A ^Retired Plastic Surgeon's Notebook

Seattle Plastic Surgeon discusses pregnancy after tummy tuck.

There must be something in the water lately.   I just got word of another one of my tummy tuck patients being pregnant.  This will be the third one and they have all been in the past year.

All of these ladies were several years out from their surgery and all of the pregnancies have been unexpected but not necessarily unwanted.  The first two had no problems with their pregnancy and both had a remarkable recovery of their abdominal tone after delivery.  I hope this most recent patient does as well.

There is nothing about a tummy tuck that would interfere with pregnancy but there is certainly a chance that after another child, the abdomen would need a little re-tightening.    This is why tummy tucks are recommended after childbearing is complete.  It’s a great operation but the recovery can be tough and you only want to go through that once!

Thanks for reading.  Dr. Lisa Lynn Sowder

Seattle Plastic surgeon teaches patients to visualize liposuction volumes and weights using butter.

One pound of butter = one pound of fat.

One of the most frequently asked questions in my office is “how much fat will you remove?”  The answer usually ranges somewhere between 1 – 10 pounds.

So how much is 1 – 10 pounds?  This can be hard to visualize.  I recommend thinking of excess fat as sticks of butter.  One stick of butter is 1/4 of a pound.  A box of butter – 4 sticks- is 1 pound.  Ten  boxes of butter – 40 sticks – is 10 pounds.  That’s a lot of butter and a lot of fat!

Liposuction results in targeted weight loss which is why liposuction is so useful in patients with uneven fat distribution – think of the lady with a narrow waist but heavy thighs.  She would have to starve herself to see much slimming of her thighs.  Liposuction could remove several pounds – think several boxes of butter – of fat from each thigh.

Liposuction is not so useful in patients who are significantly overweight all over.   It is not possible to safely remove an extra thirty pounds with liposuction.  That weight needs to be lost through lifestyle changes.   Once a healthier weight is reached and if there are still areas of recalcitrant fat, then liposuction will likely be indicated.

Thanks for reading!  Dr. Lisa Lynn Sowder

Seattle Plastic Surgeon riffs on how those Downton Abbey women stay so slim and what it all has to do with the modern day tummy tuck.

A tummy tuck is a little like having an internal corset.

The ladies of Downton Abbey spend a lot of time having their corsets laced up by their maids – and it’s always right before they go down for dinner.  No wonder they all stay so slim.  Who can overeat when laced up tight?

And this brings me to a recent study about weight loss in ladies who have had a tummy tuck.  This is a common observation in my practice but I had never before seen it reported in the plastic surgery literature.  It seems that the internal corset that is part of most tummy tuck operations results in automatic portion control just like an old fashioned corset does.

Just another great thing about tummy tuck.  You get to wear your corset 24/7 and you don’t even need a maid!

Thanks for reading!  Dr. Lisa Lynn Sowder

Seattle Plastic Surgeon discusses a very thoughtful mother’s last wishes.

“To my daughter, I leave $$$$$ for the purpose of plastic surgery.”

One question I always ask when a patient is thinking about having a plastic surgery procedure is “why now?”    The answer can be very interesting and often very relavent.  Here are some answers I have received over the years:

• I’ve always wanted to do this but my husband wouldn’t let me and now we have split up and I can do what I want.
• I’m old enough to make my own decisions now.
• I saw a photo of myself at my son’s graduation and was shocked when I saw my double chin.  I didn’t think it was that bad.
• I flipped a house in Ellensburg and have the money.  (This was, of course, before the real estate crash.)
• I finally have my kids through school and can spend the money on me instead of them.
• I’ve worked so hard to get down to and stay at this weight and now I want to do this as a reward.

Recently I received an totally unexpected answer to this question.  My prospective patient had recently lost her  mother after a long illness.  In the last few days, the mother confided in her daughter that she had put aside some money for a face lift.  The mother was a fan of plastic surgery having benefited from a breast reduction years earlier.  She wanted to make sure her daughter used this money for plastic surgery, specifically a mommy makeover.  That mother knew that everytime her daughter slipped into her swimsuit and enjoyed her surgical result, there would be a smile and a “Thanks Mom”.

Thank you for reading!  Dr. Lisa Lynn Sowder

Seattle Plastic Surgeon thinks her patients are the best.

Earlier this week one of my patients had bruises all over her body and I was a little worried about her until she told me that she and a bunch of friends had competed recently in a Muddy Buddy Race.  I knew what she was talking about because the Seattle Times had covered this race and after reading the article and seeing the photos, I thought,  “I bet that is a lot of fun!” 

But now after seeing those bruising and hearing a first person account of the obstacles (an ice water “hot tub”, being hoisted up many climbing walls, and electrical shocks) and a waiver that is called the DEATH WAIVER, I think I will leave that sort of fun for others.  But I am so proud that one of my patients was a finisher. 

Do my patients rock or what? 

Thanks for reading!  Dr. Lisa Lynn Sowder

Seattle Plastic surgeon thinks a picture is worth a thousand words in explaining what she does with the muscle during an abdominoplasty a.k.a. tummy tuck.  

Check out these drawings of the abdominal wall.  The one on the left shows what I see during an abdominoplasty a.k.a. tummy tuck.  The white area in the middle is the fascia (it looks and feels like packing tape) connecting the two rectus muscles on either side.  With pregnancy and sometimes weight gain, the muscles get separated and the mid-line becomes very weak and the abdominal tone decreases.  This separation is called rectus diastasis which translates into separation of the rectus.

During abdominoplasty a.k.a. tummy tuck, the surgeon peels up the fat and skin layer and exposes this stretched out area.  Then stitches are placed in the fascia where it meets the rectus muscles and used to pull the edges  back together.  These stitches accomplish what exercise really cannot.  Exercise may strengthen the muscle but it does not move the muscle back into a normal position.   

Maybe this explains why I prefer the term adominoplasty to tummy tuck.  The former acknowledges the repair and reshaping that takes place with this operation.  The latter makes it sound like just a quick nip and tuck.   It’s not!  It’s a real operation but one well worth the recovery for the vast majority of patients.

Thanks for reading.  Dr. Lisa Lynn Sowder

Seattle Plastic Surgeon blogs about a common tummy tuck question.

The belly button does not move, but everything around it does.

I do alot of tummy tucks and patients often have questions about what happens to their belly button.  There is a common misperception that somehow we “move” it.    We don’t “move” the belly button but we move everything else.

At the beginning of a tummy tuck, and incision is made around the belly button and it is released from the skin and fat that surrounds it.  It remains attached to a stong band that runs between the two rectus muscles.   That means that NO, I can’t drop it on the floor!  (A common worry with tummy tuck patients).

Then the lower incision is made and the abdominal fat and skin is peeled up to and beyond the belly button.  Then the fat and skin is pulled down with the patient flexed a bit at the waist and the excess is excised, usually the fat roll between the pubis and the belly button.

The belly button is then brought out through a little incision in the remaining fat and skin and stitched into place.   Then the lower incision is closed. 

So the belly button see’s very little action during a tummy tuck.  It just sits there awaiting its new home while everything else is being thinned,  tightened and excisied. 

Thanks for reading!  Dr. Lisa Lynn Sowder

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

Seattle Plastic Surgeon prefers the “wedge excision” technique for labiaplasty.

Labiaplasty is an operation that I never do exactly the same way twice.  That’s because there is so much variation “down there” and every woman presents with her own unique anatomy.

One thing I almost always do, however, is to try to leave a natural looking labial edge.  In the adult female, the edge of the labia is pigmented and textured.  The “wedge excision” technique preserves a natural looking edge.

I started doing labiaplasty this way in 2008 after learning about this technique from Dr. Gary Alter.  He is a plastic surgeon in California who pioneered aesthetic genital surgery.

Prior to that, I was doing a zig zag incision along the labial edge and then interdigitating the zigs with the zags on either side of the incision.  This left a smooth edge without a suture line running along it but it removed the unique skin along the edge.

Labiaplasty is a great example of a procedure that has evolved.  What started out as a simple snipping off of the excess labia has been refined into a procedure that can shorten and reduce the bulk of the labia but preserve the natural form.

It’s this sort of constant tweaking that keeps my vocation so interesting and fulfilling.

Thanks for reading!  Dr. Lisa Lynn Sowder

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