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: Tummy Tuck


Improved posture – another benefit of tummy tuck.

September 6th, 2012 — 2:45pm

Seattle Plastic Surgeon observes that many of her tummy tuck patients have improved posture after surgery.

These waistline close up photos show marked improvement in this tummy tuck patient’s posture.

Tummy tuck is one of those great operations that improves both form and function.

Removing the excess skin and fat makes the torso look better but tightening the muscle layer makes the torso function better. 

This before and after photo shows this very clearly.   On the left, the patient had lordosis a.k.a. a sway back.  On the right, after surgery, her lordosis is almost gone.  The tightened abdominal muscles are now working better to support her back. 

Also, many patients who have low back pain prior to surgery find that they have much less pain after surgery. 

The abdominal muscles are important for back support.  Crunches may help but if the abdominal muscles have been separated by pregnancy, a tummy tuck may be necessary to get them back in the correct position. 

Thanks for reading!  Dr. Lisa Lynn Sowder

Body Contouring, Now That's Cool, Tummy Tuck

Pregnancy after tummy tuck?

August 28th, 2012 — 10:19am

Seattle Plastic Surgeon discusses one of life’s little surprises.

I have seen 2 patients in the past week who had babies after having had a tummy tuck.  These were surprise pregnancies and both patients had been concerned about 1) the effect of their surgery on their baby and 2) the effect of their baby on their surgery. 

The post tummy tuck abdomen is perfectly capable of s-t-r-e-t-c-h-i-n-g and there is no evidence that the tightened abdomen  interferes with pregnancy. 

If after delivery, the abdomen does not return to a satisfactory shape, re-tightening can be done but in my two patients, their tummies snapped back into shape after a couple of months and a lot of crunches and no re-tightening was needed.    

Soooooo……………………if you have a tummy tuck and then get a little surprise, make an appointment to see me a couple months after delivery and I’ll take a look and let you know if re-tightening is indicated.  Make sure to bring the little surprise package in with you.  We all love babies in my office!

Thanks for reading!  Dr. Lisa Lynn Sowder

Body Contouring, Mommy Makeover, Tummy Tuck

Fat Necrosis: it looks and sounds worse that it really is.

August 24th, 2012 — 9:52am

Seattle Plastic Surgeon explains fat necrosis.

Fat necrosis often gets much, much better with a little tincture of time and usually does not require reoperation.  It occurs most frequently in overweight patients who have a thick layer of fat.

     Recently I re-operated on an abdominoplasty patient of mine for fat necrosis.  The term, fat necrosis, sounds so awful that I am compelled to blog about this uncommon and totally manageable problem that can occur after any surgery that removes and/or rearranges fat. 

     Fat necrosis occurs when the blood supply to the fat is inadequate.  The fat cells die and as they die they release fatty acids and other chemicals that causes inflammation and swelling and sometimes pain.  Usually fat necrosis presents as a non-tender lump but in my patient’s case, the area was quite painful. 

     Fat necrosis can look a lot like a wound infection to the patient.  Diagnosis is made by evaluating the patient for other signs of infection such as fever or chills and examination of the surgical site.   Fat necrosis has a very doughy texture.   It feels just like bread dough under the skin and is rarely very tender.

    In most cases the lump shrinks over time and ends up as a firm little lump that many patients just ignore,  If it is a bother, the lump can be excised under a local anesthetic through a small incision.  

       The lady I re-operated on had an area of fat necrosis the size of a small plum.  Two days after removal, she felt like a million bucks and is on her road to a quick recovery from this “lump in the road”. 

    

  Thanks for reading.  Dr. Lisa Lynn Sowder

Body Contouring, Breast Reduction, Obesity, Postoperative Care, Tummy Tuck

Overeating – the addiction of choice for “carers”

June 19th, 2012 — 11:11am

Seattle Plastic Surgeon shares an article in last Saturday’s Wall Street Journal that takes on the problem of food addiction in women.

I am a bit of an expert on the subject of overeating.  I’ve been in practice over 20 years and many of my patients are women with “food issues.”  I always try to gently probe for any eating disorders in women who are over or underweight or who have a history significant weight  fluctuations.  Eating disorders, especially compulsive overeating, are always difficult to talk about but it’s very, very important, especially in patients who are coming in for breast and/or body contouring. 

This weekend, I came across an article in the Wall Street Journal that addresses the problem of food addiction in women.  It’s painful to read but I think it is spot on for many of my patients who have confided in me about the emotional work they had to go through before they could really address this lowest ranking of addictions and finally get on track to better self care.  Check it out here and let me know what you think.

Thanks for reading, Dr. Lisa Lynn Sowder

Body Contouring, Breast Contouring, Liposuction, Mommy Makeover, Obesity, Tummy Tuck

Smoking and tummy tucks – a bad combination that makes me wanna holler.

March 13th, 2012 — 6:42pm

There’s nothing that makes me wanna holler much more than an anatomically perfect patient for tummy tuck who smokes!

Last week I saw two patients in one day who were both absolutely anatomically perfect patients for tummy tucks.  They were both done with child bearing, they were both thin and both had abdominal muscle separation and loose jelly belly skin and they both had c-section scars.  This kind of patient makes me almost droll at the thought of how straight forward their surgery would be, how much improvement they would have and, most of all, how happy theywould be with their surgical result.

That was the ectacsy part of the consultation and now for the agony part.  Both of these patients were long time and dedicated smokers.  And that made them very, very poor candidates for tummy tuck regardless of their favorable anatomy.

The issue with smoking is the damage that smoking does to blood vessels.  With many procedures such as tummy tuck, face lift, breast lift and some body lifts, the blood supply of the skin is stressed because the skin must be peeled up for a distance either to remove extra skin or to alter structures under the skin.  Peeling the skin up cuts many, many small vessels that provide circulation to the peeled up area and that area is then dependent on a secondary blood supply for post-operative healing.   In a smoker, that secondary blood supply is not reliable and the chance for the peeled up skin dying is much higher than a non smoker.  We surgeons have a fancy name for things that die – necrosis and it’s a word I loath using in describing a post surgical wound in my post-operative notes.

So I had to deliver the two smokers that bad news that I could not operate on them until they were non smokers for at least three months and even then, they are still at increased risk for healing problems.   I am sure I am not the first doctor to tell them they should quit smoking but maybe, just maybe, if they want than tummy tuck enough, they will finally find the strength to kick the habit.

Body Contouring, General Health, Mommy Makeover, Patient Safety, Plastic Surgery, Tummy Tuck, Uncategorized

600% Increase in Body Lifts in the Past Decade

March 10th, 2012 — 1:12am

Seattle Plastic Surgeon’s hunch confirmed by recent report – body lifting is in demand.

I really, really like doing body contouring procedures on patients after massive weight loss.   There are many, many types of lifts that are done below the neck.  They include:  lower body lift, flank lift, mons lift, brachioplasty (upper arm lift), thigh lift, breast lift, buttock lift and tummy tuck which is sorta kinda a lift. 

These procedures make such a huge difference in both how the patients look and feel.  Many of these patients, despite being at or close to their ideal weight, still feel obese because of all of the excess skin and sags and bags.

It’s a good thing I like doing these procedures because according to the American Society of Plastic Surgeons, these sorts of lifts have increased 600% over the past 10 years.  The reason, of course, is the obesity rates have gone up as thus the incidence of formerly obese patients has gone up.  

 About 1/2 of my massive weight loss patients have had weight loss surgery.  The other half have accomplished their weight loss through huge and profound permanent lifestyle changes usually with the help of a peer support group such as Weight Watchers or Overeaters Anonymous. 

I feel very, very privileged to help these patients finally achieve their personal best after they have suffered so much from their obesity and have worked so very, very hard to improve their health and their appearance.  I say, keep ’em coming! 

Thanks for reading.  Dr. Lisa Lynn Sowder

Body Contouring, Breast Contouring, Breast Lift, Obesity, Tummy Tuck

Are you short or long waisted?

March 8th, 2012 — 6:13pm

Seattle Plastic Surgeon blogs about the influence of body type on body contouring procedures.

Short waisted on the left and long waisted on the right.

It is super important for your plastic surgeon to be aware of body type when he or she undertakes a body contouring consultation.  A lovely hourglass waistline is on every patient’s wish list but sometimes it is not possible to achieve with body contouring. 

Patients who are short waisted have a rib cage that almost abuts their pelvis.  There is very little vertical room for a waistline.  Those with long waists have a lot of vertical room between the rib cage and the pelvis and are move likely to get that lovely hourglass figure with body contouring.

But take heart, you short waisted women out there (I am one of your tribe).  We usually have nice long legs where as our hourglass sisters usually have shorter legs. 

The lesson here is, of course, to make the most of what you are blessed with.   And choose a plastic surgeon who will give you a realistic idea of what sort of results you can expect. 

Thanks for reading.  Dr. Lisa Lynn Sowder

Body Contouring, Liposuction, Mommy Makeover, Plastic Surgery, Tummy Tuck

It’s not an “outie”. It’s an umbilical hernia.

March 6th, 2012 — 12:48am

Seattle Plastic Surgeon finds (and fixes) umbilical hernias in about 20% of her tummy tuck patients. 

I do a lot of abdominoplasties a.k.a. tummy tucks and I fix a lot of umbilical hernias. 

It's not an "outie'. It's a hernia but I'm here to help.

Here’s how I approach this very common problem:

During surgery, I carefully exaimine the umbilicus (that’s belly button in normal speech) to feel if there is any weakness in the abdominal wall.  Sometimes the weakness is obvious like in the photo, but often it is not.  If I think there is a hernia, I will incise the umbilicus from the center to the 6:00 position and take a look at the abdominal wall underneath.  If there is a hernia, it shows up as a little or not-so-little blob of fat that is poking out from the inside to the outside.  I coax the little fat blob back into the inside and put 1 – 3 permanent sutures in to repair the small hole in the abdominal wall.  Then I stitch up the belly button incision and proceed with the rest of the surgery. 

Most of these little hernias are asymptomatic meaning they do not bother the patient.  So why do I fix them?  Abdominoplasty increases the pressure inside the abdomen just as a tightening procedure would be expected to.  This increased pressure can make the hernia worse and an previously asymptomatic hernia can become a problem.  The other reason is that patients usually prefer an “innie” and fixing the hernia turns an “outie” into an “innie”. 
 
Now you know yet another one of my secrets.  But don’t try it at home.  Thanks for reading.  Dr. Lisa Lynn Sowder

Body Contouring, Mommy Makeover, Tummy Tuck

Not all fat is created or treated equal.

January 27th, 2012 — 11:13pm

Seattle Plastic Surgeon blogs about the importance of distinguishing belly fat a.k.a. visceral fat from subcutaneous fat.  Pull up a chair.  This is going to be a long one.

Abdominoplasty a.k.a. tummy tuck is a BIG operation and it is in every ones best interest to do everything possible to make sure that the surgery is safe and effective.  Careful patient selection is the key.

Abdominoplasty does several things:

  • Tightens the muscle layer by pulling the two rectus muscles together in the midline.
  • Removes the excess skin of the abdomen.
  • Removes the excess fat between the skin and the muscle.
  • Fixes a ventral or umbilical hernia (if present).

One really important thing that abdominoplasty does not do:

  • Remove the excess fat inside the abdominal cavity, so called visceral or belly fat.

Take a look at this before and after photo.  Depressing, huh?  BTW – this is NOT my patient!

My guess is that this patient is not very satisfied with her result.

This patient had mostly visceral fat and this fat resides inside the abdomen.  It surrounds the intestines, infiltrates the liver and collects in a structure called the omentum.  The only way to reach this fat is to go inside the abdomen.

Even if the surgeon were really, really aggressive and went inside the abdomen, it still would not be possible to remove this fat.  The structures that collect the fat are either vital organs or carry the blood vessels to vital organs.

So how does one get rid of belly fat?  Not with surgery but rather with weight loss.  As a patient loses weight, the belly fat melts away and the abdomen becomes flatter and flatter.  If there is a lot of excess and loose skin left after the weight loss, then the patient likely is a  candidate for abdominoplasty.  Here’s a patient of mine that shows it very well.

In the first photo, most of this patient’s fat is visceral fat.  She wanted an abdominoplasty and I told her that she would have a lousy result and needed to loose weight first.  (This is NEVER what a patient wants to hear but it is what they need to hear from a doctor.)  She worked very,very hard to change her lifestyle and came back a year later having lost almost all of her excess weight.  She looked and felt like a million bucks.  I could not have wiped the smile off her face.  She was now the perfect patient and I did an abdominoplasty and a breast lift on her and she got a really, really nice result.  We were both thrilled.  She is a great success story and has kept her weight off.  She really has a whole new life.

I can take credit for about 10% of her new life.  She did 90% through diet, exercise and changing her whole lifestyle.  She not only looks so much better, she feels better and is in much better health.

So when I say “no”, and believe me, saying “no” is hard to do, it is because I don’t want a patient to go through the expense, time, discomfort and risk for a really, really mediocre result that they will likely be unhappy with.

Thanks for reading.  Dr. Lisa Lynn Sowder.

 

Body Contouring, Obesity, Plastic Surgery, Tummy Tuck

Having a tummy tuck or a body lift? Considering getting a WALKER. Really.

January 23rd, 2012 — 9:44pm

Seattle Plastic Surgeon recommends a WALKER for recovery from tummy tuck and body lift surgery.

Years ago I did a body lift on a patient who had lost over 100 pounds.  She advised me to advise other patients to consider getting a walker for post surgical recovery.  She found it so much easier to get up and putter around like we ask our patients to do the very first day after surgery. 

Patients who are able to be up and about are much less likely to develop problems with blood clots or areas of lung collapse after surgery.  These can both be very serious which is why we never like a patient to take to bed and not move after surgery.  It’s not that we like to see patients suffer any more than necessary, we just don’t want any complications.

A  patient may feel a little silly using one of these for a week or so but it will make  recovery faster and safer and even easier.  I’ve seen walkers at second hand stores and even new, they aren’t terribly expensive or maybe there is a family member who has access to one. 

Keep an open mind and consider getting a walker for your recovery.

Thanks for reading.  Dr. Lisa Lynn Sowder

Body Contouring, Postoperative Care, Tummy Tuck

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