Photo GalleryBreast AugmentationTummy Tuck LiposuctionEyelids/Blepharoplasty     Ask The Doctor / Contact   Resources/Links     Dr. Robert Steven Backstein, MD, FRCS(C) is a fully qualified plastic and cosmetic surgeon who holds a Fellowship in the Royal College of Surgeons of Canada. He graduated and completed his plastic surgery residency training at the University of Toronto Medical School, and has been recognized by multiple scientific publications in major medical journals. Currently on staff at Humber River Memorial Hospital, Toronto Ontario, Dr. Backstein performs all surgery in a hospital setting, with the option for a private clinic setting available as well. Please scroll page down to read Dr.Backstein's articles on cosmetic surgery procedures.       Tummy Tuck or Liposuction - Which Cosmetic Surgery Is Right For Me? A common misconception amongst patients considering cosmetic surgery of the abdominal area is that the choice exists to have either a tummy tuck or liposuction and that either of these two procedures will produce similar results. In most cases, a patient is a far better candidate for either a tummy tuck or liposuction and the procedures are not interchangeable. The decision as to which plastic surgery procedure is best must be made in conjunction with a qualified plastic surgeon but the following is a general guideline: Typically, patients whose abdominal area has loose excess skin, or significant stretch marks will need a tummy tuck and will not benefit from liposuction alone. This is because liposuction is a procedure that only removes fat. Skin is esentially unaffected. Therefore if there is substantial loose skin or stretch marks to start with, liposuction will not remove any of the extra skin or any of the stretch mark-bearing skin. Furthermore, liposuction in these circumstances can actually worsen the problem by removing the "foundation" on which the skin rests, i.e. the underlying fat thereby leaving even looser skin than the patient started with. Liposuction to the abdominal area is more appropriate in cases of younger patients with firm, taut abdominal skin whose main problem is extra fat. In these cases, skin reliably shrinks over the liposucked area and a great cosmetic result can be obtained. Remember that this is only a guideline. The ultimate decision as to which procedure(s) is best for you should be made during a private consultation with a qualified surgeon. Who is a Candidate for a Tummy Tuck? A tummy tuck can benefit individuals with the following features of the abdominal area: (1) excessive, loose, sagging skin (2) stretch marks, such as after pregnancy (3) excess fat on the abdomen (4) a rounded tummy that would benefit from flattening How is a Tummy Tuck Done? A tummy tuck involves multiple surgical steps, each designed to enhance the cosmetic appearance and feel of your abdominal area. The tummy tuck starts by making an incision low down on the abdominal wall. Dr. Backstein places this incision as low down as possible so that it is generally not detectable in a bathing suit or a bikini. Depending on your body structure, fully hiding the incision scar may not be feasible. Following the initial incision, a tummy tuck will involve plication (firm tightening) of the muscle layer, excision and removal of as much excess skin and fat as possible, and placement of the umbilicus (belly button) into an anatomically pleasing location on the abdominal wall. Dr. Backstein includes liposuction of the upper abdominal area and love handles as part of the tummy tuck procedure.      Tummy Tuck Cosmetic Surgery Scars. There are two scars that are left by a tummy tuck. These are a horizontal scar placed low down above the pubic area and a circular scar carefully placed around the belly button. Both of these scars are absolutely needed if a tummy tuck is to be done properly and effectively. Any procedure that attempts to avoid these scars will always compromise the result of the surgery in terms of tightening, flattening, and overall abdominal beauty. Scars in general are dynamic. This means that scars go through phases during which the visibility of the scar changes from more to less. During the first two months after a tummy tuck or liposuction, scars will usually have a certain amount of redness to them. This is called the inflammatory phase of wound healing. Following this, for up to a full year, the scars will fade more and more. It is important to note that healing of surgical incisions is very much an individual trait much like hair colour or skin tone. People will heal incisions and form scars differently even when undergoing the exact same surgery done by the same surgeon. As a rule, patients are so thrilled and excited by the dramatic flattening of their abdomens and the psychological lift that this provides that tummy tuck scars are quickly overlooked and ignored. Tummy Tuck Recovery. How Much Pain Will I Have? Following a tummy tuck, patients describe a major feeling of tightness around the abdomen. The discomfort is described as an intense muscle ache similar to the feeling after an aggressive abdominal workout. Dr. Backstein feels that the best tummy tucks will cause a certain amount of post operative discomfort. This is related to the extent of tightening that the surgeon has achieved. If a tummy tuck doesn't hurt at all, the abdomen was likely not tightened adequately. Swelling and bruising is always seen after a tummy tuck or liposuction. Dr. Backstein always provides supplemental liposuction to the upper abdominal area and love handles and bruising will be seen in these areas. Do I Need To Stay Overnight? Most patients are able to leave the hospital on the evening of the surgical day. Arrangements can always be made for patients to stay overnight if so desired. Although straining, heavy lifting and bending should be avoided, tummy tuck patients must start minimal walking and leg exercises the day of the surgery. Lying in bed for hours at a time is dangerous and must be avoided to minimize the risk of blood clots. When going to sleep, a couple of pillows under the knees and behind the head will act to ease the tension on the surgical incision and will help relieve discomfort. When Can I Return To Work? Patients with jobs that require significant physical activity including bending, lifting, or quick movement will need about 4 weeks off before being able to return to full duties comfortably. Those patients with jobs not demanding physical activity can return to work after 2 weeks. When Can I Work Out? Light work outs involving exercises that do not strain the surgical incision or the abdominal muscles can begin at 2-3 weeks. This includes brisk walking or stationary bike riding. Heavier work outs including abdominal crunches, sit-ups and running should not be attempted for about 1 month. Do I Need to Wear a Special Garment? Yes, tummy tuck patients should wear a compressive corset provided by Dr. Backstein for the first 3-4 weeks post plastic surgery. Complications Associated with Tummy Tucks. Significant complications following a tummy tuck are rare. This is very much related to the fact that a tummy tuck is a superficial cosmetic surgery focusing on the skin and fat and upper muscle layers and not involving major or vital organs. All potential tummy tuck complications will be reviewed with you in detail by Dr. Backstein during your initial consultation. These include: anesthesia side effects and complications infections post-operative bleeding incision separation blood clots slow healing areas Tummy Tuck: The Only Cure For Stretch Marks. One thing is abundantly clear about stretch marks and that is that absolutely no cream or topical ointments exist to remove them. Stretch marks are scars that occur within the substance of the skin when it is exposed to excessive stretching or shearing force. The abdominal area develops stretch marks during pregnancy due to the stretching of the skin by the growing fetus in the womb. Just as no cream exists to erase scars on the skin, none exists to eliminate stretch marks either although there are many products on the market that claim to do so. A tummy tuck will remove about 90% of stretch marks from the abdominal wall. As a rule of thumb, all the stretch marks below the level of the belly button will be removed with the large piece of skin and fat that is discarded during the tummy tuck surgery. Moreover, the stretch marks that are above the belly button get pulled far down on the abdomen, just above the pubic area as part of the tummy tuck procedure. This means that about 90% of your stretch marks are removed completely and the rest shift to a much less visible area. It truly is fair to say that tummy tuck surgery is the only cure for abdominal stretch marks. The Effects of Pregnancy On Tummy Tuck Surgery. It is all too clear that pregnancy induces unwanted changes in the abdominal area that often lead people to seeking surgical improvement. These pregnancy-induced changes include general weight gain, looseness and laxity of abdominal skin, and of course, stretch marks. A tummy tuck operation is the very best surgical procedure to dramatically improve all of the above mentioned changes of the abdominal region. Unfortunately, much of the improvement achieved through a tummy tuck can, at least in part, be diminished by the effects of subsequent pregnancy. It is important to remember that our bodies are dynamic and constantly changing. The beneficial effects of tummy tuck surgery are not "carved in stone", but need to be maintained. Pregnancy after a tummy tuck will lead to generalized weight gain, and stretching and distension of the abdominal wall as the baby grows in the womb. This will cause some degree of skin laxity and stretch marks similar to that present prior to the tummy tuck surgery.  Your tummy area will,however, still look better than it would have had you never undergone tummy tuck surgery. Exercise and Diet: Maintaining The Results of Your Cosmetic Surgery. The human body is dynamic and always in a state of change. No surgical procedure exists to reshape, recontour or tighten a body region that is absolutely permanent. The results of a tummy tuck and liposuction need to be maintained. A healthy lifestyle must be followed after surgery to maintain the dramatic flattening and tightness of the abdominal region that a tummy tuck or liposuction provides. Poor diet and sedentary lifestyle will, over time cause weight gain and skin stretching after tummy tuck surgery. Happily, the vast majority of patients find that after a tummy tuck or liposuction, they feel so good both mentally and physically that excercise and healthy eating become a welcome part of their post surgical lifestyle. Who is a Candidate for Liposuction? Liposuction is intended to treat localized fatty deposits that are out of proportion with your body as a whole. It should not be regarded as a weight loss technique but rather a body contouring procedure to remove fat collections that are resistant to exercise and dieting. Liposuction can be performed on many different body areas from the face to the arms, abdominal area, and legs. Liposuction is also an excellent approach to treating gynecomastia, a condition in which a man develops abnormally large breasts. Although it can be performed in all age groups, liposuction results are best in younger individuals with firm and elastic skin. In cases with good skin elasticity, the overlying skin will not become excessive or loose once liposuction has been performed. In patients whose skin has lost elasticity, other procedures such as a tummy tuck or thigh lift may be more appropriate. How Is Liposuction Performed? Liposuction can be performed either under local or general anesthesia. It is almost always a day surgery with no stay required. Typically, liposuction involves multiple small incisions which allow Dr. Backstein to first infiltrate each area with solution containing local anesthesia and a vasoconstrictor (to decrease bruising) and then to aspirate unwanted fatty deposits using a liposuction cannula. The duration of the procedure depends on the amount of fat that requires removal. Liposuction Recovery. How Much Pain Will I Have? Liposuction is typically not overly painful. Areas treated experience a dull ache that fades over the first 7- 10 days. Do I Need To Stay Overnight? Very few patients need to stay overnight unless they are from out of town or have no assistance at home. When Can I Return To Work? Patients can return to jobs requiring minimal physical activity after 3-7 days. Patients with more rigorous jobs may need 2 weeks off prior to resuming full duties When Can I Work Out? Work outs can begin as soon as you feel able and comfortable. This is usually after the first week following liposuction surgery. Do I Need to Wear a Special Garment? Yes, liposuction patients should wear a compressive garment provided by Dr. Backstein for the first 3-4 weeks post surgery. Complications Associated With Liposuction Plastic Surgery Unfortunately, liposuction has received somewhat of a bad rap in the media. When done properly by a qualified plastic surgeon, liposuction should be a safe procedure. Most of the "horror stories" that one hears about through the media are easily explained. These cases can usually be attributed to unqualified medical practioners trying there hand at liposuction or cases in which overzealous surgeons remove too much fat in a single liposuction procedure. Complications associated with liposuction include: bruising swelling blood clots irregularities in contour (1-5 of every 100 patients will need a minor touch up) During your consultation, Dr. Backstein will review the complications associated with liposuction in great detail. When done correctly, liposuction is a safe procedure with excellent body contouring results. Can Liposuction Remove Cellulite? Unfortunately, the answer is no. Contrary to popular belief, liposuction is not an effective treatment for cellulite. Cellulite is a dimpled appearance of the skin similar to the texture of an orange peel that is a result of fibrous attachiments of the underside of the skin to the underlying muscles. Cellulite is not only found in people that are over weight but is also seen in fit and slim individuals. Because cellulite is not a result of excess body fat, liposuction is not effective in treating it. In fact there is no proved treatment for cellulite. All of the creams and topical ointments advertised on television are of little to no use for treating cellulite. A more recent treatment called endermology attempts to treat cellulite using a roller/suction device but the results are highly questionable and likely not significant. In short, we don't have a very good treatment for the problem of cellulite. Liposuction should not be advertised to patients as a means to treat cellulite because it will not work. Factors To Consider With Breast Implant Surgery. There are several factors to think about prior to undergoing breast augmentation. These are: the type of implant to be used (saline or silicone), the incision, the plane of the implant (above or below the chest muscle) and of course the size of the implant. A relatively new issue that has arisen is the choice a woman has in Canada to use silicone or saline (salt water) implants. Silicone implants, prior to the 90's, were the implant most often used. In the early 90's controversy began to arise about the safety of silicone implants. There were links made between silicone implants and what we call connective tissue disease such as lupus, scleroderma, pain syndromes etc. The situation deteriorated to the point that silicone implants were essentially banned and saline became the only choice. In the last few years, silicone implants have made a big comeback here in Canada. The reason that this has been allowed to happen is that the excellent scientific research that was done to investigate the safety of silicone implants has found that there is NO relationship between silicone and connective tissue diseases. This is not to say that women who were complaining of being sick were not really sick, but that there was no cause and effect relationship between their silicone implants and their symptoms. What the studies found in essence was that the incidence of connective tissue disease was the same in groups of women who had and who did not have silicone implants. Unfortunately, it is human nature (and very reasonable) for a young woman who was previously healthy and then went on to develop disease to associate her new medical condition with silicone implants. What we know now is that this same woman was destined to fall into the larger group of women overall who are destined to develop the disease whether or not she had implants. Having said all of this, I by no means encourage or "push" silicone implants on my patients. I do not work for the company or get paid any royalties. In fact, I would encourage any woman struggling with the idea of putting silicone implants into her body to avoid them and use saline. Cosmetic surgery should be a positive, uplifting experience. A woman who will continuously worry about her silicone implants is still best off going with saline. The other side of the coin is that almost all plastic surgeons would agree that silicone implants are a better product in that they look and feel more like a natural breast. They are a better replica of the human breast and give a better esthetic result. At the end of the day, a woman along with her family must take all of this information into account and choose the implant type that is best for her. Techniques for  Breast Lifts. There are two main techniques to lift a sagging breast. These involve using a breast implant to "fill out" the loose skin of a drooping breast or surgical excision of extra breast skin and tissue to create a tighter, more youthful breast form. The advantage of using a breast implant to lift the breast is that the scarring left from the procedure is relatively minor, and no greater than when standard breast augmentation is performed for breast enlargement. A possible drawback of this technique is that the breast will, of course, become larger in the process of using an implant to lift it. To a certain extent, the degree of lift that is achieved is directly proportional to the size of the implant used. This means that a very sagging breast may need a substantial size implant to achieve significant lift and this, in turn, will also make the breast larger in volume. If a larger breast is not desired, the second breast lift method can be used. This is in some ways similar to a breast reduction surgery in which specific areas of breast skin and tissue are removed in such a way that when stitched, a lifting effect is created almost like an internal bra. The disadvantage of this technique is that more incisions are required and this translates into more scars left on the breast. Often a good compromise, is a combination of a smaller implant and a less extensive skin excision done at the same time. This technique will allow the surgeon to achieve excellent breast lift results while not enlarging the breast too much and also not leaving as much scarring as  a skin excision breast lift alone. Why Choose A  Qualified Cosmetic Plastic Surgeon? These days, there is a great deal of confusion about who is a cosmetic surgeon. When cosmetic surgery originated, it was exclusively performed by plastic surgeons. Plastic surgeons are physicians who have completed 5-7 years of additional training in the specialty of Plastic & Reconstructive Surgery. This specialty training is essentially an apprenticeship done under the supervision and guidance of senior plastic surgeons and encompasses many areas of surgery that fall within the realm of plastic surgery. These surgical areas include cancer surgery, burn surgery, trauma, as well as cosmetic surgery. In recent years , other medical specialties such as ENT surgeons, dermatologists, and even family physicians have begun performing cosmetic surgical procedures. Medical licensing boards in Canada and the United States generally do not prohibit any doctor from performing the surgical procedures of a cosmetic surgeon. This has lead to some confusion on the part of patients as to who is and who is not a certified cosmetic plastic surgeon. Furthermore, many doctors that are not plastic surgeons do not make this clear in their advertisements and marketing tools. ENT surgeons, also called facial plastic surgeons, are comprehensively trained in facial surgery and are qualified to perform these procedures as well as to deal with any complications encountered.  Other physicians who perform cosmetic surgery procedures may, in fact, not be plastic surgeons or surgeons at all. While complications can arise during or after cosmetic surgery no matter who performs the procedure, a certified cosmetic surgeon has a wealth of surgical training under his or her belt to efficiently deal with surgical complications such as bleeding, and post-operative infections. It is a patient’s right to know the precise qualifications of any surgeon who advertises him or herself as a cosmetic surgeon. Ask questions about training and background to ensure that your cosmetic surgeon is adequately trained in cosmetic surgery and not a physician who unilaterally decided to become a cosmetic surgeon years after their formal medical training was completed.       .