logo
Contact Us
Dr. Sowder's Fabulous Blog
  • Meet Dr. Sowder
  • Our Office
    • Meet My Staff
    • Office Hours
    • Weekends and Holidays
    • Office Location of Seattle Plastic Surgeon, Dr. Lisa Lynn Sowder
    • Our Outpatient Surgery Center
    • Financial Policy and Insurance Issues
    • Consultation Fee
    • Secondary Surgery Policy
    • Patient Rights and Responsibilities
  • Procedures
    • Breast Procedures
      • Mommy Makeover
      • Breast Implants a.k.a. Breast Augmentation
        • Breast implants. It’s after hours. Should I have the doctor paged?
      • Breast Lift a.k.a. Mastopexy
        • Breast lift questions and concerns. When to have the doctor paged after hours.
      • Fat Transfer for Breast Enlargement
      • Breast Augmentation Combined with Breast Lift
      • Breast Asymmetry Treatment
      • Breast Reduction
        • Breast reduction concerns. When to have the doctor paged after hours.
      • Tuberous Breast Deformity Treatment
      • Breast Implant Removal
      • Breast Implant Revision and/or Replacement
      • Breast Reconstruction
      • Inverted Nipple Treatment with Nipple Piercing
      • Nipple Reduction
      • Male Breast Reduction a.k.a. Gynecomastia Reduction
      • Combination Breast and Body Contouring Procedures
    • Facial Procedures Performed
      • Face Lift
        • Post operative face lift questions and concerns. When to have the doctor paged after hours.
      • Eyelid Surgery (Blepharoplasty)
        • Post operative blepharoplasty questions and concerns. When to have the doctor paged after hours.
      • Transblepharoplasty Brow Lift
        • Post operative transblepharoplasty browlift questions and concerns. When to have the doctor paged after hours.
      • Forehead Lift a.k.a Browlift
        • Post operative browlift questions and concerns. When to have the doctor paged after hours.
      • Submental Liposuction a.k.a. Neck Liposuction
      • Ear Surgery a.k.a. Otoplasty
      • Ear Lobe Rejuvenation
      • Facial Implants
      • Facial Skin Lesion Excision
      • Lipostructure a.k.a. Fat Grafting a.k.a. Fat Transfer
      • Chemical Peeling
      • Botox Cosmetic for Facial Wrinkles
      • Combination Facial Procedures
      • Medical Skin Care
    • Body Procedures
      • Mommy Makeover a.k.a. Maternal Restoration
      • Tummy Tuck a.k.a. Abdominoplasty
        • Tummy tuck. It’s after hours. Should I have the doctor paged?
      • Liposuction a.k.a. Suction Assisted Lipectomy
        • Liposuction: When to have the doctor paged after hours.
      • Medial Thigh Lift
        • Medial thigh lift: When to have the doctor paged after hours.
      • Upper Arm Lift a.k.a. Brachioplasty
      • Lower Body Lift and Belt Lipectomy
        • Lower body lift and belt lipectomy: When to have the doctor paged after hours.
      • Bra-line Back Lift
      • Brazilian Butt Lift a.k.a. Buttock Enhancement
      • Body Contouring After Massive Weight Loss
      • Labiaplasty
      • Gynecomastia (enlarged male breasts) reduction
      • Mons Pubis Lift and/or Reduction
        • Mons pubis lift and/or reduction: It’s after hours. Should I have the doctor paged?
      • Fat Transfer for Hand Rejuvenation
      • Body Contouring of the Obese Patient
        • Recommended surgical weight loss centers.
      • Combination Body and Breast Contouring Procedures
      • Combination Body Contour Procedures
    • For Men Only
    • Facial Non-Surgical Procedures
      • Injectable Fillers
      • Skin Rejuvenation with Chemical Peels and Medical Skin Care
      • Skin Rejuvenation-Eyes
      • Botox Cosmetic and Dysport
      • Kybella
  • Your Procedure
    • Initial Consultation
    • Preoperative Visit
    • Getting Ready for Surgery – A Few Tips
    • Day of Surgery
    • Post-operative Information
    • Out of Town Patients
  • Photo Gallery
    • Mommy Makeover
    • Breast Procedures
      • Breast Implants
      • Breast Implants with Breast Lift
      • Breast Lift & Reduction
      • Treatment of Breast Asymmetry
      • Fat Transfer to the Breast
      • Treatment of Tuberous Breasts
      • Breast Implant Removal/Revision
      • Gynecomastia & Nipple Procedures
    • Body Contouring Procedures
      • Abdominoplasty (Tummy Tuck)
      • Liposuction
      • Massive Weight Loss
      • Arm & Hand Contouring
      • Leg & Thigh Contouring
      • Buttock Enhancement
    • Facial Procedures
      • Face Lift
      • Brow Lift
        • Transblepharoplasty Brow Lift
      • Ear Surgery
      • Eyelid Surgery
      • Neck & Chin Liposuction
      • Fat Transfer to the Face
      • Lip Enhancement
      • Nonsurgical Procedures to the Face
      • Skin Resurfacing
    • Miscellaneous
      • Scar Revision
      • Skin Cancer & Other Skin Lesions
  • What’s New
    • Fat Transfer for Breast Augmentation
    • Reduction and/or Lift of the Mons Pubis
    • Hand Rejuvenation
    • Lipostructure (fat grafting)
    • Vertical Breast Reduction and Breast Lift
    • Botox for Excessive Sweating (Hyperhidrosis)
    • CAST Liposuction for Heavy Upper Arms
  • Recommended Reading
  • Trustworthy Web Sites
  • Testimonials
  • Blog
Contact Us My Blog

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: This Makes Me Cranky.


I’m anti anti-vaxer

June 4th, 2018 — 8:27am

Anti-vaxers have been on my mind lately.  I recently had a nasty comment directed at my @breastimplantsanity Instagram telling me I should be ashamed of myself for promoting these “toxic bags of death”.  Those who follow @breastimplantsanity closely know that I am not a huge breast implant fan and much prefer other options for breast enhancement but I digress.  This particular detractor’s Instagram was militantly anti-vaccination   I just about choked on my Diet Coke.  So, breast implants are to be feared but not smallpox, polio, diphtheria, mumps, rubella, measles, chickenpox, meningitis, shingles, genital warts, cervical cancer, tetanus, pneumococcal pneumonia, etc?  Give me a break.

I am being generous here when I say anti-vaxers are misguided and so very coddled and sheltered from the reality of communicable diseases of childhood in and adulthood.  They don’t know what they don’t know but they don’t know even know that. 

Take a look at this photo.  This is from a book called Sleeping Beauty which consists of medical photos taken during photography’s earliest era and curated by Stanley B. Burns, M.D.  The book was published in 1990 and unfortunately is out of print.  This photo, “Mother With Her Dead Daughter”, was taken in the early 1900’s.  This may strike the modern reader as really sicko but most working class families of that era could not afford to have a photographs taken but would often splurge for a photo of a dead loved one.  Take a closer look at the photo.  Does the daughter look dead or even ill?  Doesn’t she just look like she is sleeping in her mother’s lap?  The real give away is this poor mother’s face.  It’s just haunting with its steely resolve. The daughter looks so normal because she died so fast.  Childhood mortality in this era ranged from 30 to 50 percent (!) with most children dying quickly from a wide variety of infectious diseases.  Those diseases so common then now make the news and are almost always associated with pockets of low vaccination rates.

It wasn’t so long ago that the whole world was a low, no really, a zero vaccination rate pocket.  Back in 1990, I was touring The Breakers, the mansion owned by transportation magnate Commodore Cornelius Vanderbilt (1794 –  1877) in Newport, Rhode Island.  Our little touring group was ushered into the mansion’s library to await our tour guide.  There were many family plaques hanging on the library walls and I was really moved to see how many family members, members of this rich and elite clan who could afford the best medical care of the time, died in early childhood.  But this was before the modern era of vaccination.

I am old enough to sport a smallpox vaccination scar on my upper arm and to remember lining up in a local grade school gym to receive one of the first oral polio vaccines.  These two scourges of humanity are all but wiped out thanks to world wide immunization.   And I am old enough to remember being sicker than a dog with red measles and I still see my faint chickenpox scars when I puck my eyebrows.  And I had a college dorm buddy, only one year older than me, with legs crippled by polio.  He missed the vaccine by a year.  These are real diseases that the young whipper snapper anti-vaxers have been spared because their neighbors do vaccinate themselves and their children thereby providing herd immunity.

So little miss smarty pants anti-vaxer Instagram diva, I could wish the pox on you, but I won’t.  I wouldn’t wish the pox on anyone, not even an anti-vaxer.

Boy, I feel better having written this and thanks for reading.  Dr. Lisa Lynn Sowder

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

 

General Health, This Makes Me Cranky.

Did you know that I am “Woman of Year in Medicine and Healthcare” and that “Seattle’s #1 Ranked Plastic Surgeon” is not a plastic surgeon?

May 17th, 2018 — 12:20pm

Seattle Plastic Surgeon ponders the meaning of all of these awards than just seem to arrive in the mail along with a place for credit card information.  

Dr. Sowder, you are really are the best.

Dr. Sowder, you are really are the best.

I was dejunking my office this week and came across a bunch of letters and a few emails informing me how fabulous I am and inviting me to order various plaques and trophies (prices range from $99 – $530) so I can spread the news of my fabulousness.

Over the past few years I have been named one of “America’s Top Surgeons”, one of  “America’s Top Plastic Surgeons” (with honors of distinction and excellence), one of the “Leading Physicians of The World”, one of the “Best Doctors in America”, one of “Washington State’s Best Doctors”, “the 2015 Best Business of Seattle in the category of Cosmetic Surgeons”, “One of the 10 Best Plastic Surgeons for Washington”, “Top 100 Health Professionals – 2018”, and (my favorite), “Woman of the Year in Medicine and Healthcare.”

I have to say that I am honored and humbled by all of these accolades but I have a sneaking suspicion that these “associations” really don’t know anything about me or my practice and just want my money.  I’m pretty cheap so you won’t see any this stuff hanging on my wall.

But …………… I am not at all shy about letting the world know about the fabulous awards I actually have received without having to fork over a dime.  Going way, way, way back – here they are, at least the ones I can remember:

  • Tidiest camper at Camp Sweyolaken as a Campfire Girl.  You would laugh at this if you could see my desk right now.
  • Best Book Week Poster – 5th grade, Hutton School, Spokane, Washington (Mom was so proud).
  • First Place Beginner Dog Obediance (shared with Mickey, the wonderdog), Spokane Canine Club.
  • Best Undergraduate Research Paper, University of Washington, 1978 (I got $400 which back then was a boat load of money.  Actually it still is a boat load of money).
  • Phi Beta Kappa – University of Washington, 1978.
  • Alpha Omega Alpha – University of Washington School of Medicine, 1983.
  • Best Paper, Senior Plastic Surgery Residents’ Conference, 1991.
  • Golden Hands Award for the best cosmetic surgery case, Washington Society of Plastic Surgeons, 2005.
  • “The Dom”. a.k.a. best presentation, Northwest Society of Plastic Surgeons, 2009.  It’s called “The Dom” because the prize is a bottle of Dom Perignon.

Oh, and this just in:  There is a new doctor in town who claims on his home page that he is ranked the #1 Plastic Surgeon in Seattle.  And his home page is cluttered with the aforementioned fake plastic surgeon awards.  Problem is that he has not spent one day in an approved plastic surgery residency, is not certified or eligible to be certified by the American Board of Plastic Surgery (the only real plastic surgery board), and is not a member of the American Society of Plastic Surgeons, the American Society for Aesthetic Plastic Surgery, the Washington Society of Plastic Surgeons or the Northwest Society of Plastic Surgeons.  In other words, he is not a plastic surgeon!!!  Is he a good non-plastic surgeon?  Don’t know.  I do know that he is not an honest surgeon.

Thanks for reading and be careful out there when picking a plastic surgeon.  Make sure you pick a real one.  Check your surgeon’s credentials by visiting the American Board of Plastic Surgery 

Thanks for reading, (Multiple Award Winning) Dr. Lisa Lynn Sowder

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

 

My Plastic Surgery Philosophy, Now That's a Little Weird, This Makes Me Cranky.

Give me great massage but please hold the b.s.

May 8th, 2018 — 5:22pm

 

Alison giving the elbow to one of our hard working nurses.

Yesterday we had a wonderful massage therapist come into the office to give our staff 30 minute massages in celebration of Nurses Week.  Oh yeah, I sneaked in and had one too and it was great.  While having my back, neck and shoulders, arms and hands kneaded, pulled, rubbed and elbowed, I had a very nice chat with Alison the therapist.  She is a weight lifter and I had a lot of questions about the mechanics of power lifting, what she thought of body builders, strength training for the over 60 crowd (me, for example), dwarf throwing contests and a bunch of other stuff.  I was so impressed with her knowledge and explanations of how strength isn’t just from muscle bulk but also from neurons in the neuromuscular junction acting in a coordinated fashion, from muscle memory for some actions, from bone strength and angle and from mechanical advantage.  This lady’s b.s. meter was set at zero, just where I like it.

It was particularly nice to have this encounter because a few days earlier there was an article in the Seattle Times about craniosacral therapy which had my b.s. meter red-lining.  Nicole Tsong, who is a yoga instructor, has a nice weekly column about exercise, nutrition and other self care and I usually enjoy reading it.  But this past Sunday, yikes did she go off the rails.  Nicole’s treatment, basically a massage, sounded pretty standard and pleasant but then the therapist started talking nonsense.

Cut and pasted from the article:  Craniosacral therapists observe your cerebrospinal fluid, which moves in roughly eight-, 20- and 100-second cycles, Christman said. My flow was good from my tailbone up until she got to my left shoulder, she said, where the flow contracted. She could work on my connective tissue to help the fluid move, or manipulate the fluid to move back into my shoulder, she said.

Yes, this is a head rub and it feels great but she’s not manipulating your skull and she is not observing your cerebrospinal fluid. Just sayin’.

Christman had asked me before the session about head injuries, and I told her about a concussion I had in college. After working on my spine and pelvis, she moved to my head and started gentle pressure around my skull to manipulate the tissue and bones. I was already relaxed, and when she started to work on my head, I succumbed and closed my eyes, nearly nodding off.

Since this is my blog, I’m just gonna get this off my chest.   Cerebrospinal fluid (CSF from now on) sort of circulates and sloshes around in the ventricles of the brain, between the brain and the skull and in the center of the spinal cord but ………………… 8, 20 and 100 second cycles?  Why not 34 seconds or 82?    Hmmm.  It has been awhile since I took neruoanatomy but that sounds like b.s. to me.  Oh, and the therapist observes the CSF?  I don’t think so.  CSF can be observed when doing a diagnostic spinal tap or doing a spinal anesthetic or during brain or spine surgery or in cases of a skull fracture when CSF can be observed dripping out of ears and nostrils.  Methinks Ms. Christman was not really observing CSF in a therapy session.  But why would she say she was?  Oh, and then CSF in the shoulder?  Nope.  Not there.  There is synovial fluid in the shoulder joint but not CSF.  If you have CSF in your shoulder you should report of the emergency room … stat.

Now lets deconstruct that head rub that Nicole got.  God, I love a good head rub, don’t you?  But I know that a head rub does not manipulate the skull.  The skull does have joints (called sutures) but they fuse in early childhood.  The only way to move a skull around is with power tools and preferably in the OR with a neurosurgeon.

Nicole almost dropped off to sleep and maybe would have been the best way to avoid listening to this balderdash which is fancy word for b.s.

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

 

 

 

General Health, This Makes Me Cranky.

Liposuction-Augmentation Mammaplasty – A Bad Idea IMHO

May 3rd, 2018 — 9:33am

Liposuction-augmentation mammaplasty has been on my radar since I stumbled across an Instagram video a few months ago of a surgeon sucking the fat out of a perfectly full breast and then inserting an implant to make up for the lost volume.  I started humming Ozzy Osborn’s Crazy Train!  The rational for this procedure is to provide a bit of a lift without the lift scars. This procedure is described in detail in this April’s edition of the Aesthetic Surgery Journal.  The authors reported on 125 patients and compared them with 188 patients who had just a regular old breast augmentation.  The amount of lift achieved was very, very modest.  The authors were very meticulous in their details – age and weight of patients, how much fat was removed and how large an implant was inserted.  Their minimum follow up was 12 months. These authors put a ton of work into this study and I admire them for that.

BUT…………………………………………..Just because something can be done does not mean it should be done.  And I think this procedure is misguided.   Breast tissue is made to last a lifetime and it does.  Implants last maybe 20 years or so if a patient is lucky.  Here is a list of implant related problems:  too high, too low, too lateral, too medial, too loose, too tight, leak or rupture.  Here is a list of breast tissue related problems: benign cysts and breast cancer.  Why, oh, why would a lady trade in her natural breasts for implants (unless she has breast cancer)?  Apparently there are some patients out there, mostly young, who want a really fake look and you bet that this procedure can deliver a fake look that a breast lift cannot.  But isn’t it our duty to let these young patients know that when they are 60, they will likely be on their 3rd or even 4th set of implants with no end in sight because their natural breast volume was sucked away?????  And those high round globes will look pretty odd on their post menopausal body.

And there’s more:  Removing fat from the breast via liposuction leaves a breast more glandular and fibrous and thus harder for breast cancer detection on mammogram.  And add an implant and the mammogram is even harder to interpret!  A lifted breast poses no issues for mammograms once the internal scars have settled.  And speaking of scars, breast lift scars almost always fade to a point of being a non-issue.

There is one instance where I think liposuction-augmentation mammaplasty is a reasonable idea and that is in cases of breast asymmetry.  It is really, really hard to get a great result when one breast is mostly implant and the other either has no implant or a very small implant.  In these cases, i think it is reasonable to reduce the larger side either with liposuction or an actual breast reduction so implants of similar volume can be used.

I do not know if this technique will gain traction but I hope it does not.  My enthusiasm from breast implants has waned over my 26+ of practice.  I’ve just seen so many implant related problems.  If I can get a breast looking good without an implant, that is what I will recommend.  If implants are the only way to get a nice result, I will certainly go there but I can assure you that I am not going to sucking or cutting away perfectly good breast tissue and replacing it with an implant!

Thanks for reading and be careful out there.  Dr. Lisa Lynn Sowder

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

Breast Contouring, Breast Implants, This Makes Me Cranky.

The truth about plastic surgery chains.

March 22nd, 2018 — 9:57am

I came across this well written article by plastic surgeon Jennifer Greer on www.Kevinmd.com.  I think it provides some good information about plastic surgery chains like Lifestyle Lift (out of business for a few years now) and SonoBello which appears to be expanding.  If you haven’t heard the SonoBello jingle you must never listen to the radio.  According to a recruiting letter I received from them today, SonoBello spends $75K – $100K per month on TV infomercials, radio ads and internet marketing in each market.  That is one ginormous advertising budget!  Anyway I don’t work for any of these chains mainly because I think they provide less personalized and inferior care compared to a private office like my own and I have a visceral disgust of high-pressure sales tactics.  Oh, and I’ve reviewed the records of three SonoBello deaths in the Pacific Northwest, one for a news organization and two for attorneys.   Anyway, the author of this article works both for herself and for a couple of years worked for a chain that sounds like SonoBello.  Here is her advice to prospective patients based on her experience.

One day? Really? I don’t think there is a single procedure I do where patients look their best after one day.

JENNIFER GREER, MD | PHYSICIAN | MARCH 17, 2018

 Over 17 million cosmetic surgery and minimally invasive procedures were performed in the U.S. in 2016. With the increasing popularity of cosmetic procedures, it seems nearly everyone is out to get a bite of the apple.

Cosmetic surgery chains are growing in size and popularity in an attempt to cash in on this market. Examples include: LifeStyle Lift in the U.S., which declared bankruptcy in 2015 and Transform in the U.K. With this growing popularity, consumers should ask themselves whether having surgery at a cosmetic surgery chain is a good idea. Today, I’m going to explain what to look for during your cosmetic surgery consultation and what you should stay far away from.

I’m in a unique position to discuss the safety of cosmetic surgery chains. First, I’m a board-certified plastic surgeon in Cleveland, and cosmetic surgery makes up over half of my private practice. I currently operate in both a traditional hospital and an outpatient surgery center. But for the past two years, I was employed part-time by one of these cosmetic surgery chains. I even had liposuction surgery performed at that center, so I’ve got a unique insider view of what really happens at those chains, and how it’s different from seeing a physician in private practice. I’m going to tell you the truth about these centers and what to look out for.
The first red flag to watch out for is high-pressure sales tactics. If you check websites such as ConsumerAffairs.com and the Better Business Bureau, you’ll find this is a common complaint about cosmetic surgery chains. High-pressure sales tactics may include:
  • Requiring you to put money down before you ever meet a physician.
  • Pressuring you to make a decision that day.
  • Insisting on applying for a loan at your initial consultation.
  • Offering a special “limited time” discount.

High-pressure sales can occur at both a private practice and at a cosmetic surgery chain. Regardless of where you encounter them, they are a huge red flag. As a consumer, you want a doctor who is focused on providing the best care possible, not on meeting a revenue goal. Focusing on money over patient care can lead to some scary medical decisions, like operating on people who really aren’t healthy enough to have surgery.

The second red flag to watch out for is misleading statements about pain during and after surgery. LifeStyle Lift had many complaints that their advertising gave the impression the procedure was quick and the recovery painless. In reality, the procedure lasted three hours or longer, and the downtime afterward was about two weeks. When you see a surgeon for a consultation, she or he should tell you what the average experience is like, as well as best and worst-case scenarios for recovery time. If this part is glossed over in your consultation, alarm bells should be going off in your head.

The third red flag you should watch out for is a surgery center or physician that only offers a very limited number of procedures. The center I worked at did liposuction, but no tummy tucks or skin removal. So if you were looking for a flatter stomach, they would only be able to offer you liposuction, even if you would get a better result with a tummy tuck. This is where the high-pressure sales comes into play again as well; if you have a sales person who needs to meet sales goals, that person is highly motivated to sell you his or her product, regardless of whether it’s actually the best option for you.

The fourth and final red flag to watch out for is the safety of the facility. Hospitals have the strictest oversight for patient safety, followed by surgery centers. But if surgery is performed with only oral medication, it can legally be done in an office that has no type of accreditation. This doesn’t mean having surgery isn’t necessarily safe, but you do want to ask what happens if there is an emergency, and how the staff are trained to deal with that. You also want to ask your surgeon if he or she has privileges to do your surgery in a hospital; non-plastic surgeons usually cannot get privileges to perform cosmetic surgery procedures such as liposuction in a hospital because they don’t have the training. If your surgeon only operates in an office or surgery center, this is a red flag that he or she is not board-certified in plastic surgery.

In my experience working for a cosmetic surgery chain, I was able to give patients some fantastic results. And I myself had a safe procedure by a surgeon I trust. But I think there is a huge difference in the mindset between a physician in private practice and a corporation. Physicians go into medicine because we want to help people, first and foremost.

Corporations exist to make money. Although there are certainly exceptions in both groups, I hope you can use the information I’ve given you to ensure you have a safe surgery experience wherever you go.

Jennifer Greer is a plastic surgeon and can be reached at Greer Plastic Surgery and on Twitter @greerplastics.

Thank you Dr. Greer for giving us a little inside view and some very good advice.  Dr. Lisa Lynn Sowder

Body Contouring, Liposuction, Patient Beware, This Makes Me Cranky.

Silicone injections are deadlier than ever.

March 13th, 2018 — 2:34pm

Silicone has quietly become beauty’s own modern-day scourge. Here’s what you need to know about the infamous injectable.

From Haper’s Bazaar, January 30, 2018 by Jolene Edgar

We often write about—and unapologetically enjoy receiving—popular cosmetic injections, like line-relaxing Botox and hyaluronic acid fillers. Thankfully for our foreheads and lips, the FDA has deemed these injectables safe and effective. And we trust our board-certified dermatologists and plastic surgeons to administer these treatments 100 percent appropriately.

Marilyn Reed is spending 8 years in prison for her buttock enhancements done with industrial grade silicone and a calking gun. Her patients didn’t get off so easily.

But a disturbing number of news reports have surfaced detailing unlicensed providers injecting all kinds of life-threatening stuff—from industrial silicone to lamb fat—with the goal of Kardashianizing women on the cheap. The FDA issued a safety alert late last year warning the public of the catastrophic risks involved with liquid silicone injections in particular.

All over the country, “people are dying from these shots,” said Beverly Hills liposuction surgeon Aaron Rollins, echoing statements in the FDA alert. Silicone, a permanent synthetic substance, is not FDA-approved for cosmetic purposes, but since it was greenlighted in the 1990s for certain uses in ophthalmology (serious stuff, like retinal detachment), injecting it into the skin to plump and fill lips, breasts, and butts is technically considered “off-label”—i.e. not illegal.

Still, the insidious goo is an infamous troublemaker. “I wouldn’t touch it with a ten-foot pole,” adds Rollins. “It may look good at first, but over time, the body forms scar tissue around it, so the injected area keeps growing and growing, as the silicone weaves its way into your tissues, becoming lumpy and hard, and nearly impossible to remove.”

Subtract an experienced injector from the equation, and silicone goes from dicey to deadly. “You hear about these so-called pumping parties at hotels, where unlicensed doctors visiting from other countries are injecting patients with massive doses of silicone,” says Dr. Clyde Ishii, president of the American Society for Aesthetic Plastic Surgery (ASAPS). “They’re literally buying it from Home Depot or Lowe’s,” he explains, “because it’s so much cheaper and easier to get than medical-grade silicone.” To lower their cost even more, some of these unlicensed doctors mix in toxic filler-type materials, like cement and motor oil, says Miami dermatologist Manjula Jegasothy. “Even in Beverly Hills,” notes Rollins, “there are people using caulk guns to inject stuff into women’s bodies, and tragic things are happening.”

It’s not uncommon for these unlicensed practitioners—inexperienced with human anatomy—to inadvertently shoot silicone into a blood vessel. And when they do, it can travel to the heart or lungs, blocking blood flow, and causing sudden heart attacks and strokes. The risk is especially high when injecting the vascular buttocks. Yet, for some, silicone’s price tag is just too good to pass up. According to Atlanta plastic surgeon Wright Jones, “Silicone butt injections may cost a tenth of the price of a legal gluteal enhancement using one’s own fat”—which is currently regarded as the most effective way to boost a backside. A Brazilian Butt Lift, using liposuction and fat transfer, can cost upwards of $10,000.

In light of the recent wave of silicone horror stories, and with butt augmentation fast becoming one of the most popular plastic surgery procedures in the U.S., not to mention a burgeoning business for untrained injectors, the Aesthetic Surgery Education and Research Foundation (a division of ASAPS) felt compelled to publish a safety protocol for gluteal fat grafting in the current issue of the Aesthetic Surgery Journal.

That’s not to say fat is the only safe solution for a shapeless bottom. Many dermatologists and surgeons do use FDA-approved cosmetic fillers “off-label” here— to either produce an immediate, yet temporary, lift from hyaluronic acid gels; or a gradual, long-term improvement from the collagen-stimulating Sculptra (which is currently only approved to soften the appearance of nasolabial folds). But such shots can be wildly expensive.
Which brings us back to silicone and its unfortunate recipients, many of whom are millennials, says Jones. At age 22, Heather*, a model in Los Angeles, visited a Koreatown medical spa for silicone butt injections. “I was booked to do a big photo shoot, and wanted my bum to look perkier,” she says.

About six months later, she noticed several golf ball-size lumps in her bottom, a common side effect of silicone. On the advice of a trusted friend, Heather says she went to see Rollins, who was able to camouflage the hills and valleys by liposuctioning fat from her arms and injecting it into her butt—an $8,000 fix.

Lips have long been another hot spot for silicone. Tired of having to draw on a juicer pout each morning, Madeline paid $50 to have her lips injected with silicone in a salon basement in Queens when she was 26 years old. Now 40, she says, “I feel like I messed up my mouth for the rest of my life.”

The size and shape of her lips change daily, often with the weather. “Usually in summer [the silicone] lays okay, but in the colder months, it moves around a lot, and concentrates in one area, bulging out.” To have her smile repaired will cost roughly $10,000, she’s been told, and surgeons can’t promise a total improvement.

Cosmetic injections should only be performed by board-certified dermatologists or plastic surgeons. If your injector is not, ask thorough questions about their training and experience. How many years have they been injecting patients? What formula are they using? If you’ve found the injector through a bargain website or coupon—the deal is likely too good to be true. The bottom line: Heed the warnings. “Don’t allow silicone into your body—ever,” says Rollins. At best, “you’ll be buying a problem for the rest of your life.”

Now a word from Dr. Sowder:  The above article is very well written and is not, I repeat, is not alarmist.  People are dying from these injections and others are being maimed for life.  I have taken care of a couple of ladies who had silicone injected into their breasts in Asia and cleaning this up is such a mess.  Whenever I hear about another silicone injection disaster, usually done by a non-physician in some hotel room, I just shake my head.  I mean, really, how dumb can you be?  I do not endorse blaming the victim but in cases like this I think the person allowing a charlatan to inject their butt or breast with silicone bears some responsibility.  Those on the other end of the calking gun need to go to jail and many in fact have.  The lesson here is that you get what you pay for.

Kudos to Ms. Edgar for a cautionary tale and to Harper’s for publishing it.  Thanks for reading and don’t let anyone get near you butt or breast with a calking gun!  Dr. Lisa Lynn Sowder

 

Body Contouring, General Health, Patient Beware, Patient Safety, Plastic Surgery, This Makes Me Cranky.

Breast Implant Illness Fear Mongering

May 23rd, 2017 — 10:01am

I came across a post on the Breast Implant Illness Instagram site recently that really made me really cranky.  And it made me want to holler, “STOP THE FEAR MONGERING!”

Let me walk you through this image.  Obviously it is a lady and in the upper left corner you can see her breasts which have been removed and placed on a serving tray.  Um, very edgy.  And you can see the chest width slash across her chest where her breasts used to be.

The Breast Implant Illness community is on a mission to ban all breast implants, saline and gel, for enhancement and for reconstruction.  Their modus operandi is to scare the bejesus out of anyone who has breast implants, has had breast implants or is thinking about getting breast implants.  I find their IG posts mostly rather boring especially when it is the same set of moldy and/or ruptured implants that have been posted half a dozen times already.  But this post really crosses the line.  This post implies that breast implant removal requires a double mastectomy and an incision across the width of the chest.  I have been doing breast implant removal for over 26 years and I have never, make that NEVER had to do a mastectomy or use an incision of this length.  And most of my patients look better after parting ways with their implants.  I see ladies in my office frequently with old, hard, nasty implants who have suffered with pain and tightness and embarrassment for years but have been fearful to seek implant removal because they equate implant removal with mastectomy. Disinformation like this IG post feeds that fear and is a disservice to women.

Posting this sort of rubbish must provide a certain type of person with a feeling of satisfaction and self worth.  As for me, I prefer to satisfy myself by providing careful, competent and reality based care for women seeking breast implant removal.  If you want to see what breast implant removal really entails, I have a ton of information on this web site and also my IG:  @breastimplantsanity.

Thanks for reading.  Dr. Lisa Lynn Sowder

Breast Implant Illness, Breast Implant Removal, Breast Implants, This Makes Me Cranky.

Breast Implant Illness – a seasoned plastic surgeon’s humble opinion. Updated October, 2017.

February 28th, 2017 — 2:24pm
worried_1375864c

“This stuff online just scares me to death.”

Warning:  This is a long one.  A really, really long one.

I recently counted up all of my operations for 2016 and I removed more breast implants than I put in.  Last year I removed implants from 44 women. Twenty-seven of those women had removal for the usual reasons:  “I don’t like them anymore, they make me look fat, they are too hard, I finally divorced that s.o.b., I’m becoming a nun, etc.”  But 17 women had breast implant removal because they believed their implants were ruining their health.  I have gotten to know these patients (and many more from prior years) and their families, have heard their concerns, looked at their medical histories, examined them and removed their implants.

I have given this topic of breast implant illness a lot of investigation and thought.  This blog represents my opinion based of what I have read, what I have heard from patients and my colleagues, what I have seen in the exam room and OR in over 25+ years of practice.  I recently presented a paper on breast implant illness for the Northwest Society of Plastic Surgeons.

A very brief history:  Back in the early 1990’s, just when I was entering private practice, silicone gel breast implants came under intense fire for being linked with health problems, notably autoimmune diseases like lupus and rheumatoid arthritis.  This concern led to silicone gel implants being taken off the market in the United States for cosmetic purposes.  It also lead to large amounts of money finding its way into the pockets of trial attorneys, the bankruptcy of silicone supplier Dow Corning, and at least one case of a woman removing her own implants with a razor blade in a fit of anxiety.  This moratorium on gel implants lasted well over a decade.  For over ten years, the only gel implants I used were used in one of the several studies of gel implants in which I was an investigator.  Finally, in late 2006, after exhaustive analysis of many implant studies, gel implants were again approved by the F.D.A. for cosmetic use.  Interestingly gel implants remained available for post-mastectomy reconstructive use during the moratorium.  I always thought it was odd that the it was okay for patients with a history of breast cancer to have the same silicone gel implants that were deemed too risky for a healthy woman.  And I thought it was odd that the FDA was not recommending the removal of implants that were deemed unsafe for use.    So did breast cancer survivor and congresswoman Marilyn Lloyd who asked in 1992, “How scientific is the FDA’s decision that no woman should have implants put in, and no woman should have them removed?”  Good question.

Fast forward to the past few years and I start seeing women with implants who are convinced their implants are ruining their health.  About 1/3 of them have saline implants which were never taken off the market.  These breast implant illness ladies tend to be a little younger than my average breast implant removal patients.  They tend to embrace alternative medicine and distrust the medical establishment.  And they are all connected to the online breast implant illness community.  And another thing I find so odd – some ladies with all of these symptoms often look so healthy and they ask questions like “When can I go back to teaching Pilates?”,  “Can I hike the Appalachian trail two months after surgery?”, “Is it okay if I go snowboarding after a couple of weeks?”.

Many of the symptoms of breast implant illness are a vague and/or very common complaints.  Most of these symptoms have significant overlap with the most common complaints related to common health issues including menopause, hypothyroidism, depression, anxiety, general aging and the human condition.  And some patients blame conditions with very clear etiology on their implants.  A few examples include plantar fasciitis (an overuse injury of the foot seen in runners and dancers), chronic Epstein-Barr virus (cause by a ….. virus!), Lyme disease (a tick-borne bacterial infection) and dental cavities (caused by the acid produced by sugar loving bacteria).    And then there are the fringe disorders such as leaky bowel, chronic candidiasis, multiple chemical sensitivity, etc.  To quote the very smart Dr. Marcia Angell, former editor of The New England Journal of Medicine: “These much discussed but elusive disorders remain entirely speculative …. they are variously said to consist of just about every symptom imaginable in biologically improbable and shifting combinations.  Since they have yet to be objectively and consistently defined, it is impossible to study whether they have anything to do with breast implants.”  For some really good reading and a wonderful primer on the scientific method and statistical analysis by Dr. Angell, you should really check out her book:  Science on Trial:  The Clash of Medical Evidence and the Law in Breast Implant Cases by Dr. Marcia Angell.  This book is a decade old but its lessons are very timely.

If a patient goes to enough alternative health providers, they will eventually find one willing to take their money to tell them that they have one, two or more of these disorders and that it’s their implants that are at fault.  They may even offer $50,000 worth of testing and treatment (as reported by one of my plastic surgery colleagues). I have one patent who saw seven naturopaths before she found one who told her what she wanted to hear. Did she ever go at an actual rheumatologist for her autoimmune symptoms?  Of course not.  She could not trust a rheumatologist.  I have patients who pay hundreds of dollars for hyperbaric oxygen treatment that does not involved a pressurized capsule.  Ladies, if you are sitting in a room without an airlock you, are not getting hyperbaric oxygen!   Several months ago I saw a middle aged lady who after reading one of the breast implant illness websites was worried that her implants were causing her sleep disturbance, brain fog, low energy and general feeling of malaise.  Then she told me that those symptoms had recently resolved.  Upon further questioning, she told me her primary care doctor had diagnosed depression and had put her on an SSRI.  After a week or so on medication, she was feeling so much better.  And her implants not only looked fine, they looked great!  This lady did not have breast implant illness.  She had depression.  She needed medication and a boost in her seratonin, not an operation.  Oh, and then a few weeks ago my nurse took a call from a lady who was in a panic about needing her 10+ year old implants removed the next day before they killed her.  I was scrubbed in the OR and could not talk to her.  My nurse explained that she would need to come in for a consultation and that it may be a few weeks before I had the OR time to do her surgery.  She berated me, my nurse, the universe and then hung up before we could get contact information on her.  I have no idea what has happened to her but whoever in the BII community scared her silly about her breast implants did not do her a favor.

I regularly visit some of these breast implant illness websites and Facebook groups and Instagram and to be very honest, I find so much of the content just outrageous.  Several of my patients noted the onset of their breast implant illness after stumbling into one of the breast implant illness communities.  Is this the nocebo effect (the placebo effect’s evil twin a.k.a. the power of negative thinking)?  Maybe.  One thing I find very interesting is the number of women who have their implants removed and still feel ill months and years later.   Do they think that maybe their problems were perhaps not related to their implants?  No, they are told that even after removal of the implants and scar tissue, the fact that they ever had implants condemns them to a life of ill health as if implants somehow have thrown a biological switch from healthy to sick.  Some of these posts are just heartbreaking to read. And most of the advice being given by non-physicians has no basis in reality based medicine.  And then there is the dismissal of surgeons like me who spent their youth training in medicine and surgery (I completed my residency training at the tender age of 35), took the Hippocratic Oath and devote most of their waking hours doing their best to provide competent and conscientious care to patients.  I take it a little personally when someone is more receptive to the advice or opinion of someone on Facebook who posts photos of themselves having a coffee enema that to the advice of a fully trained and experienced plastic surgeon.  And then there are those who feel that banning breast implants and denying their access to women who either want to enhance or rebuild their breasts is somehow empowering.  Give me a break.  I get cranky just thinking about it.

Do I think breast implants can cause problems?  Oh yeah.  For a small number of unlucky patients, breast implants can be a mess.  Although implant construction has improved over the years, implants can still get hard, they can become too loose, too tight, too low, too high, too medial, too lateral, too anything.  They can develop thick scar capsules that can cause distortion and cause pain in the breast, chest wall, upper extremities, neck and back.  Implants can leak which will deflate a saline implant.  A leak or rupture of a gel implant can result in silicone granulomas of the breast and even the chest and abdominal wall.  And then there is the more recent worry of ALCL which is looking like it occurs exclusively with textured implants but the jury is still out on that one.  I sometimes see patients who have had 3, 4 or more operations related to implant problems.  And yes, I am the original surgeon on a couple of them.  And yes, if a woman has breast implants she will likely need an implant related procedure sometime in the future.  And one more thing – IMO the bigger the implants, the bigger the problems.  That’s why you don’t see any large casaba melons in my photo gallery!  And you will also see a lot of non implant breast surgery in my photo gallery.  If I can make a breast look nice without an implant, I will encourage the no-implant route.

Do my implant removal patients feel better after removal?   Most, but not all of them, do feel better.  One interesting finding in almost all of my breast implant illness patients is a tight implant capsule.  Sometimes it is very thin and fragile and sometimes it is thick and even calcified but they are always really, really tight.  That tight scar tissue can cause discomfort that can include the entire upper extremity, chest, back and even the neck.  Removal of the scar tissue capsule (a procedure called a capsulectomy) will often result in a lot of relief.  Sometimes in surgery, I think I can hear the pectoralis major muscle breath a sigh of relief as I remove the tight scar tissue.   Also, capsule formation is an inflammatory process and we all know that inflammation is the new bogeyman.  And then there is the placebo effect.  I have a deep belief and deep respect for the mind–body connection.  Some patients fret every day about their implant’s effect on their health.  After removal, they often report just feeling better all over.  Is it that they don’t have the constant worry anymore or something else?  I really don’t know.  I can never guarantee what effect breast implant removal will have on a patient’s health.  I think many of my breast implant illness patients are worried sick and if the object of their worry – breast implants- can be removed, I am happy to do that.   I will also go after every bit of the scar tissue around the implants if it is safe to do so.  And, if the breast tissue is healthy enough, I will do a breast lift at the same time if it will improve the appearance of the breast.  And there’s more!  I will consider doing fat transfer a few months later if the patient wants a little volume back and has some good donor fat.  And I have to say, I just love sending patients on their way to an implant-free rest of their lives with no worries about the need for further implant related surgery. I call this “graduation” from breast implants.

If you are looking for a careful and conscientious surgeon who will remove your implants and capsules and offer non-implant options to enhance your breast appearance, I’m your gal.  Come see me!  If you are looking for a surgeon who believes that breast implant surgery destroys women’s health, I am not your gal.  And really, would I use breast implants if my implant patients came crawling back to my office sick?

So, if you want your implants out for any reason, come on in.  I will  listen to your concerns and answer your questions to the best of my ability.  I’m not Marcus Welby but for a surgeon, I am really pretty nice (at least that what I have heard).

Wow, this was a long one.  Thanks for reading!   Dr. Lisa Lynn Sowder

If you want to follow me on Instagram, I would be honored.  Look for me at @breastimplantsanity. and @sowdermd.

 

 

Breast Implant Illness, Breast Implant Removal, Breast Implants, General Health, This Makes Me Cranky.

The worst possible way to spend your time when recovering from surgery – surfing the net.

May 19th, 2016 — 10:45am

Every week I get some questions sent to me by the website RealSelf.  I am always amazed by the many questions submitted by patients sometimes within a day or two of surgery.  I cannot fathom why a patient would turn to an online community of doctors rather than their own surgeon to answer their questions and address their concerns.

OMG. Is that going to happen to me?

And then there are patients who scrub the web for scenarios that are either much better or much worse than their own.  I just don’t get it.

I advise my patients to concentrate on their situation, their surgery, their recovery. Going online and finding someone who is healing quicker than you or slower than you or just differently that you is not helpful and let me tell you, it makes your surgeon a little cranky.

So……………..take your meds as prescribed.  Get some rest.  Drink lots of water.  Go out for a little walk.  Make yourself a sandwich.  Make your caregiver a sandwich.  Clean our your junk drawer.  Questions?  Concerns?  Run them by your surgeon.  Just don’t go online.

Thanks for reading!  Dr. Lisa Lynn Sowder

Postoperative Care, This Makes Me Cranky.

Patient selection and surgeon selection. We have to like each other!

February 2nd, 2016 — 12:38pm
blog dislike

“And I feel the same way about you.”

Recently I saw a patient who I just did not like.  I did my best to be professional and courteous but there were some very important health issues that he was unwilling to discuss.  It was sort of like he thought I was a technician who could just do what he told me he wanted done.  He had had several body contouring operations by other surgeons over the years to treat his weight problem.  He was unhappy with his surgical result, had had some significant postoperative complications (which he blamed on his surgeons) and he just wanted me to “fix things”.  I wanted to explore his weight issues which included secondary serious medical issues but he would have none of it.  I also wanted to know more about his previous surgery and he wanted none of that either.  He refused to allow me to obtain records of his previous surgery.  I wasn’t being nosy.  I was doing my job.  After about 10 minutes (seemed much longer) of this back and forth, he decided he didn’t like me and left.  I honestly cannot remember the last time this happened and I felt bad that I was unable to establish rapport with a patient.  But I am really, really glad he and I decided to dislike each other before I had a chance to operate on him!  Operating on someone is kind like going steady for several months.  Love my not be necessary but like certainly is!

Thanks for reading!  Dr. Lisa Lynn Sowder

My Plastic Surgery Philosophy, Plastic Surgery, This Makes Me Cranky., Uncategorized

« Previous Entries     

↑ Back to top

Contact Dr. Sowder

Do you have questions about plastic surgery procedures or wish to make an appointment? Please fill in this contact form with your query and I will respond.

  • This field is for validation purposes and should be left unchanged.

Recent Blog Posts

Read this blog post
To everything there is a season…………&...
Read this blog post
Happy Thanksgiving
Read this blog post
Eddie Van Halen – R.I.P. and thanks for the memories.

Subscribe via Email

  • Subscribe2


  • Blog Categories

    • Acne
    • Aging Issues
    • Anesthesia
    • Body Contouring
    • Botox
    • Brachioplasty
    • Breast Contouring
    • Breast Implant Illness
    • Breast Implant Removal
    • Breast Implants
    • Breast Lift
    • Breast Reduction
    • Children
    • Dental Issues
    • Earlobes
    • Emergency Room
    • Excess Sweating
    • Eyelid Surgery
    • Face Lift
    • Facial Fillers
    • Fat Injection
    • Fat Transfer to the Breast
    • Financial Issues
    • For Men Only
    • Gardening
    • General Health
    • Government and Politics
    • Gynecomastia
    • Hand Surgery
    • Health Care Costs
    • Highly Recommended Reading
    • Hyperhidrosis
    • I Love Seattle!
    • Ineffective
    • Irish Step Dancing
    • It's All About Me.
    • Jawline
    • Labiaplasty
    • Laser Liposuction
    • Lip Enhancement and Augmentation
    • Liposuction
    • Male Plastic Surgery
    • Mommy Makeover
    • My Plastic Surgery Philosophy
    • Nasolabial Folds
    • New Technology
    • Nipples
    • Non-invasive
    • Now That's a Little Weird
    • Now That's Cool
    • Obesity
    • Patient Beware
    • Patient Safety
    • Plastic Surgery
    • Postoperative Care
    • Preoperative Care
    • Scar
    • Skin Cancer
    • Skin Care
    • Stuff I love
    • sun damage
    • Surgical Eductaion
    • This Makes Me Cranky.
    • Trauma
    • Tummy Tuck
    • Uncategorized
    • Wardrobe Observations
     
    Facial Procedures
    When you look in the mirror, does your face fit your inner image? Do you feel a lot younger than you look? Facial plastic surgery can help merge that image in the mirror with the way you feel inside.
    Breast Procedures
    Too big, too small, too droopy, uneven or more than one of the above? Plastic surgery can change your size and/or shape to better match your build and lifestyle. You may find that bra shopping can be fun, really fun.
    Other Body Procedures
    A healthy lifestyle goes a long way towards a pleasing figure, but sometimes even the most dedicated gym rat will need a little help. So... when you have done your best, let me do the rest!
    Non-Surgical Procedures
    Not ready for surgery? The boom in injectables and medical skin care has revolutionized the way plastic surgeons think about and treat facial aging.

    FACIAL PROCEDURES

    • Face Lift
    • Eyelid Surgery (Blepharoplasty)
    • Transblepharoplasty Brow Lift
    • Forehead Lift a.k.a Browlift
    • Submental Liposuction a.k.a. Neck Liposuction
    • Ear Surgery a.k.a. Otoplasty
    • Ear Lobe Rejuvenation
    • Facial Implants
    • Facial Skin Lesion Excision
    • Lipostructure a.k.a. Fat Grafting a.k.a. Fat Transfer
    • Chemical Peeling
    • Botox Cosmetic for Facial Wrinkles
    • Combination Facial Procedures
    • Medical Skin Care

    BREAST PROCEDURES

    • Mommy Makeover
    • Breast Implants a.k.a. Breast Augmentation
    • Breast Lift a.k.a. Mastopexy
    • Fat Transfer for Breast Enlargement
    • Breast Augmentation Combined with Breast Lift
    • Breast Asymmetry Treatment
    • Breast Reduction
    • Tuberous Breast Deformity Treatment
    • Breast Implant Removal
    • Breast Implant Revision and/or Replacement
    • Breast Reconstruction
    • Inverted Nipple Treatment with Nipple Piercing
    • Nipple Reduction
    • Male Breast Reduction a.k.a. Gynecomastia Reduction
    • Combination Breast and Body Contouring Procedures

    OTHER BODY PROCEDURES

    • Mommy Makeover a.k.a. Maternal Restoration
    • Tummy Tuck a.k.a. Abdominoplasty
    • Liposuction a.k.a. Suction Assisted Lipectomy
    • Medial Thigh Lift
    • Upper Arm Lift a.k.a. Brachioplasty
    • Lower Body Lift and Belt Lipectomy
    • Bra-line Back Lift
    • Brazilian Butt Lift a.k.a. Buttock Enhancement
    • Body Contouring After Massive Weight Loss
    • Labiaplasty
    • Gynecomastia (enlarged male breasts) reduction
    • Mons Pubis Lift and/or Reduction
    • Fat Transfer for Hand Rejuvenation
    • Body Contouring of the Obese Patient
    • Combination Body and Breast Contouring Procedures
    • Combination Body Contour Procedures

    NON-SURGICAL PROCEDURES

    • Injectable Fillers
    • Skin Rejuvenation with Chemical Peels and Medical Skin Care
    • Skin Rejuvenation-Eyes
    • Botox Cosmetic and Dysport
    • Kybella
    HIPAA Notice
    © Lisa Sowder MD, FACS 2021. All rights reserved. Responsive WordPress by Superlative. Login.