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 Safety


A victory for truth-in-advertising.

September 11th, 2015 — 4:22pm

 

Appeals court affirms previous victory for Utah Society, ASPS, ABPS truth-in-advertising efforts

blog cosmetic surgeons

The 10th District U.S. Court of Appeals in Denver, Colo., on Aug. 31 upheld the September 2013 dismissal of a lawsuit filed by an ENT and oral surgeon against the Utah Plastic Surgery Society (UPSS), ASPS, the American Board of Plastic Surgery – as well as 19 individual plastic surgeons – which had contended that patient-safety education advertisements amounted to monopolistic efforts and messaging that caused direct financial damage to the non-plastic surgeons.

The appellate court decision provides another victory for patient safety and organized plastic surgery, while also serving as implicit validation of the ASPS “Do Your Homework” public-education campaign to improve patient safety.

The plaintiffs claimed in the original complaint that the Utah Society’s advertising – specifically billboards posted along one of Utah’s main interstate highways, as well as media interviews modeled after the “Do Your Homework” campaign – were in violation of the Sherman Antitrust Act and amounted to false advertising claims in violation of the Lanham Act. The plaintiffs asserted that the campaign was deceptive by indicating that cosmetic surgery is safer when performed by plastic surgeons rather than cosmetic surgeons.

The Appeals Court concluded late last month that the plaintiffs failed to show any plausible antitrust or deceptive advertising violation, and it affirmed the previous ruling in favor of UPSS, ASPS, ABPS and the individual plastic surgeons named in the lawsuit.

“This decision further confirms the value and importance of our efforts to instill public awareness on the distinctions between ABPS-certified plastic surgeons and lesser-trained physicians who present themselves as similarly skilled,” says UPSS President Brian Brzowski, MD. “We were helped tremendously by ASPS through its early financial and material support and its guidance in crafting the overall ‘Do Your Homework’ effort.”

“Despite the hurdles we have had to cross in dealing with the lawsuit, I was always supremely confident that we would prevail in promoting safe plastic surgery in Utah and beyond,” adds UPSS immediate-past President Trenton Jones, MD. “This public-safety education campaign was modeled largely after the ASPS campaign, so it’s a victory for organized plastic surgery and a huge win for the Utah Society.”

“We’re pleased that the legitimacy of the public-education efforts of UPSS and ASPS have been recognized yet again by the federal court,” says ASPS President Scot Glasberg, MD. “We applaud the Utah Society for taking a stand for patient safety and our specialty – and we welcome any local, state or regional society to confer with the leaders of the ASPS Public Education Campaign to raise awareness and promote patient safety in their states and localities.”

ASPS acknowledges Dr. Brzowski, Dr. Jones and the Utah Plastic Surgery Society for their efforts to both bring the ASPS “Do Your Homework” campaign to their state, and for defending patient-education efforts.

Thanks for reading!  Dr. Lisa Lynn Sowder

Patient Beware, Patient Safety, Plastic Surgery

HRT and plastic surgery

April 2nd, 2015 — 2:36pm

HRT and Plastic Surgery:  Insight from a menopausal plastic surgeon.blog hot flash

It is well know that hormone replacement therapy can increase the risk of postoperative deep vein thrombosis (DVT).  Some surgeons just recommend to “just stop taking your HRT medication for two weeks before and two weeks after surgery.”   I take a different approach.  “Just stop taking your HRT” means different things to different women.  Some women would just have to put up with a few night sweats but other women (yours truly included) would have a thermo nuclear meltdown.  And adding thermo nuclear meltdown to your list of preoperative and postoperative issues is not very appealing, is it?

My recommendations for women on HRT depends on their menopausal symptoms, their general health and the type of surgery they are having.  In most cases, if a woman has several risk factors for DVT and is one of the thermo nuclear types, I will put keep her on her HRT and put her on Lovenox, a low dose blood thinner for a week after surgery.  Lovenox is injected just under the surface of the skin and, thanks to very friendly packaging and a teeny tiny needle,  even the most squeamish patients and caregivers can inject it.   And, knock on wood, I have yet to see serious bleeding issues with this medication.

Thanks for reading and keep cool.  Dr. Lisa Lynn Sowder

 

My Plastic Surgery Philosophy, Patient Safety, Postoperative Care, Preoperative Care

Saying goodbye to a plastic surgery giant, Dr. Mark Gorney

November 25th, 2014 — 2:45pm
blog mark gorney

Dr. Mark Gorney, 1924 – 2014

Plastic Surgery loses one of its giants.

From Plastic Surgery News

Mark Gorney, MD, Napa, Calif., who led ASPS as its president in 1983 and served as a founding member and first medical director of The Doctors Company (TDC), passed away Monday, Nov. 17, at age 89.

Dr. Gorney led the Society during a period of relative calm in the early 1980s. The stability of his term of office stood in contrast to his other roles with the Society and the specialty, in particular his work with risk prevention.

Dr. Gorney used his extensive knowledge of the specialty and the nuances of matters of risk and insurance coverage to become a valuable resource for both plastic surgeons and insurers. In 2005, he stepped down from his TDC position and assumed Life Member status in ASPS.  

See Napa Valley Registrar Obituary

From Lisa Lynn Sowder, M.D.
I first met Dr. Mark Gorney when he was at the top of his game.  He was winding down his successful clinical practice and winding up his work as the one of the founders of  The Doctors Company, my medical malpractice insurer. This was a man who really had it all, who had seen it all, and who had done it all.

He gave a talk at the Senior Residents’ Conference in 1991 on risk management.  His idea of risk management is do good work, don’t operate on mentally unstable people, and above all,  be kind.  He introduced us to the Gorneyogram which I think about every time I consider a patient for surgery.   The Gorneyogram compares the patients concern about a problem with the magnitude of the problem and the difficulty of the surgery needed to treat the problem.     Here are two examples:  A patient with an almost microscopic mole on her face who says it is ruining her life may go off the rails when she sees that removal of the microscopic mole leaves a microscopic scar.  Now that scar will be the thing ruining her life and guess who is responsible for that scar?   This  patient has an unfavorable Gorneyogram rating.  Contrast that patient with a mother of 4 whose breasts are so gigantic that she has trouble chopping wood for her  wood burning stove.  She’s going to be thrilled with a breast reduction even if it doesn’t give her the chest of a Victoria’s Secret model.  And guess who she is going to send chocolates to every Christmas?   This patient has a favorable Gorneyogram rating.  I was so taken with his honesty and his directness and his wisdom but it was what happened next that really touched me.

After Dr. Gorney’s excellent talk, one of the residents raised his hand and asked this question:  “Dr. Gorney, we who are sitting here are just about to finish our training and enter practice.  What is it like to be you, someone who has accomplished so much and who has contributed so much to plastic surgery?”  I will never forget Dr. Goney’s answer.  His voice cracked, almost imperceptibly when he said:  “All I’ve done and all I’ve got plus a buck gets me on the bus.”  This was a man of great modesty who did not let his accomplishments go to his head.

The last time I had the privilege of seeing Dr. Gorney was in November of 2008.  I attended the annual meeting of the American Society of Plastic Surgeons and attended one of his talks about the psychology of the plastic surgery patient.  He shared the podium with Dr. David Sarwer, a professor of psychology.   They gave a terrific presentation using many examples of unhappy patients who had sued their surgeons.  Dr. Gorney examined each case with his usual candor and humanity.  I could tell that he was slowing down and knew that his teaching days were likely coming to a close.   Even though I will never again be able to hear his wise words in person, those words are with me every day.

R.I.P Dr. Gorney

 

 

Patient Safety, Plastic Surgery, Surgical Eductaion

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

Postoperaive nausea and vomiting: It doesn’t have to be that way.

March 21st, 2014 — 1:04pm

Seattle Plastic Surgeon discusses a magic pill for postoperative nausea and vomiting.

blog postoperative nauseaI saw a patient today who was thrilled with his postoperative recovery.  Yes, he was sore and couldn’t wait to take a shower but he was sooooo thrilled not to be nauseated. He had experienced postoperative nausea and vomiting with every surgical procedure he had ever had.  Fortunately he told me about this problem prior to surgery and I was able to prescribe him a magic pill called Emend.

Emend is a medication that is taken several hours before surgery.  It doesn’t treat the problem.  It prevents the problem.  And postoperative nausea and vomiting can be a very serious problem especially with some types of procedures.  It can stir up bleeding in facial surgery and can compromise the abdominal muscle repair done with tummy tucks.  And even if no damage is done, barfing after surgery can make you wish you were never born.

Emend is really, really pricey.  This patient paid $45 for one pill but that was all he needed to sail though his recovery without one hurried trip to pray to the white porcelain god.

Thanks for reading and if you have a problem like postoperative nausea and vomiting, let your surgeon know!  Oh, and the makers of Emend don’t pay me anything to promote their product.  My reward is in the form of non-barfing patients.  Dr. Lisa Lynn Sowder

Patient Safety, Postoperative 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

I’ve moved!!! Come check out our fabulous new office.

February 1st, 2014 — 10:12am

Seattle Plastic Surgeon, Dr. Lisa Lynn Sowder, is spending her weekend moving into her new office and outpatient surgery center.  Oh my aching back!

Alert:  My new address is 1101 Madison Street, Suite 1101, Seattle, Washington, 98104.  My new phone number is  206 467-1101 and new fax is 206 812-4344.  I even have a new email:  sowder@sowdermd.com or   lsowder@madisonplasticsurgery.net.

I should probably schedule that massage now.

I should probably schedule that massage now.

On Monday, I will start seeing all my patients at Madison Plastic Surgery, a brand new office and outpatient surgery center.  This beautiful new space is the brain child of my associate Dr. Shahram Salemy.  We are joining forces to provide our patients with the most excellent plastic surgery experience possible.  Every decision with designing and building out this new facility has been with patient safety, comfort and convenience  in mind.  Our construction crew, computer geeks and staff have been working long hours to get this space ready.  I’ve been working long hours sorting out 22 years of accumulated stuff in my old office.  It’s been a trip down memory lane (but that’s another blog post). Our new office is just across the street from our old office so I have been moving most of my stuff myself with the help of a very well designed hand cart.  I’ve gotten a lot of exercise the past few days and I think by Monday, me and my aching back will be ready for nice massage. Thanks for reading!  Dr. Lisa Lynn Sowder

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

I’m not being nosy, I’m being a good doctor!

October 17th, 2012 — 2:36pm

Seattle Plastic Surgeon explains why she asks soooooo many questions.

I ask because I care.

    This week I saw a patient who was interested in a rather extensive Mommy Makeover.  She was a little bit put off by all of the questions I asked her about her medical and social history.  I think she thought that I was just being nosy.    

    I explained to her that anyone who may be having an operation needs a very thorough history so anything that could cause a problem is identified and managed before the day of surgery.  Just a few examples include high blood pressure, bleeding tendency, problems with acid reflux or sleep apnea.   

     The social history is also important.  I will not do a Mommy Makeover on a woman unless she is able to arrange for help with the kids for the first week or two after surgery.   

    Sometimes I feel that patients don’t regard plastic surgery with the same seriousness they regard other types of surgery.  Surgery is surgery.   And I’m a doctor first, a surgeon second and a plastic surgeon third.  And yes, I do ask a lot of questions! 

Thanks for reading.  Dr. Lisa Lynn Sowder

My Plastic Surgery Philosophy, Patient Safety, Uncategorized

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