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Monthly Archives: April 2015

ABMS Maintenance of Certification

Certification Matters

 

I was pleased to receive a letter from The American Board Of Plastic Surgery, Inc. confirming my active participation in the Maintenance of Certification in Plastic Surgery Program. This letter and certificate are only available to ABPS board-certified plastic surgeons who have currently satisfied the MOC-PS requirements as of 2015.

When choosing a plastic surgeon, I would encourage potential patients to look for the Starmark logo when researching on-line.

Linder ABPS

SEROMA, TRAUMATIC-INDUCED

Patients present with severe painful breast seromas, status post blunt trauma. The patient in this example is a 34-year-old African-American female presenting with severe blunt trauma to the right breast. Notice on her preoperative photo the right breast is approximately 60% larger than the left with superior retroposition of the implant, massive swelling, asymmetry and disproportion. She presents with severe pain and history of blunt trauma 14 days ago to the medial breast.

 seroma-traumatic-induced

These patients should undergo ice compression and immediate exploration of their breasts in order for complete decompression of the massive amount of fluid. The longer the fluid remains within the pocket, I believe the more encapsulation, the thicker the scar tissue becomes and it is more difficult to create a normal shape and softness to the breast. Patients should be told in preop that if there is any evidence of infection or pus that the implant should be removed and not replaced for a while, a JP drain should be placed as well as cultures taken. So, on the consent forms, possible explantation without reimplantation and drainage placement should be included. In this specific case, in the operating room it was found that the patient has a 600 cc straw-colored clear seroma with no evidence of infection. This was an enormous seroma with well over a half liter of fluid suctioned out. The pocket was subsequently irrigated, implants were replaced, and softened capsulotomies were performed.

The after photograph shows on the operating room table great symmetry and evenness of her breasts and no evidence of hardening. The patient will be maintained on antibiotics orally for seven days, the sutures removed in 14 days.

KNOB KNEE PROCEDURE

The knob knee procedure is an excellent new procedure that Dr. Linder  performs removing the inner or medial knee pad.  This is an area referred to as “the knob knee area” where when the legs are brought together these areas of fat show disproportionate distribution of the fat or adiposity leading to a knob knee appearance.  This can be removed through simple microscopic pathology lipo-sculpting under sedation or local anesthesia with a small 2 mm triple lumen blunt tip cannula.  This is a nice well-defined fat pad in the medial knee area which can easily be suctioned out and cleaned to allow a nice contour of the inner knee region.

Dr. Linder performs knob knee procedures on majority of patients undergoing lower extremity liposuction of the saddlebags, medial thighs and hip areas in order to allow for a nice medial contour.

 

Case Study: “Linder Knob Knee Lipectomy Procedure”

Patients present for liposuction of the medial and lateral thighs, but also have concerns of their inner knee area.   A small stab incision can be made under local or IV sedation in the medial knee area (the inner knee) and a small fat pad usually as well localized fat that can be suctioned using a very small 2 mm cannula after a small infiltrate of tumescent fluid.  This fat pad is usually a compact fat and therefore suctions out smoothly and evenly without skin laxity problems or looseness of the skin.

The example shown shows a patient with well-defined inner knee/knob knee lipodystrophy and postoperative day one shows smoothing out of the inner knees and a small amount of bruising which is expended.  The knob knee procedure can be performed with total body contouring, including inner and outer thigh liposuction which helps once again to give enhanced contour of the entire inner medial thigh area from the knee all the way up to the groin.

Pre Op Back View / Post Op Back View / Post Op Frontal View

Breast Reconstruction Status Post

INFECTED BREAST IMPLANTS – COSTA RICA

This patient presents with breast implants placed in Costa Rica in which she pusses out and ended up with severe abscesses. Implants were removed in Costa Rica three months later. She is now seen one year later, traveling to Beverly Hills for reconstruction.

Pre Op Photo

Post Op Photo

On a close-up view of the bottom vertical scar of the bilateral breast, right greater than left, you can see the thinness and laxity of the skin which is quite thinned out poor vascularity, continuous. Postoperatively, the patient underwent augmentation mammoplasty procedure using 465 high profile style 68 Natrelle saline implants through a lateral periareolar incision under the nipple. Her postoperative view shows excellent fullness, scar healing nicely under the nipple, shape is excellent and the breasts now remain soft with no evidence of recurrent scar tissue and there is nice shaping of the lower poles of the breast compared to her preoperative photos.

Patients travel internationally to have breast reconstruction here with Dr. Linder in Beverly Hills in order to often repair problems, including infections of previous breast augmentation surgery.

WHAT THE DIFFERENT LIPOSUCTION FAT COLORS MEAN

 

The color of the fat within the liposuction cannula can give you great indication as to the amount of blood loss from the surgery. Below, you will see several examples of liposuction fat. All of these examples were suctioned by Dr. Linder with the patient under general anesthesia and given tumescent fluid per 1 liter of normal saline, 1:100,000 epinephrine and 40 cc of 1% plain Lidocaine mix. Notice the darker specimen shows more blood within the mix and a cobblestone-like appearance. Patients who undergo straight liposuction without tumescent technique will end up with very bloody-appearing fat in which there is no cobblestoning appearance to the tissue and there is a significant amount of red blood streamlined confluently with the fatty adipose tissue. Notice as the tissue becomes more bright yellow, this is associated with a significantly minimal amount of blood loss. In fact, in real tumescent fluid it has been found that the blood aspirate is less than 1% of the total amount of aspirate removed, 99% fat, 1% blood. Pure liposuctioning using the tumescent technique with the epinephrine causing its vasoconstrictive effect and reducing bruising and blood loss is very effective.

It is the goal standard with the American Board of Plastic Surgery that liposuctioning should be performed by only Board Certified Surgeons who have the experience and training to understand the anatomy of the human body, including risks and complications by liposculpturing in areas remote and deep to the fatty areas.

psarticles-liposuction-fat-color

Clarifying Expectations, View Before & After Photos

Plastic Surgery Before and After Photos

Before and after photos are an excellent way to understand and help clarify expectations when determining the type of plastic surgery procedure one may be considering. For the past 15 years in my practice, I have recognized the benefit of before and after photos and have been honored to have thousands of my patients choose to share their positive experiences with others on my website.

I encourage new patients that are considering plastic surgery to not only seek out a board-certified plastic surgeon, but also take the time to view the plastic surgeon’s before and after photos to get a realistic idea of possible outcomes from these photos.

Liposuction Before & After

Tummy Tuck Before & After

Gynecomastia Before & After

 

Breast Augmentation Before & After

Breast Augmentation Before & After

How to Get the Best Results From Liposuction

Liposuction Results

 

There are quite a few things you can do before and after a liposuction procedure to ensure you get the best results. Start with selecting a qualified surgeon who is board certified by the American Board of Plastic Surgery, be sure to eat a healthy diet and exercise regularly for optimum health, and do not smoke or take any anti-coagulant medications for about two weeks before the procedure. The best liposuction candidates are not markedly overweight and do not have a significant amount of loose, sagging skin. After the procedure, lasting results can be achieved with liposuction if you follow these tips:

 

Wear Your Compression Garment

 

After liposuction, your body’s natural response is to fill the treated area with fluid. Wearing a compression garment will reduce the pain and swelling that results from surgery, and it will also help the body take on its new and improved shape. Most patients wear their garments constantly for at least two weeks or until the swelling has gone down, and some prefer to wear them much longer for comfort. I prefer that my patients wear their garments for six weeks after the procedure.  

 

Maintain a Healthy Diet

 

Right after the procedure, it is important to drink plenty of liquids to stay well hydrated. The body swells for several days, which is why more liquids are necessary to prevent dehydration. Restricting your fat and calorie consumption later after surgery can significantly improve the long-term outcome of liposuction. While you won’t gain fat in the treated areas as easily, it is still quite possible if you are not careful. A healthy diet can help maintain your results and possibly enhance them. Remember that liposuction is not a substitute for weight loss, and it is not a safeguard against weight gain.

 

Exercise

 

It is important to avoid being sedentary early on during recovery. Walking at a comfortable pace will help reduce the risk of blood clots, which is a complication that can occur after any surgery. It will also help you to feel better and more “normal” after the procedure. You should not become a “couch potato” after the procedure, but strenuous exercise also must be avoided for four weeks. With less fat after liposuction, many patients tend to see results from exercise more quickly, and this motivates them to continue with a  healthier lifestyle. Looking better helps to make it easier and more fun to exercise.

 

Long-Term Results                   

 Some people heal more quickly than others, so it is difficult to generalize when your best results from liposuction will appear. Initial swelling goes down over the first few weeks. A smaller amount of swelling can last for a few months. The skin may also gradually tighten somewhat over several months, which is why the final result takes several months to become complete. No matter how long it takes to fully recover, the long-term results of a slimmer, more proportionate body from the procedure are generally the same for all patients.


If you are considering undergoing liposuction feel free to give us a call (310) 275-4513 to schedule a consultation or email us for more information.

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