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Dr. Linder's Blog


Category: Ambulatory Facility

Plastic Surgeon and Surgery Facility

Beverly Hills plastic surgeon

As a Beverly Hills plastic surgeon and also a member of the American Society of Plastic Surgeons (ASPS), I must perform surgery in a facility that abides by the rigorous standards set for patient safety.

As I have stated in the past few blog articles, there are many key questions to ask when determining the right surgeon for your procedure. Along with doing your due diligence to decide on the right procedure, plastic surgeon, and anesthesia, I would encourage patients to ask not only where the surgery will be held but also what type of accreditations the facility meets.

As an ASPS member, I must meet the criteria of performing surgery in accredited, state-licensed, or Medicare-certified surgical facilities only. I am proud to state that I use Brighton Surgical Center, which is located in the same building as my office in Beverly Hills and carries two of the most stringent and distinguished certifications of accreditation for ambulatory facilities and hospitals within the state of California. The center has both Medicare certification as well as accreditation from the Joint Commission of Accreditation of Hospitals (JCOH).

For your safety, please ensure that your plastic surgeon is choosing an accredited ambulatory or hospital facility for your surgery. Please give us a call at 310-275-45413 or email us if you need more information about our surgery center.



Brighton Surgical Center is the center that we use for plastic and reconstructive surgical procedures.  This center has both Medicare certification as well as JCOH, which is the Joint Commission of Accreditation of Hospitals.  Brighton Surgical Center completed both Medicare certification and recertification in 2013 and has recently become a JCOH-approved hospital facility.  These are the two most stringent and higher certifications of accreditation for ambulatory facilities and hospitals within the State of California.  The process of JCOH ensures all patients the highest safety, highest quality of care, treatment and services.  Certification was completed on January 3, 2014 with the Joint Commission for Brighton Surgical Center as an Ambulatory Healthcare Accreditation Facility.  This required inspection as well as observation of surgery and gastrointestinal procedures.

We always desire to have the highest accreditation for the safety of our patients at Brighton Surgical Center where our surgeries are performed under IV sedation and general anesthesia.

Plastic Surgical Team Beverly Hills

For any successful surgical outcome, it requires teamwork from several multi-talented physicians, nurses, and techs.  As you would expect, your plastic surgeon must be Board Certified with the American Board of Plastic Surgery and Diplomate of the American Board of Plastic Surgery and should also be members of the American Society of Plastic Surgeons.  The anesthesiologist putting the patient to sleep should equally be Board Certified with the American Board of Anesthesia.  Here, they should be qualified in all forms of IV sedation and general anesthetics, including the use of laryngeal mask airways and endotracheal tube intubations as well as understanding all aspects of critical care medicine.  ACLS is required from both the Anesthesiologist and the Director of Nursing.  The Director of Nursing must be a Registered Nurse in all Medicare licensed ambulatory facilities such as ours at Brighton Surgical Center.  The Director of Nursing should have years of experience in both ICU Hospital as well as ambulatory outpatient surgery facility patient management.  The Recovery Room Nurse must be a Registered Nurse as well in all Medicare State Licensed facilities.  The circulating nurse in the operating room can be an RN or an LVN.  We use RNs.  They should be well-versed at all aspects of circulating, including helping to prepare each patient in the operating room, pulling supplies, filling out all paperwork and accountability for instrument needle sponge counts with the scrub tech as well as performing a timeout at the beginning of the surgery which includes patient’s name, allergies, surgery that will be performed and antibiotics that are given.

Finally, the Certified Scrub Tech should have years of experience in plastic surgical procedure understanding the instrumentations and how to expose tissue during the operation to allow for easier surgical manipulation by the plastic surgeon.  The Certified Scrub Tech is also responsible for the sterility of all instruments and autoclaving of all supplies.  Every aspect of the chain is essential in the loop of creating excellence for our final surgical outcome.

Anesthesia and Quality Control

Multiple factors are required to achieve a successful outcome in plastic surgery.  Not only must the surgeon be Board Certified with the American Board of Plastic Surgery, but the facility should be licensed as ours is with Medicare licensure and the anesthesiologist should be Board Certified with the American Board of Anesthesia. In my practice we only used Certified Diplomates of the American Board of Anesthesia.  In other words, Board Certified Anesthesiologists to put our patients to sleep either under IV sedation or general anesthesia.  I believe there are no substitutes that Board Certified Anesthesiologists have the experience and judgment to perform anesthesia in a safe and controlled environment.  Medicare law requires that a timeout be performed in the operating room.  That means before the patient is put to sleep that one of the members of the operating room team will give the patient’s name, specific operation, allergies and antibiotics given.  This is referred to as a “timeout.”  This is very important to reduce mistakes in the operating room.  This is considered standard of care.  Interestingly, recently I just operated on a patient who had two surgeries performed on her breasts in a three-month period with a disastrous outcome.  What is most interesting about this patient is specifically that she states not to have seen her plastic surgeon either before surgery, in other words, the doctor was not seen and did not mark the patient, he was not found in the operating room nor was he seen in the preop holding postoperative recovery room after she was extubated.  She interestingly did not even see the doctor for the next seven days.  In other words, the patient never saw the doctor whatsoever from the beginning of surgery to one week after.  It is extremely important that your plastic surgeon mark you himself or herself in the preop holding area, that you see the doctor in the operating room as well as in the postop recovery room.  It is also vital to see the surgeon the next day in order for him or her to remove the dressings and place you into your surgical garment.  This is considered standard of care in the United States and all patients should be treated by at least the standard. The Board Certified Anesthesiologist that we use has performed well over 7,000 surgeries with me and thankfully has an excellent and perfect record.  Complications can occur during the anesthesia and as a result, anesthesiologists who are Board Certified have the experience and training to anticipate and treat these problems to prevent life serious and threatening disasters.

Plastic Surgery Center, Ambulatory Facility Qualifications

Recently, all ambulatory Medicare licensed surgery centers were recertified in the United States.  This was a Federal Government Medicare requirement.  The recertification process allowed us to importantly review all the reasons why having Medicare licensure is so important.  The certification of Medicare in an ambulatory facility allows a similar standing to those hospitals that are federally certified throughout the United States and the standards must be upheld in a similar fashion.  Recertification was multi-modality.  Investigative team reviewed all the physicians, surgeons, anesthesiologists, registered nurses, and certified scrub techs for credentials and made sure all certifications were updated and were up to present status.  Peer reviews were evaluated for all MDs and similar fields of surgery or anesthesia.

Chart examinations were performed in order to evaluate the specific details of charting both by the surgeon, anesthesiologist as well as by the circulating nurse and recovery room nurse.  Mediations are reviewed, including crash carts, postoperative recovery as well as documents for all narcotics.  Specific minutes as well as quality insurance was also reviewed in order to make sure that all standards are upheld with Medicare.  We are pleased that Brighton Surgery Center is a Medicare certified facility and that it allows the safest environment for a patient to undergo plastic and reconstructive surgery under general anesthesia.  In our surgery center we only allow Board Certified Anesthesiologists to perform anesthesia either intravenous sedation or general anesthesia.

The specific anesthesiologist that I have worked with for over 12 years, I have performed well over 8,000 general anesthetics without a single complication.  Experienced judgment will allow for safe surgery and maintaining Medicare status will allow patient the comfort in knowing that the surgery center is of the highest certification and standards in the United States.  Recently, I received a testimonial with a patient specific to the anesthesiologist and nursing staff.  I provide this for your perusal.


Besides, the two wonderful women you have in your mainoffice; Adrina and Nelli and of course you’re the best plastic surgeon in the WORLD and has always been such a blessing to me and made me feel like family. You have always done all these things and more that I have written below about these three people. So, thank you.

I wanted you to know what a great team you have in Sheila, Nurse Vicki and Dr. Hoffman. Anytime you enter a surgical center, there’s always some anxiety and you’re very nervous, however this team makes you feel like you’re right at home and that they care about the patient!

No matter the procedure you’re having, from the time you walk in with Sheila, to Nurse Vicki and then Dr. Hoffman you forget all about the surgery and before you know it, the procedure is all over. This team I must say, is first class, they really care about the patients and always ensure you’re ok with a smile. (Read More)