Breast augmentation in a body builder

we are now 3 months after the surgery and here are the results:


This patient had the thickest, strongest pectoral muscle I think I’ve ever operated on. The end result of placing the silicone round breast implant under the muscle through the areola turned out pretty nice. She has a nice shape and symmetry. Her pectoral muscles are not prominent even though they are sitting on top of the implant. She is now back to her normal life and will resume her upper body exercises shortly. I recommend a gently start. Start with lower weights and slow gently movement. No sudden jerks until the muscle is fully healed.

Christmas Party 2013

Last night we had our office Christmas party, organized by our expert on all things social, Rebecca.

Held at the Dyne restaurant on Avenue Rd in downtown Toronto, the staff got to sample some amazing food by Dyne’s amazing chef, appetizers, and drinks. The beef tartare was just amazing, as was everything else.
It was amazing to see how much we have grown since opening our new facility in the Royal York Hotel. And it is all thanks to our amazing team.

All the people that make Toronto Cosmetic Surgery Institute run. This is the team that works in the background making sure your visit to our clinic goes smoothly, safely, and that at the end of it all you walk away happy and smiling.

The second floor of Dyne Restaurant was reserved for our party (Dec 13, 2013)

Rebecca and Maggie

One of the three tables on the second floor of Dyne.

Facelift Surgery: Which Technique is the Best?

Facelift surgery is one of the most popular surgeries we perform. It is popular with our patients, and it is also our staff favourite procedure because of the dramatic results it can achieve.

There different ‘schools of thought’ on facelifts, and in Toronto you will find different surgeons performing different techniques. So how do you know which is the best facelift surgery? Who is the best facelift surgeon in Toronto?

Facelifts techniques range from ‘simple’ to ‘complex’. Simple facelift usually refers to a ‘skin only facelift’ where the surgeon simple tightens the face and neck skin. On the other side of the spectrum is the ‘deep facelift’, where the deepest layers of the face (facial muscles and something called the SMAS) are undermined and repositioned along with the facial skin. And there are many variations in between that move the skin and deeper layers to some degree.

So which is the best facelift technique? Would you guess that the “Deep Plane Facelift” would give you the best results? If you said yes, you would be wrong. Although it seems logical that the more complex and more extensive face lifting would give better results, a study performed in the US on twins disproved that theory. In this study four top plastic surgeons who specialize in facelift surgery performed a facelift. For each pair of twins, one twin had an extensive ‘deep’ facelift, and the other twin had a simple more superficial procedure. They were then followed for many years to see how they aged. What was found was that there was no real difference in the outcome. The simpler procedure resulted in a beautiful facelift that lasted as long as the more complicated procedure. All this without the complexity, risks, and a much longer recovery of the deep plane facelifts.

Dr. Jugenburg performs the ‘simple’ facelift technique and adds to it some muscle tightening, depending on each patients specific anatomy. Benefits of this approach are:
  • Shorter surgery
  • Minimal risk of bleeding
  • Minimal risk of nerve or muscle injury
  • Less pain, swelling and bruising
  • Much quicker recovery

See for yourself. Take a look at out photo gallery.


Abdominal muscle repair (diastasis repair)

Diastasis recti, or the abnormal separation of the abdominal rectus muscles is common after a pregnancy or after a significant intra-abdominal weight gain. Both these processes act to stretch the rectus muscles out and apart. Once this happens, there is no amount of exercise or physio that will bring them back together. When the separation is small, it has minimal effect on a woman’s body. However excessive separation can have functional impacts and cosmetic impacts. Functionally, the proper dynamics of the muscles are impaired leading to an abnormal strain on the back muscles and the spine, poor posture. Cosmetic impact is a protruding belly, which in extreme cases can make you look like you are pregnant.

The image below shows a relatively mild case of a muscle diastasis which was repaired during a tummy tuck surgery


This second patient shows a more severe diastasis and subsequent repair via a tummy tuck



To learn more about what we can do for you, call our office at 416-834-6640 (or fill our our contact form) to schedule an appointment with Dr. Jugenburg.

Facelift Frequently Asked Questions

Facelift FAQs

1. Who is a good candidate for a facelift?
Anyone with loose and lax facial and neck skin can benefit from this procedure. There is no particular age restriction for a facelift.

2. What kind of facelift is best?
The vast array of facelift techniques can be bewildering: deep plane, high SMAS, short scar, skin only, MACS lift, SMASectomy and the list goes on. The debate between a “Deep” facelift and a “Skin Only” facelift has been going on for years. Both can create beautiful results. Deep facelifts take a lot longer to heal and patients remain swollen for a longer time. A twin study where one twin had a deep plane facelift and the other twin had simpler facelift demonstrated that at two years after the surgery there was no visible difference between the quality of results.

It is more important to find the right surgeon than decide for yourself the right surgical technique. If you like the results of facelifts done by a certain surgeon, regardless of his or her technique, then you are on the road to obtaining the results you want.

Dr. Jugenburg intends to make patients look younger and more refreshed through minimally invasive superficial procedures rather than deep plane procedures. We find that these results have generate beautiful results for our patients while decreasing the downtime and significantly lowering the risk of complications.

3. How long does the surgery take, and what is the recovery time?
A basic facelift takes about 2-2.5 hours. If additional procedures are added, such as eyelid surgery, then the procedure length can take up to 3-3.5 hrs.

Patients' recovery times differ, but in general, noticeable swelling will go down within 5 to 7 days. Our patients often return to work in two weeks. To be sure you'll be at your best for special occasions, schedule surgery a month before the special event.

4. How will I look different?
Most patients look refreshed. A good facelift is one where the patients looks younger, not “operated on" as if nothing has been done beyond rest and relaxation. If you need an explanation... just say you came back from two weeks in a tropical paradise.

5. What should I look for in a plastic surgeon?
Many of us have seen facelifts gone wrong: patients who look perpetually surprised (eyebrows raised too high on the face), who’s their eyes are round and hollow following excess skin and neck fat removal. Other bad results include uneven or overdone necks, pixie earslobes or lower eyelids that merge unnaturally with overly flat and windswept cheeks.

How can you avoid these outcomes? Look carefully at a variety of patient examples from the surgeon you are considering. Look at their websites but also ask for additional photos of patients who have received facelifts so that you can be confident that you and your surgeon have the same understanding of how much will really change.

As with any procedure, ensure that a surgeon is certified by accredited medical boards such as the American Board of Plastic Surgery or the Royal College of Physicians and Surgeons of Canada. This guarantees that they have gone through a specific training program, examinations and requirements for recertification to avoid complications and make cosmetic surgery safe.

6. What are the risks?
Facelifts are safe if performed by a well-trained Plastic Surgeon. Like any surgery, facelift procedures carry some risks. Infection, bleeding, and abnormal scarring can occur but these are not common. Nerve injury is rare and usually temporary. Healing is usually uneventful unless a you are a smoker.

The incidence of these risks relate closely to the surgeon's skills. However, these remain small but real risks even in the best surgeon's operating room.

7. I want to lose a few pounds. Should I wait to have my facelift?
Loosing a few pounds will not make that much of a difference in results. If you plan to loose a large amount of weight (>30lb) then you should wait until your weight has fallen off and stabilized.

8. How long will the effects of a facelift last vs. fillers?

Fillers are temporary. So-called "liquid facelifts," were in vogue until it became clear that the result was too often a swollen, bloated appearance. Patients did not look younger -- they looked different.

On the other hand, a real facelift will last for years.

Note that although fillers are not the same as facelifts, they can be combined with facelifts to enhance the facelift results..

9. I've been considering another procedure (rhinoplasty, fillers, etc.). Should I do the procedure in conjunction with my facelift? If not, how should I prioritize?

It will depend upon the patient, but the most common procedure done with facelifts is eyelid surgery (blepharoplasty). In fact, these procedures are performed together more often than not.

When adding more procedures such as rhinoplasty (nose reshaping), the patient should understand that the additional procedure will add a bit more discomfort and perhaps lengthen recovery time. The well-trained plastic surgeon will arrive at a surgical menu that is safe and appropriate for each patient, and the best course of action is to consult with your surgeon to see what he or she recommends.

10. What is the difference between facelifts, upper and lower facelifts, mini-lifts, and neck lifts?

When plastic surgeons discuss facelifts among ourselves, we're referring to a procedure that has an impact on the cheeks, jowl and neck. It requires incisions placed in front of and behind the ear.

A neck lift addresses neck skin redundancy or deformity, and involves an incision behind the ear and usually beneath the chin.

Mini-lifts are usually done for patients who have relatively minor concerns about their cheeks and jowl. They are often done to refresh a face that has had a facelift before.

Upper and lower facelifts are usually scheduled together and are another way of saying "facelift."

What can I do to avoid ugly scars?

Scars are a normal part of surgery. Nobody wants to have visible large ugly scars and that is why Plastic Surgeons close all wound very meticulously, hide them in great hiding spots, and use help of scar - reducing treatments such as silicone-based dressings.

In our clinic we use Kelocote, a silicone based cream which is applied over a healing scar to minimize the scarring process. It helps to keep the scar from being raised and helps the colour to go away. A flat colourless scar is about as invisible as a scar can get.

Scars form when any human tissue is cut or injured. It is a normal response of the body which deposits collage to form a scar. Scars then go through a growth and remodelling phases. Massage, in addition to silicone based treatments are likely the best tool to fight unsightly scars.

400cc breast implants

400cc is the average size of breast implants in some clinics, while at other clinics the average size of breast implants is smaller. In Texas, we suspect, the average would be significantly larger but we don’t have any recent studies to support that hypothesis ;-)

What is a 400cc breast implant? What cup size will it give you? --- IT DEPENDS

Breast cup size is measured relative to the chest size. For a woman who is short and has a narrow chest a 400cc breast implant will create very large cup size. D or even DD cup size. Yet this very same implant on a woman who is tall and has a broader chest, this exact same implant may only produce a full B or a small C cup size. So the letter is not really important when choosing your breast implants. What really matters is what looks good on you. For that reason we have all shapes and sizes of breast implants in our clinic, including the 400cc implants. When our patients come in for a breast augmentation consultation, they are allowed to look at and feel any implant we have in our clinic. They are allowed to try them on to see what looks good on them. Ultimately, what you want is to look in a mirror and feel great about yourself, not worry whether or not a 400cc implant is too big, or whether a C or a D cup is what you want. Choosing the best breast implant can be nerve wracking. We can help you.

What cup size is good?

Cohesive gel breast implants

Cohesive gel breast implants is another name for silicone breast implants.
Cohesive gel means the silicone is in the form of a gel and the gel is very sticky, more solid than liquid. A gummy bear is more cohesive than Jello. In the same way, modern silicone breast implants are more cohesive than the older type of silicone breast implants. The downside of this change is that the implant feels a little harder. The up side is that the gel stays together and does not ‘leak out’ when a silicone breast implant ruptures. Another up side of the increased cohesiveness of the new silicone breast implants is that these implants have less rippling than the older type of implants. Allergan company has a new INSPIRA line of silicone breast implants which are more cohesive and more filled. Mentor has COHESIVE 1, 2, and 3 referring to increasing degree of cohesiveness. COHESIVE 3 is the most cohesive type of silicone and this is the true ‘gummy bear’ breast implant but this is found only in anatomic (tear drop shaped) breast implants. The Allergan company’s version of gummy bear shaped implants are called STYLE 410.

Cohesive silicone gel breast implants have been available in Canada since 2000.

Cohesive gel implants require a slightly larger incision for insertion compared to saline implants because they are more solid and more difficult to squeeze in through a small incision. . Because of this, insertion is usually performed through an incision in the fold under the breast or occasionally through an incision around the areola. Armpit incision is possible but only up to a certain size. The largest cohesive gel implant Dr. Jugenburg would place through an armpit incision would be 450cc.

Cohesive gel implants are more expensive than basic saline implants and this explains the difference in the surgical fee of gel vs saline breast augmentation.

If you are curious about cohesive gel implants and breast augmentation, your next step would be to schedule an appointment with Dr. Jugenburg at our downtown Toronto location. During your consultation Dr. Jugenburg will go over the details of breast augmentation surgery with you and also show you actual cohesive gel implants. You will be able hold them and see how they feel, as well as try on different implant sizes and shape to see which one you like best.


Dual Plane Breast Augmentation

Dual Plane Breast Augmentation is a method where the breast implant is placed under the pectoral muscle, but the lower part of the breast implant is sticking out and is not covered by the muscle. This is done by releasing the pectoral muscle insertion to the ribcage to allow the breast implant to sit below the muscle insertion. This is because for many women, their breast hang lower and should the pectoral muscle not be release, the implant would be forced to sit too high and a potential double bubble would be formed.

Releasing the pectoral muscle can be done in a different number of ways, and an article in the Plastic and Reconstructive Journal (April 2001) by Dr. Tebbetts describes the three different types of dual plane breast augmentations, as demonstrated by the graphic below.
Screen Shot 2013-11-30 at 10.43.06 PM

Which type is best for you? That depends on how much your breast hang on your chest, how much glandular breast tissue you have and also whether or not the breast tissue sitting on top pectoral muscle needs to be repositioned relative to the pec. Dr. Jugenburg will examine you and explain to you which type will give you the best results.

To find out more, schedule your consultation by calling 416-834-6640 or click here

Double Bubble breast deformity

The double bubble is a possible complication of breast augmentation. Patients have what appear to be two parallel breast folds along the lower pole of the breast. The upper fold represents the original breast fold. The lower fold represents the implant outline when the implant is sitting below the original breast fold. In another words, you have one ‘bubble’ of the original breast, and a second ‘bubble’ of the implant. When the implant and the breast are not aligned, these two ‘bubble’s are two instead of one ant that does not look appealing.

A recent article in the Journal of Plastic and Reconstructive Surgery (Dec 2013 issue) addressed this issue and described how to correct this problem.

This image (taken from the article by Dr. Handel) demonstrates the double bubble. The inframammary fold has been released and the breast implant has slipped down below the level of the original breast fold. As the illustration shows, now you have to folds, a double bubble.
The treatment described by Dr. Handel is to release the constricting bands that keep the original fold and stretching of the skin. However when the double bubble fold is because of a prominent breast glandular tissue sitting on top of the breast implant, the treatment is to remove this hard, non-malleable tissue. In my experience, this breast shaping technique has been very effective in addressing the glandular cause of a double bubble.

In situations when the double bubble happens because of bottoming out, the treatment is to repair the breast fold and reposition the breast implant.
When the source of a double bubble is capsular contracture, the treatment is to remove the contracture and soften the breasts.

If you think you may have a double bubble, contact our office for an assessment at 416-834-6640 or click here