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: Preoperative Care


Do I have to cancel my surgery because of a common cold?

October 8th, 2015 — 9:14am

Fall is the time of year when we get a lot of questions about the common cold.  Murphy’s law dictates that about week before surgery, patients wake up with a sore throat and a runny nose and a sinking feeling that we will cancel their upcoming surgery.  Here are the guidelines my anesthesia and nursing staff and I use:blog common cold

A significant cough will probably require rescheduling of most surgical procedures, especially those done with a general anesthetic.  General anesthesia can irritate the airway and make a cough worse.  Also, some procedures, tummy tuck for instance, does not go well with a cough.  If the cough is minor and is likely secondary to post nasal drip, it may be okay to go ahead with surgery.  Most of the narcotic pain meds we prescribe after surgery are also powerful cough suppressants.

A mild sore throat with no other symptoms is probably not a reason to cancel surgery.  The anesthetic may make your sore throat a little worse for a day or two.   A raging sore throat with swollen, nasty tonsils is a reason to cancel surgery.

A runny nose without other symptoms is not likely to interfere with anesthesia or recovery but a nasty sinus infection, either viral or bacterial, should be resolved prior to surgery.

A fever will require rescheduling your surgery.  Fever is indicative of something bad enough to get your body fighting back.  You don’t want to pile on with surgery.

We always appreciate a “heads up” if a patient thinks there is something brewing that may affect their surgery.  Don’t hesitate to give us a call!

Thanks for reading!  Dr. Lisa Lynn Sowder

 

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Anesthesia, General Health, Patient Safety, Preoperative Care

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

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

No need to be a nervous wreck the day of surgery.

March 24th, 2014 — 4:31pm

Seattle Plastic Surgeon gets an inside view of the surgery check in process at a famous Seattle hospital.

Recently I helped a much loved family member check into a famous hospital in Seattle for some orthopedic surgery.  He is by nature a pretty calm person and had great confidence in his surgeon and was really, really looking forward to playing soccer again.   But still, he was about to undergo the knife.

We arrived in the parking garage, went up the elevator and came to a gorgeous, modern, clean surgery reception area.  The lady at the front desk was very nice and courteous but there was so much stuff she had to do.  There were forms to fill out, papers to sign, phone numbers to give, prescriptions to fill, ID to show and yada, yada, yada, yada.  My loved one rolled with it but I could see he was getting a more than a little nervous.

This got me to thinking about much better we do it in our office operating room.  Our patients come in for a pre-operative visit usually about 2 weeks before the surgery date.  At this visit, we leisurely go over the operative plan, review consent forms and instructions, fill out the history and physical exam and anethesia forms, get all necessary signatures, get all the financial business taken care of and write the patient their prescriptions for them to fill before the day of surgery.  This way, when the patient comes in for their surgery, all of this necessary yada, yada, yada has been done.

I know this preoperative visit makes the day of surgery go a lot smoother for me and I think it also makes the day of surgery a lot easier and calmer for our patients.  I think the preoperative visit is time very, very well spent.

Thanks for reading.  Dr. Lisa Lynn Sowder

 

 

 

 

 

 

My Plastic Surgery Philosophy, Preoperative Care

Body Lifting 101

September 11th, 2013 — 1:26pm

Seattle Plastic Surgeon discusses the importance of “translation of pull” in body lifting after massive weight loss.

Try this at home!  If you get a lot of lift and smoothing of the skin by pulling, you will likely do well with a body lift.

Try this at home! If you get a lot of lift and smoothing of the skin by pulling, you will likely do well with a body lift.

I have seen quite a few massive weight loss patients interested in body lifts in the past several weeks.  The fall and winter months are the best time to have this type of surgery and these patients are wanting to sort out their options so they can take advantage of cool and dismal months and  be fully recovered by the time spring rolls around again.

Body lift is a really big procedure and should only be considered if the patient has a really good chance of getting a lot of improvement.  The requirments for this procedure include excellent health,  a stable and healthy weight, a good support system, the ability to take enough time off of work for healing, and good translation of pull. Translation of pull refers to how much the skin reacts to traction.

Many massive weight loss patients are like this lady where the skin can be yanked up almost like a pair of panty hose.  In this case, she is likely to have great result.

Some patients, however, either because of residual fat or thick and tethered skin, hardy budge with this manuver.  Sometimes additional weight loss helps but sometimes it does not.  Those patients with lousy translation of pull will not see much improvement with a body lift.  And a body lift would be a very, very long run for a very, very short slide for these patients.

Thanks for reading!  Dr. Lisa Lynn Sowder

Body Contouring, Preoperative Care

Timing is everything in music and in surgery

April 20th, 2011 — 10:34pm

Seattle Plastic Surgeon discusses the importance of timing in music and in plastic surgery.

Keith Moon keeping time for The Who.

Keith Moon keeping time for The Who.

I have been practicing a song with my husband that we are going to perform at a recital in a couple of weeks. I’ve been playing guitar and singing for many years but my husband is a beginner. One of the challenges we have is getting the timing just right – or as our zen master guitar teacher says, “really getting in the groove”. A few little chord or note mistakes here and there can sometimes fly right by most listeners but even the tone deaf will pick up an error in timing.  There is no drummer in the world who would have the patience to practice with us so we rely on an electronic metronome.

This, of course, reminds me of plastic surgery because almost everything reminds me of plastic surgery. Timining is also so important when patients schedule surgery. It’s not that I mean 4/4 time with a swing rhythm at 92 beats per minute. I mean timing the surgery so that the procedure and the recovery fit into the everyday rhythm of a crazy, busy, modern life and I don’t think this sort of timing is ever easy. But it is so important.

Almost everything I do requires a little “down time” even if it is just resting five minutes after a Botox injection or an hour with a cold pack after filler injection. Surgical procedures require anywhere from 3-5 days “off” for small area liposuction to a full 2-3 weeks off for a body lift or some face lifts or deep chemical peels.  The cases that are hardest on the patients are the cases such as a face lift or a deep chemical peel where the patient feels pretty good but looks really bad and where over activity can really delay healing by prolonging bruising and/or swelling.

I always try to tell it like it really is so patients know what to expect and can plan accordingly. I have a page on my web site devoted to this topic because not planning a realistic recovery can leave a patient very sore and very frustrated.

On this topic, I am speaking from personal experience as a pretty bad plastic surgery patient. I remember attending jury duty a few years ago and having to attend to my surgical drains during breaks. I took a lot longer to heal that average and it was no one’s fault but my own. What a naughty patient! Do as I say and not as I do.

Thanks for reading!  Dr. Lisa Lynn Sowder

It's All About Me., Postoperative Care, Preoperative Care

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, Face Lift, Patient Beware, Plastic Surgery, Preoperative Care

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