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Dr. Linder's Blog


Monthly Archives: June 2009

Post Surgical Scar Therapy – Beverly Hills / Las Vegas

logo001Dr. Linder prefers to use the new Kelo-Cote spray on his patients that have undergone large body sculpting procedures, including breast lifts, breast reductions and tummy tuck surgeries.

Kelo-Cote is an advance scar formula that greatly reduces redness, flattens raised scars and softens the scars as well.  It is a patented topical silicone gel that will manage and can also prevent abnormal scar formation and reduce incidents of hypertrophic scarring and keloid formation.  It has been used to manage scars from trauma burns as well as postsurgical.

Indications for Kelo-Cote include keloid, hypertrophic scarring, burns, acne scars, stretch marks, scarring from plastic surgery, augmentation, reduction, and post-laser peel redness.  Also, pregnancy, abdominoplasty, C-section, mastectomy, hysterectomy, body contouring and cleft lip scarring.  The Kelo-Cote spray or gel can be used twice a day and Dr. Linder uses it after the sutures have been removed, usually on postop day 14 through 17.

Other important differences with Kelo-Cote patented silicone gel formula from other scar treatments are that it self-dries to a waterproof gas permeable membrane and acts like an extra layer of skin which ensures a constant contact time to the entire surface of the scar, which allows it to work 24 hours a day.



breast_rev5Dr. Linder sees patients weekly for breast revision surgery.  He is licensed both in California and Nevada.  He sees patients with double-bubble breast deformities quite frequently.  The etiology of a double-bubble deformity can be multifaceted.  Most commonly, it is associated with simply malposition of the implants (where the implant is too high, superiorly retropositioned) and scar tissue forms along the inframammary fold and pushes the implant up.  This can occur due to malposition associated with the original surgery in which the implant was placed in improper pocket.  In other words, the parasternal and the inframammary lateral attachments of the pectoralis major muscles were not released, which does not allow the implant to fall into its normal pocket.  Last week, I had patients in from Phoenix, Arizona as well as San Diego for this operation.  In both cases, the implants could not lower into its normal position due to the muscle not being released correctly along the parasternal inframammary fold.  So, the most common cause is malposition associated with implant placement from the original surgery.

Textured implants may also create a double-bubble deformity in that the implant will adhere like Velcro into the improper position in a superior position and cannot fall even if the pocket inferiorly along the bottom is open.  These textured implants are removed and smooth salines can help with this problem.  Often, the patients will have double-bubble deformity with ptosis in which the surgeon attempted to do a round block or a nipple areolar lift, but did not remove skin vertically along the inframammary fold, which leads to a double-bubble deformity and a grade 3 ptosis with skin over-drape.  This is usually corrected by formal mastopexy using the inferior pedicle Wise-pattern technique or Wise anchor scar technique.

The way that I fixed both of the above-mentioned specific surgeries was by removing textured implants, performing an open capsulectomy both superiorly as well as an inferior open capsulotomy along the base, completely releasing the thick and hard scar tissue, as well as the muscle attachments of the pectoralis major along the parasternal and along the lateral inframammary fold.  This then allowed the new smooth saline implant to drop and then sitting the patient up, remarking the Wise-pattern or anchor pattern, repositioning the nipple areolar complex superior, removing the skin vertically as well as along the inframammary fold.  In order to fix a double-bubble deformity, the correct surgery must be performed, which will require releasing the pectoralis major muscle appropriately which may not be performed through transumbilical or transaxillary approaches during its original surgery.



When patients undergo breast augmentation or breast revision surgery, especially when implants are placed behind the muscle, there is always risk for a bleeding or hematoma to occur.  As a result, in Dr. Linder’s practice he prefers that patients 1) do not take aspirin, Advil, Motrin, Excedrin, Ibuprofen or nonsteroidal anti-inflammatory medications within two weeks prior to the operation, if possible, in order to reduce bleeding.  Also, patients who can refrain from elevating their arms above their shoulders may have a reduced incidence of bleeding and hematomas postoperatively.  Patients in Dr. Linder’s practice are instructed not to lift their arms above their shoulders to wash their hair or to reach for an upper cupboard item.  This can increase stretching of the pectoralis major muscle, tearing arterial vessels, causing significant hematomas requiring immediate intraoperative intervention, including evacuation of the hematoma, bleeding, hemostasis, irrigation, and drain placement.

The number one complication of all surgeries, including breast augmentation, is bleeding or hematoma.  Again, following the rules of your surgeon should greatly reduce this incidence.

Fox New Five Special – Silicone versus Saline Augmentation

fox_5_news_logoDr. Linder recently filmed a new segment for Fox News in Las Vegas dealing with silicone and saline augmentation.

In this segment we describe risks, complications and benefits on saline versus silicone augmentation. We describe diagnostic testing, including ultrasound, mammography and MRI’s, how to detect rupture in silicone versus saline, as well as which patients are better candidates for saline versus silicone due to body anatomy, structure, etc.

This segment should be played in the next seven days on Fox News Las Vegas.