Plastic Surgery Information/Plastic Surgery in Canada [Tuesday, June 09, 2009]
Choosing a Plastic Surgeon that is Right for
<>br> Sandra J. Freer

More and more Canadians are seeking plastic surgery for many reasons based on a combination of aesthetic, social, professional and emotional factors.

Along with the increase in popularity is the increase in concerns from the patients. The decision to undergo any type of elective surgery is extremely personal. They want to ensure how to select the most qualified plastic surgeon for their particular surgery.

The Canadian Society for Aesthetic Plastic Surgery (CSAPS) and the Canadian Society of Plastic Surgeons (CSPS) encourage Canadians to educate themselves before their trip to the plastic surgeon's office.

“As surgeons, we understand that it can be intimidating for many people considering plastic surgery to speak openly and honestly with their surgeon about the procedure and about the surgeon’s qualifications and experience, but we’re concerned to see that so many Canadians still go into a surgeon’s office undereducated and even misinformed,” said Dr.Yvan Larocque, President, Canadian Society for Aesthetic Plastic Surgery.

“We therefore felt it was important to speak out, and as leaders in the plastic surgery field, provide guidance for Canadians on how to find out more about their surgeon to ensure that they are speaking with someone who is qualified to perform the procedure”.

We asked Dr. Frank Lista and Dr. Richard Warren to share their knowledge for anyone seeking information on plastic surgery.

They encourage patients to “Ask questions, consult with more than one plastic surgeon, and check their credentials and specialty; so, you are able to make an informed personal decision.”

Like many fields, plastic surgery has undergone significant technological and conceptual changes in recent years. There are constantly new advances; which translate into a faster patient recovery and more natural appearing results. Education is an important part of the activity of these organizations both to the membership and to the general public. Annual scientific meetings are held to share knowledge and expertise in order to improve our quality of care and advance the practice of plastic surgery.

Dr. Frank Lista is often called upon to share his expertise with his peers, especially breast implant surgery techniques.

“All specialists are now required to maintain their competency; to keep their specialty certificate they are required to attend continuing medical education sessions. Patients should visit more than one surgeon for a personal consultation and research the surgeon’s specialty by visiting Although the College of Physicians and Surgeons verifies the surgeon’s medical license it doesn’t determine their specialty” explains Dr. Lista.

We all want to feel comfortable with the surgeon we choose and we want to feel that we can communicate openly and honestly with him or her.

“The relationship between patients and their plastic surgeon is very important, especially with surgeries requiring more technical skills like breast augmentation and liposuction. Our primary goal is to make sure that any Canadian who is seeking a cosmetic procedure is fully informed and is receiving the best standards of care by a certified surgeon,” said Dr. Achilleas Thoma, President, Canadian Society for Plastic Surgeons.

“Most importantly, patients need to feel comfortable talking with their physician, before and after surgery and we hope that by raising awareness of available tools that Canadians can use, we will achieve that and discard the myths that exist around plastic surgery.”

There are advertisements suggesting that breast implants have to be changed every 10 years and replaced with cohesive gel implants. We asked Dr. Lista and Dr. Warren their opinion on this confusing advertising message. We want to know why a woman would or should replace her implants, especially if she is absolutely okay.

“Any elective surgical procedure carries some risk. Problems and a higher rate of complications can incur when you introduce a second risk. There is no medical evidence to suggest that breast implants should be replaced if there are no problems.

Plus, there is a huge misconception that one implant is better than another. There is a difference in implants and a good surgeon uses whatever implant is right for that particular patient.” Dr. Lista further explains that he does not use just one supplier's brand or style of implant. “It depends on the patient”.

Just as important as your choice of surgeon is the comfort to know that your surgeon has the knowledge of several options for your personal surgery. We suggest that you ask your surgeon why he or she would chose a certain type of implant and what surgical technique is suggested for your own body type.

“There are basically two types of breast implants: saline and silicone. Saline implants can spring a leak and deflate - something which can only be corrected by having an operation to insert a new implant. I would not recommend unnecessary surgery to replace saline implants when there is nothing wrong with them.

However, older silicone implants like those banned in 1992 were often filled with a liquid form of silicone which could potentially leak and get into the surrounding tissue. There have been two main changes to silicone implants: a more durable shell (thicker and stronger), and the gel inside is cohesive, which means that if a crack develops in the shell, the gel will stick together, and not leak out like a liquid filler would.” explained Dr. Warren

Obviously we would want to know for sure before we would replace breast implants, but, is there a suggestion that women replace their cohesive gel implants, just in case?

Dr. Warren explained further that, “If the shell of a silicone gel filled implant is thought to be ruptured, most surgeons will recommend its replacement. However, it is difficult to determine if such a shell has become broken. Currently, the best means to detect a crack in the shell of a cohesive gel implant is with an MRI and that is not 100% accurate. Also, some surgeons feel that a cohesive gel implant with a crack in the shell may be left alone because the body creates a protective layer of scar tissue around any object. This thin layer, which is similar to Saran Wrap, will contain the gel if there has been disruption of the implant shell.”

Another surgical procedure we wanted clarification on was liposuction and the mixed opinions surrounding tumescent liposuction (does not always mean without general anesthetic).

“Tumescent is a technique used in liposuction where large volumes of dilute local anesthetic are injected into the fat. This method can be used with the patient awake or under general anesthetic. With local anesthetic there is a risk of xylocaine toxicity, because of the amount of xylocaine( local anesthetic) needed to inject while the patient is awake. General anesthetic has made significant advances; with new drugs and safety measures the patient is barely asleep.

Even with light anesthetic I ensure it is administered properly by an anesthetist with me during surgery to ensure safety and eliminating any toxicity concerns.”clarified Dr. Lista.

Problems and dissatisfaction can be minimized by fully understanding and having realistic expectations. It is extremely important to choose a surgeon who will clearly and thoroughly explain potential side effects and risks. He or she should also have proper and extensive training, along with an accredited facility.

Dr. Warren explained, “Unless you are doing liposuction on a small section at a time, most plastic surgeons believe a better result can be achieved if the patient is under general anesthetic. Certainly, if large or multiple areas of the body are to be done for a patient who is awake, it is difficult and potentially dangerous to achieve complete freezing of all areas because of the large amount local anesthetic which must be injected.

Based on the person’s weight, surgeons can calculate the maximum dosage of local anesthetic which can be given to any patient and determine if general anesthetic is in the patient’s best interest.”

A clear understanding of the qualifications of the surgeon you choose is imperative. He or she should also have proper and extensive training, along with an accredited surgical facility if not operating at a hospital. Check with to verify accreditation and regulations concerning a private surgical facility.

The aim of the Canadian Association for Accreditation of Ambulatory Surgery Facilities is threefold: To establish facility and equipment guidelines that facilities must meet before being accepted for membership; To designate appropriate qualifications for individuals working in an ambulatory surgical facilities; To ensure that these standards are maintained in the day-to-day operation of the facility

Canadians interested in plastic surgery should visit to find a qualified plastic surgeon and learn more about procedures including breast augmentation, liposuction and facelifts. A Canadian plastic surgeon is a well-trained, qualified specialist who has passed the Royal College of Physicians and Surgeons examinations and is certified to practice Plastic Surgery. The Canadian Society of Plastic Surgeons and the Canadian Society for Aesthetic Plastic Surgery are the Canadian organizations to which practicing plastic surgeons belong.

Bring questions and take notes during your consultation; decide if you feel at ease with the surgeon and the surgeon’s staff, the surgical facility and most importantly do you feel comfortable with the surgeon’s qualifications and experience?

Ask friends who have had plastic surgery or that may know someone who has. Check with your family physician, as this is also a reference point to see if he or she has seen any patients who may have had plastic surgery.

Typical questions you should ask during your consultation are: What happens if I have a problem after the surgery? Is there someone I can call 24/7? Is there a support person I can speak to if the surgeon is not available? Are there before and after pictures of previous patients that I can see?

After you have done your homework; the decision is…a personal choice.

Background on physicians quoted:

Dr.Yvan Larocque, MD, FRCSC, President, Canadian Society for Aesthetic Plastic Surgery Professor in Plastic Surgery at the University of Montreal

Dr. Frank Lista,MD, FRCSC Board certified specialist in plastic surgery in Canada and the United States. Medical Director of the Plastic Surgery Clinic, Mississauga Former Chief of Plastic Surgery at Trillium Health Centre (The Mississauga Hospital) for over 10 years. Founder and Past President of the Ontario Society of Plastic Surgeons. Past President of the Canadian Society of Aesthetic (Cosmetic) Plastic Surgery Chairman Canadian Association for Accreditation of Ambulatory Surgery

Dr. Achilleas Thoma, MD, MSc, FRCS(C), FACS President, Canadian Society for Plastic Surgeons Clinical Professor, Division of Plastic Surgery, McMaster University, Clinical Professor, Department of Surgery, an Associate Member of the Department of Clinical Epidemiology and Biostatistics Director of the Surgical Outcomes Research Center (SOURCE), McMaster University

Dr. Richard Warren,MD, FRCSC Clinical Professor of Plastic Surgery, University of British Columbia Public Relations Chairman, Canadian Society of Plastic Surgeons Medical Director of the Vancouver Plastic Surgery Center

Websites for your reference: