May 14th, 2012
Before chin implant
After chin implant
According to the American Society of Plastic Surgeons, the chin implant (genioplasty) is the fastest growing cosmetic plastic surgery procedure. The increase from 2010 to 2011 was an amazing 71%, with almost an equal amount of men and women. Chin augmentation even has a new trendy name, the “chinplant”.
Evidence suggests that video chatting may be the reason for the increase of the procedure. With the popularity of Skype and Face Time, people are now seeing themselves while talking. It is one thing to see a picture of yourself, but rarely before would you see yourself talking. Many are not happy with what they see, with the head tilted downward, the chin and neck tends to double up. The chin and jaw line are among the first areas to show signs of aging. The silicone chin implant extends the chin which pulls the skin of the neck tighter giving it a thinner look.
The procedure tends to make a dramatic but subtle improvement. Friends and family may notice an improvement but can’t really identify what the change is.
The increase in chin augmentation procedures is more than the increase in breast augmentation, Botox and liposuction combined. For more information on chin implant surgery, see the blog dated January 31, 2012
Before chin implant
After chin implant
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April 4th, 2012
When to have a facelift(also known as a rhytidectomy) is a very popular question among San Francisco Bay Area patients. The short answer is when you feel ready. There isn’t a particular timeline because there are many variables to consider such as:
• The elasticity of the skin
For some patients they may start noticing the skin in the jowls and neck are starting to sag. This is usually the most disturbing condition that prompts many to seek solutions. The sagging of the skin is not age specific, for some it can start as early as the mid thirties and for some fortunate ones maybe not until their fifties! This is more of a genetic issue and not something you can control.
• The condition of the skin
This is something that is part heredity but how the patient cares for their skin can make a big difference. Being very careful in the sun from an early age is important. Sunburns can do a lot of damage but usually do not show up until later in life. Using sun screen, hats and sunglasses is recommended. There are many good skin care products on the market that can help keep the skin clean and moisturized. Drinking lots of water will help keep skin hydrated.
• Patient’s mental attitude
Deciding to have a facelift is very personal, for those who just are not sure if they are ready should wait. But if someone is determined and if their surgeon is in agreement there is no reason not to proceed and age should not be a factor.
• Expectations and desires
Everyone wants perfection, including the surgeon, but that is not realistic or possible. Having good communication with the surgeon is very important so that a patient understands what to expect from the results of the surgery. Many times patients only want to correct what is bothering them such as the neck. This can make the rest of the face look unnatural having one area youthful and another area aged. Having facial harmony is the ideal and experienced Board Certified Plastic Surgeons will explain this to their patients. Patients must consider downtime for recovery, risks from surgery and costs.
• Finding the right surgeon
An experienced facial plastic surgeon will be able to guide the patient in making the right decision as to when they are ready for surgery by asking all these important questions. Seek out a Board Certified Plastic Surgeon who specializes in facelifts and be sure to see many before and after pictures of the surgeon’s patients. It is reasonable to ask to speak to patients of the surgeon to hear first hand of their surgical experience.
For the patient that wants to start early, they will find that their results are more subtle leaving them with a refreshed look. This is the preference of many who wish to keep their surgery unobvious and having revisions or secondary surgery later when things start to relax in order to continue to look great. But some patients want to delay as long as possible not minding a more dramatic look as they only want to have surgery once. There isn’t a right or wrong answer; it is what the patient feels most comfortable with.
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March 27th, 2012
Many San Francisco Bay Area patients are concerned about the safety of their rhytidectomy( face lift) surgery. If it is an elective procedure, how much of a risk is it? With tremendous advancements in medicine and anesthesia the risk factor for all surgical procedures is greatly reduced.
The greatest risks for face lift surgery which is the same for most surgical procedures include:
• Bleeding (hematoma)
During recovery it is possible a hematoma may form. A hematoma is when blood collects under the skin with increasing swelling and pressure. In most cases the surgeon would insert a tube to remove excess blood. Typically a hematoma will not impact the result of the surgery. The likelihood of this risk is only about 1% to 5%.
• Infection
Infection from a facelift is rare. Patients are placed on antibiotics before, during and after surgery. Having surgery in a private surgery center such as Dr. Delgado’s “Marin Cosmetic Surgery Center” greatly reduces exposure to infection due to the limited amount of patients, staff, and strict quality control.
MARIN COSMETIC SURGERY CENTER
• Blood Clots – Deep Vein Thrombosis (DVT)
Air travel, inactivity and other conditions may increase the incidence of blood clots. The use of compression stockings can help prevent clots from forming in the veins of the leg.
• Neurological Dysfunction (nerve injury)
After face lift surgery it is very common to experience numbness around the neck and ears. This will improve over the course of a few months as the nerve branches grow back. If a nerve branch is severed during a face lift procedure, permanent interference with muscle animation of the face can occur. In choosing a well qualified Board Certified Plastic Surgeon this complication is extremely rare.
• Anesthesia Complications
Today anesthesia is remarkably safe, there have been dramatic improvements in anesthetic medications, technology and training. The anesthesiologist begins with a thorough pre-operative evaluation checking a patient’s medicalcondition and history. During surgery the anesthesiologist uses several different drugs that are individualized for each patient taking into consideration a patients age and weight among other factors. Having Board Certified
DR. RANDY GAYNOR, ANESTHESIOLOGIST
Anesthesiologist, Dr. Randy Gaynor at Marin Cosmetic Surgery Center insures the patient is getting optimal care.
• Loss of Hair at Incision Site
It is possible to have some hair loss on the areas where the incisions are. Dr. Delgado is very precise in making incisions in natural folds of skin where there may not be hair to cover it.
• Asymmetry (unevenness between the two sides of the face)
Swelling can temporarily make the face look uneven; choosing an experienced Board Certified Plastic surgeon will greatly reduce any likelihood of permanent asymmetry.
There are many things that a patient can do to prepare for face lift surgery, see the blog on our main surgery site here.
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February 21st, 2012
PIP BREAST IMPLANT
In a Press Release dated January 17, 2012, Dr. Delgado explains the dangers of the French made Poly Implant Prosthese(PIP) breast implants. Starting in 2001 the manufacturer was using industrial grade silicone instead of medical grade for their gel breast implants. Use of industrial grade silicone makes them more prone to rupture and leakage.
The news media carried many stories starting in December 2011 warning women of the potential danger. Many countries recommended women to have the PIP implants removed, but some countries only recommend that women seek the advice of their doctor. Dr. Delgado points out that the American Society for Aesthetic Plastic Surgery (ASAPS) recommends that women with PIP implants have them removed.
For women in the United States, silicone implants were not available from 1992 to 2006 due to possible health issues but when they were proved safe, the FDA once again approved them. However PIP silicone implants were never approved for sale in the United States and therefore would not have been implanted in any American women unless they had breast augmentation surgery outside of the U.S. Dr. Delgado recommends that all women know; the size, manufacturer and if their implants are saline or silicone.
It is believed there are at least 40,000 women in the U.K. that have PIP silicone implants. Britain set up an expert committee to examine specific risks associated with the implants and to date they have concluded that if a woman is not having any symptoms that there is not enough evidence to recommend early removal. However the government is offering for women to have removal and replacement if they have PIP implants at no charge if the patient had the surgery by the National Health Service (NHS) ¸who routinely does reconstruction after mastectomy with implants. The government thinks that private clinics will follow suit. In the meantime, the NHS is warning women to watch for symptoms such as:
• lumpiness of the breast
• lumpiness or swelling in the area around the breast
• change in shape of the breast
• deflation of the breast
• redness
• tenderness of the breast
• swelling of the breast
• pain or sensitivity
Recently in a BBC news report dated February 15, 2012, a woman from Edinburgh, Scotland went in for a breast scan after hearing the warnings in the news. She was horrified to discover that one of her implants had indeed ruptured and silicone had gone into her lymph nodes. A further disturbing fact is that she had no symptoms, no pain and no change in the shape of her breast. She was totally unaware that she had a rupture.
Meanwhile, the Paris based International Master Course on Aging Skin (IMCAS) which represents plastic surgeons and dermatologists had their annual conference in Paris, January 27, 2012 and according to IMCAS the PIP affair seems to be having a short term impact. Beauty procedures including liposuction, breast augmentation, and Botox injections grew globally in 2011, up 10.1%, and set to grow 11.12% in 2012. It is believed that approximately 20 million women worldwide have breast implants, and PIP only represents 1.5% with about 400,000 women using the product.
If you think you may have PIP implants or Rofil M-Implants (rebranded PIP implants by a Dutch company) Dr. Delgado recommends that you get an evaluation by a Board Certified Plastic Surgeon.
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January 31st, 2012
Chin augmentation is usually done to balance the face by making the chin longer or more protruding. Men and women with weak or receding chins are the best candidates as long as they have a normal dental bite.
When balancing the face with a chin implant, along with rhinoplasty (nose surgery) or a facelift, it may give a “finished” look with a strong profile more in line with what is considered classically attractive in our society. Many patients who seek rhinoplasty may not realize that they may benefit from chin surgery (mentoplasty). Computer imaging is a wonderful tool that allows a surgeon to show patients how they might look with the added chin implant with or without a rhinoplasty.
Chin implants come in a variety of shapes, sizes and made of different materials. Some implants are made of Teflon, Dacron or Silicone, and in some cases real bone or fat tissue is used. Dr. Delgado prefers silicone implants that are made of a solid consistency. They have a proven safety record and in most cases are good for life. Implants made from fat or bone can sometimes be reabsorbed.
The incision is usually made either inside the mouth or outside under the chin. A pocket is made in front of the chin bone and under the muscles and the implant is placed in the pocket or it can be affixed to the jaw bone. Dr. Delgado prefers the incision under the chin instead of inside the mouth as it decreases the risk of infection. The scar is well concealed and barely visible.
A liquid or soft diet will be necessary for the first few days. Most of the swelling will be gone in six weeks. After several weeks of healing the implant is practically undetectable to the patient.
Remarkable subtle changes are obtained by adding balance and definition to underdeveloped features. Many of Dr. Delgado’s San Francisco Bay Area patients have benefited from his refined judgment, skill and good aesthetic eye.
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December 9th, 2011
Skin care after a facelift is a little more complicated than less invasive cosmetic procedures because you need to treat your wounds, manage swelling, and keep up with everyday skin care for the best result.
Dr. Miguel Delgado advises his Marin County cosmetic patients that they need to minimize swelling with the regular use of ice or cold compresses, especially the first three days after surgery. To avoid an increase in swelling overnight, sleep with your head elevated above your heart.
Arnica Montana, is an herbal supplement and may help minimize bruising or discoloration. It is usually started before cosmetic surgery and taken for a few days after.
Your face will be sore after facelift surgery, but you need to cleanse your skin regularly to help with healing and avoid build-up in your pores which can lead to breakouts. Wash with mild astringent pads gently. Then apply a gentle moisturizer that is non-comedogenic (something that won’t clog the pores). The goal is to keep the area clean and moist.
It is best to avoid direct sun for the first few days after a facelift, if you go out be extra vigilant about sun protection, use a sunscreen that blocks alpha and beta sun rays. SPF 30 or 40 is good; the ones with higher SPF tend to block the pores. Wear a hat and sunglasses for further protection.
It is extremely important to keep the skin hydrated. Drink six to eight glasses of water a day to rejuvenate your skin from the inside out and flush any toxins from your system.
Once your skin is healed and you get the go ahead that you can start using makeup, use a mineral based line such as Jane Iredale. Mineral based makeup is gentler on your skin and provides excellent coverage. If you have red skin or purple bruising after your facelift, a green base will help balance those colors and give a more natural looking skin tone. For the best result, top this base with a powder about one shade darker than you usually wear.
To maximize your facelift result be sure to follow a good skin care regimen with the highest quality of products. Dr. Delgado’s esthetician Alise Hassler assists his San Francisco Bay Area patients to get on a program that is individualized for their skin type. Alise is very knowledgeable of all the products available at Dr. Delgado’s office and the store on his website. The products include; Jane Iredale makeup, Dr. Delgado’s exclusive Preferred Line, Obagi, Skinceuticals and various prescription strength skin care products.
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November 29th, 2011
Many San Francisco Bay Area patients ask “How critical is it to stop smoking before surgery, such as a facelift, tummy tuck or breast surgery?” My answer is that it is extremely important for all surgeries; smoking can increase inflammation and cause severe skin healing issues including skin loss and necrosois of the skin resulting in significantly more healing.
Smoking increases carbon monoxide and nicotine in your blood. Nicotine closes the blood vessels responsible for bringing oxygenated blood to the tissues. Besides its healing power, oxygen also fights infection and helps to keep tissue alive, as well as delivering important medications like antibiotics. Furthermore, smoking clogs the lungs, and thus increases risk of pulmonary infection such as pneumonia. Nicotine also contributes to increased platelet adhesiveness which can increase the risk of blood clots.
Studies show that nicotine gum is not an alternative as the nicotine can interfere with healing the same way it does with cigarettes. Second hand smoke may also delay healing.
At the 2010 annual meeting in San Diego, California of the American Society of Anesthesiologists a study was presented that showed smokers were:
1. 50% more likely to develop pneumonia
2. 57% more likely to have cardiac arrest
3. 80% more likely to have a heart attack
4. 73% more likely to have a stroke
For patients planning elective surgery such as breast reduction, liposuction and breast augmentation, this is an exciting event. Having surgery can be somewhat stressful, and trying to quit smoking when under stress is even more difficult. For most patients I require them to be smoke free for a minimum of two weeks before and two weeks after surgery, but prefer a month. All precautions are taken to ensure the safety of the patient. If you are a smoker and are considering surgery, try to stop smoking as soon as possible then reward your efforts with the surgery you desire.
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October 11th, 2011
Presented at the American Society of Plastic Surgeons annual meeting this September, were the promising results of ongoing clinical trials for the treatment of crow’s feet. Botulinum toxin gel, referred to at this time as RT001 is a topical gel to be applied only in a doctor’s office. It will not be available over the counter for home use as it is a drug. The gel will penetrate the skin and cause the muscles to relax thereby reducing wrinkles.
This is a very exciting development for the patient that wants the benefit of Botox but has previously shied away due to the use of needles. The application of the gel will be painless, and without bruising, as sometimes an injection can cause. 
So far over 500 patients have been tested in eleven different trials with successful results. Still in clinical trials and not yet approved by the FDA, phase 11 testing is being finished and phase 111 must be completed before it goes to market. As reported in an article in the Cosmetic Surgery Times, the results seem to last as long as the injectible version.
Botox has an interesting history for different applications besides wrinkle reduction. It has been used for treatment of chronic migraines, profuse sweating, muscle spasms and more. We will keep you informed of any new developments and especially when the gel will be available
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September 15th, 2011
With the advance of dermal fillers, such as Radiesse, more options are becoming available to cosmetic patients such as the “non-surgical nose job”. Nose reshaping can be achieved with a filler instead of a scalpel. It is possible to correct broad nasal bridges, nasal bumps, nasal asymmetry or change the angle of the tip of the nose.
This is done as a quick office procedure, usually in 30 minutes or less with no down time, allowing the patient to return to work or social activities immediately. Radiesse has been known to last for 10 months to a year, and in some patients even longer. By not being permanent, the patient can see what the results are and then determine at a future date if they want rhinoplasty surgery. Also, it allows many patients to have a procedure at a fraction of the cost until a time that surgery would be affordable.
Radiesse is FDA approved; it has similar chemical characteristics as human bone. It is made of calcium hydroxyapatite particles and has lidocaine mixed with it to significantly reduce injection related pain. Radiesse acts as a scaffold under the skin, providing structure and stimulating your own natural collagen to grow.
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August 22nd, 2011
One of the biggest dilemmas that San Francisco breast augmentation patients face is what size breast implant they want. It is a choice that they will have to live with unless they want to go through another breast surgery, so most try to make the right choice
the first time. Breast augmentation specialist, Dr. Miguel Delgado helps his patients determine the correct size by showing them how to do the “rice test”.
The materials you need for the rice test are:
• a bag of uncooked rice
• a measuring cup
• a soft bra, without padding or under-wire
• a pair of pantyhose cut off above the ankle or a pair of knee highs
One cup of uncooked rice equals 250cc’s of volume. So you might want to start with 1 ¼ to 1 ½ cup of rice for each stocking, do not tie off too tight, you want the rice to be able to move around a bit. Then lay a bra on a table top facing you, set each bag of rice into a cup of the bra, lean over and fasten the bra. Stand up and move the rice around your breast as evenly as possible. Now put on a tight fitting T shirt and see if this is the look you want for your breast enhancement. Adjust the amount of rice if you want bigger or smaller. Try on several different outfits to see how you will look in your clothes. When you have the size you want try wearing the bra with the rice when you go out and about for a couple of days and see if you are still comfortable with the breast enlargement size. Once you have determined the size, measure the rice for each breast and your surgeon will be able to determine what size implant it would be equal to. See breast augmentation before and after pictures on Dr. Delgado’s main website: www.sanfranciscocosmetic-surgery.com.
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