Frequently Asked Questions

Many of our patients prefer not to have their photos posted on the internet. We only post photos if our patients give us consent to do so.

Yes. Dr. Pirani is a board certified plastic surgeon. In addition to being a plastic surgeon, he is one of only a few plastic surgeons in Toronto with formal fellowship training in cosmetic plastic surgery. This means that after becoming a plastic surgeon, Dr. Pirani then did further training in cosmetic plastic surgery above and beyond that taught to most plastic surgeons.

Don’t automatically choose the surgeon with the lowest price. Newer surgeons with less experience often charge less when they first start out. Similarly, non-plastic surgeons may charge less. The geographical area you are in may also play a role in pricing.

This is a personal choice. In Canada, it is important to choose a surgeon that is board certified by the Royal College of Physicians and Surgeons of Canada. Surgeons with this certification will have the FRCSC designation after their name.

It is important that you understand who your surgeon is, and what kind of surgeon they are. The term “Facial Plastic Surgeon” usually refers to ENT (Ear, Nose, and Throat) surgeons, not plastic surgeons. Similarly, a “cosmetic surgeon” is not necessarily a plastic surgeon. General surgeons can use that term. “Cosmetic physician” is a term often used by GPs and family physicians.

Fat repositioning is an excellent and very valuable tool. It is very common. In the right patient, it can produce excellent results.

You should only stop these medications if your physician says that it is safe to do so. I prefer that my patients be off of these medications for 2-3 weeks pre-op.

I generally recommend getting Botox 3-4 weeks before your wedding. This will allow time for any touch-ups that may be needed.

A recent trend is for patients to come in for prophylactic Botox. The idea behind this is to prevent lines and wrinkles from developing in the first place. It is a proactive approach that is increasingly popular.

It can take up to 2 weeks to see the complete effect of your Botox injections.

Yes, Botox can be used to decrease the appearance of your gums when you smile.

In a Botox Brow Lift, the muscles that depress the brow are inactivated so that the frontalis muscle which elevates the brow is unopposed. This results in an elevated brow.

Yes, Botox can be used to inject the masseter muscles (jaw muscles) to decrease facial width.

In general, the results will last 3-4 months. As you use Botox more, the frequency may decrease. Botox used for hyperhidrosis may last longer (6-9 months).

This will vary greatly by the location and who is doing the injections. Dr. Pirani performs all Botox injections himself. As a board certified plastic surgeon, Dr. Pirani charges $14 per unit.

This is always a difficult decision for some. In my opinion, the best thing to do is have a thorough sizing session. I provide my patients with a range of about 3-4 implants that are appropriate for their specific measurements. I then have them try these implants on in a special sizing bra. With this process, my patients have been able to choose their own implants. I have found this to be the best method for implant sizing. Your surgeon should be willing to spend the time with you doing this.

There are surgeons that will do awake surgery for breast augmentations, but I do not. Most surgeons in North America do not offer awake breast augmentation surgery. There may be a cost advantage to being awake; however, I believe that the safety and comfort of my patients is paramount. Accordingly, I prefer to have my patients asleep for breast augmentation surgery.

The pocket refers to the space that is created for the implant to be inserted into. We have to create a space in which to place the implant – that’s the pocket.

There is no way to guarantee a particular bra size. Bra sizing varies greatly between bra manufacturers and a C in one bra will be a D in another. What matters more than the assigned bra size is the way the implants look on you. The best option for your body and aesthetic goals can be determined in a thorough implant sizing session.

Implant sizing depends on several factors. One of the most important factors is your breast width. Generally, your surgeon will measure your breast width, and then provide you with a range of implant sizes appropriate for your native breast size. There are more nuances to it than just what I’ve described, but this approach works for most women.

I usually have my patients bring in a large bra and a tight t-shirt to do sizing. I’ll then choose 3-4 implants that I feel are appropriate, and have my patients place them in the bra under the tight t-shirt. My patients can then look in the mirror and get a good sense of what they will look like with the provided implant sizes. My patients like this approach and get a great idea of how they will look.

By using this technique, I can outline a range of appropriate implant sizes that will be aesthetically pleasing, and you make the final decision.

I don’t know of any proven methods that don’t involve surgery. Be careful of any products promising natural breast enhancement.

Silicone/cohesive gel implants will run somewhere between $7000-$9000 in most cases. Saline implants are usually a few hundred dollars less. The size of your implants rarely impacts the price.

There are several things to consider when deciding on which incision you use to perform your surgery. Cosmesis and the resulting scar are certainly an important consideration. Another consideration is the risk for capsular contracture. When a foreign body is placed in the body, the body reacts by forming a capsule of tissue around the foreign body. In the case of breast implants, this capsule can be soft or it can become hard and even painful. They can even distort the implant and result in poor cosmesis. This is termed a capsular contracture, and the rates of these can be quite high, depending on implant choices and incision type.

Recent evidence seems to indicate that there are higher rates of capsular contracture with peri-areolar (nipple) incisions. Using an incision in the fold under your breasts (IMF incision or inframammary fold incision) seems to be associated with the lowest rates of capsular contracture. The cosmesis of this incision is also ideal as it is hidden under your breasts. Armpit incisions have the potential of being seen every time you lift your arms.

The IMF incision also provides the surgeon with the best approach to perfect your implant pocket, alter the IMF if needed, and obtain hemostasis. Much of the armpit approach involves blind and blunt dissection.

Sleeping on your back is your best option in the early post-operative period. Sleeping on your side is your next best option. I tell my patients that sleep will be an issue in the first few weeks after breast augmentation surgery, as you now have two weights on your chest which can make it more difficult to fall asleep.

In general, my post-operative surgical bra guidelines are based on the following:

If I want the implant to drop (usually after a subpectoral or under the muscle augmentation), I have my patients go without a bra. I may also use a bandeau which pushes the implants down. This is because implants tend to ride high in the first few weeks after a subpectoral augmentation, and I want to get my patients to the final cosmetic result as soon as possible.

If I have inserted an implant in either the subfascial or subglandular space, I usually have patients wear a surgical bra, as I don’t want the implants to drop or distort the position of the IMF. The IMF is the fold under the breast (inframammary fold).

In cases where I have altered the IMF position for symmetry purposes, I will have patients wear an underwire bra to help define the new IMF.

• Submuscular = the implant is COMPLETELY under the muscle with no release of the muscle (rarely done).
• Subpectoral = the implant is placed under the pectoralis major muscle, with the inferior edge of the muscle released so that the lower portion of the implant is covered by gland. This is what most people refer to as “submuscular”; however, they are technically incorrect. A classical subpectoral placement is the same as a Dual Plane I.
• Dual Plane = a form of subpectoral implantation with varying degrees of muscle release/separation from the gland in order to vary the amount of muscle/gland coverage ratio.  Dual Plane is a form of under the muscle or subpectoral placement.

As for scars, I tell patients it will take a year to see the absolute final result. Practically, however, by 3-6 months the scar will be very close to the final result. I suggest 3M paper taping combined with a silicone ointment that I provide. I use a specific scar massage protocol to help speed scar resolution in my patients.

The literature would indicate that there is a 15% chance of losing sensation to your nipple-areolar complex. Having said that, I think the numbers in the literature are very high. I certainly haven’t had this problem with my augmentation surgery.

Although the rates of sensation loss may be as high as 15%, a significant proportion of these cases will be temporary. It all depends on the degree of injury to the nerves that provide sensation to your nipple. If the nerves are just bruised (neuropraxia), your sensation should return within 6-12 weeks. Increased sensation or hypersensitivity is also a possibility.

When I perform a breast augmentation, I’m very careful when dissecting the lateral pocket. This is where the main nerve(s) supplying your nipple are located.

My experience has been that there is a huge variation in the amount of time needed off from work. I have patients that go back to work the next day (against my advice), and I have had patients take as much as 2 weeks off from work. It really depends on what you do for work, and how you feel. As for taking care of your kids, if your implant is placed under the muscle, it will be a few weeks before you feel comfortable enough to pick them up.

Recovery really depends on a few factors. Adequate pain control is likely the most important. Individual pain tolerances differ greatly. I find that women who have had children generally have less post-op pain, as they have a much higher pain tolerance. From a surgical point of view, there are several things the surgeon/anaesthesiologist can do to decrease your post-op pain.

I generally perform breast blocks prior to making any incisions with a mix of short- and long-acting local anaesthetics. I have found this greatly reduces post-op pain. I also encourage patients to take the prescribed pain killers regularly every 4 hours especially for the first 24-48 hours. If you don’t stay on top of the pain in the immediate post-operative period, it is extremely difficult to “catch-up”. Most of my patients experience very little post-op pain after their breast augmentation surgery.

Of course, the type of breast augmentation you have will also determine your post-operative discomfort. Larger implants, and subpectoral implant placement will also increase post-op discomfort. This doesn’t mean you shouldn’t get large implants, or place them under the muscle – you simply need to know what to expect. Many women also experience difficulty with sleeping in the first few weeks after augmentation due to the weight of the implants on their chest. This is more significant in back-sleepers.

Every case is unique, but in general 50-80% of the transferred or grafted fat will survive.

It really depends on how much fat you have available to transfer, the elasticity of your skin, and how big you want to go. More than one surgery may be needed. The best way to get specific answers for your body and your goals is to see a board certified plastic surgeon in your area for a customized and personal consultation.

Unfortunately, no. You cannot use someone else’s fat to augment your breasts as your body will reject it.

Yes, fat grafting the breasts is an accepted method of augmenting the breasts. Using fat grafting with the BRAVA device should enhance the results. Several sessions of fat grafting are required to obtain final volumes, with the number of sessions depending on the amount of augmentation required.

Yes, you can get a breast lift (mastopexy) without implants. You should only receive an implant if you want larger breasts. Some surgeons will use implants to fill out the upper pole of the breast at the same time as a mastopexy. This, however, can be accomplished without an implant by rearranging the breast tissue if you have enough tissue.

The best way is to choose a surgeon that has shown you pictures of their facelifts, and judge the appearance of these results. The wind-swept appearance occurs from placing the skin on too much stretch. We now know that the skin on the face is not the main cause of jowls and the descent of youthful facial features. The problem is with the underlying layer of tissue known as the SMAS (superficial musculoaponeurotic system).

Most of the lift obtained in a modern facelift is achieved by raising the SMAS. This can be done by either creating a flap in this layer of tissue and re-draping it, or by using sutures to tighten this layer. Regardless of the specific technique used, addressing the SMAS is the key factor in achieving ideal cosmesis in a modern facelift. Once the SMAS has been addressed, the facial skin can then be re-draped, and a minimal amount of skin can be removed. The skin should be inset with very little to no tension. This avoids the wind-swept appearance, and improves scar healing.

The answer depends on the type of facelift performed. In my opinion, the longest longevity is achieved with facelifts that address not only the skin, but more importantly the muscular layer of tissue beneath the skin (SMAS layer). SMAS stands for superficial musculoaponeurotic system. This layer of tissue is responsible for the age related changes we see in the midface/neck/jaw. By raising this layer and repositioning it, a long-lasting facelift can be achieved. I would expect the results of such a facelift to last up to 8-10 years. Of course, everyone is different. Sun-loving smokers may not experience such lasting effects.

I think the best facelift for a smoker is NO facelift. The risk of skin necrosis is too high. At the very least, you should be able to stop smoking for 4 weeks before and after a facelift.

A certain amount of bruising is to be expected. Bruising is called ecchymosis. A hematoma is different – it’s an actual collection of blood that forms. In the case of a facelift, hematomas are less likely than ecchymosis. There are several factors that can affect whether you develop a hematoma after a facelift:

• Surgical technique – Your surgeon must be meticulous about obtaining hemostasis intra-operatively.
• Your Biology – if you have a coagulopathy, or are taking blood thinners, or are naturally predisposed to bleed more (red-heads), you have a higher chance of developing a hematoma.
• Hypertension – an elevated blood pressure in the peri-operative period can cause a previously occluded vessel to dislodge a clot and bleed, thus, resulting in a hematoma. Medications such as clonidine can be given in the peri-operative period to keep your blood pressure low. I usually admit by facelift patients overnight and have a nurse monitor their blood pressure.
• Dressings/Drains – although there isn’t any good evidence for this, many surgeons will use drains at least overnight to prevent any pooling of blood. Some surgeons will also apply a compressive dressing around your head to prevent bleeding.
• As for bruising, I think Arnica has helped reduce the amount of bruising my patients have after surgery. This is certainly not scientifically proven, and not essential.

The surgical technique for facelifts are very similar for men and women. Men often bleed more and their skin/soft tissues are thicker, but otherwise the actual techniques are the same. Sideburn management is also slightly different in regards to incision placement in men, but that’s a minor part of the surgery.

In my practice, I allow patients to dye their hair 6 weeks after all of the incisions have healed. If done earlier, you run the risk of tattooing your incision lines. In my opinion, it’s not worth the risk to dye your hair earlier.

They are still performed but if you want a long-lasting improvement then I prefer to tighten the underlying muscle layer (SMAS). The traditional skin only facelift is rarely used today.

The price can vary greatly depending on your geographical location and the skill/credentials of your surgeon. In Toronto, it can easily cost anywhere from $9500 to $20,000 which is a large range.

It varies greatly from patient to patient but I usually tell my patients that most of the swelling and bruising will resolve within 10 days. Some residual bruising and swelling can last longer, even up to 4-6 weeks post surgery. I usually recommend Arnica Montana to help with this.

The use of fillers has not been approved during pregnancy. It’s not worth the risk.

We can use something called a microcannula. It looks like a needle, but is blunt-tipped. We believe this decreases the chance of hitting a vessel, thus, reducing the risk of bruising.

Currently, liposuction for gynecomastia is not covered by OHIP.

What is the limit to how much fat can be removed in one session?

Most common liposuction procedures cost around $5000-$7000 but it depends on how much needs to be suctioned, etc. The only way to know for sure is to see a plastic surgeon in person for a consultation.