A ^Retired Plastic Surgeon's Notebook

Thinking about liposuction?  Autumn is the time to come in for a consultation.

When the leaves start to fall, think of body contouring surgery.

I love this time of year.  The air is crisp.  The leaves are a riot of color.   And best of all – my children are back in school!  Autumn is a great time to curl up with a nice cat and a good book and savor the season.

Autumn is also a great time to have body contouring and here is why:  Body contouring procedures always require wearing post surgical compression garments for several weeks after surgery.  And one area in particular – the calves and ankles -require compression stockings for up to three months after surgery.  See this previous blog on cankle liposuction.

The compression garments we use are fairly comfortable and patients get used to them (or sometimes even fall in love with them in a kind of Stockholm Syndrome way) but they are warm and wearing these garments in the summer is something I do not recommend.  Yes, patients have body contouring surgery in the summer but they can be pretty uncomfortable even in temperate Seattle.

So if you are thinking of looking better in those spring and summer fashions, plan ahead and consider having your body contouring surgery now.  Call for a consultation:  206 467-1101.

Thanks for reading!  Dr. Lisa Lynn Sowder

These arms are NOT the result of plastic surgery!

Seattle Plastic Surgeon discusses options for upper arms.

The thermometer in Seattle is finally hitting 70 degrees after the most wretched sping in recorded weather history and I’m getting a lot of questions about upper arm enhancement.

The First Lady’s arms are the result of good arm genes and a great personal trainer.  Also, she has not yet entered the menopausal years (more about that in a future post).  For those without Mrs. Obama’s genes or trainer, there are a few procedures that can be done to improve the upper arm.  Which procedure is the most appropriate is dictated by several factors:

• Skin tone
• Thickness of the fat layer
• Condition of the underlying muscles
• Scar history

Patients with a thin layer of fat and poor skin tone are usually older and thin.  The only procedure that will improve the upper arm is a brachioplasty.  This procedure involves removing the excess skin of the upper and inner arm.  This always leaves a scar from the axilla (arm pit) to the elbow.  I strive to keep this scar on the surface that is hidden against the side when the arms are down.  The question patients must ask them selves is: “Am I willing to trade these bat wings for a scar?”  In patients who heal well and the scar is narrow and light, the answer is usually “yes” but I do have one brachioplasty patient who has a lovely arm shape and excellent scars who is still too self-conscious to go sleeveless.  I may have hit a surgical home run with her but I don’t consider the case a complete success.

Patients with chubby upper arms and good skin tone are great candidates for the CAST procedure.  This procedure involves circumferential treatment of the arm with very careful tumescense power- assisted liposuction.  The fat removal is limited to the outer arm where the excess fat resides but the inner arm is also treated with undermining the skin with the blunt liposuction cannula off of suction to stimulate shrinkage and tightening of the skin.  Patients wear a compression bolero to help the skin tighten postoperatively.

Patients who are “in between” are often candidates for a combination procedure where the incision and resultant scar can be confined to the axilla and the very, very upper inner arm where the sun hardly ever shines.

So if you want perfect Mrs. Obabma’s arms, sorry it’s not likely to happen.   But is you want better arms, there is likely something I can do to get you to your personal best.

Thanks for reading!

Seattle Plastic Surgeon, Lisa Lynn Sowder, M.D.

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 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 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.

Permanent weight loss – here’s what I’ve learned from my patients

How to lose weight for good according to Dr. Lisa Lynn Sowder’s weight loss patients.

I am a bit of an expert on weight loss, not because I have ever had major weight loss, but because I know so many patients who have and have been able to maintain their weight loss.  These are patients who come to me for body contouring procedures such as abdominoplasty, breast lift, upper arm lift, thigh lift, flank lift, lower body lift and so forth.   

I always ask them how they managed to finally lose the weight and keep it off.   I ask them to go into some detail.  This is not because because I want to write the next “diet bestseller” and buy a small island in Greece (although that would be nice) but because I want to pass on their secrets of success to other patients who struggle.

 About 40% of my weight loss patients have undergone weight loss surgery.  That’s another blog.  The other 60% have done it through life style changes. Here is what that 60% have told me:

• Without exception, they have all sworn off sweets and refined carbohydrates.
• Many have embraced a very low carb diet – think Adkins  diet.
• Almost all have maintained regular aerobic exercise – walking and biking are the most popular with my patients.
• Many of my patients have been helped with support groups such as Overeaters Anonymous, TOPS, and Weight Watchers.
• A few of my patients have been helped with nutritional guidance from a physician or nutritionist.
• I cannot remember a patient who mentioned a prepackaged food or liquid diet system. 

And here are a few patients I will never forget:

• One gentleman lost 60 pounds when he quit drinking with the help of Alcoholics Anonymous.
• One lady was able to stay 180 pounds overweight despite her gastric bypass through continuous and careful overeating.  She finally dropped her weight 150 pounds when she addressed her emotional issues with a psychologist and the help of Overeaters Anonymous.
• One lady lost over 100 pounds by jogging.  She started really, really slow and got faster and faster as she lost weight.   She became addicted to a runners high which I guess is better than most addictions.
• Several of my patients were able to slim down only after leaving a dysfunctional relationship.
• One teenager lost 40 pounds just by giving up soda.
• One lady in her 60’s lost 100 pounds after having bilateral knee replacements.  She had been very, very sendentary and once pain free,  became more active.

So there you have it folks; Dr. Sowder’s  Guide to Slow, Deliberate, Difficult, Soul Searching, Sweating, Hungry but Long Term Weight Loss.    Just think, I could have written that best seller and here I am just giving it away.

Thanks for reading.  Dr. Lisa Lynn Sowder

Got cankles? Liposuction can usually help.

This Seattle Cosmetic Plastic Surgeon tells it like it is!   There are a few procedures I do that come close to immediate gratification but treatment of “cankles” is not one of them.

This week I saw a patient who wanted to have ankle liposuction ASAP so she could look really great for her upcoming  highschool reunion at the end of August.

The good news:  Ankle liposuction can  help most patients with heavy ankles (a.k.a. cankles) and/or calves.

The bad news:  Ankle and/or calf liposuction requires a long recovery period and patients need to wear heavy support hose for 3 to 6 months following the surgery.   Because the ankles are so dependent (meaning they are way below the level of the heart), they hang onto post liposuction swelling longer than, say, the area under the chin or even the upper thighs.  ( If you ever come across a doctor who wants to lipo your ankles who tells you otherwise, he/she is either ignorant and/or deceptive and you should run the other way.)

So my advice to this really, really lovely young woman:

1. Find a great pair of slimming summer slacks that almost touch the ground when she is wearing a fab pair of high heeled sandals.
2. Make the most of her lovely shoulders with a halter top.
3. Book her ankle liposuction for October.

Next summer she can show off her nice ankles with a photo on her Facebook page.

Thanks for reading!

Seattle Cosmetic Plastic Surgeon, Dr. Lisa Lynn Sowder

Seattle Plastic Surgeon Discusses the Risks of                         Laser Liposuction.

I 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.

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

Take 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!