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


Keep those fresh scars out of the sun!

September 5th, 2012 — 11:30am

Seattle Plastic Surgeon discusses the importance of keeping fresh scars out of the sun.

This ankle scar would have turned out much better had it been protected from the sun.

Seattle is enjoying a beautiful late summer with warm, sunny days and crisp and cool nights.  There’s lots of skin showing out on Seattle streets and I am compelled to nag a little (again, for the bazillionth time) about sun protection.

Fresh scars are very susceptible to the sun and can turn permanently dark unless protected.  A “fresh” scar is defined as any scar that is still pink.  A “mature” scar is defined as any scar that is soft, flat and normal skin color or a little lighter.  Most adults have a “mature” scar by about a year.  Childrens’ scars may take longer to “mature”. 

 The best way, in my opinion, to keep a “fresh” scar protected is to cover it with clothing or with a piece of flesh colored tape or, if you prefer, a Hello Kitty band aid.  Really good sunblock will also likely do the trick if you remember to reapply it several times during the day.   Keep that scar protected until it fades to normal skin color or lighter and then sun exposure is unlikely to cause it to hyperpigment.

 A dark scar may be helped with hydroquinone cream or laser or surgical scar revision.  But, as per usual, an ounce of prevention is worth a pound (and $$$) of cure.

 Thanks for reading!  Dr. Lisa Lynn Sowder

Plastic Surgery, Postoperative Care, Scar, Skin Care, sun damage

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

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

Would someone please lend me their crystal ball?

March 1st, 2012 — 12:45am

Seattle Plastic Surgeon blogs about needing a crystal ball to answer many of her patients’ questions.

How will your breasts look 20 years after your surgery? Let me look into my crystal ball.

I had one of those days today where every patient asked me to predict the future.  

  • Will I be able to drive a week after a tummy tuck? 

  • Will these implants look okay after I have children? 

  •  Will I get fat on my hips if I have liposuction on my abdomen?

  •  How long will a face lift “last”? 

  • Will my breasts grow back after a reduction? 

  • Will I gain weight when I go through menopause?

My honest answer to all of those questions is this:  I DON”T KNOW. 

I am always very, very happy to share what I have learned from being in practice for over twenty years and what most of my patients have experienced but I cannot predict the future for any given patient!  I am an optimist by nature but that being said, I am not one to sugar coat the realities of postoperative discomfort, postoperative scars, the effects of gravity, the physical and mental price of childbearing, or the horrors of menopause. 

So if any of you wonderful readers out there have a crystal ball, please let me know when Seattle is going to have the “BIG ONE” meaning our long over due devastating earthquake.  I want to be visiting my mom in Spokane when it hits.

Thanks for reading and sorry about being a little prickley.  It’s been a long day and I still have another hour of paperwork!  Dr. Lisa Lynn Sowder

Postoperative Care, Scar

Something magical happens at 40 days of post operative recovery.

February 29th, 2012 — 12:52am

Seattle Plastic Surgeon tells her patients to give it 40 days (that’s about 6 weeks) and then something magical and mystical happens. 

Forty days has been a mystical period of time for millennia.

I’ve been thinking about the 40 day phenomenon lately.  First of all (in case all of you pagans missed Ash Wednesday), it is Lent and Lent lasts 40 days.  And second of all, my husband recently passed the magical and mystical 40th post operative day and indeed, he feels like he has turned a very sharp corner with his recovery from knee surgery.  He’s back to his usual and cheerful self.

I am always telling my patients to “give it 6 weeks”.  It is at that point patients say, “I’m glad I did this” instead of saying,  “Maybe this wasn’t such a good idea.”  This 40 something number of days of recovery seems to hold for many, many different procedures whether it’s a face lift or a tummy tuck or ankle liposuction.  And it’s not that patients don’t look okay much sooner, it’s just that they don’t feel quite right.  They are often fatigued and grumpy and emotionally fragile.  And then ………. on the fortieth day, all was wonderful.

Forty days has been found to have significance in many religious and pagan stories and traditions. .  Check out this website for more on the magic and mystery of forty days. 

Thanks for reading.  Dr. Lisa Lynn Sowder

Postoperative Care

Having a tummy tuck or a body lift? Considering getting a WALKER. Really.

January 23rd, 2012 — 9:44pm

Seattle Plastic Surgeon recommends a WALKER for recovery from tummy tuck and body lift surgery.

Years ago I did a body lift on a patient who had lost over 100 pounds.  She advised me to advise other patients to consider getting a walker for post surgical recovery.  She found it so much easier to get up and putter around like we ask our patients to do the very first day after surgery. 

Patients who are able to be up and about are much less likely to develop problems with blood clots or areas of lung collapse after surgery.  These can both be very serious which is why we never like a patient to take to bed and not move after surgery.  It’s not that we like to see patients suffer any more than necessary, we just don’t want any complications.

A  patient may feel a little silly using one of these for a week or so but it will make  recovery faster and safer and even easier.  I’ve seen walkers at second hand stores and even new, they aren’t terribly expensive or maybe there is a family member who has access to one. 

Keep an open mind and consider getting a walker for your recovery.

Thanks for reading.  Dr. Lisa Lynn Sowder

Body Contouring, Postoperative Care, Tummy Tuck

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

Feeling a little itchy after surgery?????

November 4th, 2011 — 5:33pm

Seattle Plastic Surgeon empathises with those who itch after surgery.

I’m a naturally itchy type.  I keep a back scratcher on my bed side stand.  I’m one of those types who gets prickly heat with 5 minutes exposure to sun and every ten years or so get hives for no apparent reason.  So if you are itching after surgery, I feel your itch and your pain.

Itching is no laughing matter.  Itching sensation is carried by the same nerve fibers (so called c-fibers) that cause pain.  I personally, on any given day, rather hurt than itch.

Post-operative itching of incisions is absolutely normal.  It is cause by the chemical histamine, which is present in healing wounds.  It is also present in nettles.  Some patients find a lot of relief in just knowing it is a sign of healing and will diminish.   Others find even more relief in an over the counter antihistamine such as Zyrtec, Afrin or Allegra which are good for daytime use or Benedryl which is great at bed time because it also has some sedation qualities.   There are also prescription medications for recalcitrant itching.

Post-operative all over itching is usually a reaction to a post operative medication.  Narcotics such as Percocet and Vicodin also cause histamine release and often an antihistamine helps or changing medication can help.  Also, some antibiotics cause itching if a patient is sensitive.  In these cases, changing antibiotics usually takes care of the problem.

Another thing that I have found helpful is a topical cream called Caladryl which is a combination or Camomile and Benadryl Cream.   Caladryl kept me from going crazy during a hive outbreak about 20 years ago.   Don’t put it on your incisions unless you get the okay from the doctor but you can slather it on itchy areas away from the incisions.

Don’t itch and suffer in silence.  There is almost always something that can help.

Thanks for reading.  Now I’m feeling a little itchy.  Dr. Lisa Lynn Sowder

General Health, Postoperative Care

The truth about breast surgery in the obese patient

November 4th, 2011 — 12:01am

Seattle Plastic Surgeon tells it like it is for obese women seeking breast surgery.

A recent article published in The Journal of Plastic & Reconstructive Surgery caught my attention.  This article looked at breast surgery outcomes in  7982 patients (that would be almost 16,ooo breasts!!!!) and divided the patients in obese and non-obese.  Their results were not surprising to me but they may be surprising to you.  The obese patients had a nearly 12 fold increase in postoperative complications when compared to non-obese patients.

Breast reduction is the most common breast operation performed in obese women.  That operation has a nearly 9 fold increase in postoperative complication in obese women compared to the non-obese.

This is not news for those of us who do a lot of reductions.  The sort of problems that obese women tend to have are fluid  collections (seroma), bleeding, delayed healing and infection.  These complications sometimes require a trip back to the operating room and they always require many, many postoperative visits.  Despite a rocky postoperative recovery, many obese women are still glad they had a reduction after everything is healed up.

So what’s the big deal?  All’s well that ends well, right?    Let’s look at this from an few different points of view.  If insurance pays for the reduction, they don’t want to see more bills for a hospital readmission to stop postoperative bleeding or a bajillion office visit bills to treat an infected wound.   And insurance companies are looking more closely at surgical outcomes and costs and using this information to rate surgeons.

If the reduction is private pay, the surgeon is unlikley to bill for increased postoperative visits which can run into 10 – 20 additional visits during recovery.  This can get very time consuming and expensive.

And for the patient it is no picnic having to pack an area along the suture line that either became infected or fell apart.  Post operative complications are just a total bummer all around, especially when the surgery is totally elective.

And here another issue.  Let’s say an obese lady has 5 pounds of breast tissue (which is 99% fat) removed and her weight drifts back up to her preoperative weight which almost always happens.  This means that she has gained 5 pounds of fat.  If that fat is just external fat, say on her hips, it’s not a big health issue but if it is intraabdominal fat a.k.a. belly fat a.k.a. visceral fat, it is a huge health risk.  Her breasts may no longer be killing her neck and back but her belly fat may literally be killing her.

So what am I really trying to say here.  Obese patients need to understand that breast reduction has a high rate of complications and that a reduction may actually make them less healthy if they gain back their weight as belly fat.

So this is a real sticky wicket.  Obese reduction patients are usually helped with back and neck pain with a breast reduction but weight loss would also help those back and neck pain issues.  Non surgical weight loss has no surgical risk and is accompanied by a host of improvements in a patients health.  Think high blood pressure, type 2 diabetes, arthritis, high cholesterol, etc.

So if you are obese and want a breast reduction from me, you will get a little weight loss lecture from me and may get turned down for surgery until you are able to shape up and slim down a little.    You may be willing to accept a high risk for a postoperative complication but I may not be.

Thanks for reading.  And if you have a quick, easy way to lose weight, please let me know.  I’m all ears.

 Dr. Lisa Lynn Sowder

Body Contouring, Breast Contouring, Breast Reduction, Health Care Costs, Obesity, Postoperative Care

Happy Halloween

October 31st, 2011 — 3:51pm

Seattle Plastic Surgeon, Dr. Lisa Lynn Sowder recalls a Halloween to remember.

A couple of years ago around Halloween I had a patient play a very, very mean trick on me.  She had had some major body contouring following her major weight loss and she had a few areas of her incision that festered because of spitting stitches.  (Spitting stitches deserves it’s own blog so here is a link.)

These spitting stitches were a problem for several months after surgery but finally, we thought she had done all the spitting she was going to do. 

Then, a year later, I saw her on my schedule and figured she had come in to explore her next “round” of surgical self improvement.  I entered the exam room and she slipped down her slacks and said, “I think it’s another problem stitch”.  She had a big dark and inflamed spot on her incision line and I just wanted to cry until upon closer inspection I saw it was a wound tattoo.  Boy, she really had me for a few agonizing moments.  We both had a good laugh (her more than me) and she sweetly gave me some fake wound tattoos that really, really look like the real thing.  You may want to check these out in time for Halloween.  Put on a few before your visit with your plastic surgeon.  You just may give him/her a little trick and then a treat when he/she realizes it’s just a joke.

Happy Halloween and thanks for reading!  Dr. Lisa Lynn Sowder

Now That's Cool, Plastic Surgery, Postoperative Care

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