Other consultations that day also included mommy makeover, including breast implant lift, tummy tuck and liposculpture of the hips.  These patients present to Beverly Hills from Las Vegas for surgery, including breast augmentation, breast revision, breast lift, breast reduction, liposculpture, and abdominoplasty.

Patients are presenting for cosmetic dentistry with Dr. Kevin Sands, a world recognized leader in cosmetic dentistry, including all forms of dental bonding, veneer and perfect smile dental work.  He has a multitude of celebrity clientele who have undergone his masterful artistry in perfect dental reconstruction and cosmetic perfection.  Patients are also presenting for facial rejuvenation surgery, including eyelids, rhinoplasty and dermal fillers. 

Dr. Robert Kotler is a facial cosmetic surgery specialist who performs absolute remarkable beautification and rejuvenation, creating a youthful appearance to the face through his eyelid surgery, brow lift and facelift procedures.  He is a world recognized leader in rhinoplasty and nasal surgery, creating the absolute perfection of proportionality of the nose to the specific woman’s facial structure.  Robert Kotler is considered a truly greater facial plastic surgeon with well over 35 years of experience and celebrity clientele from every major Hollywood studio. 

In a similar fashion, patients present for body sculpting, including breast enhancement, breast revision, breast reduction, breast lifting, tummy tucks and total body lipo-contouring, to us, Dr. Linder, Beverly Hills Body Sculptor.  The name Linder with the Dr. Linder Bra has become a “figure in the community,” consistency with body sculpting from patients of every walk of lift, from celebrities and patients of international travelers worldwide. 

The Beverly Hills Extreme Makeover includes complete body and facial transformations from worldwide leaders and experts, including cosmetic dentistry, Dr. Kevin Sands; facial plastic surgery and rejuvenation with Dr. Robert Kotler and total body mommy makeovers and extreme body sculpting, lipo-contouring with Dr. Stuart Linder.

Many patients are confused as to the terms, Tummy Tuck, Abdominoplasty, and Panniculectomy.  In fact, all three of these are very similar operations.  An Abdominoplasty and a Tummy Tuck are both the same operation in which skin is removed after significant undermining of the abdominal wall and tightening and plication of the rectus sheath muscles with permanent sutures.  A Panniculectomy is an enormous abdominoplasty, often referred to as removal of an abdominal pannus.  This can occur after massive weight loss such as bariatric surgical or gastric bypass patients.  These patients who have lost well over 100 pounds, often have a massive abdominal apron or pannus which requires careful dissection and removal of the pannus.  Usually the abdominal wall is so diastatic and so thin that suturing the wall is not feasible or appropriate.  Paniculectomies are enormous abdominoplasties.  The dissection is usually less aggressive superiorly up to the subcostal margin in order to maintain blood supply of the flap down to the abdominal wall.  The umbilicus is usually spared, but in some circumstances must be removed in the larger paniculectomies.  Paniculectomies are always performed under general anesthesia, two, if not three, Jackson-Pratt drain tubes will be placed in order to drain the fluid that accumulates after the flap dissection, for at least 7 to 10 days postoperative.  In the enormous paniculectomies I do not tighten the muscles internally.  This is instructed to the patients preoperative and that normally the muscle will tear with these sutures, increasing the risk for bleeding and not really greatly affecting the final outcome.  Paniculectomies are a functional surgery.  In fact, patients often have hygienic problems with as dermatitis along the suprapubic region extending along the inguinal creases bilaterally.  They may also have lower back pain significantly due to the massive amount of skin over-draping, which can drape all the way to the suprapubic region. 

Abdominoplasties on the other hand are normally considered a cosmetic or elective procedure in which again simple removal of tissue and skin with tightening of the rectus sheath is performed.  Patients who undergo abdominoplasties normally have had one or more children, large deliveries or have had a mild to moderate amount of weight fluctuation.

 Thank You, Dr. Stuart A. Linder

The first stage is the abdominoplasty with liposuction of the hips.  Three to six months later, complete lipo-sculpting of the abdominal flap, flanks and upper iliac crest rolls can be accomplished to greatly debulk the flap in order to truly reduce the size of the woman’s midriff.  We instruct all of our patients preoperatively as to whether they will probably be a candidate for a second stage surgery requiring liposuctioning of the abdominal flap in order to reduce the thickness of it.  Remember that liposuctioning the flanks and upper epigastric region is dangerous during the initial abdominoplasty procedure due to vascularity and blood supply problems.  Once the vessels are cut along the lower C-section areas aka inferior epigastric and the circumflex iliac arteries, the blood supply comes from the upper flank areas.  There are three specific blood vessel suppliers and if these are sculpted and liposuctioned, they could end up devascularized in the abdominal flap, which could lead to skin necrosis and death of skin and fatty tissue from the flap.  In order to be as safe as possible, lipo-sculpting should be delayed of the upper epigastric and upper flank areas for three to six months to allow revascularization of the lower flap.  Large abdominal pannus patients will require a second stage in order to debulk the flap.  This will make the patient much happier with her final result and should be instructed to the patient preoperatively.

Patients present for abdominoplasty revision or tummy tuck redo’s several times throughout the year.  This is most consistent with patients who have undergone gastric bypass surgery and had massive weight loss and concurrently with the original gastric bypass have had paniculectomies prior to losing their significant amount of weight.  As a result, patients often lose anywhere between 50 and 120 pounds and now present with further skin laxity as well as large dog ears on the hips. 

 The treatment for this is surgical correction by secondary full abdominoplasty, tightening of the muscles as necessary, resection of the hip dog ears and often liposculpturing of the flanks and upper hip region.  Tummy tuck revisions are rewarding, especially in patients who have had gastric bypass or bariatric surgical procedures who require secondary removal of redundant amounts of skin laxity after continued weight loss.

Because 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.

Dr. Linder is proud to be an advocate as well as a specialist for Kelo-cote on their recent infomercial now playing throughout the United States.  Because a disproportionately large part of Dr. Linder’s practice is body sculpting women, scarring is an inevitable concern, especially with the multitude of breast lifts and abdominoplasty surgeries. 

Having used Kelo-cote for over two years, Dr. Linder has found it to be extremely helpful when used after sutures are removed, twice a day, for at least three months.  Bio corneum is a new product with the Kelo-cote component as well as the SPF to reduce problems associated with the UV light.  Bio corneum is used for management and preventing keloids and hypertrophic scarring.  It is excellent for patients who have had surgical scarring and desires to have less redness, smoothing, flattening and less visibility of scars. 

The benefits of Bio corneum include:  it’s 100% silicone scar treatment with SPF30.  It dries within 45 minutes.  It flattens and softens scars, reducing redness and discoloration.  It also relieves itchiness and discomfort.  The SPF30 of the Bio corneum reduces sun-induced redness discoloration.  Bio corneum and Kelo-cote are excellent products for scarring.  Dr. Linder uses them every day on his patients who have postsurgical scars associated with augmentation, breast revision, breast lift and abdominoplasty procedures.

Women who have had children and/or breastfed, often what is called involutional upper pole atrophy or loss of fullness of their breasts.  Adding an implant as well as lifting the breast if there is significant skin looseness, leads to a beautiful reshaped breast.  The lower abdominal wall, when there is skin redundancy below the umbilicus but not above, may do well with a mini abdominoplasty.  A similar C-section like scar is made and extended toward the hips bilaterally and the tightening of the lower abdominal muscles from the umbilicus to the suprapubic region can be done at the same time.  The example of a mini Mommy Makeover above is showing breast enhancement surgery with a mini abdominoplasty.

The patient is now six weeks postsurgical, status post silicone gel augmentation mammoplasty procedure with high profile gel 325 cc Natrelle implants placed to the dual plane with a small incision underneath the nipple.  She also has a full abdominoplasty, and plication of the midline rectus sheath.  The rectus muscles have been plicated into the midline.  She also has undergone a core sculpting of the inner and outer thighs.  Please note her pre- and postoperative photos.  The patient is six weeks postsurgical and is doing extraordinarily well.  This is an excellent example of our usual and customary Mommy Makeover procedure combining breast enhancement, full abdominoplasty and sculpting of the inner and outer thigh areas.