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Interview Transcript

Barb DiGiulio: So thrilled to have him back in the studio.  Dr. Stephen Mulholland is Canada’s top cosmetic plastic surgeon at SpaMedica and he is back to talk about a number of different things and the phone lines are open as well if you have any questions.  But first, welcome back.

Stephen Mulholland: Well happy new year, Barb and thank you.

Barb DiGiulio: Yes.  Yes it’s great to see you.  Things are, I trust, busy in the improvement industry.  I don’t know is that what you…

Stephen Mulholland: I would say it’s the self-enhancement facilitation industry [Laughs].  Yes indeed.  It has been the 6 weeks of leveraging people’s new year’s resolutions.

Barb DiGiulio: Is that right?  Yes.

Stephen Mulholland: I’m going to lose that love handle.  I’m going to make an effort to look 10 years younger than my chronological age.

Barb DiGiulio: We’ve talked a number of times when you’ve been here about really interesting things if people have that extra 10 pounds I guess around the midsection, things that can actually melt the fat.  Now, can those things be done instead of going to the gym or do they supplement going to the gym?

Stephen Mulholland: I think that’s a good term, supplement.  I think that I always encourage patients to diet and exercise and get your ideal body mass index and physique to where you’re comfortable, realistically within your lifestyle, and even at your ideal body weight 99% of all adult Canadians have that little annoying area, a pot or a love handle or some…

Barb DiGiulio: Do we all have that?

Stephen Mulholland: Yeah.  It’s a virtual certainty that at a certain age there’s going to be somewhat of a convex collection affectionately termed [Laughs] like a waddle or a dulap or a [Laughs] batwing and that’s where these technologies come in.  You know, we can…it’s the one time, for example, a product CoolSculpting is the only time that you’re glad you can actually freeze something in Canada [Laughs].  We can freeze your fat and kill it, without the risk of liposuction, with no downtime.  So, we’re good at melting 2 and killing 2 or 3 or 4 cm almost anywhere on the body…

Barb DiGiulio: Wow!

Stephen Mulholland: Without the need for liposuction.

Barb DiGiulio: And is that instant?

Stephen Mulholland: It is an instant.  So, it takes about an hour an area and then over 6 weeks the fat cells that have been traumatized with the hypothermic simulus [ph], via the engine of that cell turns off its light and quietly goes to sleep…

Barb DiGiulio: Wow!

Stephen Mulholland: And as it dies slowly the contents, those Big Macs and the McDonald’s french fries…

Barb DiGiulio: Yeah.

Stephen Mulholland: And they are gradually leached from the cell, safely metabolized by the body and about 6 weeks later your love handle or your pot or your double chin is a fraction of what it was.

Barb DiGiulio: Really!

Stephen Mulholland: Yeah.

Barb DiGiulio: And is it something that happens so slowly you can’t really…it’s not like you come in with a certain jean size and have to leave two sizes smaller.

Stephen Mulholland: No, so that’s sort of the modern versions of liposuction, SmartLipo, BodyTite and things like that in one hour _____ [00:02:47] you remove all the fat and within a week or two it’s gone and you see the flattening.  These non-surgical techniques work over about 6 weeks.  There is this…in the new year a new chemical released by Health Canada called Kybella in the United States and Belkyra here in Canada.  It’s a simple chemical injection in your double chin.  Similar to having Botox or Restylane or Juvederm and 6 weeks later your double chin is no more.

Barb DiGiulio: Really!

Stephen Mulholland: Yeah.  So, it’s an injectable double chin management technique.

Barb DiGiulio: So, what is the comparison between that and the surgery that people have to do for a double chin or choose to do for a double chin in terms of cost, in terms of recovery, in terms of all of that?

Stephen Mulholland: Yeah.  So, the Belkyra injection is a series of 1-3 injections for a modest double chin.  You know, if you have one of those chins that start in your lower lip and ends in your chest and then…

Barb DiGiulio: Is that considered a double chin?  I know what you mean.

Stephen Mulholland: That’s considered really a no chin and that’s usually a hereditary disposition of fat that needs to be surgically managed with lipo.  But for modest little, you know, pinch 2 or 3 inches, that little annoying double chin that has been accentuated by selfies.  You know…

Barb DiGiulio: Yes [Chuckles].

Stephen Mulholland:The double chin selfie and these chemicals work very well.  And, so, it’s about half the cost of liposuction.  There’s no downtime or risk.  You come in to a plastic surgeon or dermatologist’s office and you have your consult and as long as you don’t have too much loose skin it does a good job at taking 2 or 3 inches of a double chin and over one injection a month, often up to three injections, your double chin is gone forever.  So, it’s a simple, natural occurring chemical called a lecithin [ph] that lysis [ph] the cell membrane of your fat cell and allows it to just sleek [ph] like popping a balloon, a water balloon, it just leaks and your body safely metabolizes those chemicals.  So, that’s huge because double chins are everywhere.  Even if you’re in shape sometimes you have that little extra inch you don’t like and you’re not going to go under some sort of liposuction surgery and, so, this is Botox for fat basically.

Barb DiGiulio: (416) 872-1010.  If you have any questions for cosmetic plastic surgeon Dr. Stephen Mulholland you can text us your questions if you prefer at 71010.  You do a lot of teaching in terms of the procedures.  You’ve invented a lot of procedures and you teach a lot.  When new techniques like this one for the double chin when they come out, I mean is this sort of as you’re going along through the years you can see these things coming or do you ever get surprised by the next thing to come out?

Stephen Mulholland: Well, 20 years ago when I started I was often surprised because the regulatory control of a lot of these products was somewhat lacking and, so, something would come out of nowhere and then you’d wonder well was it adequately studied, but Health Canada has become much more rigorous FDA, the EU with the breast implant crisis in the 90s and other such products that have come to light.  Rarely does something come to market, a laser, an energy device or a chemical or an injectable or pharmaceutical without an intense amount of scrutiny and testing.  So, Canadians can feel comfortable that Health Canada is usually looking after their interests and ensuring that products like this are thoroughly tested before it ends up in the random double chin in Regina [Laughs].

Barb DiGuilio: Well, what do you do as a cosmetic surgeon to I guess educate yourself?  What do…everyone who does what you do when new products come out you have to be trained in them?

Stephen Mulholland: Yeah.  So, you would look at the literature, look at the peer reviewed studies, look at the what are called the AEs or adverse events and then the pharmaceutical company or the distribution arm of a capital equipment company would reach out and train interested doctors and you would become certified in that procedure and technique.  So, most of these things are not as complicated as or let’s say facelift surgery, so it doesn’t take years of residence to become certified.  Usually, it’s a hands-on course where you have some volunteers and you do the laser treatment or the chemical and the injectable treatment and if you’re already practicing the art of aesthetic medicine or plastic surgeon or dermatology it quickly becomes another paint…

Barb DiGiulio: Hmm, hmm.

Stephen Mulholland: In your easel and your paint brush, but let’s say you’re a physician who perhaps doesn’t know how to paint then it could be somewhat difficult.  And, so, you’ve got to buyer beware.  Make sure your physician is certified in the art of aesthetic medicine would be it a family doctor or dermatologist or plastic surgeon and they haven’t just decided oh, you know, I’m tired of seeing runny noses perhaps I’ll be injecting Botox _____ [00:07:25] [Laughs].

Barb DiGiulio: Well, let’s talk about that when we come back because I’m suddenly seeing…I’ll tell you honestly I’ve searched for dermatologists that deal with acne…

Stephen Mulholland: Hmm, hmm.

Barb DiGiulio: For one of my kids and I’ve all of a sudden everybody does fillers and injectables and let’s talk about that when we come back.  If you have any questions for Dr. Stephen Mulholland (416) 872-1010.  Text us a 71010.  He is one of Canada’s top cosmetic plastic surgeons.  He is with SpaMedica here in Toronto.  You can text us your questions.  I see a lot coming in.  71010 or (416) 872-1010.  It’s the Night Side at 9:16.  Welcome back to the Night Side.  Dr. Stephen Mulholland is here.  He is one of Canada’s leading cosmetic plastic surgeons.  The clinic is SpaMedica.  You are at Avenue Road and Bloor.

Stephen Mulholland: Avenue Road and Bloor.  Yeah 66 Avenue Road right across from Hazelton Lanes.

Barb DiGiulio: Oh very nice location.  I believe there’s a Whole Foods right there.

Stephen Mulholland: There is indeed.  My staff call it Whole Pay Cheque [Laughs].

Barb DiGiulio: Yeah.  No kidding.  (416) 872-1010.  You can text us at 71010.  A reminder you can always call in anonymously.  Don’t be afraid to do that because we’re getting tons of text messages and we are happy to answer questions on the text board, but if you want to call and speak directly to Dr. Mulholland, ask particular questions about procedures, costs, recovery time that is what he’s here for.  What do you normally charge for a consultation?

Stephen Mulholland: Well, in the medical spa, which is a non-invasive centre, the consultations are no charge.

Barb DiGiulio: Oh.

Stephen Mulholland: To see myself and undergo a surgical consultation, which is usually 45 minutes to an hour, it’s about $150.00 and then that is applied to any treatment that you might then have.

Barb DiGiulio: All right.  So, people can call in without having to put out $150.00 and get the advice from you right now.

Stephen Mulholland: They can indeed.  And, so, wow we should take online donations [Laughs].  

Barb DiGiulio: Yeah.  (416) 872-1010.  Okay let’s start with some of these tons of questions we’re getting on the text board.  Can one reduce fat without surgery taking Warfarin?

Stephen Mulholland: Yeah.  No, Warfarin is an anti-coagulant and, you know, there is some discussions about its effect on the fat cell, but it’s clinically insignificant, so the answer is no.  If you take the anti-coagulant Warfarin, Number 1 you put yourself at risk because your blood will be thin.  If you get a cut it won’t stop and you could bleed inside your cranium, you could have other bleed locations, so it would be very unsafe to take an unwanted trip for weight loss and it will not affect significantly your figure, shape and form.

Barb DiGiulio: Why do…is there some kind of urban myth out there that it does reduce fat?

Stephen Mulholland: Well, there’s a number of drugs like that thyroid, hormone, growth hormone, Warfarin where there are anecdotal reports of weight loss.  And, so, there is no as yet safe Health Canada approved medication to lose weight, you know, other than the willpower to keep your upper teeth opposed to your lower teeth [Laughs].

Barb DiGiulio: Yeah.  I know isn’t it…you know we all struggle with it, but it’s funny you just…I was hearing a show today about this diet and that diet and what diet worked for you and I’m thinking to myself we can’t always practice what we preach, but stop eating crap is the main diet that works.

Stephen Mulholland: We really do live in a fast food culture and because we’re busy and we tend to eat food that is not prepared and it’s not and, you know, grazing small amounts several times during the day with a nice healthy balanced of protein, complex carbohydrates and fats is a good way to and then minimize alcohol consumption of course.

Barb DiGiulio: Hmm and that might be a difficult thing for a lot of people.

Stephen Mulholland: Hmm, hmm.

Barb DiGiulio: (416) 872-1010.  Matt is on the line.  Hey, Matt welcome to the show.

Matt: Hey, Barb how are you?

Barb DiGiulio: Good.  Thank you.  Go ahead with Dr. Mulholland.

Matt:Thank you.  Quick question for you.  I’ve been back and forth in my weights for the last 10, 15 years.  I’ve lost 80 pounds so far.  I probably have about another 110 to go, but I know that I’m probably have to have excess skin removal, is there anything that I can do right now to make I guess help my skin bounce back to make it easier for surgery later?

Stephen Mulholland: That’s a good question, Matt and congratulations on the weight loss.

Matt: Thank you.

Stephen Mulholland: It’s always a tough journey and at the end of that amount of weight loss, massive amounts of weight loss the skin will take its toll not dissimilar to say a woman who’s had several pregnancies, the skin gets stretched and when it’s unstretched depending on your age its elastic recoil has suffered much like and elastic band being over stretched.  Now, there are some areas of the body following massive weight loss that, for example, the upper arms and the upper tummy and the neck we’re doing bulk heating radio frequency treatments with products that you’ll read about like the Venus Freeze…

Barb DiGiulio: Hmm, hmm.

Stephen Mulholland: Or Thermage or the Forma or BodyFx or Exilis.  These are non-invasive radio frequency treatments that are known after 6 sessions about 10 minutes in each area to make 20% more collagen.  So, if you have a marginal area after weight loss sometimes you don’t need excision.  You can sustain at that envelope with tightening and it’s kind of disheartening for a lot of massive weight loss patients because they look great after losing all that weight until, you know, they take of their shirt and they…

Barb DiGiulio: Yeah.

Stephen Mulholland: Say oh…or they have a lot of laxity and it reminds them of the weight that they had.  And, so, generally for massive weight loss patients that’s over 100 pounds of weight loss there’s going to be a serial set of excisions, most guys and women will start with their neck because you can’t hide that and then maybe the tummy and the arms and the inner thigh and after, you know, a series of skin removals you can get that envelope tight, matching the underlying fat content and hopefully muscle content you’ve built.

Barb DiGiulio: All right, Matt thanks a lot for the call.  (416) 872-1010.  We continue on with Dr. Stephen Mulholland, cosmetic plastic surgeon at SpaMedica and before we get back to the phones.  Hi, can you ask Dr. Mulholland where the SpaMedica staff gets such great uniforms.  I’ve been to their place; staff always looks so fantastic in their lab coats besides providing wonderful service.

Stephen Mulholland: Well, thank you very much.  That’s a nice comment and most of my staff have been with me for a very long time.  Average amount of times between 10 and 14 years and they search out constantly a uniformed look that is professional yet not dreary or drab or that speaks to the unhealth of being in a hospital environment.  So, generally they’ll wear black and I can’t remember the name of the company.  But it’s a Canadian company they purchase from, a uniform company and I try not to get involved in those kinds of human resources discussion [Chuckles] or I’m outvoted 28-1 [Laughs].

Barb DiGiulio: All right.  We’ve got an anonymous call for Dr. Mulholland.  Hi, welcome to the Night Side.

Anonymous: Hi, thanks for taking my call.

Barb DiGiulio: Sure.  Go ahead.

Anonymous: Actually, I just have a quick question.  I’m in my early 20s and a fried of mine and I have been thinking about getting lip injection.  Now, I’ve been researching it a little bit and I heard that if you have lip injections that after 5 or 6 months they start to deflate.  Is that actually true or does it just go back to your normal lips?

Stephen Mulholland: That’s a good question as it’s commonly asked.  Whether…let’s say you do a filler in your lip or your cheeks or your bridge of your nose will you get some sort of excessive atrophy over and beyond what you would have had would be horrifying and the answer is no.  In general, lip augmentation to enhance what was genetically given you, if it was deficient, gives you a nice enhancement and depending on the product it can last anywhere from 8-12 even 16 months depending on the product.  There’s a number of good products out there.

Anonymous: Okay.  What kind of product should I be looking for?

Stephen Mulholland: If this is your first time you might not want to try something that lasts for a year and a half, although the good news is if you stick to what I call the sugar gels or the Hyaluronic acid sugar family like Restylane, Perlane, Juvederm, Ultra Plus, Voluma, Volbella, TSL Kiss these are some of the more popular products.  If you don’t like it it can be enzymatically digested and adjusted so there is an antidote to a lip that you don’t like.  And, so, those are probably the 5 or 6 most common injectables.  Generally, it can be injected with a small microcannula, very little bruising.  There’s about swelling for the first 12 hours, so if you’re going to a wedding particularly your own, don’t do it the day of.

Barb DiGiulio: Hmm.

Stephen Mulholland: Plan ahead.  If you have a big event, even a date or if you want to post a selfie on Pinterest or Instagram [Laughs] or even Tinder don’t do it on the day of.  Give yourself a couple days for it to resolve.

Barb DiGiulio: All right thanks a lot for your call.  We’re going to continue on with the calls and you just reminded me of a funny story.  Someone I know had some kind of thing like that done and I think it was fillers in the cheeks and she had to take her passport picture that day and she said for 5 years I had to stare at this picture and I was swollen and it was just terrible.  (416) 872-1010.  Text us at 71010.  Dr. Stephen Mulholland is here.  If you’re on hold stay on the line we will get to your calls just as soon as we return.  You’re listening to the Night Side.  It’s 9:30.  Welcome back to the show.  Dr. Stephen Mulholland is here.  One of Canada’s top cosmetic plastic surgeons.  The clinic is SpaMedica and we’re taking your calls and I’m going to try to get to all of…we’ve got great, great questions on the text board.  (416) 872-1010.  Text us at 71010.  Susan is next.  Hi, Susan.  Welcome to the show.

Susan: Good evening.

Barb DiGiulio: Hi.

Susan: Great show.

Barb DiGiulio: Thank you.

Susan: Given that our skin textures differ from different parts of our body let’s say our face, our hands and our legs, for example, in harsh cold weather like this like we’re going to be coming in to, you know, one day where’s it’s going to be or one night where’s it’s going to be -30 something, 36, 38, what can we do especially in winter for our skin, face, hands, legs, you know, arms things like that?

Stephen Mulholland: Well, that’s a great question.

Barb DiGiulio:Hmm, hmm.

Stephen Mulholland: Because you’re exactly right.  The problems that you get in youth and age with exposed surfaces versus facial area.  Our facial area tends to be a little bit sebaceous, meaning you make sebum, a little oilier, little thicker than the back of your hands or the exposed parts of your neck or your chest.  And, so, in the winter months generally you still want to…do you want to have a cleanser, an exfoliant and a toner for your face and if you have sensitive skin you’re going to have sensitive skin products.  If you have acnea form acne type skin you’ll have acne products on top of that.  And then a good moisturize that has a little more of an emollient to it because you want a barrier between the harsh winter wind that we have in Toronto and in Canada in general.  And then for the hands and the neck and the chest it’s just so thin there’s no real significant oil glands that you really want to cover those up and it’s moisturizer, moisturizer, moisturizer and then, you know, for that 13 days that we get sunshine [Laughs] you want to always sun protect and remember even if in the winter the sun can burn and cause sun damage and aging and photo aging and skin cancer.  And, so, you know, if you happen to be skiing in the winter in Tremblant or out west you want to always make sure you’re wearing a 60 block even if it’s very cold out the sun and the UV light still can have damaging effects.

Barb DiGiulio: Are serums really the sort of miracle thing and for anyone who’s listening who doesn’t know they go under the moisturizer, right?  It’s like an oily product that you use under a moisturizer.

Stephen Mulholland: Yeah.  So, the serums have become a great way to deliver active ingredients in products that work and there’s some that a doctor has to prescribe and some you can get over-the-counter, but in general the antioxidants have been very popular and effective for some time especially Vitamin C.  Ascorbic acid excellent antioxidant and it scavenges up all the things going on in your skin that are nasty as a result of age or inflammatory effects of alcohol and smoking and pollution and sunrays.  And, so, there are serums that have Vitamin Cs and different types of chemicals and they will be a big part of a healthy profile.  And, in general, they are going to be purchased at the high-end counters of your department stores or through a dermatologist or plastic surgeon’s office.

Barb DiGiulio: All right, Greg is in Hamilton.  Hi, Greg.  Welcome to the Night Side.

Greg: Yeah thanks very much.  Good evening.

Barb DiGiulio: Good evening.  Go ahead with Dr. Mulholland.

Greg: Yeah I was just curious if there is anything, any procedures that can be…minimize dark circles, not bags, but circles under the eyes?

Stephen Mulholland: Dark circles, Greg are very common and dark circles can be bluish tinged or brown tinged.  And, so Mediterranean skin types, Greek, Italian, Mediterranean base in individuals, south east Indian tends to be brown or melanin based and we do have some lasers that will work on that type of melanin and we have lightening agents that can be prescribed, Hydroquinones and Kojic acids that will lighten, maybe never cure, but certainly control.  And then the other type are blue tinges and blue tinges are usually, if you stretch your lower lid down and look in the mirror you’ll see some vessels and it’s like a leg vein constellation you would get under the lower lid.  Again, we have some lasers that will work on those types of veins and sometimes the darkness is because you have a bag, which you don’t, but some do and the darkness of the shadow cast under the bag and sometimes a simple filler.  So, there’s many non-surgical ways you can minimize that look without having and resorting to Elton John sunglasses [Laughs].

Barb DiGiulio: Thank…

Greg: Well, that’s good.  I guess there’s hope then.

Stephen Mulholland: Well, there’s always hope [Chuckles].

Barb DiGiulio: There’s always hope.

Stephen Mulholland: Remember and for guys it doesn’t matter how we look it’s about power and money [Laughs].

Barb DiGiulio: It’s so true.  And you see, you know what’s funny, you see some children with dark circles so that’s just really…

Stephen Mulholland: Yeah.

Barb DiGiulio: The blood vessels.  Is that…

Stephen Mulholland: Blood vessels or melanin depending on the ethnicity and it’s [Laughs] just a lower lid sort of genetic colour curse.

Barb DiGiulio: Power and money, you guys are lucky that’s all you have to…we have to worry about the looks.

Stephen Mulholland: Oh not even that it’s a perception of power and money.

Barb DiGiulio: Okay.

Stephen Mulholland: You don’t even have to have it.

Barb DiGiulio: Oh that’s true, right?

Stephen Mulholland: Perception.

Barb DiGiulio: Okay.  Tons of great questions here on the text board.  Let me see where I have to begin.  Hi, Barb I’m in my last year of the 40s and I have had a small vertical line between the eyebrows that I would like removed, how many treatments would I need, cost and would it ever go away?  I’ve had this for at least 10 years, but want to treat myself for upcoming birthday.

Stephen Mulholland: Well, it’s a very common phenomenon and usually it starts as a Number 1 and within a few years becomes your 11s an those are the two lines you form between your brow and that’s also the frown lines and usually there’s a strong muscular cause for it on either side and that’s where Botox, a simple chemical injected into the muscle, very safe and it ceases to allow contraction and the frown line will smoothen.  If you start early enough in your 40s and sometimes even the 30s, I think one show a couple months ago I told you that in the last 10 years the average age of a Botox users have gone down 10 years.  So, young women and men will come in in their 30s now which I never saw in the 90s and they’ll be prophylactically treating this Number 11s or these lines because they saw their Mother had them and worked very hard to get rid of them and they just don’t want to form them.  So, if you stop the muscle moving early enough the line will never ever form.  Yes, you have to get Botox twice a year or three times a year, but you’ll never form it.  Now, if it’s very, very deep and it’s not a line, let’s say it looks like a crevice or fiord on Mount Everest that [Laughs] is very deep; you have to actually fill it.  And, so, you have to take…

Barb DiGiulio: Oh wow!

Stephen Mulholland: A filler and fill it and then use Botox to keep it smooth, but it is one of the most commonly treated areas.  It’s very safe and you have to be careful because it does emote.  When you have a frown line it says you’re angry…

Barb DiGiulio: Hmm. Stephen

Mulholland Now, if you’re a Mom of some young kids and you can’t frown and you’re going Johnny you’re making me very angry and your child sees no frown lines [Laughs] they’re going to have very mixed messages on how to deal with women in the future.  Or, if you’re a policeman or judge definitely a negative.

Barb DiGiulio: I’ve got this one.  I’m going to read it verbatim.  I think there was a spelling error on this next text message.  Anything important to know about breast enchantments [Laughs]?

Stephen Mulholland: Yes.  Well, enchantment breast procedures that’s…well…

Barb DiGiulio: I think we meant enhancements.

Stephen Mulholland: I think so.  Although a good enhancement can be enchanting.

Barb DiGiulio: It can be enchanting [Laughs].

Stephen Mulholland: And, so, I’m also presuming this is female and not male.  And, so, there are pec implants for men and they go under the muscle to make your chest look stronger and then there’s breast implants for women and they are usually to enhance projection and size and you can divide your implants into natural implants or artificial implants.  Natural implants would be fat grafting.  So, one of the more popular things if you want a ½ cup to a ¾ cup size improvement is to take fat where you’ve been saving it for a rainy day like your love handle and your thigh and harvest it safely, improve your figure down below and enhance the top and the nice thing about that it’s your own fat.  It’s not artificial, it’s never going to rupture, leak or cause a ripple and it’s a very popular technique.  Now, if you want a couple of sizes then it’s going to be a breast implant and by far the most common implant are the gummy bears or the gel implants and they come with a lifetime warranty, various shapes and sizes and nowadays we have 3D imaging machines, so you can stand in the imaging machine, it takes a picture of your naked torso and you hit a button and there’s that 180 gram implant, another button there’s 250 grams, so you can very accurately pick your shape so you can try before you buy.  So, gone are the days where women might be disappointed in her implant size selection because it’s become a very scientific and three-dimensional opportunity.

Barb DiGiulio: So, you mentioned about the men breasts and, so, men tend to not want to enhance their chest, what can men do?  It’s gynecomastia, right?

Stephen Mulholland: Gynecomastia or the dreaded moob, the man boob [Laughs]…

Barb DiGiulio: Yes.

Stephen Mulholland: And moobs are usually a collection of either glandular collection or overgrowth and that often you would want to look for hormonal imbalances or artificial sources of estrogen like eating way too much Kentucky Fried Chicken or even steroid substance you might use if you were bodybuilding, but it’s usually a hereditary thing, you get a little breast bud in adolescence and you get kind of an embarrassing little early breast formation and that can easily be treated with some advanced liposuction techniques and then for a lot of guys it’s just fat.  You know you get a bit chubby and you’ve got that 50 year old male pot and a love handle and a double chin and a little bit of breast tissue and the fatty tissue is also subject to techniques like BodyTite or SmartLipo where a simple outpatient treatment in an hour we can remove the fat, tighten the skin and, you know, you’re back to looking like a Marvel Superman [Laughs].

Barb DiGiulio: Dr. Stephen Mulholland is here.  We’ve got a few more minutes with him after the break.  (416) 872-1010.  Text us at 71010.  One of Canada’s leading cosmetic plastic surgeons.