the myth that local anesthesia is somehow safer than general anesthesia.  There are some practices that use the “we only use local anesthesia” as a selling point to imply that their practice is  safer, more advanced or “less invasive”  than a practice that offers general anesthesia.  My advice is to really look into the anesthetic options and  not go with a physician who offers only local  anesthesia.

A physician who does only local may do only local because he/she is flying under the radar of state regulations for office surgery.  Office operating rooms that do not provide general anesthesia are often exempt from certification and/or inspection at the state or federal level.  Another reason for a physician  to do only local is lack of proper anesthesia equipment which (like everything else in the medical industrial complex) is expensive.  And yet another reason is that the only local physician cannot find and an anesthesiologist to work with him/her for various reasons or the only local physician does not have privileges to do the procedure in a hospital that can provide general anesthesia.   If you aren’t saying YIKES, you may want to go back and read this paragraph again.  Also, read this related blog.

Local anesthesia works great for many procedures.  I do some minor face, breast, body and lipo cases with only local.    In these cases, I can keep the cost down, the patient comfortable, the recovery rapid and, unless I have used sedation, the patient can often drive him or herself home.  Sweet, huh?

But for many major or lengthy procedures, it is downright dangerous to use only local because the dose needed to provide comfort for the patient may exceed the toxic level.   All local anesthetics need to be administered within a safe dose and that safe dose varies with the area being injected, how fast it is injected, whether or not the local contains epinephrine and the size and health of the patient.    And the really scary part is that a local anesthetic overdose is often not evident until hours after the surgery has ended, when the patient is not longer in a doctors office, surgery center or hospital.  Patients can die from local anesthetic overdose.  This tragedy happened a couple of years ago in Bellevue, Washington at a clinic that only does local.  It this particular case, the patient kept complaining of discomfort during her extensive liposuction procedure and the doctor kept injecting local, way beyond the recommended dose.  He did not have an anesthesiologist there to help him keep the patient comfortable with intravenous sedation or general anesthesia or to help him keep track of how much local he was using.   She did not suffer the consequences of the overdose until hours after she left the office

There is no cosmetic surgery result so fabulous (or a price for that fabulous result so low) that  is worth dying for.  For my major cases, I really, really want to have an anesthesiologist there either to provide the general anesthesia or, in cases where I am injecting the local anesthesia, to provide sedation and monitoring and airway control (another topic and another blog) if needed.

Yes, the anesthetic equipment and anesthesiologists are expensive, and inspection by state and federal agencies are a hassle.   But the expense and hassle are well worth the safety that all patients, including cosmetic surgery patients, deserve.

Remember, better paranoid than sorry.  Thanks for reading.    Dr. Lisa Lynn Sowder.

Patient Beware, Patient Safety, Plastic Surgery

Mini Tummy Tuck – Proceed With Caution

January 5th, 2012 — 8:47pm

Seattle plastic surgeon blogs about the lessons she has learned (the hard way, of course) about Mini Tummy Tuck.

Indications for a Mini Tummy Tuck are few and far between.

Sometimes a procedure just seems too good to be true and that is often the case for Mini Tummy Tuck.  It seems that every week I get a question about this procedure from a patient who thinks she may be the perfect candidate.

The appeal of the Mini Tummy Tuck is really easy to understand.  A short scar just above the pubis (like a C-section scar) and a quick recovery.  Sweet, huh?

The problem with this procedure is that it is often done with a dose of wishful thinking on the part of both the surgeon and the patient.  This procedure only addresses issues in the lower abdomen and cannot be expected to help upper abdominal issues of skin laxity or muscle weakness.  So it is not unusual for a Mini Tummy Tuck patient to be disappointed with the result.  The lower abdomen may end up nice and tight and smooth and then the untreated upper abdomen looks worse when compared to the lower abdomen.  Also, the longevity of the procedure may not be so great.  I have had several ladies who had a Mini Tummy Tuck come back years later for a full tummy tuck because of the toll that aging took on the upper abdomen.  Contrast that with a close to zero rate of repeating a full tummy tuck.

So if I tell a patient that she is not a good candidate for a Mini Tummy Tuck, it’s not because I want her to have a longer scar and recovery and I want  me to have a larger surgeon’s fee.  It’s because I am using my experience as my guide.  And, as I say almost every day, I learned this the hard way!

Thanks for reading!  Dr. Lisa Lynn Sowder

Body Contouring, Mommy Makeover, Patient Beware, Plastic Surgery, Tummy Tuck

Michael Jackson, Conrad Murray, the Moon Walk and Scope of Practice

November 8th, 2011 — 7:42pm

The Moon Walk, not everyone should try this.

Seattle Plastic Surgeon weighs in on the Dr. Conrad Murray verdict.

I remember clearly the day that Michael Jackson died.  I was operating at Seattle Surgery Center and the news went around the O.R. quickly as did speculation of his cause of death.  Drugs was at the top of my list.

As the story unfolded, we in medicine were blown away by the bizarre circumstances of Jackson’s death.  Propofol overdose.  What?  Propofol given by his private physician in his home.  You have got to be kidding.  How nuts is that???

This very sad story at least allows for some education of the public on the topic of Scope of Practice.   It is not a well known fact that there are no federal scope of practice laws and no state scope of practice laws in California, Washington (where I practice) or in most states.

What this means is that physicians with a medical license are not restricted as to what type of medicine they practice.  In the case of Dr. Murray, he was practicing anesthesia without training, experience or certification in anesthesia.  Yikes, huh?

The formally trained and board certified anesthesiologist with whom I work use Propofol all the time but they use it in an operating room with monitoring of the patient, control of the patients airway and with resuscitation equipment at hand.  Those essential ingredients were not available at Michael Jackson’s home.  Another thing lacking was Dr. Murray’s judgment.  It took him 20 minutes to call for help.

Something in plentiful supply was hubris.  Dr. Murray was in way, way over his head but did not recognize or admit his folly.    Hubris is also plentiful in “cosmetic surgery”.  Over the past 20 years there has been a flood of non plastic surgeons physicians entering the field of “cosmetic surgery” through the back door.  These physicians have formal residency training in fields from radiology to ophthalmology to obstetrics/gynecology to emergency room medicine.  There are no laws that prevent these physicians from calling themselves cosmetic surgeons.

One reason for this flood is financial.   Twenty years ago there was a sea change in medical reimbursement and physicians have been squeezed financially by third party payers to the point where many physicains honestly can barely make it.   The “easy money” of “cosmetic surgery” is tempting.   Take a weekend course on liposuction or breast augmentation or buy this fancy, dancy laser!   But honestly, there is absolutely nothing easy about cosmetic surgery.  Many of these physicians (and their cosmetic patients) learn this the hard way.

Also, more and more surgery is being on in the private office setting.  One does not need hospital operating room privleges to operate in their own private O.R.  And even most state and federal regulations of outpatient operating rooms do not have requirements about the training and board certification of the physicans using the operating room.  The regulators are more concerned with the facility that the physicians who use it!  And in some states, an operating room can “fly under the radar” of all regulation because they use only local anesthesia.  And that topic is worth a whole blog of its own.

And, it gets even darker.  There are also at least a dozen “boards” and organizations that a physicain can join to give them credibility with potential patients.  Confusing?  Oh yeah.  On purpose?  Oh yeah.

So if you are looking for a plastic surgeon for a cosmetic procedure, don’t settle for a “cosmetic surgeon”.  If that surgeon were fully trained and boarded in plastic surgery, believe me, they would call themselves a plastic surgeon.   You can check to see if your” cosmetic surgeon” is a board certified plastic surgeon here.

 I know that I don’t know how practice radiology, opthalmology or ob/gyn or emergency medicine and I don’t try.  And I certainly know I don’t know how to Moon Walk.

Thanks for reading.  R.I.P. Michael.  Dr. Lisa Lynn Sowder

General Health, Government and Politics, Patient Beware, Patient Safety, Plastic Surgery

Let’s lose the misleading before and after photos, please.

September 29th, 2011 — 6:16pm

Seattle Plastic Surgery, Dr. Lisa Lynn Sowder gets picky and prickly about before and after photos.  You should be picky and prickly too!

I have blogged about this topic on many occasions but this example takes the cake!  Not because it is blatantly Photoshopped but because it comes from an advertisement insert in the latest edition of Plastic Surgery Practice and the “from the editor” editorial is on the topic of misleading before and after photos used by vendor reps promoting a product or device!  Hello Captain Irony.

The example above is a case of poor photographic technique where the lighting in the “before” photo is from above and in the “after” photo is more face on.  This makes the result of the nasolabial fold treatment much more dramatic than it likely is.  I know not if this is advertent or inadvertent.  Either way, it is misleading.

This sort of stuff drives me to blog about it and it makes me lose confidence in the products or devices that show these photos to doctors or to prospective patients.

GRRRRRRRRRRRRRRR.

Thanks for reading and send me any examples you have found of misleading photography.  I collect this stuff!  Dr. Lisa Lynn Sowder

Facial Fillers, Patient Beware, Plastic Surgery

So, what is a “Lifesytle Lift”?

April 5th, 2011 — 7:28pm

So what is a “Lifestyle Lift”?

Seattle Plastic Surgeon Discusses          Lifestyle Lift

Okay, okay. I have had a jillion questions about the “Lifestyle Lift” in the past few weeks. All I can figure is that they are doing some sort of marketing blitz. I don’t watch T.V. so I am a little out of the loop. I am not one of those anti T.V. snobs. It’s just between work, the kids, this blog, my guitar practice, my reading, my working out, my sort of decent social life and my all time favorite thing (sleeping), I don’t have the time.

Here I will tell you everything I know about “Lifestyle Lift”. This information comes from patient reports, the reports from one of our employees who checked it out, and what I know about facelifts (a lot) and what I know about in office operating rooms (a lot). Here goes.

1. A “Lifestyle Lift” is a short scar (usually just in front of the ear) face lift done to improve the lower face and jawline. Additional procedures are necessary to improve the neck, the forehead and/or the eyelids. There appears to be no difference in the technique of a “Lifestyle Lift” compared to other short scar or minimal access facelifts that most plastic surgeons (including me) perform for on some patients.

2. The procedures are done under local anesthesia only.

3. In office operating rooms that do procedures under local anesthesia only (for example “Lifestyle Lift” clinics) do not require any inspection or regulation at the state or national level. They are “under the radar”.

4. Patients are evaluated by non-surgeons. Often the person evaluating the patient has no medical training. They are often “saleswomen” who receive a commission for each patient they schedule. In my opinion, only the operating surgeon can determine if a patient is a good candidate for surgery.

5. The doctors who do the surgery arrive at the “Lifestyle Lift” clinic, meet the day’s patient(s), do the surgery and then return to their home clinic. Their main practice is not at the “Lifesytle Lift” clinic.

6. Some of the  doctors who do the surgery at the “Lifestyle Lift” clinic are not certified by the American Board of Plastic Surgery.

7. Follow-up care is often provided my non-doctors.

8. “Lifestyle Lift” has been prosecuted and fined for “astroturfing”, that is providing false online reviews.

9. The Seattle Lifestyle Lift doctors are Ear, Nose and Throat doctors and are not certified by the American Board of Plastic Surgery.

10. Wikipedia has a good entry: http://en.wikipedia.org/wiki/Lifestyle_Lift

Any questions? Shoot me an email at sowder@eplasticsurgeons.net.

Aging Issues, Facial Rejuvenation, Patient Beware, Plastic Surgery, Preoperative Care

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