Tag: obesity

FAQ: Should I lose or gain weight before surgery?

October 21st, 2014 — 2:21pm

What’s the ideal weight for plastic surgery?

Which Oprah will do best with surgery? Probably the one in the red dress!

I get this question a lot from patients who are thinking about having breast and/or body contouring.  It’s an important question and I am always glad to hear it because it tells me that the patient understands that weight fluctuations can make a difference in surgical outcome.  Take Oprah for example.  There have been times in her life where her weight has yo-yoed all over the place.  Operating on her during these times would be like operating on a moving target.  A great result seen two weeks after surgery could turn into a lousy or even bizarre result a few months hence if her weight went up or down 30 – 40 pounds.

Sooo……patients should be at a stable and sustainable and healthy weight prior to surgery.  Did you notice that I did not say ideal?  Ideal weight may be achievable for some patients but unless it is sustainable, I would rather operate on a patient who is a little bit or even quite a bit over their ideal as long as they are healthy.

Healthy is the key word here.  If a patient is carrying a lot of excess weight and has type 2 diabetes, high blood pressure and has trouble walking up a flight of stairs, that person is not healthy and should not be having elective surgery.  That is the type of patient I will refer to a weight loss specialist.  If on the other hand, the patient is carrying extra weight and does not have diabetes, high blood pressure and plays an hour of pickle ball every day, I have no problem doing elective surgery on them.  And at the other end of the weight spectrum there are issues with being too thin.  I screen carefully for patients with eating disorders such as anorexia nervosa or bulimia.  Those conditions are serious illnesses and patients need evaluation, care and support – not plastic surgery.  Thin patients who are well nourished and weight stable usually make excellent surgical candidates.

So as you can see, it’s not about the number on the scale or the BMI or the dress size.  It’s about being healthy.

Thanks for reading!  Dr. Lisa Lynn Sowder

Body Contouring, Breast Contouring, Obesity

Don’t just sit there! MOVE!

July 12th, 2012 — 10:16am

Seattle Plastic Surgeon is very, very grateful that she does not have a desk job.

Earlier this week I had one of those crazy days at work.  I did a 5 hour operation followed by a 2 hour operation followed by a 1/2 hour office procedure followed by a couple of follow-up patients.  I was tired inside and out by the time I finally sat down to dinner with the famn damily. 

The next day, right there in the Wall Street Journal was this article about how sitting too much can kill.  That right, k-k-k-k-kill.  It made me think about how much I am up and running around really every day, whether  at work or at home.   Part of this is just my hyperactive nature and part of it is in the job description. 

Soooooo, if you have a desk job, think of ways you can get off your duff frequently.  In our office, even those employees who have desk jobs are always up and about, either looking for a patient chart or interacting with patients and other staff. 

If you are sitting too much, consider scheduling some “up time” into your day or even consider getting a standing desk or, if your office allows, an exercise ball to sit on.  Do whatever you can to KEEP MOVING.

Thanks for reading!  Dr. Lisa Lynn Sowder

Body Contouring, General Health

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

Predicting Patient Satisfaction With Liposuction – Here’s The Math.

June 11th, 2012 — 11:06am

Seattle Plastic Surgeon blogs about predicting patient satisfaction following liposuction.

Later this month, I am giving a talk to the Washington Society of Plastic Surgeons on Plastic Surgery and the Overweight or Obese Patient.  This is a very prickly topic and a difficult one to discuss, especially with the overweight or obese patient.  I do my best to be straight forward and honest about what body contouring can accomplish in this patient population and try to educate patients about realistic expectations.

While researching this topic, I came across this very helpful diagram.  This was published by Dr. Rod Rohrich and associates at the University of Texas Southwestern.  They looked at the effect of post liposuction weight changes on long term satisfaction .  They came up with this very helpful chart.  I am going to start using this chart for all my body contouring patients, regardless of their weight.

Thanks for reading!  Dr. Lisa Lynn Sowder











Body Contouring, Liposuction, Obesity

A Surgical Cure for Type 2 Diabetes?

April 13th, 2012 — 2:23pm

Seattle Plastic Surgeon shares some great news about Type 2 Diabetes.

For years it has been observed that obese patients with Type 2 diabetes have a dramatic improvement in their diabetes after gastric bypass surgery.   And this improvement is seen almost immediately after surgery, long before the patient loses significant weight.  Now there is something more that just anecdotal reports of this finding.

Recently the results of a randomized, prospective study of 150 obese, type 2 diabetic patients treated with  surgery or intensive medical therapy was released.  This study was carried out at the Cleaveland Clinic and took a look at the blood sugars of patients one year after surgery vs. one year after intensive medical treatment. 

The surgery patients blew the medical patients out of the water with their blood sugars going down, way down, despite stopping their diabetes medications. 

This study confirms the many anecdotal reports of the past decade or so.  Could it be that the first line of treatment for this devastating disease that afflicts so many obese patients will be major surgery?   It’s too soon to tell but as these types of surgical weight-loss procedures become safer and safer, that just may end up being the case. 

Now we just need a fix for obesity that triggers most cases of Type 2 diabetes.    Send me your ideas for this.  I’d love to be in on it. 

Thanks for reading!  Dr. Lisa Lynn Sowder

General Health, New Technology, Now That's Cool, Obesity

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

Supersized marshmallows. So why are we getting so fat?

July 7th, 2011 — 6:11pm

Seattle Plastic Surgeon is shocked, shocked! at the size of these marshmallows.

As a plastic surgeon, I am often asked what I think is causing the obesity epidemic.  I’m not an epidemiologist or an endocrinologist but I  am a mom who shops for her family and I think I know the answer.

Last weekend, I was shopping for our Fourth of July celebration and the makings for S’Mores was on my list.  The grocery store had a nice display of everything one needs for these tasty campfire treats including these gigantic marshmallows.  I estimate they are four times the size of a “normal” marshmallow.  Yikes!  What is next?  Graham crackers and chocolate bars the size of an ipad?

One of my sons thought these supersized marshmallows were great until he roasted one.  Due to the decrease in surface area/size of these monsters, the inside does not get gooey enough unless the outside is over-roasted.  This makes for an unsatisfactory S’More that is too thick to fit into even the largest mouth.

So we’re giving a thumbs down to the supersized marshmallows and hopefully to the expanding waistline.  It’s easy for my growing, active kids to burn up the calories from all of our oversized food.  But for those of us of a certain age, it would take 12 minutes on the rowing machine to burn off one of these sugar bombs.

Thanks for reading.  Dr. Lisa Lynn Sowder

Body Contouring, General Health, Obesity

What can dog toys teach us about obesity?

June 22nd, 2011 — 6:45pm

Meet Henrietta and Earl

Seattle Plastic Surgeon shares her dog toy wisdom.

My aussie/border collie/snapping turtle, Stella, just loves her Henrietta and Earl chew toys.  Henrietta emits a high pitched squeal when chewed.  Earl produces a realistic flatus-like sound.  Stella, Henrietta and Earl make for some great hilarlity – for about 30 seconds.

Henrietta and Earl do, however, have some redeeming qualities in that they are very useful for obesity education.

Henrietta has a problem with external obestiy.  Her excess fat is mostly external and distributed kind of all over – her hips, back, chest, upper thighs and tummy.  This fat is unsightly but not much of a health issue.

Earl, on the other hand, has the dreaded internal belly fat.  Earl, who has an inappropriately elevated level of self esteem, will say, “It’s muscle, not fat.  Feel it, baby, it’s hard.”  Well, it’s not muscle, Earl.  It’s belly fat and it puts Earl at risk for diabetes, high blood pressure, stroke, heart attack, etc.

Henrietta’s fat is best addressed with weight loss but it can also be addressed with breast and body contouring surgery.  Earl’s fat on the other hand can only be addressed with weight loss.  Surgery cannot remove Earl’s internal fat although Stella is doing her best to chew it off.

Thanks for reading!  Easily asmused Seattle Plastic Surgeon, Dr. Lisa Lynn Sowder

Body Contouring, General Health, Now That's a Little Weird, Now That's Cool, Obesity, Patient Safety

Laser Liposuction? No Thanks.

February 21st, 2011 — 8:15pm

Seattle Plastic Surgeon Discusses the Risks of                         Laser Liposuction.

blog subdermal plexus 2I just returned from the annual meeting of the Northwest Society of Plastic Surgeons. The best presentation was a panel on new technologies – when, how and why or adopt them or, in many cases, not adopt them. A very interesting statistic was presented. Ninety-five percent of new technologies – meaning the latest and greatest, gotta have it, cannot survive without it – did not exist 5 to 6 years after it’s introduction. Wow, what a number. Laser liposuction was one of the featured new technologies that this panel of plastic surgeons did not think would make the cut. In fact, a recent survey of fully trained (as opposed to the imitation) plastic surgeons who had used laser liposuction, over 96% did not like it. This is the first time that I have heard that 96% of any kind of surgeons agree on anything. http://www.abplsurg.org/

One of the panel members, arguably the most laser friendly plastic surgeon on the planet, summed up laser liposuction with this comment: “Last time I checked, the subdermal plexus still existed.”

Stay with me; You are about to learn something important. Take a look at the illustration of your largest organ (the skin) above. See where the pink (skin) turns yellow (fat). That is the subdermis and that is the target of the laser in laser liposuction. After removing fat, the laser is used to heat up the subdermis in an effort to get the skin to shrink. I always get the image of bacon frying for some reason. Well, it’s not nice to heat this layer because the blood vessles that supply the skin live here. If a large enough area of blood vessles is fried, the skin will die. Dead skin is a very, very bad thing.

Non-laser liposuction spares most of the blood vessels because the intruments used (cannulas) are blunt and push the vessels aside rather than damage them. Because most skin has some elastic quality, the overlying skin usually shrinks to some degree once the underlying bulk is reduced.

I have seen my share of skin necrosis in patients who have heard the siren song of laser liposuction thinking it would spare them the necessity of a truly skin tightening procedure such as tummy tuck. I remain sooooo glad that I did not invest in one of these very, very expensive gizmos. It would be keeping our old furniture in our basement storage unit company.

Body Contouring, Liposuction, My Plastic Surgery Philosophy, Obesity, Patient Beware


October 26th, 2010 — 10:36am

Seattle Plastic Surgeon discusses the limitations of some of the newest, most expensive and most advertized gizmos.

scan0005Take a look at this “before” and “after”.

As promised, here’s the inside of the brochure that shows the “results” and you can be sure these are the best results the company could come up with. The “CoolSculpting” gizmo is promoted as a non-invasive body contouring procedure. I would say non-invasive and ineffective.

Most of the doctors that will purchase this device or one of the dozens similar to it are non-surgeons. These doctors do not know how to do an abdominoplasty (tummy tuck) so they offer this instead. I’m sure they go into it with high hopes but how can they not be disappointed at such a “result’? Once they have paid the $$$$$$ for the gizmo, they need to promote it to make sure they get a decent return on investment.

If any of my abominoplasty patients had a result like this, they would feel ripped off. I suspect the doctors using “CoolSculpting” are going to have some unhappy patients. Geez, everyone could have saved all that time, money and gnashing of teeth by referring those patients to me!

Body Contouring, Ineffective, Laser Liposuction, Liposuction, New Technology, Patient Beware, Plastic Surgery, Tummy Tuck

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