Ask the Doctor

When you get the go-ahead from you board-certified plastic surgeon, typically 6 weeks in my Toronto plastic surgery practice, it may feel a bit uncomfortable the first time, but afterwards, it should feel essentially the way it did before. Patients who received a labiaplasty near Toronto who had pain before due to the size of their labia minora will find that relieved. In rare cases, patients can suffer from ongoing pain during sex – this is an unfortunate complication that luckily does not happen often.

Generally, most patients will experience some discomfort for about 2 weeks after a breast lift in Toronto. Patients generally come back to our office saying that the pain was less than they expected and pre-operative drains are not necessary. In most cases, you’ll be able to return to light activities after 2 weeks. However, each plastic surgeon in Toronto does things differently, so make sure to interview a few and go with the one that you feel most comfortable with.

During a tummy tuck in Toronto, there is nothing that can be done to improve the appearance of stretch marks, unless they are removed as part of a tummy tuck to a certain extent. In general, the stretch marks below the belly button is can be removed from the plastic surgery, but above the belly button stretch marks usually, have to remain.

While breast implants don’t have a set expiry date, it’s common to change them around 10 years because that’s how long the warranty is. If you aren’t having problems with your implants then there is no need to ‘rotate’ them on a specific schedule. In some cases, you may have issues so it’s probably time to book a consultation with a board certified plastic surgeon near you to see what your surgical options are. Breast revision surgery in Toronto is helpful to restore and replace implants if malpositioned or more.

The distance between a woman’s breasts is determined by the width of her sternum (breast bone) and the existing footprint of her breasts. While implants can sometimes be moved closer together surgically it runs the risk of them coming completely together and creating a synmastia which is a difficult problem to solve.

Fish oil and some other supplements should be stopped before surgery because they act as a blood thinner, which can lead to excessive bleeding during surgery. Other supplements that can act like blood thinners include Glucosamine/Chondroitin, Ephedra, Echinacea, Gingko, Ginseng, Kava, Garlic, St. John’s Wort and Ginger. I generally suggest stopping these for at 2 weeks before surgery and waiting at least 2-3 days after to restart.

There are a few things that need to be considered when talking about breast implant placement for breast augmentation: Pocket location (where are the implants going to go) and incision (how are they going to get there).
Pocket location is generally described in terms of subglandular and submuscular. With subglandular placement the breast implant is placed below the breast tissue itself, but above the pectoralis major muscle. In a submuscular pocket the implant is placed below the pectoralis muscle which is raised off the chest along with the breast.

In terms of incision choice, the goal is to create the best final scar. Because it’s not yet possible to make an incision and heal it completely scarlessly, the goal when deciding on incision placement is to have a final scar that is either well hidden, healed so that it is nearly invisible or both. There are two locations that are used most often – an inframammary crease incision is placed in the fold under the breast and a periareolar incision goes along the border of the areola and the breast skin underneath the nipple. There are also transaxillary (done through an incision that is placed in the armpit) and transumbilical (through the belly button) breast augmentations as well, but these are less common.
There are many pros and cons for each pocket or incision choice which is why there is no single implant placement that works best for everyone. Ultimately, the choice for implant placement comes down to figuring out which combination of incision and pocket location is going to be the right fit for each patient.

The thought behind breast implant massage is to keep the capsule around smooth implants large and loose to allow for some natural movement of the implants and theoretically decrease the likelihood of capsular contracture. Breast implant massage is falling out of favour as we are finding over time that it didn’t really make much of a difference but can potentially cause issues with implant position if done wrong. There are still some specific instances where it can be useful, but is generally not recommended across the board the way it once was. Textured implants are designed to have the capsular tissue grow into the microscopic nooks and crannies to hold them in place (kind of like Velcro), so massaging them is definitely a bad idea.

A mini tummy tuck is an ideal procedure for someone who has some loose skin below the belly button and doesn’t need their muscles repaired, but this is a very limited group of people. This is a procedure that removes the excess skin and pulls the remaining skin below the belly button tight. The belly button is usually left untouched with a mini tummy tuck, so people looking to have the shape of their belly button corrected wouldn’t be candidates for a mini. A full tummy tuck goes all the way up to the rib cage and shifts a lot more skin down for removal. The belly button is separated from the overlying skin and placed through a new opening once the excess is removed and the skin pulled tight again. If someone has a frowny belly button, or a piercing they want to be removed then this would be the procedure for them. A full tummy tuck is also needed for anyone with separation of their abdominal muscles needing repair (common for women after pregnancy), with a lot of excess skin and/or excess skin above the belly button and those with extensive stretch marks they want removed.

This is a great and very common question. The answer is a bit different for the two procedures as the tummy and breasts return to their pre-pregnancy state at different times. In terms of the tummy tuck, I would suggest waiting at least 6 months after a standard vaginal delivery to allow for the uterus to shrink back to its pre-pregnant size and to allow for the muscles and skin to recoil as much as possible. Re-draping the skin over an abdomen that is still enlarged will lead to residual loose skin once the abdomen flattens again. In the case of a caesarian section I would strongly urge anyone to wait a full year to allow for the scarring of the abdominal wall to fully mature, allowing for better visualization and dissection of the skin from the muscles below.As for the breast lift, I would suggest waiting at least 6 months, ideally one full year, after completing breastfeeding (if you are planning to breastfeed) to allow the breasts to settle into their final shape. The hormones associated with pregnancy and breastfeeding cause significant changes in the shape, size and texture of the breasts so in order to get the best, and most long-lasting, result with your breast lift it is important for your hormone levels to have stabilized so that the breasts don’t change significantly after the procedure.

While I can’t speak for every surgeon, I personally have my liposuction patients wear the garment 24/7 except to shower for 3 weeks post op followed by another 3 weeks during the day only for 3 main reasons:
1. Controlling swelling: the compression on your tissues helps your body to reabsorb the edema fluid that accumulates in the tissues after any procedure. This can take quite some time to happen without help from the compression garments
2. Improving contour: the compression helps to keep the tissues adherent to the underlying structures while healing, this can help prevent the wrinkled skin appearance that can happen when the tissues heal in ways we don’t want them to.
3. Improving scarring: pressure has been shown to improve the appearance of scars. Although liposuction scars are fairly small, no one has ever complained about having a scar that is too invisible.
For those reasons many of us would argue that the compression is every bit as important as the liposuction itself in determining the final outcome.

Excellent question. Belkyra (Kybella in the USA) is not like Botox in that you should expect to go back to life right afterward. The recovery is definitely not anywhere near the recovery for surgery though. The common side effects include swelling (87% of patients), bruising (72% of patients), pain (70% of patients), transient numbness (66% of patients), redness (27% of patients), and areas of hardness in the treatment area (23% of patients). Less common side effects include tingling, nodule formation, itching, skin tightness, and headache. These side effects typically resolve without treatment and do not commonly result in patients discontinuing treatment. I try to do all of my Belkyra injections on a Thursday or Friday so that my patient can recover over the weekend and get back to life by Monday. I also have my patients take Arnica for 2 days before and for several days after to minimize and resolve the bruising.

ABSOLUTELY! In my opinion, permanent sutures should never be used for an abdominoplasty. If your muscles are being tightened or a separation is being repaired, you will need sutures that last a while in the muscle layer, so the body can heal in the way we want it to, but the permanent sutures that were used historically aren’t necessary any more. We have long-lasting, absorbable sutures that will hold things where they need to be long enough for your body to heal, and then dissolve so nothing is left behind. Between 6 weeks and 3 months you should be able to return to full activities depending on how active you are, and by 1 year, everything has completely dissolved!

This is a very common question I get and it’s actually pretty easy to know which breast procedure you’ll need. If you like the size of your breasts, but want to improve the shape then a lift alone is what you need. If you want to have larger breasts as well as breasts with a better shape, then a combination breast lift with augmentation is what is necessary. Where it gets confusing for some patients is when they want things to be fuller in the upper pole of the breast, but don’t really want to increase their overall breast size. In most cases, I can use some of the breast tissue from the lower half of the breast to “auto-augment” the breast, giving the same upper pole fullness that comes with a breast implant, but without having to increase the overall size of the breasts or add a foreign object (the breast implant).

This is a constant concern for liposuction patients and unfortunately, there is no real catch-all answer to this. There is always some contraction of the skin after liposuction and the research seems to show that it takes about a year for this contraction to complete. The amount of contraction varies wildly amongst patients depending on the elasticity of their skin. Skin also loses elasticity as we age, so someone who might have been a good candidate for liposuction when they were younger may not still be. When I evaluate someone for liposuction I always pull a bit on the skin in the area to see how much resistance there is as well as how quickly the skin recoils to get a sense of whether they will be a good candidate for liposuction, or will likely need some sort of skin excision surgery to remove the excess skin. Another thing to look at is stretchmarks. Skin that has stretch marks has by definition lost a significant amount of its elasticity, so it would not contract well after liposuction.

Yes, absolutely. Asthma alone is not an absolute contraindication to breast augmentation surgery (or any other elective surgery for that matter) and mild asthma in particular shouldn’t be a problem. I would have a patient with asthma meet with my anaesthesiologist ahead of time to make sure that everything is optimized for surgery and that my anaesthesiologist is comfortable with the severity of the asthma, but it would be rare that an otherwise healthy person be denied surgery for mild asthma.

A full year would be preferable but if everything has returned to normal you could be ok. If there is still any milk coming out however then the glands are still active and you may see further changes after your breast augmentation procedure. Similarly, if you are planning to have more children, your breasts shape, size, and volume will change during and after pregnancy. The only way to know for sure is to book a consultation with a board certified plastic surgeon near you to see what your options are.

Although there is a slight difference in the texture between these implants, all silicone gel implants available in North American today belong to the 4th or 5th generation of silicone breast implants, and all would be considered “gummy bear” implants. In reality, there is little difference in the feel of these two implants once they are actually inside a patient’s breasts. However, a consultation with a board-certified plastic surgeon can help aide you in the process of choosing the ideal implant for you, based on your physical anatomy, desired results, and many other factors.

Age and plastic surgery is a common question. Your age doesn’t matter so much compared to your overall health. A lot of people in their 50s and 60s are having cosmetic surgery, in particular mommy makeovers, so there is no reason that you should be overly concerned about your age. The only way to know for sure is to book a consultation with a board-certified plastic surgeon to see what your best options are, and whether your health will impact the results of your surgery.

Great question. Once the abdominal muscle tightening has healed, generally after 6 weeks it is considered permanent unless you have an injury or become pregnant, in which case the muscles will stretch as is natural with pregnancy. Whether the sutures stay for life depends on what your surgeon uses. Some people will use a permanent suture, which will be there forever. I use a dissolving suture that takes a long time to dissolve, leaving a stable scar holding your muscles together but no foreign material that can cause problems. In general, a normal amount of heavy lifting should not be an issue once you have healed, in order to tear the muscles apart you would need to do something significant that would likely result in an injury whether you have had a tummy tuck or not.

While it is rare to develop a tolerance after just a few sessions, it is possible to build up a tolerance for Botox® Cosmetic making it ineffective. Usually this occurs after years of treatment if at all. You may want to try switching to Dysport or Xeomin to see if those work as the molecule for each is slightly different.

It’s really impossible to predict how your breasts will look once you are done breastfeeding but if you want to breast feed your child then you should just go ahead and do it. If things change afterward it’s not that hard to revise your breasts but you certainly don’t want to miss out on something as special as breastfeeding because of aesthetic concerns. In terms of safety, there is at least one study I’m aware of that shows breast milk has negligible levels of silicone in patients with implants, less than what is found in a commercial formula so it’s certainly safe.
Learn more about Breast Augmentation in Toronto

A “Mommy Makeover” isn’t a set combination of procedures but rather a customized suite of surgeries to reverse the changes to a woman’s body after pregnancy, childbirth and breastfeeding. It commonly includes a tummy tuck and a breast procedure, but that could be an augment, a lift or a combination of the two. Liposuction, labiaplasty, vaginal tightening are also common additions. The only way to know what’s right for you is to book a consultation with a board certified plastic surgeon near you to see what your options are.  

There is a good chance it will work there, and will eventually be approved for that location, however at this point it is only approved for use under the chin. The best solution for medial thigh fat is still liposuction.

I personally have my liposuction patients wear the garment 24/7 except to shower for 4 weeks post op for 3 main reasons:1.) Controlling swelling: the compression on your tissues helps your body to reabsorb the edema fluid that accumulates in the tissues after any procedure. This can take quite some time to happen without help from the compression garments2.) Improving contour: the compression helps to keep the tissues adherent to the underlying structures while healing, this can help prevent the wrinkled skin appearance that can happen when the tissues heal in ways we don’t want them to.3.) Improving scarring: pressure has been shown to improve the appearance of scars. A tummy tuck scar is quite long and right on the front of your body so anything that can help make it flatter, softer and less visible is to your advantage.For those reasons many of us would argue that the compression is as important as, if not more important than, the method of liposuction used in determining the final outcome. While a commercial product like spanx will be ok later in the healing process, the surgical compression garments your get from your surgeon have a higher level of compression and should be worn for the first 3-4 weeks at least.