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: Skin Care


Got Sunscreen?

June 12th, 2018 — 9:47am

Seattle Plastic Surgeon comments on the results of a long running sunscreen use study from Austrailia. 

90% of this ladies skin aging is due to the sun. I hope her grandson uses sunscreen.

90% of this women’s skin aging is due to the sun. I hope her grandson uses sunscreen.

It’s that time of year when I must nag about tanning.  In rainy Seattle it is so tempting to soak up the sun once summer arrives (that is usually about July 5th).  But please, think before you rip off your clothes, don your thong and grab your beach towel.

A good study published by the Annals of Internal Medicine and reported in the Wall Street Journal  has shown that regular use of sunscreen reduces skin aging by 24%.  It had already been shown many times that sun protection prevents most types of skin cancer but now what seemed to be obvious has also got some scientific cred.   Now my nagging has some scientific backing!

I’m certain we are hardwired to love the feel of photons bombarding our skin but way back when we were being hardwired and learning to walk upright, we would die from an abscessed tooth or a ruptured appendix or (if we were lucky) a quick take down by a leopard long before we developed skin cancer or even a bad case of the wrinkles.

Fortunately, sun protection has finally caught up with our longer life spans.  We have really good sun screens and sun block, protective and comfortable clothing and don’t forget about umbrellas, cabanas and the most lovely shade of all, trees.   And lets hear it for staying indoors when the sun is at it’s strongest.  How about a nice glass of ice tea with some fresh mint leaves and a good book.  May I recommend The Storms of Denali by Nicholas O’Connell, or A Visit from the Goon Squad by Jennifer Egan, or I Remember Nothing by the late and great Norah Ephron?

And just to remind you, I nag because I care.  Thanks for reading.  Dr. Lisa Lynn Sowder

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

Aging Issues, General Health, Skin Cancer, Skin Care, sun damage

Continuity of Care – A Great Value!

August 31st, 2017 — 1:55pm

Seattle Plastic Surgeon implores patients not to fall for “Botox on Sale”.

Occasionally I have patients come in for Botox or fillers who have flitted around from doctor to doctor looking for the “best price”.   I hear statements like  “the last Botox didn’t work” , “the Restylane didn’t last”, “I’m not sure what she used but I didn’t like it”, and this is my favorite, “it was on sale but it didn’t last”.

This flitting around in search of a “deal” makes it very hard for a hardworking plastic surgeon (moi, for example) to figure out what, where and how much injectable to inject.  In my practice, we keep very accurate records of all of the above so I can judge what works best for any given patient.   And believe me, every patient is different.

Sometimes I think just because it is “cosmetic”,  patients don’t take these treatments seriously enough.  I cannot imagine anyone shopping around for the “best” price on, say, steroid injections into a bum shoulder or the “best” price for an hour of psychotherapy!

Usually continuity of care provides the best value of all, even if the prices are not bargain basement.  So for injectables, find a good doctor and stick (nice pun, huh?) with him/her.

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

General Health, Non-invasive, Patient Beware, Plastic Surgery, Skin Care

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

Driver’s side skin damage. Check this out!

June 8th, 2017 — 8:12am

Got sunscreen in your glove box?  You should!

 This is an ABC news report written by Serena Marsh and edited for length by me.  This was originally posted in 2012.

Sunny Side Old: Pic Reveals Sun’s Aging Effects

William (Bill) Edward McElligott is two different ages, 66 and 86 yeaars old. 

If you look at McElligott from the right, he looks like any 66-year-old would expect to, but from the left, wrinkles and sagging skin place him far beyond his years. He is a living demonstration of the importance of protecting your skin from the sun.

“It would take me an hour to drive to work and an hour to come home,” McElligott said. “It was a semi route, I’d have six to eight stops. … 6 a.m. to 3 p.m. on the road.”

For almost 30 years, McElligott drove a truck during prime sun hours throughout the city of Chicago delivering milk to stores and gas stations.

“My left arm was always more tan than my right, because a lot of the time I had the window open (since) we didn’t have A.C.,” McElligott said.

The 66-year-old truck driver suffers from unilateral dermatoheliosis or photo-aging, which was caused by repeated, long-term exposure to UVA rays of the sun.

It was 15 years before he noticed any difference between the two sides of his face, but McElligott ignored it, that is until his grandchildren’s questions got the best of him.

Dr. Jennifer Gordon a dermatology resident at UT Southwestern saw McElligott while on a rotation at Northwestern in Chicago and submitted his case study, which was featured in the April edition of the New England Journal of Medicine.

“It was very stark,” Gordon said. “We are used to seeing photo damage, photo aging every day, (but) for it to be so one sided? We were taken aback.”

Gordon explained that since McElligott spent so much time in his car, his left side was exposed to UVA rays that can penetrate glass and cause the majority of photo-aging, unlike UVB rays, which cause sunburns.

“We think its because it (UVA) can penetrate more deeply into the skin than UVB and affect your collagen and elasticity,” she said. “When you destroy those that’s what gives you the aging appearance that we see.”

Dr. Mitchell Chasin, a dermatologist who did not treat McElligott, says it is extremely common to see patients that come in with more damage to their left side than their right.

“Most people are completely unaware and most people who come in to have sun damage treated, they often times will point to their left side saying they see more spots, more wrinkles, more aging, but never put two and two together,” said Chasin.

Chasin says that whenever people are outdoors, even when covered from the sun directly or on a cloudy day, they should be aware they are not safe from the reflected rays of the sun and should wear sunscreen.

“Sun block is the answer, really, for someone 365 days a year, whether it’s cloudy whether it’s sunny, whether someone is outdoors, in the car, or at the beach,” Chasin said. “If someone wants to age as best they can, sun protection is a daily regimen no matter what you are doing. Put sun block on before you leave the house.”

With summer approaching and vacations and road trips, it’s important to make sure your sunblock has protection against both UVA and UVB rays.

Last year the FDA demanded sunscreen manufacturers update their labels to offer protection for both UVA and UVB, as well as to stop the use of misleading claims such as waterproof. The agency recently extended the deadline to December for manufacturers to comply.

For McElligott sunscreen with UVA and UVB protection has become a daily fixture.

“When I’m out in the sun, when I’m going to be driving, I have sunscreen on,” he said. “I always carry it with me.”

Thanks for reading.  And do you have a favorite sunscreen?  Send me an email and let me know. lsowder@madisonplasticsurgery.net

Dr. Lisa Lynn Sowder

Follow me on Instagram: @sowdermd and @breastimplantsanity

 

Aging Issues, General Health, Now That's a Little Weird, Skin Care, sun damage

Chemical peels can help undo sun damage. But first you have to be a pepperoni pizza.

June 21st, 2016 — 12:44pm
Chemical peel

Top: Before deep chemical peel. Bottom: 9 month after the deep chemical peel.

It’s summer and time for me to start ragging and nagging about sun protection.  Well, today it’s gonna be a little different.  I am going to talk about what can be done after the sun damage is done.

Many years ago, I spent 6 weeks training with Tom Baker, Howard Gordon and Jim Stuzin in Miami.  This trio wrote the book on facial rejuvenation and I think the location of their practice has something to do with the depth of their understanding of facial aging.  Some of the patients in their practice had skin that was so sun damaged it resembled leather.  It’s almost impossible to get a great face lift result on that type of skin.  Baker, Gordon and Stuzin were very quick to nix the idea of a lift and instead turn to an aggressive chemical peel.  A chemical peel can do things for sun damage that a face lift cannot.

Take a look at this lady.  Her skin is pristine compared to some of the faces I saw in Miami but she does have a lot of sun damage.  She and her husband run a ranch in Northern Idaho and she spends a lot of time outside on her horse.  She has a lot of fine wrinkles and she has a big area of hyperpigmentation, sort of like a gigantic freckle.  It may even be a very early and non invasive melanoma (so called lentigo maligna).   I did a deep chemical peel on her about 9 months ago.  I used a variation of the peel that was developed by Baker and Gordon many years ago.  She looked like a pepperoni pizza for about 10 days.  She’s tough as nails and it didn’t bother her much although she did get tired of her husband saying “But I ordered a cheese pizza, Honey.”  As you can see from her post peel photo on the bottom, she has a lot of smoothing out of her wrinkles and even some tightening along her jaw line and, look, the gigantic freckle is GONE!

I don’t do as many chemical peels as I would like to do.  The recovery is very challenging and it takes a tough cookie like this lady to sign up for it.  But really, when the problem is sun damage, I think a deep peel is the way to go.

Thanks for reading and thanks to my awesome and beautiful patient and her handsome husband for letting me share their experience.  Dr. Lisa Lynn Sowder

Skin Care, sun damage

Very effective sunblock blocked by the FDA.

June 10th, 2015 — 11:33am

 

Border patrol K-9 unit trained to sniff out illegal sunscreen.

Sparky is especially trained to sniff out illegal sunscreen. Woof.

This is an article from the May/June 2015 King County Medical Society Bulletin.  It’s a little long and technical but just hang onto that attention span and read it!

Packing a Sunscreen Souvenir

Tourists Grab UVA Treatments Common Elsewhere, Illegal Here

By Barbara K. Gehrett, M.D.

Some international travelers are returning with pharmaceutical souvenirs – new UVA sunscreens available in Europe, Canada, Mexico, and other countries and not yet approved in the United States.

Ninety-five percent of the solar UV radiation that reaches earth is UVA.  It has a wavelength between 320 and 400 nanometers and is present during all daylight hours, summer or winter, cloudy or clear.  UVA passes through glass and penetrates deep into skin.  It is responsible for more damage to basal keratinocytes in the epidermis than UVB.

Most UVB damage occurs in the superficial layer of the epidermis, producing suntan, sunburn, and aging skin.  Protection from UVB with sunscreens reduces the risk of non-melanoma skin cancers.

Two short-acting, barrier-type UVA sunscreens have been approved for use in the U.S.  These are zinc oxide and oxybenzone.  Dermatologists argue that their protection is limited and requires repeated application because they break down quickly.

Ecamsule is a longer-acting “chemical filter” made by L’Oreal and is one component of a U.S. approved lotion, Mexoryl.  The FDA turned down the application to release ecamsule as an over-the-counter UVA sunscreen, although it has been available in Europe since the late 1990s.  It is regulated there as a cosmetic, which has a different standard than the drug category it falls into in the U.S.  All sunscreens in Europe must give both UVA and UVB protection.

Eight UVA sunscreen products have been languishing in line (one since 2003) for FDA consideration.  Congress and President Barack Obama attempted to pressure the FDA by passing the Sunscreen Innovation Act in December of 2014.  This new law requires the FDA to issue an approval or disapproval ruling within 60 days of receiving a complete application for sunscreen.   All eight of the new UVA sunscreens were expeditiously disapproved by the FDA early in 2015.

The FDA wants long-term data on safety before approval will be given.  Typically this means two Phase 3 clinical trials, which are expensive and time-consuming.  It is possible ;that future data on skin cancer protection from other countries would move the agency.  Or perhaps ;the procedural review taking place at the agency will result in a different set of criteria for sunscreens.

In the meantime, U.S. travelers stocking up on sunscreen  when they are outside the country are violating the Food, Drug and Cosmetics Act by importing unapproved drugs.  According to WebMD, the FDA does not generally pursue violators, unless the quantities involved are egregious.  One other work of warning:  online purchases should be made with caution, because of international counterfeiting of drugs.

Thanks for reading!  And keep using that lousy U.S. approved sun creen.  It’s better than nothing.   Dr. Lisa Lynn Sowder

General Health, Government and Politics, Skin Cancer, Skin Care, This Makes Me Cranky.

Fifty Shades of Sun Damage

February 24th, 2015 — 8:50pm

Seattle Plastic Surgeon spends a week in Hawaii and returns with no tan lines!

sun-damage

Last week I attended the annual meeting of the Northwest Society of Plastic Surgeons on the Big Island of Hawaii.  And contrary to popular belief, I actually sat in a conference room for about 5 hours a day and actually learned how to be a better surgeon.  The other 7 or 8 hours of daylight presented a bit of a challenge to a sun shunning person of pallor such as my Germanic self.  But it can be done.  Here are my rules:

  1. Slather with sun block first thing after that morning shower.  The spray on stuff by Neutrogena works great.
  2. Wear a hat and sunglasses.
  3. Lounge in the shade.  Walk on the shady side of the street.  (Duh)
  4. Wear a rash guard while snorkeling after respraying yourself with sun block.
  5. Spend the few hours of the really nasty mid-day sun in the bar.  (Duh)  Drink cocktails with umbrellas.  (Duh)
  6. And most of all, embrace your pallor.  I hear that the Hawaiians and Southern Californians refer to us as “Chalk People.”  Bring it on.  I won’t be spending my golden years tending to my skin cancer.
  7. Oh, and look for my new book, “Fifty Shades of Sun Damage” soon to be a major motion picture staring this dude with the bad skin.

Thanks for reading!  Dr. Lisa Lynn Sowder

Skin Cancer, Skin Care, sun damage

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, General Health, Scar, Skin Care

Add a Rash Guard to your summer wardrobe. Your skin will thank you for it.

June 9th, 2014 — 12:06pm

Seattle Plastic Surgeon loves her rash guard.  She also hopes you also have one to love.

cc rash guardI love this time of year in Seattle because the outdoor public swimming pools are open and the lakes are warm enough, barely, for a really quick dip.  And I loooove to swim, especially outdoors.  And I loooove my rash guard which not only protects me from the strong summer sun, it keeps me warm in the chilly waters of Lake Washington and Green Lake and when I am really, really brave, the frigid waters of Puget Sound.

I was a real water dog growing up, spending most of my summer days in Northern Idaho’s Lake Coeur d’Alene or Spokane’s Comstock Pool.  My mother made me wear a t-shirt into to the water in the mid day sun.  As much as I used to gripe about it, I now appreciate her wisdom.  I do have sun damage on my chest and back but it would be much worse without my mom’s nagging.

I have my kids trained so they almost feel a little underdressed without their rash guards.  There’s no need for a baggy, soggy t-shirt to ruin your beach or pool style.  Rash guards come in colors and designs for just about any taste.

Oh, and the lady here is not actually me but I do own this rash guard!

Thanks for reading and happy, happy, happy summer!  Dr. Lisa Lynn Sowder

General Health, Skin Care, sun damage, Wardrobe Observations

Do you or someone you love rock the Kojak look? Don’t forget a hat!

May 13th, 2014 — 9:09am

Seattle Plastic surgeon beseeches all young Kojaks to wear a hat this summer.

blog telly savalasWe all owe a lot to Telly Savalas, a.k.a. Kojack.  He was man enough to embrace his male pattern baldness and opt for the clean shave rather than a nasty comb-over or a nastier toupee.  And that was way back in the 1970’s when the earth was cooling, I was in high school and the rock opera Hair was all the rage.  Telly was soooooooooo  fashion forward.

So I love it when guys who are challenged in the coiffure department rock the Kojak look but………………………….these guys need to protect their pate.  A nice shiny bronze dome may look great on the beach (especially if attached to a six pack) but fast forward a couple of decades and that scalp will be sprouting skin cancers like crocus in my garden in February.

I have seen all three types of skin cancer on bald heads.  There’s basal cell cancer which usually grows slowly and is usually caught and treated before it causes too much trouble.  And then there is squamous cell cancer which spreads wider and faster and is not as easy to diagnose visually.  And then there is malignant melanoma that can lead to a much too early grave.    These cancers are all related to sun damage that occurred decades earlier.

So all you testosterone oozing Kojaks out there and all you ladies who have one of these in your life, don’t forget a hat and take a good look at that gorgeous scalp at least twice a year.  If you find something funny, get thee to a dermatologist.

Thanks for reading and you can leave your hat on.  Dr. Lisa Lynn Sowder

Skin Cancer, Skin Care, sun damage

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