A ^Retired Plastic Surgeon's Notebook

Tag: abdominoplasty

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

The benefits of TUMMY TUCK may be more than just a trim tummy.

April 20th, 2012 — 11:42am

Seattle Plastic Surgeon discusses non-tummy benefits of Tummy Tuck

This patient has not had a thigh lift. Her tummy tuck (abdominoplasty) resulted in lifting and tightening her medical thighs.

Tummy tuck is one of my favorite procedures because it is so beneficial to patients who have abdominal laxity.  I can take a very saggy abdomen and make it smooth and flat and strong.  And many patients have added benefits that do not involve the abdomen.  

The pull of the operation will often pull up the medial thighs and really improve the contour.  This lady on the right is a great example of that.  I didn’t touch her thighs, honest!  You can try this at home.  Stand in front of a mirror and grab you lower abdominal fat pad and pull it up.  Cool, huh?

Another benefit of tummy tuck is reduction and lifting of the mons pubis which can be bulky and/or saggy.  I have to say that this is a benefit that many, many patients are thrilled with. 

Lastly, sometimes patients have a substantial improvement in their posture.  Many patients with abdominal laxity have lordosis, which is a fancy word for sway-back.  Once their abdominal muscles are tightened with a tummy tuck, their spinal support is improved.  Some women with back pain issues find their back pain much improved.

 When I am evaluating a patient for a tummy tuck, I make sure to take a look beyond their tummy and get a good look at their posture, their thighs and their mons pubis.

Oh, and these added benefits don’t cost a dime extra.  Now that is a nice twofer, threefer or even fourfer.  

Thanks for reading!  Dr. Lisa Lynn Sowder


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

A Valentine’s Day Gift that won’t end up on your hips.

February 7th, 2012 — 7:42pm

Put this on your list for Valentine’s Day.  It won’t end up on your hips and you can wear it in public!

Pink SmartWool Artisan Socks – Perfect for Valentines Day

I am totally smitten with SmartWool stockings, especially the Artisan variety.  They come in an array of very cool and funky designs and colors and they last and last and last.  There’s nothing like a new pair of snugly warm socks to warm my heart in winter.

Did ya know why SmartWool socks aren’t itchy?  It’s because the type of wool that is used is very, very fine and flexible compared to normal wool which is thick, stiff and poky.   I don’t itch at all in these sock and I am a very, very itchy gal by nature.   In fact, I am sitting here right now thinking how itchy my boiled wool jacket is.   And you know how that makes me feel?  Well, it rhymes with itchy.

So check out some pink SmartWool socks for Valentines Day.  And no, no, no, I do not get a dime or even a free pair of socks for this blog.

Thanks for reading.  Dr. Lisa Lynn Sowder

Now That's Cool, Wardrobe Observations

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

Meet your new postoperative best friend

September 23rd, 2011 — 6:51pm

This is your BFF, at least for a couple of weeks.

Seattle Plastic Surgeon, Dr. Lisa Lynn Sowder gives a tip for a more comfortable postoperative recovery.

Today I saw a lady for her preoperative visit for her upcoming tummy tuck.  During this visit,  I review the operative plan, do a physical exam, check any necessary lab work, write prescriptions, make sure all the patient’s questions are answered and make sure all of the paperwork is done.

I also use this preoperative visit to discuss recovery with the patient so they really know what to expect.  I’ve been under the knife a time or two myself, so I really know what I’m talking about!

I often will recommend that tummy tuck and breast surgery patients buy a body pillow if they don’t already have one that they used during pregnancy.  The body pillow can be used to make side sleeping more comfortable and safer for those patients who just cannot sleep on their back as recommended after surgery.  They are also useful for keeping that man on his own side of the bed.  When I was expecting, my husband referred to my BFF body pillow as the “Berlin Wall”.

Thanks for reading!  Dr. Lisa Lynn Sowder

Body Contouring, Breast Reduction, Plastic Surgery, Tummy Tuck

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