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Dr. Linder's Blog


Monthly Archives: July 2010



linder liposuction cobalt CoveringBelow is the extremely interesting case of a patient who is now four weeks postoperative for augmentation mammoplasty as well as abdominal contouring as well as thigh liposculpture at six months of age undergoing radiation therapy for neuroblastoma of the gastric or stomach region.  The patient on preoperative photograph has loss of fatty tissue and some muscle development along the left lateral wall.  The umbilicus is shifted to the left.  She was very disturbed in her clothes through the years of the extra fat along the iliac crest roll or hip lower flank area as well as the periumbilical lower abdomen and epigastric area which rolled up upon her pants.  She also is very unhappy with the gynoid appearance of her lower third showing severe lipodystrophy of both the inner and outer thigh in a pear-like figure.  The patient underwent abdominal CT scan showing no fascial defects or hernias on the abdominal wall along the right side of the umbilicus and therefore she was safe to undergo tumescent liposuction of the epigastric right area and the hip as well as of course to sculp the thighs. 

The patient underwent augmentation mammoplasty procedure with a 210 cc saline implant through the subpectoral periareolar approach as well as tumescent liposuction removing over 1.2 liters of fat of the periumbilical, right hip, lower flank and contouring of the inner and outer thighs. 

The patient is ecstatic with her results.  Most importantly, when she wears her clothes and pants, the fat no longer rolls up above the jean line.  She underwent the Linder Bi-directional Flank Liposuction Technique, both in the vertical and oblique plane on the right hip and smoothed out the lower epigastric area.  The thighs are beautifully contoured and she cannot be happier.

This is an extremely interesting case as a young six-month old with a very rare tumor of a stomach.  She had undergone cobalt and radiation therapy which caused necrosis and complete atrophy of the left abdominal wall.  It is always a challenge, but it is very pleasing to be able to help patients not only with cosmetic appearance, but certainly the functional impairments that they have throughout their everyday lives.


NatrelleMentorCardsIt is unbelievable to me, seeing the number of revisions that I perform, that patients have no idea what implants they have received from past surgeons.  Not only do they not know the manufacturer of the implants, they often do not know the volume in cc’s, the shape of the implant or whether they are textured or smooth.  It is absolutely imperative that the patient during consultation understand which implants are best suited for their individual needs, understand the following variables of the implant.
1. Saline vs. silicone.  You need to know whether you’re getting salt water implants or silicone gel implants.  Salt water/saline implants are useful for patients who have thick tissue endomorphic build and would do well and would have little risk of visibility or palpability of the implants along the side of the breast, even under the muscle.  Silicone gel implants are very useful for ectomorphic build women who are quite thin with minimal amounts of breast tissue and may do well with the cohesive silicone gel in order to reduce visibility and rippling.
2. Textured vs. smooth.  It is imperative that patients understand whether they’re using a smooth or extra coating to the implant.  In 2010, we primarily use smooth implants, both in silicone and saline, to reduce fibrous effusion of the implant in an improper position, especially superiorly or laterally.
3. Shape and style of the implant.  There are several shapes, including anatomical, wide-based and round implants.  We only use round implants.
4. Profile.  There are three profiles of the Allergen implant, moderate, moderate plus, high profile.  It is imperative you know which profile will best fit your need.  Narrower women may do well with high profile versus wider women who may do well with moderate plus saline or silicone implants.
5. Manufacturer, Allergan vs. Mentor.  Both are excellent implant companies, providing FDA-approved saline and silicone implants.  It is useful to know catalog, lot number and serial numbers of the implants which shall be provided on the implant manufacturer cards which each patient should be given in the recovery room immediately after the surgical procedure.
In conclusion, it is vital that each patient become an active member of her plastic surgical procedure when undergoing breast augmentation surgery in order for her to know what implant shape, style and manufacturer will best fit her needs, as well as to maintain the device with identification card for future surgeries and/or revisions.

Examination Of The Implanted Breast


linder bio photoMany patients present to Dr. Linder for breast revision surgery.  They have concerns over “feeling something that is just not right” within one or both breasts.  It is important to decipher whether there is a mass, lesion, scar tissue contracture or the implant edge that is leading the patient to this disfigurement and/or palpability of a mass versus the edge of the bag.  With saline implants, scar tissue contracture can lead to enfolding of the bag and with a Baker IV contracture, can lead to pointing and deformity of the implant causing the edge to feel obvious and palpable.  Patients often do not know whether this is the implant edge or a mass.  If there is any question and the surgeon cannot decipher a mass from the edge of an implant, diagnostic radiographic testing should be performed.  With saline implants, mammograms and ultrasounds are sufficient.  With silicone gel implants, an MRI can be used in order to determine whether there is a rupture of the cell of the implant as well as to determine the integrity of the implant itself.  Any suspicious mass within the breast should be diagnosed by mammogram ultrasound and if necessary, tissue biopsy through FNA (fine needle aspiration) or true core biopsy.  Because of the significant rate of breast cancer in women (approximately one out of every eight and a half women may develop breast cancer), all masses in our practice are looked at seriously and diagnosed through proper diagnostic and/or biopsies. 

Scar tissue contracture may certainly lead to distortion of the implant causing palpability of the edge of an implant.  Patients often are not sure what this edge is, whether this is a mass or the bag edge.  With silicone gel implants, it is more difficult to detect the edges of the implant on enfolding and therefore MRIs are very useful.  Most importantly, any time a woman’s breast feels different, we must decipher lesions, palpable masses, pre-malignant tumors versus implant edge versus scar tissue contracture.

Ultimate Scar Cream, Kelo-Cote


KeloCoteBecause Dr. Linder performs so many surgeries where scarring is such a significant part of his procedures, including mastopexies, breast lifts, abdominoplasties and breast augmentations, reducing the scarring is absolutely a main necessity.  The best product that we have used, certainly in the last decade, has been Kelo-cote or Bio Corneum.  Kelo-cote is a silicone gel spray which is used twice a day after sutures are removed, usually on day 14 to day 21, for at least three months.  The silicone gel spray greatly reduces the redness as well as hypertrophic keloiding of the scars and has smoothed out scars beautifully over the last two years. 

Look out for the next one and two-minute infomercials from Kelo-cote where Dr. Linder has been used as a scar expert for Advanced Bio Technology.  Because we believe so wholeheartedly in the use of Kelo-cote, giving worldwide testimonial as to the benefits of Kelo-cote, goes without reservation.  We look forward to seeing the Kelo-cote used worldwide and on television sets throughout the country.

Entertainment Tonight Plastic Surgery

Recent news regarding Mel Gibson and Oksana Griegorieva with verbal discussions.

ET_LogoDr. Linder, Board Certified Plastic Surgeon, Beverly Hills, breast specialist and body sculptist, has been asked as the Consultant for Entertainment Tonight to discuss the possibilities of cosmetic surgical procedures on Oksana over the last 14 years. Reviewing her before and after photographs, it’s apparent that she may have had procedures to the face, including possible rhinoplasty with narrowing of the bridge; tip plasty, bringing the nasal tip up; possibly Botox, smoothing the wrinkles of the forehead and around the periorbital area; possibilities of lip enhancement with Juvéderm or collagen; possibly malar or cheek implants in order to develop more prominent cheekbones and enhance the malar areas. In terms of her breasts, it is possible that she has had an augmentation mammoplasty procedure, as her breasts do appear significantly larger at this time.

Please watch Dr. Linder on Entertainment Tonight, July 15, 2010 at 7:00 p.m.


In a time like no other, which the world sees great economic downturn, it is more important than ever when considering plastic surgery of the body to do your homework.  The Beverly Hills Plastic Surgeon should meet the following requirements:

1. Must be a Diplomate of the American Board of Plastic Surgery.  In other words, is Board Certified with the American Board of Plastic and Reconstructive Surgery.
2. Should be a member of the American Society of Plastic Surgeons.  This is the most prestigious society in the world for Board Certified Plastic Surgeons.
3. Should be a member of the Fellow of American College of Surgeons or FACS.  FACS doctors are those who are Board Certified in their specific surgical fields.
4. Specialist.  Dr. Linder is a specialist in body sculpting procedures, including breast augmentation, breast lift, breast revision, breast reduction, abdominoplasty and total body liposculpture.
5. Experience and judgment.  This can only come with years and years of experience, having done thousands of the specific procedure that you desire to undertake.  It is imperative that the patient be able to look at hundreds, if not thousands, of photographs of before and after pictures.  This will allow the patient to see great variations of this specific surgical procedure.  For example, on breast augmentation patients we have moderate, moderate plus and high profile implants, both saline and silicone.  Patients should have the ability to see the different implants within the body and different sizes of women in order to help them determine which profile implant they desire.
As money and finances are tighter than ever, it is important that the patient do her homework in order to fine the most qualified Board Certified Plastic Surgeon when undergoing cosmetic surgery of the breast or body, in order to allow for the highest probability of a successful outcome.


Dr. Linder sees patients throughout the world who present for breast revision surgery, especially ruptured silicone gel implants.  Interestingly, mammograms can show the implants to be intact; however, without a true MRI, often the implants are found clinically in the operating room to be completely dissolved and ruptured. 

 Preop photo








Case in point, the above patient is a 47-year-old female from Sweden, who is 18 years status post silicone gel augmentation mammoplasty procedure.  The implants were said to be intact on mammogram; however, the patient feels that there may be loose material as well as sagging and scar tissue formation and desires to have them removed.  In the operating room she was found to have bilateral ruptured silicone gel implants and massive scar tissue calcification. The photos show silicone gel free material being removed from the breasts as well as calcifications and severe encapsulation.

Silicone Gel Free Material being removed








In my practice I recommend patients who have implants of a silicone gel nature should have MRI’s every three years and as well should consider removal and replacement after 10 years, especially if there is an obvious sign of rupture.




Photo1Recently having taken a trip through the Mediterranean from Athens through Mykonos, Greece, Corfu, Greece, into Turkey and ending in Venice, Italy.  It is obvious that beauty can be found worldwide and is ageless, starting at the Acropolis or the Parthenon in Athens, Greece.  The ageless beauty of this monumental structure, although deteriorating, is unrelenting.  It is beautiful and withstanding of all time. 


photo 2In Mykonos, Greece, the two Islands of Aphrodite’s representing Aphrodite’s two breasts, shows symmetry and elegance.  The clear blue waters of the Greek Isle combined with the beauty of the land and people are amazing.  The silk used from the cocoons to create the beautiful Obeson rugs is brilliant in Kusadasi, Turkey.  The central markets show endless spices with the color is quite brilliant.  The variety of fish throughout the market shows the variation of diets that the people of Turkey maintain.  Going back to the Obeson rugs, some of the silk rugs will take up to eight years to make by a single family performing every stitch by hand.  The silk is produced from the cocoons of the butterfly, which is then placed on a special machine and then given to the laborer after dyed in specific colors to create beautiful silk rugs, masterpieces that is. 

photo 3Finally, the City of Venice, Italy presents with the beauty of St. Marks Square, people abound, the Gondolas flow through the canals with brilliant light reflecting off the waters.  Beauty can be found in many ways and in many different forms.  From the creation and recreation of the female body to a beautiful Obeson rug, to beautiful mountain ranges, to the people of the Mediterranean, who are glorious in all their splender.