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: Postoperative Care


Will there be plastic surgery under your Christmas tree?

November 30th, 2018 — 3:11pm

Seattle plastic surgeon encourage the gift of plastic surgery.How to give the gift of plastic surgery.

Looking for the perfect gift this holiday season?  That perfect gift may just be a plastic surgical procedure.  Here are a few tips if you are considering this most thoughtful and personal of presents.

  • Only consider this if your loved one has confided in you that he/she is considering “doing something” or that he/she just wishes that he/she could just “get rid of this ______(fill in the blank)”.  Remember, it’s about him/her, not about you.
  • Make sure the lucky recipient is a good candidate for surgery.  Good candidates for surgery are in good heath (physically and mentally) and are in a socially stable place in their life.   If in doubt, shoot me an email and I can probably make an educated guess.  Do not, I repeat, do not give the gift of liposuction as a substitute for weight loss.  Need convincing that doing so is a bad idea?  Check out my blogs on obesity.
  • Make sure that you can afford the surgery!  You wouldn’t want to have to back out because of sticker shock.  I have a lot of ball park prices posted on my web site.  Or feel free to shoot me an email and I can give you a financial idea of how much this could set you back.
  • Make sure that lucky guy/gal will be able to take enough time off of work and/or household duties to recover.  It’s misery to try to get back to work too soon.  You want your gift to be a positive experience.  I have recovery times listed for most procedures on my web site.  Or shoot me an email.
  • Make sure you have nice package to present.   You can’t wrap up a tummy tuck or eyelid lift, but you can wrap up something they might love to wear or use after all the discomfort and bruising is gone.  Maybe something sassy from Hanky Panky for that mommy makeover patient or a pair of beautiful Firefly earrings for that eyelid lift patient.  Or for that dude of yours, how about a nice pair of Ethica boxer briefs You can include one of my practice brochures and a procedure brochure.  Oh, I can just hear the shrieks of joy now!

And just think, your gift of plastic surgery will last years, even decades.  You and your loved one will be enjoying the benefits much longer than a new car or television or laptop.  Do the math.  It could end up being a great value as well as a great gift!

HAPPY SHOPPING AND THANKS FOR READING!  Dr. Lisa Lynn Sowder

I would be honored if you followed me on Instagram @sowdermd and @breastimplantsanity.

Mommy Makeover, Now That's Cool, Plastic Surgery, Postoperative Care

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.

 

 

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

The worst possible way to spend your time when recovering from surgery – surfing the net.

May 19th, 2016 — 10:45am

Every week I get some questions sent to me by the website RealSelf.  I am always amazed by the many questions submitted by patients sometimes within a day or two of surgery.  I cannot fathom why a patient would turn to an online community of doctors rather than their own surgeon to answer their questions and address their concerns.

OMG. Is that going to happen to me?

And then there are patients who scrub the web for scenarios that are either much better or much worse than their own.  I just don’t get it.

I advise my patients to concentrate on their situation, their surgery, their recovery. Going online and finding someone who is healing quicker than you or slower than you or just differently that you is not helpful and let me tell you, it makes your surgeon a little cranky.

So……………..take your meds as prescribed.  Get some rest.  Drink lots of water.  Go out for a little walk.  Make yourself a sandwich.  Make your caregiver a sandwich.  Clean our your junk drawer.  Questions?  Concerns?  Run them by your surgeon.  Just don’t go online.

Thanks for reading!  Dr. Lisa Lynn Sowder

Postoperative Care, This Makes Me Cranky.

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

Sleep deprivation can be a serious post-operative problem.

July 11th, 2014 — 2:25pm

Seattle Plastic Surgeon blogs about a serious post-operative problem:  Sleep deprivation.

This past week I had a postoperative patient go a little bit crazy on me.  She was over a week post-op, had a very nice early result from her surgery, had no mental health history and yet she just went, well, crazy with anxiety.  She experienced something like a low grade panic attack that lasted for several days.  I saw her repeatedly while she was feeling so anxious and two days ago I figured it out.  She had not been sleeping well since her surgery.  She was seriously sleep deprived and it was making her irrational, depressed and anxious.  blog sleep-deprived

I know a lot about sleep deprivation and feel badly that I did not make the diagnosis in this patient earlier.  As a surgery resident, I pulled impossibly long hours (this was before the 80 hour work week rule for resident physicians) and coined the term “Brain Fog” for it’s effect on my psyche.  Then five years after finishing my residency training and finally catching up on my sleep, I gave birth to twins.  I distinctly remember telling my husband shortly after their birth that I recognized this feeling.  It was “Brain Fog” again caused by sleep deprivation.  I never really went off the rails but I really felt like I might during my residency and my first year as a mother.   I am convinced that sleep deprivation is the cause or at least a major factor in post-partum depression.

Anyway, two days ago, I wrote my patient a prescription for some sleeping pills (after she assured me that she was not suicidal) and ordered her to go home and go to bed and today she came in well rested, rational and feeling so much better about her surgery.  And tonight, I will also sleep a little better because I am a worry wart by nature and this young lady had me worried and a little sleep deprived myself.

Read more about sleep deprivation.

Thanks for reading and try to get a good night’s sleep!  Dr. Lisa Lynn Sowder

 

 

 

 

General Health, Postoperative Care

The Revolution of Outpatient Surgery

June 20th, 2014 — 10:26am

Seattle Plastic Surgeon blogs about how much surgery has changed in just a few decades.

Sometimes it just astounds me how much surgery has changed since my days as a medical student.  There was a time when hernia patients spent  an entire week in the hospital following surgery.  They were admitted the night before, a bazillion lab tests were done, they got an enema after dinner and a sleeping pill before bedtime.  After surgery, they were given morphine injections, Jello and broth and bed baths.  Their incisions were checked everyday and after a week their stitches came out and they finally went home.  Fast forward to today and a hernia patient checks into an outpatient surgery center in the morning and by lunch time is home eating a ham sandwich and watching Breaking Bad reruns.  How did all of this happen in just over twenty to thrity years?blog AAAASF

Many of the changes have come about for economic reasons.  Keeping someone in the hospital for a week costs as much or more than a brand new Mini Cooper.  Insurance companies began to balk at these costs when I was a surgery resident in the 80’s.  I remember being shocked (shocked!) the first time some bozo from an insurance plan told me to discharge a hemorrhoid patient after just two days in the hospital.  I was used to waiting until those patients had managed to have their first bowel movement post op.  It was just, well, tradition.   So we started sending them home earlier and they did fine.  In fact, they did better than they if they were in the hospital being poked and prodded and woken up at midnight for vital signs.

Anesthesia has changed a lot too.  Back in the day, general anesthesia was almost guaranteed to leave a patient vomiting for a day or two after surgery.  These days, the anesthetic agents are much less nauseating and the anti-nausea medications much more effective.  And with spinal anesthesia, nausea is very rare.  I have not had to admit a patient to the hospital for nausea and vomiting and dehydration in at least ten years.

And surgical procedures have changed.  Take that hernia patient and his ham sandwich.  Thirty years ago he would have a six inch long incision in his groin and sutures tied so tightly that standing up straight would be difficult.  He would need a lot of narcotic pain meds which would make him nauseated.  He wouldn’t be able to keep the Jello down so he would need an intravenous line for a few more days.  He can’t go home until he can eat.  In contrast, these days the hernia is usually fixed from the inside out.  He has a couple of little incisions where the fiber optic scope was inserted to gently pull the hernia sac back into the abdomen when it belongs.  Then a plug of mesh is used to fill up the defect.  It’s slick and so much more gentle on the patient than fixing a hernia from the outside in.  Our patient is a little bit sore but will likely feel good enough to return to his desk job in a day or two, narcotic free.

So despite all the griping about our health care delivery system, it is actually getting better, more convenient and safer.   Now if someone could figure out how to make it less expensive.  But that’s another blog.

Thanks for reading!  Dr. Lisa Lynn Sowder

 

 

General Health, Government and Politics, New Technology, Postoperative Care, Preoperative Care

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

Chemosis – a bummer of a problem after lower eyelid surgery.

November 14th, 2013 — 3:04pm

Seattle Plastic Surgeon discusses a self limited but very annoying postsurgical eyelid condition: chemosis.

Seattle eyelid surgery

Chemosis. It looks bad and feels bad too.

If you have had lower eyelid surgery and have never heard the term “chemosis”,  count yourself as one of the lucky majority.  If the term “chemosis” is familiar and you have suffered from it, you have my sympathy.

I have had a run on eyelid surgery the past few weeks and currently have a patient who has developed post-blepharoplasty chemosis which translates into infammation and swelling of the eyeball skin following eyelid surgery.  I have had a handful of these cases in my 22 years of practice and am happy to report that all of those cases have resolved within a couple of weeks.  But that couple of weeks can be really, really miserable for the afflicted patient.

Why a small minority of  eyelid surgery patients develop chemosis is not well explained.  It almost always occurs with lower lid surgery and I have never seen nor heard of a case develop when only the upper eyelid is operated on.  Incisions inside the eyelid (transconjunctival) seem to trigger this inflammation more often than incisions on the outside of the eyelid.

I have my transconjunctival lower eyelid patients use anti-inflammatory eyedrops the first few days after surgery to help prevent this problem from occuring.  If chemosis does occur, it often helps to patch the eyes at night and use generous doses of artificial tears during the day.  The thing that seems to help the most is “tincture of time”.  I have never seen a case that did not resolve completely but waiting for “tinture of time” can seem like an eternity.

Thanks for reading and join me in wishing my chemosis patient a speedy recovery!  Dr. Lisa Lynn Sowder

Eyelid Surgery, Postoperative Care

Post-operative constipation. We need to talk about it.

November 13th, 2013 — 2:03pm

Seattle plastic surgeon warns that post-operative constipation can ruin an otherwise smooth recovery.  A proactive approach can help.

Seattle Plastic Surgeon has tips on postoperative recovery.

Constipation can be the worst part of post-operative recovery.

Many post-operative factors can conspire to cause constipation.

First of all is the inactivity that usually follows surgery.  You take to bed or the couch or the Lazy Boy chair and your bowels can decide to take a little rest as well.  Then there are the narcotic pain medications that are often necessary to stay comfortable.  And then there are changes in diet that usually mean less fluids and fiber.  Before you know it, you are post op day 5 and miserable.

Here are some tips on avoiding this lousy problem.  First of all, if you are prone to irregularity, get on a stool softener (ask your pharmacist to recommend one) or some prune juice as soon as you get home from your surgery.  Then do your very, very best to be up and around as much as you can.  Walking is better than sitting and sitting is better than lying in bed. Try to jettison the post-operative narcotics as soon as possible.  Try alternating Tylenol or Motrin with your perscription pain meds as soon as your doctor gives you the okay.  (Make sure not to exceed the recommended dose.)  And stay hydrated.  It’s okay to skip a day or two of eating but make sure you get plenty of fluids.  And really, prune juice doesn’t taste that bad and it really does provide a lot of fiber.

If you, despite all of this, become really constipated, I have an entire page devoted to post-opearative constipation on my web site.  And be assured, once the blessed event does occur, you will feel sooooo much better.

Thanks for reading and, really, prune juice is pretty tasty!   Dr. Lisa Lynn Sowder

Postoperative Care

The difference between a complication and a trade off.

October 29th, 2013 — 2:41pm

Seattle Plastic Surgeon clears up some confusion about postoperative “issues.”

imagesCAOSLYZTI recently did a pre-operative visit on a lady who will be having a face lift next month.  We have patients read an extensive informed consent document and discuss any issues that arise from that document.  She was most concerned about nerve damage that may leave her face “paralyzed and numb.”  This got me thinking about surgical complications and trade offs.

Facial paralysis after a face lift is an exceedingly rare (as in it has never occurred in any of my face lift patients) but possible complication of face lift surgery.  That is in contrast to facial numbness after a face lift which is not a complication at all.  It is a trade off meaning that it happens because of what the surgeon must do to accomplish the face lift.  In raising or peeling up the skin on the face, many teeny, tiny sensory nerves are cut and this leaves the face numb until those teeny, tiny sensory nerves grow back and the sensation returns (this usually takes about a year).

Here is another example:   A trade off for a tummy tuck is the hip to hip scar.  An incision must be made to remove the excess skin and all incisions heal with a scar so a normal scar is not a complication.  It is a predicatble and expected trade off.   Now if the skin on either side of the incision becomes infected or falls apart  and the scar ends up being really wide or indented, that is considered a complication.  It was not expected.

Complications are not expected but can happen and patients need to be aware of their risks.  Trade offs are expected and will happen and patients need to be accepting of them.

Wow, it was good to get that cleared up, at least for me it was.  Thanks for reading!  Dr. Lisa Lynn Sowder

Postoperative Care, Scar, Surgical Eductaion

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