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Dr. Linder's Blog


Monthly Archives: August 2013

Tumescent Liposuction Standard Of Care

Tumescent liposuction after the last 10 years still remains the standard of care.  Tumescent liposuction is associated with the infiltration of tumescent fluid into the localized fat deposit areas that will be aspirated with a small cannula ranging between 2 and 4 mm in size.  The tumescent fluid can vary from surgeon to surgeon.  In my practice I prefer using 1 liter of normal saline, 1:1000 epinephrine and 40 cc of 1% plain Lidocaine.  This is per each liter of fluid injected into the body.  The American Board of Plastic Surgery recommends no more than 5 liters infiltrated into the body at one time.  In my practice I like to stay below 3 liters.  This helps to reduce electrolyte imbalance and fluid hydration shifts which our anesthesiologist greatly appreciates.  For larger lipo patients we prefer to stage the operation after several months.  The aspirate removed from liposuctioned fluid should be approximately 95% fat and less than 5% serous fluid and blood.

Our patients present for liposculpture every week with the combination procedures including breast augmentation, breast revision, breast lifts and tummy tuck procedures.  Liposuctioning can be performed safely using blunt tip cannulas.  In my practice I used triple lumen Mercedes blunt tip cannulas, which help to reduce trauma to the skin and inadvertent perforation of the skin.  I use between 2.4 and 3.0 mm cannulas on the majority of our patients and stay within the localized deep fat deposits in order to reduce contour irregularities and skin contour defects.  Patients should be carefully screened as candidates for liposuction, determining the localized fat deposits and skin tonicity to ensure that the results will be excellent and there will not be excess skin or skin contour deformities.

Tumescent liposuction has remained and should remain, for many years to come, the standard of care with the American Board of Plastic Surgery and the American Society of Plastic Surgery for liposuctioning throughout the body.

Breast Revision Multifactorial Deformity

The patient below in her preoperative photograph shows an out-of-state augmentation mammoplasty performed by a different plastic surgeon.  The patient is unhappy with the appearance of her breasts, the severe scar tissue contracture of the right breast with a ruptured left saline implant and the position of the nipple areolar complexes.  She has severe pain in the right breast with encapsulation, double-bubble breast deformity, grade 3 ptosis and complete rupture of the left implant.  The patient will undergo bilateral open periprosthetic capsulectomy, circumferential open capsulotomy, removal of ruptured saline implant replacement with high profile saline implants and formal mastopexy using the inferior pedicle Wise-pattern technique bilaterally.


The after results show still slight asymmetry of the left nipple areolar complex, slightly lower than the right.  This will be correctable over the next six months.  She however has nice placement of the implants after parasternal release of the parasternal attachments of the pectoral major muscle.  The implants were now able, after muscle tissue expansion, upper pole compression band and accurate inframammary fold release, to have the implant positioned in a more normal configuration.  The right nipple areolar complex sits nicely centrally.  There is a little bit of inferior displacement on the left which will be elevated under local anesthesia, performing a left periareolar mastopexy.


The patient is very pleased with her results.  She had severe pain in the right breast which as you can see has resolved as the implant is now positioned inferiorly in its normal pocket.  She has good sensitivity bilaterally and is undergoing scar treatment including Bio Corneum scar therapy, continues with tissue expansion massage of the right breast.  This is an example of a very difficulty multifactorial complex breast deformity by a transaxillary augmentation performed by a different surgeon, implant malposition, significant skin laxity that was not addressed and nipple asymmetry.

High Profile Saline Implants

The patient below is a 19-year-old Latin female presenting with bilateral breast hypoplasia, excellent candidate for high profile saline implants using dual plane technique, periareolar approach.  The patient desired to have natural-appearing breasts which can be performed with high profile saline implants as long as they are placed in the subpectoral pocket and positioning.  The periareolar incision site was performed and the implants were placed using the dual plane technique.

Her breasts appear to be quite natural and the patient is extraordinarily happy with the shape, size and appearance of her breasts.  High profile saline implants when placed in the appropriate position lead to a beautiful natural result due to the muscle allowing softening and the upper pole of her breast is seen in her oblique view.

Peer Reviewed Physicians Award

I am privileged and humbled to have been selected as a Charter Member of the Peer Reviewed Physicians Award.  This award comes from Accel Industry Peer Review Professional’s private corporation that collects professional referrals, evaluates and compiles lists of professionals in various fields of expertise.  They collect no fees, donations or advertising in order ensure that selection is based on an unbiased evaluation.  The evaluation process consists of previous national recognition, continued medical education, consumer group ratings and board affiliations.  The referrals are confidential and no information has been distributed to third parties.

It is once again a privilege to receive the Charter Member Award for Peer Reviewed Professionals Award of Recognition, 2013.

Mommy Makeover

This patient is a 39-year-old Asian female presenting for a mommy makeover after having her second child through cesarian section.  Her breasts show involutional upper pole atrophy, loss of fullness of her breasts with significant skin laxity and sagginess.  Her left breast is significantly “saggier” than the right.  The patient gave me permission to perform a breast lift on one or both breasts as necessary after placing implants if they did not settle in the appropriate position.  She also will undergo a full abdominoplasty, tummy tuck, with plication of the muscle, tightening of the rectus sheath and lipo-sculpting of the muffin-top in order to give her a nice waist.  The frontal view, before, shows loss of upper pole fullness, grade 2 ptosis on the right and between grade 2 and 3 on the left.

Her postop photo shows nice positioning of her 375 cc style 20 Natrelle Allergan silicone implants.  Notice only a periareolar incision made.  No lift was performed and the small amount of residual nipple ptosis on the left breast is acceptable to the patient.  Her abdominoplasty scar is well hidden below her underwear and the contouring of her hips is nice, showing a reduced muffin-top and more contouring of hourglass figure.  This is an excellent example of a mommy makeover on an Asian patient with an internal tightening/lift performed without external scars.