Toronto’s Nancy Nielsen could easily be on TV’s Extreme Makeover, the cosmetic surgery show that nips, tucks and tweaks bodies to unrecognizable perfection.

But Nielsen, who is almost 50 years of age, is a pioneer whose first fix-up, more than 15 years ago, was way before TV shows such as Extreme Makeover or The Swan took shape.

“Metamorphosis and the whole idea of people changing themselves has always fascinated me,” says Nielsen whose first cosmetic surgical experience was a complicated chin augmentation to correct her bite and to change her jaw line.

She liked the result so much she went back for more — 15 more surgeries, to be exact.

“I call myself the unofficial Canadian ombudsman for patient advocacy when it comes to plastic surgery,” says Nielsen whose company, Gray Communications, oversees a patient Web site and develops Web sites for North American plastic surgeons.

If there’s anyone who knows the nip and tuck business firsthand, it’s this woman whose other surgeries have included liposuction and a variety of “age-related” things.

“As a patient who has had almost everything done myself, I see an opportunity to educate people,” she says, explaining that while most doctors are reputable, most patients are totally in the dark as to what they’re getting into.

What’s extraordinary, really, is what she knows and the rest of us can barely fathom.

For instance, who knew that any doctor in Canada with a licence to practice medicine can practice cosmetic surgery? Or that the surgeon who may have performed your breast implant surgery may actually be trained in facial plastic surgery?

Just because plastic surgery is so, well, plastic, don’t consider it trivial: This week, the New York City medical examiner finally confirmed that author Olivia Goldsmith (she wrote The First Wives’ Club) died during a routine nip and tuck from complications of anesthesia. A few months ago, Canada’s Micheline Charest, the co-founder of Quebec’s Cinar Corp. died during her cosmetic surgery.

In her online Patient’s Guide 2001, there is plenty of info regarding what to look for in choosing a surgeon.

She recommends that cosmetic surgery be performed by a doctor with the appropriate specialty degree — in other words, a surgeon trained in nose jobs shouldn’t be your first choice for a tummy tuck.

Her guide recommends selecting a surgeon who has trained in plastic surgery, ENT/Otolaryngology or Ophthalmology and who devotes their entire practice to cosmetic/aesthetic surgery. Their entire practice! Relevant Canadian Web sites which list surgeons can be found at;; and, for laser specialists,

Plastic surgery is increasingly common now that the Boomers have passed 50.

“People are living longer,” says Nielsen. “When people only lived to age 50 it was not important if, for the last five years of your life, you started to look aged. But if you know that you may live to be 80 or 90 plus, many people are not thrilled at spending almost half their lives looking aged.”

According to Medicard, a Canadian medical procedure finance company, there were about 100,569 cosmetic surgical procedures performed on Canadians in 2003.

Ann Kaplan, CEO and president of Medicard, also attributes the increase to aging baby boomers. And it’s not just surgery that Canadians are after, says the entrepreneur.

Cosmetic enhancement treatments that include laser eye procedures (such as Lasik), injectable fillers such as Botox, and laser skin resurfacing are in demand — some of them (the injectable fillers, for example — a kind of medical Silly Putty) can easily fill in wrinkles and relax worry lines with a few jabs of the needle. Boob jobs? Nearly 17,000 Canadian women had their breasts “enhanced” in 2003. Anyone you know?

Medicard, which provides health-related financing packages, information and services to Canadians for elective medical procedures, is one way that Canadians pay for their looks (

Plastic surgery, after all, is not cheap and rarely covered by OHIP. It can run anywhere from about $400 for one Botox injection to $8,000 or more for a full face lift.

Thirty questions that you might ask a doctor during your first meeting are outlined in Nancy Nielsen’s Cosmetic Surgery Guide, available online for $15 at

They include asking the surgeon how many surgeries such as the one you’re interested in he or she performs each year (if your nose is the second nose job of her career, go elsewhere) to what kind of anesthetic will be used and will it be administered by a qualified anesthetist to when will the stitches and drains be removed.

Drains! Yes — and expect some pain, bruising, swelling and bandages. (By the way, this week the New England Journal Of Medicine published a study showing that sucking up all the fat in a tummy tuck does not decrease the risk of heart disease.)

One very important question stressed by Nielsen is this one: Is the place where the surgery will happen accredited by the Canadian Association for Accreditation of Ambulatory Surgical Facilities or CAAASF? Check out the CAAASF Web site at

“Don’t be gullible,” warns Nielsen. “In spite of the many things I’ve had done, I don’t want to give people the idea that surgery is something you enter into lightly.

“You would be a fool if you weren’t a little apprehensive.”