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: Scar

Breast lift: Fear not the scars!

January 23rd, 2018 — 9:57am

I see many, many women for implant removal after years of being unhappy with their breast implants.  Many of these ladies consulted a plastic surgeon for sagging of the breasts and instead of ending up with a breast lift, ended up with breast implants.  Often the explanation for this is that the patient did not want the “scars of a breast lift”.

So here’s the deal on breast lift scars.  Yes, they are more extensive than the scars from an augmentation but,……………………… the vast majority of patients, the scars fade to near no-big-deal status in about a year.  Check out the example shown.  The top photo is before a lift, the middle photo about 6 months post op and the bottom photo is one year post op.  See the scar?  Well you hardly can see the scars in the bottom photo.  This is not an exceptional case.  This is usually how it goes.  Now there are some rare individuals who scar badly because of their particular biology but they are the exception.

So………….if you are saggy, you should get a lift.  If you are really small you should get an augmentation with either an implant or fat transfer.  As with everything, the correct diagnosis should lead to the correct treatment.

Thanks for reading and follow me on Instagram @sowdermd and @breastimplantsanity.  Dr. Lisa Lynn Sowder

Breast Contouring, Breast Implant Removal, Breast Implants, Breast Lift, Scar

Self Harm Scars

August 28th, 2017 — 2:57pm

There is no easy treatment for self harm scars.

blog cutting scars self-injury-scars-before-after-treatment-2

Surgery probably won’t help but camouflage tattooing might.

I get a lot of questions about “scar removal” and sometimes these scars are self inflicted.  Cutting, as it is called, occurs most commonly in the young and is associated with a myriad of mental health problems.  Often the turmoil that characterizes these challenging years dissipates with maturity but unfortunately the scars of cutting do not dissipate.  In addition to being unsightly, these scars serve as a reminder to the patient and to others who see them of a difficult and unpleasant period of life.  And unfortunately, these scars are very difficult to treat.   Contrary to popular wishful thinking, scars can never be removed.  They can only be revised and replaced with a better scar.  With a typical scar revision, the surgeon would endeavor to replace a wide and pink and firm scar with a narrow, soft and pale scar.  And most cutting scars are already narrow, soft and pale so there is little to no room for improvement.   And most times there are so many of them.

I rarely recommend surgical treatment of these types of scars.  The most reasonable treatment, in my opinion, is camouflage tattoo.  A good tattoo artist is able to restore a more normal color to these scars.  Often times, these scars are on areas of the body (inner arm, thighs, abdomen) that do not get a lot of sun and this makes camouflage tattoo pretty reasonable.

Oh, and it’s not just disturbed teenagers who have these scars.  I occasionally see a perfectly well-adjusted and happy middle aged patient who comes in for liposuction or a face lift or some other procedure who has these scars.  They are a testament to the reality that most of time, the angst of youth – well, it just gets better.

Thanks for reading and follow me on Instagram @sowdermd and @breastimplantsanity.   Dr. Lisa Lynn Sowder

Scar, Skin Care

Agressive treatment for acne

January 22nd, 2015 — 1:44pm

Treat acne now to avoid scars later.

blog acne scarsIf, like me, you are a fan of the cable T.V. show “Justified” you recognize this man as Johnny Crowder.   I find him very attractive despite his really severe acne scarring.  Maybe it’s because he is the quintessential bad boy or maybe it’s because he has such a soft heart despite being a total sociopath.  Anyway, he was killed last season by his even more bad ass cousin, Boyd Crowder so I won’t be able to enjoy his handsome mug anymore.  But this post is not about my taste in men but about acne scars.

Acne is often thought of as just one of the many challenges of adolescence and in many cases it is.  Mild cases can often be controlled with over-the-counter treatments and usually the acne subsides once the hormones have leveled off.  But for some, acne can be a devastating disease.  When the acne lesions are deep and cystic, they can destroy the normal fat layer under the skin and cause deep permanent scars as in David Meunier, the actor who plays Johnny.   Acne scars have not kept Mr. Meunier from  finding success but they may limit his roles somewhat.  He may find himself cast more frequently as a bad guy.

So if you or someone you know has out of control acne, get thee to a dermatologist.  Those pesky “zits” of today can turn into the life long scars of tomorrow.  Oh, one more thing – treating acne scars is really difficult and only partially effective.  It’s much better to prevent them in the first place.

Thanks for reading!  And Johnny, I miss you!  Dr. Lisa Lynn Sowder


Acne, Scar, Skin Care

A really, really excellent scar.

October 22nd, 2014 — 12:51pm
The scar is between the two purple arrows.

The hairline scar is between the two purple arrows.

Any incision that goes all the way through the skin will leave a scar.  That the way higher organisms like you and me heal.  Scarless surgery is just not possible.

Patients are always concerned about scarring and so are plastic surgeons.  Plastic surgeons are good about hiding scars in wrinkles or skin creases or along natural structures.  It’s not that we don’t leave scars.  We just hide them.

The example on the left is one of the BEST scars I have seen.  This was a lady who came in for revision of a breast procedure done about 20 years ago and I had a hard time finding this scar.   This is what we call a hairline scar because it is not much thicker than a hair.  The fact that this lady healed so beautifully the first time around is a good indicator that the scar  I leave will also end up being hard to see.  Also, my scar may end up being even a little better because the patient is 20 years older and older patients scar less than younger patients.  Weird, huh?  But it’s true.

Thanks for reading!  Dr. Lisa Lynn Sowder

Now That's Cool, Plastic Surgery, Scar

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

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


March 14th, 2012 — 11:36pm

Do you have a child with severe acne???  An ounce of treatment now is worth a ton of scar revisions later.

Left: Before a bazillion procedures. Right: After a bazillion procedures.

I have two children in high school and I often am asked for advice regarding acne.  I am not a dermatologist nor do I play one on T.V. so do not expect any advice as to the latest therapies for acne.  I do have advice, however, on whether or not one should seek therapy.   So here goes.

If the zits are small and superficial, there will likely be no lasting damage and whether or not to seek anything other than over-the-counter treatment is really a matter of how much the zits bother your child.  BUT if the zits are deep (so called cystic acne), your child needs to get treatment YESTERDAY. 

 The problem with cystic acne is that it causes inflammation deep under the skin and can result in very bad scarring that can be devastating and permanent.   And it’s not just the scarring that is an issue.  The inflammation can also cause atrophy of the fatty layer under the skin and cause sinking in of the face. 

 The example on the right shows both superficial scarring and also some deeper scarring and atrophy.  This is a mild case.  If this were a man, he probably would not have sought treatment but this is a young, beautiful, fine featured woman and this post acne scarring affects her self esteem and also results in her spending a lot of time every morning trying to cover this up.   

She an I got to know each other very, very well over about two years of procedures that included fat grafting, skin resurfacing, excisional scar revision and filler injection.  It was a long process but worth it for both of us.  She can now get on with her day without the prolonged fussing with cover-up and I just loved the bright smile on her face at her last visit. 

 Not all plastic surgeons are well suited to treat these patients because it involves a lot of patience (which I for some reason have in abundance) and a lot of hand holding. 

 But the real message here is that if you know someone with deep, cystic acne who is not under the care of a dermatologist, do what you can to get them proper care.  What seems like just a minor, cosmetic issue can be a major, difficult to treat problem later. 

Thanks for reading!  Dr. Lisa Lynn Sowder

Acne, Children, Facial Fillers, Fat Injection, Plastic Surgery, Scar, Skin 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

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