We had a staff meeting to day and our educational topic was earthquake preparedness. Joanne Jordan from Seattle’s Office of Emergency Management gave an excellent presentation that made me feel a little better about living in Washington, the third most earthquake prone state. California and Alaska are the top two. Here are a few things I learned.
Most earthquake injuries are not from people getting squished by a bus flying through the air but rather are related to people running around during the quake and tripping and falling and then walking around in debris in bare feet! Not the stuff of disaster movies, huh? Soooo….. when the big one hits, take a few steps if necessary to get into a safe place and stay put. And keep a pair of sturdy shoes (with a flashlight tucked in) under your bed.
Modern high rises like the Madison Tower where I work are really, really some of the safest places to be in an earthquake. These buildings are made to sway with the energy of an earthquake. You may be in for a wild ride but the building is not going to go down. Soooo… hope that the big one hits while you are at work.
Elevator shafts are super safe structures. So…….if you are stuck in one, stay put and make friends with your co-riders. Bad things happen to people when they try to get out of the elevator without a rescuer who knows the proper way to evacuate.
This in-service really brought back memories of the 2001 Nisqually Earthquake. I was working on the 16th floor of an older medical office building. I could see undulations of the city from my window. I saw it before I felt it and then did I feel it. Later that week, I put together an emergency kit for our family. Yeah, that was 13 years ago. This weekend my project will be to update that rather, er, outdated kit.
For great information about being ready for and earthquake or some other disaster, go to www.seattle.gov/emergency. It is a treasure trove of information.
Thanks for reading and stay safe! Dr. Lisa Lynn Sowder
Those of you familiar with my web site and this blog know that I really like to emphasize that fat transfer to the breasts is much different than a breast implant procedure. Fat transfer results in a much more subtle and natural appearing enhancement compared to breast implants. Here is a great way to determine, in the privacy of your own home, if you will be happy with fat transfer.
There are a bajillion kinds of breast enhancers (we used to call them falsies when I was in high school) on the market. I keep the June Tailor Beautiful You enhancers in two sizes in my office to help patients visualize that fat transfer can do. These enhancers are available at Joanne Fabrics and they are very reasonably priced. The larger size is pretty representative of the size increase a woman with a little breast laxity and nice juicy donor sites (hips, tummy, thighs) can expect. The smaller size is a pretty good idea of what a smaller, slimmer woman with tight breasts can expect.
So if you are thinking about fat transfer to the breasts, buy a pair of enhancers and wear them around for a few days. And if you come in for a consultation, make sure to bring your enhancers with you. That will give me a good idea of what sort of volume increase you will be happy with and help me determine if you are a good candidate for fat transfer to the breast.
The hairline scar is between the two purple arrows.
Any incision that goes all the way through the skin will leave a scar. That the way higher organisms like you and me heal. Scarless surgery is just not possible.
Patients are always concerned about scarring and so are plastic surgeons. Plastic surgeons are good about hiding scars in wrinkles or skin creases or along natural structures. It’s not that we don’t leave scars. We just hide them.
The example on the left is one of the BEST scars I have seen. This was a lady who came in for revision of a breast procedure done about 20 years ago and I had a hard time finding this scar. This is what we call a hairline scar because it is not much thicker than a hair. The fact that this lady healed so beautifully the first time around is a good indicator that the scar I leave will also end up being hard to see. Also, my scar may end up being even a little better because the patient is 20 years older and older patients scar less than younger patients. Weird, huh? But it’s true.
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.
Seattle Plastic Surgeon blabbers on and on (again) about her favorite operation.
One reason that breast lift a.k.a mastopexy is my very favorite operation is the variety of breast lift techniques that can treat many different issues with breast shape. Breast lift can do many things to improve the appearance of the breast. Obviously, breast lift can lift the breast but it can also improve the position and/or size of the nipples and areolas and can even lower the actual breast mound in relation to the nipples.
As usual (especially in plastic surgery), a picture is worth a bajillion words.
Let’s take a look at this patient. The top photo illustrates a few issues with her chest. Her nipples and areolas are a little too large and too low. The fold under her breast is too high. She has fullness of the upper lateral area near her arm pits and an indentation in the middle lateral area of her breasts.
A breast lift can address all of those issues. The nipple and areola diameter is decreased and they are raised just a bit. The actual breast mound is pulled down and the breast fold is lowered. This gives the breasts a nicer shape. And, as icing on the cake, the indentation is filled in to make a smoother transition from her arm pit area to her breast mound.
All of this is done without disrupting the blood supply or nerve supply to the nipple and areola. This patient can expect normal nipple sensation. She should not, however, expect to be able to breast feed. The breast tissue has undergone a lot of rearrangement which will likely interfere with the production of milk.
The scars around the areolas and the vertical scars will fade with time. These scars are a trade off for her nicer shape and will not interfere with normal lingerie or swimwear or even a bustier!
Left to right: Before fat transfer, one year post-op and three years post-op.
Seattle Plastic Surgeon is happy with her long term fat transfer to the breast results.
This week I saw one of my very first fat transfer to the breasts patients. I was delighted to see her and to get this three year follow-up. I beg my fat transfer patients to come in once a year but they, like all modern women, are just busy, busy, busy.
This particular patient wanted me to take a look at a little something on her face and I did. But then I asked her to pose for photos. As you can see, her fat transfer has held up well. The left image is before fat transfer, the middle image one year post-op and the right image is three years post-op. She has had no volume loss. She has had a teeny, tiny bit of sagging but that’s just gravity for you.
And she told me an interesting story about her breasts. Over the holidays, she had put on about 5 pounds (sound familiar?), and she says her breasts got quite large. The fat I transferred to her breasts had come from her hips and normally that was the place she gained weight first but now that fat was in her breasts. Her hips stayed slim but her chest went a little crazy. She took off the extra weight over a couple of weeks and her breasts went back to their post-op size.
Her story illustrates why it is so important for body and breast contouring patients to maintain a healthy and stable weight. I told her if she experiences the same weight gain this holiday season to come on in for photos!
Seattle Plastic Surgeon bikes to work. Saves time. Burns calories.
Seattle is the fastest growing city in the country and I can attest to its growing pains. There are tower cranes, torn up streets, detours, cement trucks, double dumpers and construction sites in just about every part of the city and especially in the South Lake Union neighborhood which lies right between me and my office. My five mile car commute used to take about 15 minutes in the morning and 30 minutes in the evening. Those times have crept up to 25 minutes and 45 minutes respectively.
So……………this summer I have gotten into the habit of riding my bike to and from work thus saving time, avoiding the road rage I feel (but never act on) when stuck in traffic and getting some exercise. My commute time in the morning is the same as by car but in the evening, I save a good 20 minutes. One thing that has made this possible for me is my awesome K2 lady commuter bicycle, a great Osprey commuter back pack and a shower in my new office. And with the 1/2 mile of steep incline one each end of the commute, I get a little endorphin high along with my morning cup of coffee or my evening sip of vino.
So if you are a patient of mine and see a really sweaty person in the elevator with a bike helmet who looks a little bit like me, it is! Just give me a chance to shower!
Seattle Plastic Surgeon celebrates her one year anniversary with her Electronic Medical Record.
I hate feeling like a dunce.
It was one year ago that our plastic surgery office “went live” with our Electronic Medical Record (EMR). I had a fairly bad attitude towards EMR’s in general because the government was trying to push it down our throats, the exorbitant cost, and my experience with the EMR at Swedish Hospital (where I occasionally treat patients) was SUCH A DOG. If I were called in after hours to stitch up a facial laceration in the ER at Swedish, I would spend one hour attending to the patient and an additional 2 hours trying to figure out how to document my care on their wretched EPIC system.
We spent a lot of time and energy and gnashing of teeth trying to choose and agree on the best EMR for us. Then after making the decision, we had to pack up several briefcases with large bills to pay for it. Oh and then, we had to totally re-do our servers which required another briefcase of large bills. We had webinar training sessions and more gnashing to teeth and then on July 22, 2013, we went live. I will never, ever forget that day. We had two trainers in the office. The patient load was pretty light and somehow I managed to keep up with the patient flow and the EMR documentation. The hardest part, other than feeling like a dunce, was trying to wrap my pointy little head around the absence of a patient paper chart. It just seemed so bizarre and I felt very insecure without that wad of paper called a patient chart in my hand.
A few months after live date, it was time to clear out old, obsolete patient charts. I remember going through this whole wretched stack of paper charts and suffering a very nasty paper cut on my right thumb. Well, that did it. I was finally ready to give up paper charts.
Our EMR is by no means perfect and it has crashed pretty badly on one occasion. But it sure beats the paper chase and those nasty paper cuts.
Seattle Plastic Surgeon blogs about yoga for manual laborers.
Lululemon? We don’t need no stinkin’ Lululemon.
I drive by many, many construction sites on my way to work these days. Seattle is undergoing a huge building boom and is crawling with tower cranes and construction workers.
This morning I saw a whole crew of hard hats doing yoga in the wonderful clear and cool early morning air. I got to watch them for a minute or so while waiting for the light to change. These guys and gals looked great and there was no fancy Lululemon yoga fashion in sight. I’m sure their work day goes better with a little yoga at the start of their shift. Mine sure does.
It was a year ago that I switched from some heavy duty weight training two mornings a week to some lighter duty but very challenging yoga. I’m amazed at how much it has helped my back and shoulders, and not just my flexibility but in also maintaining my upper body and core strength. And then there is the “om” factor. It’s nice to start the day with a clear head and peaceful mind because once I walk through my office door ………..
Thanks for reading and keep up with those side bends. Dr. Lisa Lynn Sowder (seasoned plastic surgeon but very, very green yogi)
Seattle Plastic Surgeon and seamstress thinks of plastic surgery while shopping for fabric.
In April I attended the annual meeting of the American Society for Aesthetic Plastic Surgery (ASAPS) in San Francisco. I sat in on many presentations, took a couple of workshops and spent lots of time comparing notes with colleagues. As per usual, I learned a lot and have tweeked a few of my procedures based on new found knowledge.
But I have to admit, I did skip a session on practice management so I could check out Britex Fabrix, a legendary four story fabric store a stone’s throw from the meeting venue.
This store had everything from fine Italian cotton the weight of tissue paper to the newest neoprene prints to a bajillion buttons and trims. And of course their collection of feather boas was amazing. I could have spent a week there.
Every floor had a full length mirror or two so customers could see the whole effect of holding a length of fabric and assessing the drape, the texture, the pattern, the color and this, of course, reminded me of plastic surgery.
A full length mirror is essential in any plastic surgery exam room because so much of the surgery we do is about balance and harmony. This is especially true with breast and body contouring. Changes made in one area can influence how another area will look. For example, larger breasts can make the waistline and hipline seem smaller. A tummy tuck can leave a patient with a flat tummy but may make her generous hips more noticeable. Even facial surgery comes into play. A face lift may really benefit a lady who has taken great care of her body over the years. Conversely, a really heavy lady may actually look odd after aggressive neck liposuction.
So fear not that full length mirror in my office. It’s useful for both the patient and the plastic surgeon to see the whole picture.
Thanks for reading and next time you are in San Francisco, check out Britex Fabrix. Dr. Lisa Lyn Sowder
We had a staff meeting to day and our educational topic was earthquake preparedness. Joanne Jordan from Seattle’s Office of Emergency Management gave an excellent presentation that made me feel a little better about living in Washington, the third most earthquake prone state. California and Alaska are the top two. Here are a few things I learned.
@lisalynnsowder
