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29 Jul 2012

‘Can I talk to one of your former patients?’- Why testimonials...

Occassionally a patient is wavering on proceeding with surgery and wants to speak with a former patient to help them decide. This is not a problem for us, but we must point out how unproductive this maneuver is in determining the quality of a practice, or what to expect in the post-operative period. Fact: We are most likely to put you in touch with a very happy patient, so you are unlikely to learn anything about the average experience of our patients. Fact: This patient can speak knowledgably about her personal experience, but not about our last 20 patients who had that procedure. If anything, her testimony may be unintentionally…

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24 Jun 2012

“I’m not happy, Doctor???

“I’m not happy, Doctor??? No Plastic Surgeon wants to hear this from a patient, but it is inevitable that a small percentage of the thousands of patients we see would be unhappy. How a practice responds to complaints may well distinguish a great practice from a good one. Why are patients unhappy? Surprisingly, it most often arises from good outcomes, as bad outcomes are thankfully quite rare. Examples (from our practice): 1. Patient seeks a more youthful appearance and facelift is recommended. Doesn’t want surgery, only injectables, despite warning that injectables like Botox and Juvederm are limited in their effect. Patient returns 3 weeks following injections, unhappy with modest effect…

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27 May 2012

Large Male Breasts- Gynecomastia

The Mansierre, The Bro, Moobs- funny on television, but no man with large breasts finds the reality of this problem funny. As ‘deformities’ go, this is particularly difficult for men as it can be an afront to their image of masculinity. Gynecomastia is common among adolescents as hormonal activity and tissue responses play havoc, but generally the breast over-development subsides over a few years. For those troubled by permanent breast enlargement, surgery is the answer. Surgical planning for each patient requires consideration of three tissues: skin fat and gland. Skin is a problem only if there has been massive weight gain/loss, and the resultant loose skin must be excised with…

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6 May 2012

Cohesive Gel Breast Implants – Are they all the same?

At the recent Toronto Aesthetic meeting, the topic of smooth versus textured cohesive gel breast implants came up for discussion. The differences between Mentor and Allergan textured implants was also debated. Studies have not consistently demonstrated the superiority of one implant over another, in part because these implants have properties that allow one implant to be better in some situations, and another implant in others.  Despite the absence of good studies, our experience and that of other top Toronto breast augmentation surgeons has been that texturing does not make a big difference in the development of capsular contracture.  Texturing does allow the use of shaped (anatomic) implants, as a smooth surface…

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6 May 2012

Labia Reduction and Vaginal Rejuvenation

I performed my first labia reduction in 1994, when just a resident. Training at the University of Toronto included a 6 month cosmetic surgery rotation in which patients could obtain cosmetic surgery from a senior resident at a reduced fee. A young woman came to the clinic requesting labia reduction because she was an actress and was being offered ‘Sharon Stone-type’ roles! Since then, Labia Reduction has grown in popularity, in part driven by the opportunity for women to see images on the internet of labia different from their own. The internet has also allowed women to become aware of the availability of this procedure. Labia reduction has obvious cosmetic…

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6 May 2012

Cheek and Chin Augmentation

Cheek and Chin augmentation don’t get enough respect from patients, or sometimes surgeons, but a recent increase in chin augmentation requests reported by the American Society of Plastic Surgeons (and observed anecdotally in our Toronto office) is giving people some cause to reflect. There is speculation that the increased use of Skype and videophones is causing people to take a closer look at themselves, and a closer look at feature enhancement. Chin augmentation is a relatively easy procedure performed with a silicone implant through an incision under the chin. There are variations of the implants intended to mask jowls, or even create a chin dimple. Cheek augmentation with implants carries…

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