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: Stuff I love


Saying goodbye to Seattle’s Alaskan Way Viaduct

January 10th, 2019 — 12:49pm

This Friday one of my favorite drives on the planet will cease to exist.  I know it’s silly to be attached to stretch of asphalt and concrete but I’m going to really, really miss the Alaskan Way Viaduct. For those of you who do not live in the Seattle area, the Viaduct is a big ugly, noisy and dirty double decker monster of a highway that is a blight on Seattle’s waterfront.  But when I’m shifting my Minicooper into 5th gear on this monster, I feel like I’m flying through a magical landscape with a bursting young city on one side and a busy and beautiful waterfront on the other.  On a clear day I feel like I could roll down the window and reach out to touch the Olympic Mountains to the west. It has the best damn view in Seattle and this view is available to anyone in a car or bus.

But alas, all good things must end, at least that’s the party line.  This Friday night, barriers will go up, connections will be made to the deep bore tunnel that took many years to drill, and in a month, the big machines will come in to tear the Viaduct down.  Over the next few years, Seattle’s waterfront will explode with new developments and I’m sure it will be awesome but I’m going to miss that big ugly magical asphalt ride.

Tomorrow, after work, I’m going to take one last ride and say goodbye.  I’m sure I won’t be the only one.

Thanks for reading and I’d be honored if you followed me on Instagram @sowdermd and @breastimplantsanity.  Dr. Lisa Lynn Sowder

 

I Love Seattle!, It's All About Me., Stuff I love

Is the ideal female breast of the future smallish? Yes, according to Blade Runner 2049.

October 10th, 2017 — 2:11pm

K (Ryan Gosling) and the very evil Luv (Sylvia Hoeks) stroll among the newly finished small breasted replicants.

My husband and I went to Blade Runner 2049 this past weekend at Seattle’s wonderful Majestic Bay Theater.  I am a big fan of the original Blade Runner thus the bar was very, very high for 2049.  IMHO, Blade Runner 2049 was too frenetic, too convoluted and the only characters I really cared much about was Rick Deckard (the still handsome and wiley Harrison Ford) and his big ass shaggy mongrel doggie.  I shed a tear when the doggie is shown peering out of a shattered building, wagging his tail just a bit, wondering where his human went.  I’m tearing up now just remembering that scene.

One thing I found interesting throughout the movie was the relatively smallish breasts of all of the female characters.  Hardly any cleavage at all – a real change for Hollywood.  K’s (played by a deliciously disheveled Ryan Gosling) made-to-order AI concubine Joi (Anade Armas) and her human side kick, Mariette (Mackenzie Davis) with whom she mind and body melds, were both small chested.  The LAPD’s Madame played by the ever wonderful Robin Wright was lean and mean and small chested.  The still-under-construction and just “born” female replicants would all measure into an A or B cup bra.    Even the gigantic virtual reality pleasure girl with the pastel hair was small breasted.  The only bouncing breasts seen in the movie was in the cocktail lounge hologram dancing girls of the distant past.  They contrasted nicely with Deckard and K beating the bejesus out of each other.

So maybe this return to a natural sized breast will be the next not-so-big thing for the ever scrutinized female figure?

Thanks for reading and if you haven’t seen the original Bland Runner, you are missing out on a great movie.  Follow me on Instagram @sowdermd and @breastimplantsanity.  Dr. Lisa Lynn Sowder

Breast Contouring, Now That's Cool, Stuff I love

Louis Pasteur and why you shouldn’t worry too much about mold or fungus in saline breast implants.

April 25th, 2017 — 9:49am

Louis Pasteur in his lab.

I have had a lot of questions lately about mold and fungus in saline implants. I have even read online that some people think intact sterile saline breast implants can somehow get filled with germs.  When I read stuff like that my thoughts go to the great French Scientist Louis Pasteur and your thoughts should too.   Pasteur contributed many, many great inventions and discoveries.  If you drink milk or wine, you can thank Pasteur for the safety of those two nourishing beverages.  If you and your children benefit from vaccinations, you can thank him for that too.  If you have pondered the deeper meaning of stereoisomers in your organic chemistry class, thank Louis.

But enough about that stuff and lets talk saline breast implants. One of Pasteur’s greatest contributions was the debunking of the myth of spontaneous generation.  You see, way back then before microscopes, microbes could not be seen.  When something would ferment or rot or putrefy or suppurate (I’m making myself a little sick), it was believed that the agent of this process just materialized from, well, nothing. The noxious effluvia that generated the aforementioned conditions was referred to as miasma.

In a series of really elegant experiments using some custom made glass vessels, Pasteur showed that a liquid rendered sterile by heating would remain sterile unless it came into contact with something that had not been sterilized.  The infectious agent had to exist in the environment.  It just did not spontaneously generate.  He figured all of this out before even seeing those nasty little germs under a microscope.  Very smart guy.

So what does this have to do with mold, fungus or bacteria in saline breast implants?  Every reasonable implant surgeon on the planet uses a closed system to fill an implant. The saline that goes into the implant comes from a bag of sterile saline for intravenous use into a sterile length of IV tubing and into the sterile implant.  The saline is never exposed to the air which can harbor spores and other creepy things we cannot see with the naked eye.  No contamination means the saline in the implants stays sterile.

What about the implant pocket?  We know that bacteria are present in cases of capsular contracture.  The current working theory of capsular contracture is that it is an inflammatory response caused by biofilm caused by certain types of bacteria.  One type of biofilm causing bacteria, Staph epidermis, is ubiquitous.  A conscientious surgeon does everything he/she can to help minimize the exposure to the implant to the environment, including the patient’s skin, prior to insertion.  Another type of bacteria could be one cause of the very creepy BIA-ALCL and again a conscientious surgeon will use techniques to minimize contamination.   So yes, we know the breast is not a perfectly sterile environment.  The more we learn about the microbiome that is us the more we realize that healthy people co-exists with a lot of “germs”.  If the presence of a microorganism meant illness, we would all be at death’s doorstep.  In fact, our mitochondria (tiny organelles in our cells that generate energy) are likely the descendants of bacteria that some single celled organism co-opted.  God, I love cell biology.  Don’t you?

What about saline implants that leak from a tear or from the fill valve?   Could microorganisms creep in there?  Yes they could but they will need something to eat.  Normal saline, which is used to fill saline implants has no energy source. Those microorganism are going to go pretty hungry.  I am aware that here are some really weird life forms that seem to exist in the most hostile and unnourishing environments – bubbling mud pots in Yellowstone, deep ocean sulfuric steam vents, etc – but me thinks that those critters aren’t going to show up in a beast implant.

I have taken out a bajillion old saline implants and, I swear on a stack of plastic surgeon journals, have never seen one that was contaminated with fungus.  I have seen a few with little floaters that I cannot explain.  When I’ve sent the saline in such implants, the cultures have come back no growth.  What does that mean?  I don’t know.  There I said it:  I don’t know.  Could a little speck of something floating around in an intact saline implant destroy a person’s health?.  I don’t know but it seems unlikely to me unless that little speck was Polonium-210.

I have had a quite a few breast implant illness patients who were absolutely bummed that their implants were not contaminated because they had become convinced that they were.  Yes, I have seen photos of really nasty and moldy implants out there in cyberspace and yes it is obvious that some implants are contaminated and that there are unreasonable surgeons who don’t used a closed system but I think those cases are rare. Nobody posts photos of old, pristine saline implants (except me on my Instagram @breastimplantsanity).  Pristine saline implants are boring.  And I promise, cross my heart, if I take out a nasty implant filled with fungus balls, I will let you know.

Soooo, if you think your implants are moldy, you could be but probably are not right.   But as anyone who knows my practice, I will take implants out for any reason.

Thanks for reading and you should read up on Louis Pasteur.  The contributions he made to science are nothing short of amazing.  Dr. Lisa Lynn Sowder

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

Breast Contouring, Breast Implant Illness, Breast Implant Removal, Breast Implants, Stuff I love

The magic of mastopexy a.k.a. breast lift

September 19th, 2014 — 5:34pm

Seattle Plastic Surgeon blabbers on and on (again) about her favorite operation.

brest lift 1One reason that breast lift a.k.a mastopexy is my very favorite operation is the variety of breast lift techniques that can treat many different issues with breast shape.  Breast lift can do many things to improve the appearance of the breast.  Obviously, breast lift can lift the breast but it can also improve the position and/or size of the nipples and areolas and can even lower the actual breast mound in relation to the nipples.

As usual (especially in plastic surgery), a picture is worth a bajillion words.

Let’s take a look at this patient.  The top photo illustrates a few issues with her chest.  Her nipples and areolas are a little too large and too low. The fold under her breast is too high.  She has fullness of the upper lateral area near her arm pits and an indentation in the middle lateral area of her breasts.

breast liftA breast lift can address all of those issues.  The nipple and areola diameter is decreased and they are raised just a bit.  The actual breast mound is pulled down and the breast fold is lowered.  This gives the breasts a nicer shape.  And, as icing on the cake, the indentation is filled in to make a smoother transition from her arm pit area to her breast mound.

All of this is done without disrupting the blood supply or nerve supply to the nipple and areola.  This patient can expect normal nipple sensation.  She should not, however, expect to be able to breast feed.  The breast tissue has undergone a lot of rearrangement which will likely interfere with the production of milk.

The scars around the areolas and the vertical scars will fade with time.  These scars are a trade off for her nicer shape and will not interfere with normal lingerie or swimwear or even a bustier!

Thanks for reading!  Dr. Lisa Lynn Sowder

 

Breast Contouring, Breast Lift, Stuff I love

Mother’s Day is almost here.

May 7th, 2014 — 3:59pm

Seattle Plastic Surgeon and mother of three teenagers (!) has a gift suggestion for Mother’s Day.  She hopes her husband and children read this blog.

This robe is as soft as a kitten.

This robe is as soft as a kitten.

I recently  had to spend the better part of a day at SeaTac, Seattle’s airport, while waiting for my delayed flight to San Franscisco to attend the annual meeting of the American Society for Aesthetic Plastic Surgery.   Fortunately, SeaTac has a really nice terminal with lots of shops and restaurants to while away the hours and whittle away your wallet while waiting.  I happened upon this wonderful robe at a gift shop called Fireworks Gallery.  It is as light and soft and cuddly as a kitten.  I almost expected it to start purring.  This robe is at the top of my list for this Mother’s Day.

If you are interested in this robe for a wonderful mom in your life, Seattle has several Firework Galleries and it’s also available online from the manufacturer’s website :  http://tourance.com/   And if the mother on your list already has a nice collections of robes, Tourance also carries a Wild Hyena Faux Fur Throw with Chocolate Rosebuds.  Sounds fun, huh?

Happy Mother’s day to all.   I’m looking forward to breakfast in bed this Sunday.  Thanks for reading!  Dr. Lisa Lynn Sowder

 

It's All About Me., Mommy Makeover, Stuff I love, Wardrobe Observations

Another reason why surgeons love the operating room.

April 8th, 2014 — 12:30pm

Seattle Plastic Surgeon explains why one of many reasons why she just loves the operating room.

Scrubs. It’s a uniform we all love.

There are many reasons that surgeons love to spend the day in the operating room.

We consider the operating room our nest and those with whom we work in the operating room our tribe.  It really is our home away from home.  And it is kind of a sacred space.  Others are loath to interrupt an operation with trivial questions like “does anyone remember who the bass player for Herman’s Hermits was?”

And surgeons like to operate.  That is why we spend the better part of our young adulthood in training so we can learn our craft.  As one of my co-residents used to say when we were weary from working such long hours, “Lisa, you gotta love it!”

Another  reason we love the OR is the operating room uniform – scrubs.  Ah, scrubs.  They are as comfortable as pajamas and we get to work in them!  And we get to wear a surgical cap which comes in very, very handy on a bad hair day.  And we get to wear really comfortable operating room clogs.  No high heals allowed in the operating room.

And here is the best part about scrubs.  At the end of the day, we take them off and put them in a magic laundry hamper.  A few days later, they appear all clean and folded in the scrub cabinet.  I sure I wish I had a magic laundry hamper at home.

Thanks for reading!  Dr. Lisa Lynn Sowder

 

 

My Plastic Surgery Philosophy, Stuff I love, Wardrobe Observations

Gynecomastia patient shows what surgery and exercise can do.

April 4th, 2014 — 10:14am

Seattle gynecomastia patient shows what can happen once a guy is comfortable going to the gym.  It’s a beautiful thing.

Top photo shows a guy embarrassed to take off his shirt.  Bottom photo shows a guy who feels and looks great after gynecomastia surgery and working out.

Top: Before surgery and some serious gym time. Bottom: After surgery and some serious gym time.

I find it very gratifying to help patients achieve their personal best through plastic surgery.  And I find it super gratifying when plastic surgery really helps a patient make a commitment to better self care.

This patient is a middle-aged guy who felt embarrassed about his pudgy chest.  He has a mild case of gynecomastia but a serious case of self consciousness.  I performed a  gynecomastia reduction on him.  I used my standard technique in this type of gynecomastia.  I removed the excess fat from his chest with power assisted tumescence liposuction and excised the little bit of excess glandular tissue though an incision under his nipple.  This technique leaves teen tiny scars that are almost imperceptible.  I am always careful to preserve a disc of breast tissue under the nipple.  This keeps the nipple from caving in.

He was well-enough healed at about 3 weeks to start  going to the gym for some weight training and before long, he was feeling really, really good about his chest.   Not all of my patients get this inspired but I sure love it when they do.  They provide me with some really, really nice before and after photos!

Thanks for reading!  Dr. Lisa Lynn Sowder

For Men Only, Gynecomastia, Liposuction, Male Plastic Surgery, Stuff I love

Voluma. I think I’m going to really, really like this new HA filler.

March 11th, 2014 — 1:32pm

Seattle Plastic Surgeon is happy to add Voluma to her toolbox.

Those who know me well know that I take a long hard look at new technology, products, procedures, etc.  I think that new is not enough.  It has to be better, safer, easier or less expensive that the technology, product or procedure it is gunning to replace.  I’m always so tickled when something new really does turn out to live up to its claims.

Seattle Voluma

My very brave first Voluma patient. Before injection on the left and after injection on the right. Note how her fuller cheekbones enhance her entire face. Oh, the eye makeup doesn’t hurt either.

Voluma is the new thing that floats my boat.  Here’s why.  Voluma is another hyaluronic acid (HA) filler, similar to other HA fillers such as Restylane, Juvederm, Prevelle, Perlane, etc.  What makes it different is that it was developed for deep injection onto the bone or in the fatty layer of the mid face.  Voluma allows for nonsurgical enhancement of the cheekbone area which in turn can improve the contour of the lower eyelids and also the nasolabial folds.

Other procedures that can enhance this area include fat transfer, cheek implants and vertical face lifts.  Of course, these all have down time whereas our Voluma patient on the left went to work about 10 minutes after her injection.  And she said it hardly hurt although maybe she was just being nice.

Voluma lasts about 2 years, much longer than the other HA fillers.

The cost for this new filler is twice that of the standard HA fillers but often less can be used because it is so “volumizing”.  A little bit goes a long way.

So this is another tool in my toolbox and one that I think I will pull out often.  Oh, and by the way, the makers or Voluma do not pay me to promote their product.  In fact, no one pays me anything to promote their products.  I prefer it that way and you should too!

Thanks for reading!  Dr. Lisa Lynn Sowder

 

Facial Fillers, New Technology, Stuff I love

Male journalist takes on Redbook’s Web Site. IMO male journalist wins.

October 7th, 2013 — 1:42pm

Seattle Plastic Surgeon shares Wall Street Journal Article from Saturday, Oct. 5, 1013:

Words Assured to Tick Off Any Man by Joe Queenan

Redbook’s website has just published a list of things you should never say to a man. Why not? Because they will make him go ballistic. The list includes such incendiary remarks as: “Your tummy is so cute,” “Do whatever you want,” “Do you think I actually believe you?” “You’re just like your dad” and the real, Katy-bar-the-door, no quarter-asked-and-none-given haymaker in this epic inter-gender brouhaha, “I really don’t respect you.”

[image] Illustraction by Nishant Choksi

Redbook, for whatever reason, is feeding impressionable young women totally false information about the male psyche. No man I know would go ballistic just because a woman said, “Your tummy is so cute.” Nor would he lose it if she said, “Well, you are a bit on the chubby side.” Or even “My, aren’t you the chunky little butterball!”

Men don’t care about their “tummies.” Never have. Never will. If they did, alcohol would have gone out of style a long time ago. Weenies might care about their tummies. Or hipsters. But not actual men. Besides, men do not refer to their flabby stomachs as “tummies.” They call them “beer guts.” At least Redbook could try to get the lingo right.

A deeper question is where this dubious material comes from. Who says “Your tummy is so cute” to a boyfriend, a partner, a spouse? Not any woman I’ve ever heard of. Did anyone actually poll men about this stuff? Or women?

The rest of the list is no better. Men don’t care if their partners do not believe them. They kind of expect it. Men also don’t care if you tell them to go ahead and do whatever they want. This is what men do anyway. It is also what women do. It is what everyone on the planet does.

Similarly, few men would object to being likened to their fathers. To most men, that’s actually the highest praise imaginable, unless your dad is named Joseph Stalin or Timur the Tartar. No, with the obvious exception of the confrontational “I really don’t respect you,” none of these remarks is even vaguely discombobulating.

And even if a man took exception to being told that he was not “respected,” he would not automatically go ballistic. He would write it off as an ill-advised comment uttered in the heat of battle. He would figure that it was par for the interpersonal course.

The list contained in Redbook is inane, misleading and stupid. It’s like those lists: “174 Things That Drive Women Wild in Bed,” or “Seven Things You Should Never Say to a Bisexual Pyromaniac.” The lists are compiled by amateur sociologists, office cut-ups, puckish ne’er-do-wells and editorial interns who are trying to get their assignments wrapped up before they go back to high school.

This is not to deny that there are phrases that will make men go ballistic. Oh no, there are lots of those. Here are just a few things you should never say to a man with whom you are having any kind of serious relationship.

“I spent all the money. All of it. On Josh Groban tickets.” “I was thinking of gaining 130 pounds. I’m feeling gaunt.” “No, you cannot invite Macho Man and Bennie the Blade over to our 35th anniversary party.” “You know the $5,000 from your Christmas bonus that you thought I was investing in safe, short-term bonds? I took a flier on a penny stock issued by a boiler room in Boca Raton. The company makes pocket-size defibrillators.” “Your mother could give Medusa a run for her money.” “You know the kid you thought was your firstborn son? Wrong!”

And finally: “I told the four guys from the Bronx that you are no longer interested in paying the vig. I did OK, right?”

 

Thanks for reading!  And if you don’t subscribe to the Wall Street Journal, you should.  It has some of the best journalism out there and it’s not just about money and business.  Dr. Lisa Lynn Sowder

For Men Only, Highly Recommended Reading, Male Plastic Surgery, Stuff I love

No fez for me.

April 30th, 2013 — 10:37am

Seattle Plastic Surgeon is soooooo disappointed to learn about Turkey’s ban on the fez.

Plastic surgery Seattle

That fez will get you in trouble with the Turkish authorities.

Just today I had a friend return from a trip to Turkey.  I had asked her to buy an authentic fez for me just for fun.  Well, there was no fez for me in her bag of gifts.  She learned, while she was there, that the fez was banned in the 1920″s as part of Turkey’s push towards secularization and modernization.

Now I am all for separation of church and state and for modernization but at such a price?   I think the fez is just one of the coolest head adornments out there – and they add a good six inches to one’s height. So my pal goes to Turkey and all I get is a lousy belly dancing scarf.

Thanks for reading!  Dr. Lisa Lynn Sowder

Stuff I love, Wardrobe Observations

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