A ^Retired Plastic Surgeon's Notebook

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

Seattle Plastic Surgeon reviews swimsuit rules.

 I came across this list of “Swimsuit Commandments” in O Magazine and thought I would share it with my readers.  I think Adam offers some pretty reasonable advice with his 10 Commandments.  But…

I do  have a beef with so many of the “Swimsuit Makeover” spreads that seem to populate every magazine targeting women over, say, age 15.  Because after 15, we all have swimsuit issues.  It seems that all of the after photos in these spreads show the makeover subject in 4 inch heels.  It is a rare woman who does not look better in a swimsuit, any swimsuit, with 4 inch heels.  But really, when was the last time you wore 4 inch heels to the beach?  I’m surprised that these spreads don’t show the women before their makeover wearing flippers.  Even Jennifer Lopez would look bad in flippers.

I also have a beef about the absence of these spreads in journals targeting men over, say, 20.  My husband writes for mens’ magazines and it seems we have a subscription to them all.  I’ve never seen a swimsuit makeover for dudes;  no Speedo recommendation for the “short torso with birdlegs” or the board shorts  for the “long torso with gynecomastia” or the boy short  for the “spare tire with nasty, fungus feet.”   Why can’t Adam be there for the dudes?   They need help too!

 My favorite bit of swimwear wisdom comes from writer Anne Lamott.  I cannot locate the exact quote so I am paraphrasing here.   Ms. Lamott, who apparently has some issues with her thighs (she has loveningly named them “the Aunties”), decided long ago that body issues will never, ever keep her from enjoying a swimming pool, a lake, a river, or an ocean.  I totally agree with that commandment:  “Thou shalt  exalt in the joy of swimming whenever and wherever possible.”  And I will also add to the venues to be enjoyed –  running through the sprinklers with one’s children on a hot summer day.  And make sure to follow with Snow Cones all around.

So, enjoy the summer.  Here in the Northwest, it’s short and sweet.  Last weekend I swam in a very brisk Lake Chelan in my very ragged,  very old Speedo and I enjoyed every second of it.

Thanks for reading!  Dr. Lisa Lynn Sowder

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

Seattle Plastic Surgeon discusses non-tummy benefits of Tummy Tuck

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

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.

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

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

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

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. 

Seattle Plastic Surgeon tells her patients to give it 40 days (that’s about 6 weeks) and then something magical and mystical happens. 

I am always telling my patients to “give it 6 weeks”.  It is at that point patients say, “I’m glad I did this” instead of saying,  “Maybe this wasn’t such a good idea.”  This 40 something number of days of recovery seems to hold for many, many different procedures whether it’s a face lift or a tummy tuck or ankle liposuction.  And it’s not that patients don’t look okay much sooner, it’s just that they don’t feel quite right.  They are often fatigued and grumpy and emotionally fragile.  And then ………. on the fortieth day, all was wonderful.

Forty days has been found to have significance in many religious and pagan stories and traditions. .  Check out this website for more on the magic and mystery of forty days. 

Thanks for reading.  Dr. Lisa Lynn Sowder

Seattle Plastic surgeon offers help for a common problem – ARMPIT CLEAVAGE

Most women have a little bit of breast tissue and fat just in front of the arm pit.  This is called the axillary tail of the breast.    This is all normal.

But some ladies, even slender ladies, have more than a little bit of breast tissue and fat in this area and I have heard it called many thing;  armpit cleavage, pit boobs, waddies, etc.  Whatever you want to call it, it can be an annoyance especially with some type of clothing.

The good news is that it is usually treatable with liposuction and this can usually be done at the same time as another breast procedure .   The excess fat and tissue is quite fibrous and therefore  a little tough to suction out.  Also, this area stays firm and sometimes lumpy for several months.  But when it’s all done and the swelling is down and the tissues softened up, it can be a really, really nice improvement.

I occasionally have to actually excise the area if it is quite large or saggy.  That incision is usually pretty easy to tuck up in the underarm area and it usually heals with a thin white line.

So if you have this annoying problem, I’m here to help.  If you get you surgery done by St. Patrick’s Day, you will be more than ready for summer clothes by Summer Solstice.

Take a look at this patient below.  She had a periareolar breast lift to lift her nipple and improve the shape of her breasts and also liposuction of her armpit cleavage.  She is shown about 3 months after surgery with a nice result.  She’ll look even better at six months as her scar around her areola fades.

Thanks for reading!  Dr. Lisa Lynn Sowder

This patient wants her nipples lifted a little and the shape of her breast improved with the least possible surgery. She also wants to get rid of her armpit cleavange.

Here she is 3 months after a periareolar lift and liposuction of her armpit cleavage. She only took a couple of days off of work. She's pleased with her result as am I.