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Dr. Linder's Blog

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Monthly Archives: June 2014

Board Certified Plastic Surgeon Beverly Hills

http://www.hautemd.com/dr-stuart-linder-june-2014/

Beverly Hills Plastic Surgeon Dr. Stuart Linder

Last week, Haute MD Network published an article about why I decided to become a doctor. They asked two questions, and I was happy to share my thoughts regarding them. I enjoyed putting this together and reflecting on how I found my career and passion so early in my life.

Why did you decide to become a doctor? As a child, what profession did you aspire to achieve? 

At the age of 13, I decided to become a physician as I followed my father as a role model.  My father was an anesthesiologist who worked not only at a large university hospital in Los Angeles as an associate professor of anesthesia, but also as chief of staff at St. John’s Hospital in Santa Monica in the early 70s. After observing several cases at the age of 13, with my father performing the anesthesia for plastic and reconstructive surgeons, I was intrigued and excited to become a Beverly Hills board certified plastic surgeon. (read more)

Despite all the high tech medical advancements, what is one old-school technique you still utilize on a regular basis in your practice?

The most common old-school technique that I utilize in my practice on a regular basis is simply having common sense and judgment. The three things that will get you the farthest in medicine as a physician are having common sense, excellent judgment, and the experience of having performed thousands of surgeries. Having common sense makes sense, but it is not always that obvious. (read more)

SIENTRA BREAST IMPLANTS

Cohesive Silicone Gel

Yesterday I had Chris Hodges stop by from the implant company Sientra. As a board-certified plastic surgeon, it’s important to have a good working relationship with consultants from these types of companies and stay “abreast” of the latest technologies available. Sientra only provides their implants to board-certified plastic surgeons.

I used Sientra’s cohesive silicone gel breast implants this morning while performing a breast augmentation, and I was very pleased with the results.

PREOPERATIVE EVALUATION

Patients who undergo plastic and reconstruction surgical procedures, just like any other type of invasive procedure from different fields of surgery, should undergo preoperative evaluation. In general, our basic guidelines within the standard of the American Board of Plastic Surgery are as follows: patients under the age of 40 should have at minimum a preoperative CBC which includes white blood count, hematocrit, hemoglobin, red blood cell count, as well as a coagulation panel, partial thrombin, and partial thromboplastin time (PT, PTT), in order to determine coagulation ability, that is the ability to COAG in the operating room in surgical dissection. Finally a beta hCG should be performed. This allows us to determine obviously if the patient is pregnant prior to surgery which would thereby indicate surgery under general anesthesia. Finally, an HIV is obtained in order to determine the status of HIV in case the operating room staff member should be stuck with a needle in the OR. Also, patients over the age of 40 will obtain 12-lead EKGs, especially if there is any history of hypertension or cardiac disease. A chest x-ray will also be performed on patients with a history of asthma or significant COPD or lung disease as determined by our preoperative internal medicine specialist.

Patients are cleared for surgery over the age of 45 by their primary care physician, especially if there is any history of cardiac, high blood pressure, diabetes, asthma or any form of rheumatoid arthritis or autoimmune disease. Specialists are absolutely required on patients with a history of diabetes, hypertension, cardiovascular disease, diabetes, history of cancer, history of autoimmune disease or any form of kidney disorder. Specialists can include cardiologists, nephrologists, as well as gynecologists, rheumatologists, autoimmune experts and infectious disease specialists in patients who have a history of MRSA or a history of infections, having undergone under surgical procedures in the past.

Mammograms are required for our patients 35 and over or with a family history of breast cancer or significant breast disease. Preoperative clearances by our Internal Medicine Specialists are absolutely essential on patients over the age of 40. All patients are required to have the expected laboratories, which should be evaluated before surgery in order to determine any abnormalities. Preparing new patients for surgery in advance will prevent problems in the operating room or postoperative complications.

Haute Living Magazine Los Angeles

Haute MD Network, Haute Living magazine  May / June, 2014  issue has Philippe Vergne on the front cover.  Inside this edition I am a part of the  concierge access to premiere cosmetic specialists around the country.

On there online website www.hautemd.com I have also had the opportunity to contribute a few articles which I am very pleased to provide.

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Malpostition, Severe, With Breast Dysphoria And Severe Deformity

This patient is a 27-year-old young female, presenting with severe malposition of her implants. Implants were too large and the pockets were made too big from which she has developed skin laxity. For the proportionality of her body, the implants are disproportionately large and show severe grade 3 ptosis and asymmetry.

Reconstruction included implant replacement and downsizing to a smaller high profile saline implant, inferior capsulorraphy and bilateral formal breast lift using the inferior pedicle Wise-pattern technique. Her side view shows severe grade 3 skin laxity with an enormous breast, way disproportionate for her thin physique. Her after photos show good symmetry with tightening of the skin and excellent nipple areolar positioning.

Looking at her frontal view of the right breast, before her reconstruction, shows bottoming out, malposition, lateral displacement of her implants. Her after shows nice decrease in size, volume proportionate for her body and good nipple areolar positioning using the Wise-pattern or anchor scar. Patients with thinner figures that are petite, shoulder undergo smaller implants in order to regain symmetry, proportionality and pocket dissection needs to be limited in order to prevent the severe bottoming out as well as the grade 3 ptosis that have occurred.

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