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


It’s been 50 years since the Surgeon General told us smoking was a bad idea.

January 14th, 2014 — 4:18pm

Seattle plastic surgeon remembers when the Surgeon General came out with the bad news about smoking.

I may be dating myself but I really do remember  the day 50 years ago when the Surgeon General reported the strong link between smoking and lung cancer in men.  That was the day I lost my job as my father’s pipe packer.  It was my job to fill his pipe with delicious smelling pipe tobacco from a little pouch and then compress the tobacco with my little thumb until it was just right.  But from that day on, I was out of a job because my father quit cold turkey, giving up his pipe, his cigars and his cigarettes.  I was sooooooo bummed.

That was a long time ago and now we know that smoking does lots of nasty things in addition to causing cancer and stinking up the room.  Smoking also causes premature aging of the skin.  This was really driven home a couple of months ago in an article showcasing identical twins with different smoking habits in the Plastic and Reconstructive Surgery Journal.  Here a few examples and you can see more on this link to the report.

The twin on the left smoked 17 years longer than the twin on the right.

The twin on the left smoked 17 years longer than the twin on the right.

The twin on the right smoked 14 years longer than the twin on the left.

The twin on the right smoked 14 years longer than the twin on the left.

The twin on the left is a non-smoker.  The twin on the right smoked for 29 years.

The twin on the left is a non-smoker. The twin on the right smoked for 29 years.

A picture is worth much more than a thousand words or cigarettes, don’t you agree?

Thanks for reading and spread the word.  Dr. Lisa Lynn Sowder

 

General Health, Skin Care

Keratosis Pilaris – a common skin disorder.

June 28th, 2013 — 10:44am

Seattle Plastic Surgeon discusses a common and annoying skin condition – Keratosis Pilaris.

Pilaris keratosis - annoying but harmless.

Pilaris keratosis – annoying but harmless.

Earlier this week I saw a young woman in my office requesting breast augmentation.  During the consultation, she also wanted me to take a good look at her upper arms and anterior thighs.   She had scattered teeny, tiny little red and while bumps.

Now there are many, many dermatologic conditions that I know very little about but her condition,  keratosis pilaris , is one I am very familiar with because I have it.The little bumps seen in keratosis pilaris are caused by plugged pores.  This condition seems to be hereditary (thanks, Mom) and usually shows up around puberty and tends to get better with age.  The most common areas affected are the upper arms, the thighs, the cheeks and the other cheeks.

Most cases of keratosis pilaris do not require medical attention because self care is often very effective.  There are many over the counter ointments that contain some type of acid, be it lactic acid, glycolic acid, salicylic acid or urea.   These mild acids break up the plugs of keratin that block the pores.  These ointments need to be used regularly to maintain their efficacy.  Sephora makes a cream specifically for this keratosis pilaris, KP Duty.  I’ve heard it works very well. And as a person ages, the keratosis pilaris usually just sort of disappears.  Just one of the many wonderful things that happens as we get older.  Really! So if you have keratosis pilaris, start with some self treatment and be glad you don’t have something worse!

Thanks for reading.  Dr. Lisa Lynn Sowder

General Health, Skin Care

Fillers may reverse skin aging????? WOW.

December 27th, 2012 — 12:17pm

Seattle Plastic Surgeon shares some very interesting research on fillers and skin aging.  Check it out.

Fountain of youth

Could fillers be the Fountain of Youth?

I read with interest today an article from Dermatology Times e news.  To my knowledge, this is the first study looking at the anti-aging effects of off the shelf fillers.  Here it is:

Ann Arbor, Mich. — It may be possible to slow down the skin’s aging process by boosting support of the dermal extracellular matrix, a new study finds.

As the skin ages, the extracellular matrix, which acts as a scaffold for skin cells, becomes fragmented, according to researchers with University of Michigan Medical School, Ann Arbor. Fibroblasts shrink and less collagen is produced causing the support structure to decline, Newswise.com reports.

The researchers found that injecting the space between the skin cells with a filler enhances the structural support of the extracellular matrix.

Investigators injected a dermal filler into the facial skin of 21 volunteers over age 70 during a three month period. Data indicated that the filler stimulated fibroblasts to begin producing more collagen and boosted the support structure of the extracellular matrix. This increased support, the researchers noted, appeared to further stimulate the proliferation of fibroblasts and increase epidermal thickness, according to the abstract. The entire layer of skin grew thicker with more blood vessels, which nourished the cells, according to Newswise.com.

“By altering the matrix using an external filler and increasing the internal pressure, we’ve shown that we can essentially trigger a signal for cells to wake up,” a researcher said. “This shows that skin cells in elderly people have the capacity to respond robustly in a very positive way to alterations in the mechanical property of their environment. We still need to know more about how cells sense their environment, but in general it appears we have made a real difference in the structural integrity of skin.”

The findings were published in the October issue of the Journal of Investigative Dermatology.

Thanks for reading!  Dr. Lisa Lynn Sowder

Aging Issues, Facial Fillers, Now That's Cool, Skin 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

Ban the Tan?

July 23rd, 2012 — 11:57am
 

Pasty white Seattle Plastic Surgeon shares her view on tanning bed restrictions.

What’s wrong with this picture???

My daughter is a competative Irish step dancer and if you don’t what that involves, you must rent the documentary “Jig”.  The Irish dancing subculture is an interesting mix of athletic, artisitic and beauty competition.   I have attended many a competition and have seen that part of the “look”, for some of the girls, includes deeply  tanned legs. 

Some of the girls have spray on tanned legs but some of them have obviously been spending time in an indoor tanning salon and, as a physician, it drives me nuts. 

 The incidence of Malignant Melanoma has been going up, up, up in the past couple of decades and it’s rising the fastest in the same group that spends the most time in indoor tanning salons – young women. 

 Many countries and some states have placed age restrictions on indoor tanning.  Brazil has an outright ban on indoor tanning.  I’m not one to advocate a nanny state, but I do think that we need to protect children from their own bad choices when the stakes are very, very high.  Isn’t that why we don’t sell children cigarettes and alcohol? 

 What do you think?  Should a 12 year old be able to waltz into a tanning salon to spend her allowance on a tanning session?  Should I say something to the parents of these tanned girls?   Should I spray paint my daughter’s legs?????

 Thanks for reading!  Dr. Lisa Lynn Sowder

 

 

 

 

General Health, Government and Politics, Irish Step Dancing, Skin Cancer, Skin Care, sun damage

POST ACNE SKIN REHABILITATION: A LONG AND INVOLVED PROCESS

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

PYGMALION – WHAT A GREAT PLAY AND WHAT A LOVELY DECOLLETE!

March 2nd, 2012 — 6:35pm

Seattle Plastic Surgeon blogs about the lessons learned in the play, Pygmalion, now playing at Seattle’s Intiman Theater.

Mark Anders as linguist Henry Higgins and Jennifer Lee Taylor as Eliza Doolittle. Her décolleté is so lovely, he dare not look!

Last night I soooo enjoyed attending Pygmalion at Seattle’s Intiman Theater.  There is something about live human beings on stage telling a story through words and action that just touch my soul so much more than film or television ever does. 

 Pygmalion, as most of you probably know, refers to the story of the artist who fell in love with his own sculpture of the “perfect woman”. 

The play, written by George Bernard Shaw and made into the musical My Fair Lady, tells the story of Linguist Henry Higgins turning the gutter snipe Eliza Doolittle into a Duchess.  In the end of course, he learns as much from her as she does from him.  It’s a great story of class and money and manners and empathy and for the plastic surgeon in the audience, the importance of sun protection on the ever important  décolleté .  

The  décolleté  is so often exposed to the sun and, unlike the face, is not amenable to deep chemical peels or laser treatments to treat the sun damage.  Therefore, prevention is paramount.  I recommend adding quick spray of Neutrogena spray-on sun block every morning to the décolleté  to every woman’s morning skin care routine.  It takes but a second or two and helps maintain skin health in this most important female landscape. 

I also highly recommend seeing this delightful play!

Thanks for reading.  Dr. Lisa Lynn Sowder

General Health, I Love Seattle!, Now That's Cool, Skin Care, sun damage

Agressive Skin Care + Enough Filler = GREAT RESULTS

December 14th, 2011 — 10:25pm

Seattle Plastic Surgeon shows off a GREAT NON-SURGICAL RESULT – take a look at this.

Seattle Plastic Surgeon, Facial filler, skin careTop photo before treatment. After photo is after agressive skin care and HA filler over a nine month period.

I saw this patient recently who I have been treating with aggressive skin care and HA fillers (eg Restylane, Juvederm, Perlane, Prevelle) over about 9 months.  She has been very, very dedicated to her skin care program and I’ve been very, very dedicated to injecting her with filler where she needs it and, as mentioned in a previous blog, using enough to really filler ‘er up.

And take a look at these photos.  Her skin quality is so much better and the shape of her jaw line and chin is so improved and her wrinkles —- what wrinkles?????

Fat transfer followed by a deep chemical peel could have achieved this result but no face lift, I repeat, no face lift could have achieved this sort of improvement.

Yes, she will need continued skin care and will need to come in every year or so for some more filler but remember, this is all with no down time and very, very little pain and suffering.

And just remember all of those things we do that also need maintenance – hair, nails, legs, bikini line (ouch),  eyebrows, etc.  Oh yeah, and how about getting your teeth cleaned every 6 months.  No down time but talk about pain and suffering!

Thanks for reading!  Dr. Lisa Lynn Sowder

Aging Issues, Facial Fillers, Facial Rejuvenation, Non-invasive, Skin Care

Fill ‘er up for higher patient satisfaction.

November 16th, 2011 — 12:48am
Seattle Plastic Surgeon recommends full tank for HA fillers

Fill ‘er up even if it means saving up some hard earned $$$.

Seattle Plastic Surgeon, Dr. Lisa Lynn Sowder blogs about patient satisfaction with HA fillers such as Restylane, Perlane, Prevelle and Juvederm. 

I’ve been using these fabulous new facial fillers for many years now and have come to really, really love the way they rejuvenate the face without looking fake or tight or overdone. 

Here is one thing I have learned over the years:  patient satisfaction is directly proportional to how full their tank is filled.  The tank is your face and the fuel is the filler

Some patients will get to full with one syringe and some will require a half dozen.  It just depends on how many creases a patient has, how deep the creases are and how much fullness would benefit the patient.   And I am not talking freak show fullenss here.  This is Seattle.  I’m from Spokane.   I don’t do freak show. 

The big issue, of course, is the cost and these magical fillers are pricey.   Many patients are reluctant to spend the money ($2800 for 6 syringes!)  especially considering that these fillers are temporary.  But …….. it has also been my experience that these temporary fillers can often last 18 – 24 months even though they are advertised as lasting 6 months.  And ……….. patient’s who fill ‘er up usually need much less volume for subsequent “maintenance”  injections. 

Fill ‘er up” patients are almost always thrilled and I know they will be back for more.  The patients who settle for just partial correction are rarely impressed and often don’t come back for repeat injections.

So if you need a lot to “fill ‘er up”, save up and let me really do it right!  Thanks for reading!  Dr. Lisa Lynn Sowder

Aging Issues, Facial Fillers, Lip Enhancement and Augmentation, Nasolabial Folds, Non-invasive, Plastic Surgery, Skin Care

Tan lines and patient satisfaction

November 7th, 2011 — 10:11pm

Seattle Plastic Surgeon, Dr. Lisa Lynn Sowder blogs about patient satisfaction. 

I can usually tell when a patient really, really likes the result of their breast or body contouring surgery, at least if they have had any sun lately.  I just take a look at their tan lines!  (Those of you who read this blog regularly know that I am totally anti-tan and I am not advocating any activity that causes tan line nor do I advocate non-tan line nude sunbathing!)

Sometimes I’ll have a patient who is super picky about a very minor imperfection but who has tan lines that tell me he/she is comfortable not wearing much at the beach or pool.   Once I had a tummy tuck patient, well into her 50s, that was upset that her string bikini didn’t cover her bikini line scar.  That is what I call a happy problem!

Hey, thanks for reading and stay away from those tanning beds.  More on that in an upcoming blog.  Dr. Lisa Lynn Sowder

Body Contouring, Breast Contouring, Breast Implants, Breast Lift, Breast Reduction, Mommy Makeover, Plastic Surgery, Skin Care, sun damage, Tummy Tuck

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