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Cosmetic and Plastic Surgery-SanFrancisco Bay Area|Marin County

Dr. Miguel Delgado’s “Non-Surgical Center of Excellence”

December 30th, 2013 Miguel A. Delgado Jr, MD



Reception at Marin County


San Francisco, California-With the same quality of concierge care offered to Dr. Delgado’s cosmetic plastic surgery patients, is the “Non-Surgical Center of Excellence” for those patients that are having one of the many non-invasive procedures that are now available.

These days it is possible to improve your appearance and reduce signs of aging without undergoing surgery. Subtle changes can make a big difference in how you feel about yourself. There are many patients who are not ready for surgery for reasons such as:

1.    Busy schedules which do not allow downtime for recovery

2.    Minimal signs of aging, not requiring surgery yet

3.    Budget restrictions

4.    Fear of surgery or anesthesia

Many non-surgical options that are available today have become extremely popular because of great results with little risk, downtime, side effects, and relatively affordable.

The exciting procedures available to patients are:

CoolSculpting Machine

CoolSculpting Machine

1.    CoolSculpting is a non-surgical treatment that reduces pockets of fat mainly in the abdomen and love handles. An area of fat is placed between two cooling plates bringing intense coldness that kills the fat cells and is naturally eliminated by the body. The treatment takes about an hour per area, and the results will be evident within 2 to 3 months with clothes starting to feel loose within 2 to 3 weeks! There is minimal pain and bruising with CoolSculpting and patients are able to return to normal activities in the same day. 

2.    Ultherapy is the only FDA approved non-surgical treatment for lifting the skin of the face and neck. Ultherapy stimulates growth of new collagen by ultrasound waves, going 3 times deeper than any other non-surgical procedure. New collagen can continue to develop for up to 6 months. Patients have no downtime and are able return to regular activities. This is an excellent treatment for those not quite ready for a facelift or for those who have a want a refresher.

3.    Fat injections or grafting is growing in popularity. A persons own fat is one of best fillers available, producing safe, long lasting, natural appearing results. It is used for rejuvenation the hands and face, filling in scars and depressions caused by liposuction, for example, gynecomastia patients that may have had too much fat removed from their chests leaving what is referred to as a “crater deformity”. Dr. Delgado now has fat banking available to his patients through AdiCyte which makes collection and banking at the time of a surgical procedure easy and convenient.

4.    Botox injections improves moderate to severe frown lines between the eyebrows, forehead and crow’s feet. Botox is the single most popular non-surgical treatment in the United States with over six million patients treated in 2012, which is up 8% from 2011.

5.    Multiple Facial Injectables come in a wide variety, each with its own advantages for a safe non-invasive way to smooth and beautify your skin. The best way to determine the best injectable for you is to have a consultation with Dr. Delgado to discuss the benefits of; Restylane, Juvederm, Radiesse, Sculptra and Artefill.

6.    Diolite is a laser used for the treatment of red facial vessels, age spots, skin tags and cherry angiomas. The Diolite laser can make an immediate and dramatic improvement by closing the vessels which may them vanish.

7.    Photo-Facial can even out skin tone, shrink pores, treat rosacea, brown spots, broken capillaries, and spider veins with an intense pulsed light (IPL), restoring the skin’s youthful appearance.

8.    Laser Hair Removal is one of the most popular cosmetic procedures performed in the United States. Hair is removed by beams of highly concentrated light designed to penetrate the hair follicles. The amount of treatments that will be needed depends on the area for removal. Popular areas of removal are; the face, underarms, legs and bikini line.

The treatments available for the “Non-Surgical Center of Excellence” continue to grow as Dr. Delgado keeps all safe, innovative procedures available to his patients. Call today for a free consultation at (415) 898-4161 or email.

Mentor’s New Breast Implant “MemoryShape” Now Available

November 30th, 2013 Miguel A. Delgado Jr, MD


San Francisco, CA-Silicone breast implants were reintroduced in 2006 after a moratorium by the FDA removed them from the market in 1992. It was believed that silicone implants may have been causing autoimmune diseases. After many years of clinical trials, it was determined that silicone implants were safe, and once again manufacturers made them available for breast augmentation surgery to women 22 years of age and older. The FDA recommends that women have an MRI periodically to check for a possible “silent leak”. 


Mentor’s MemoryShape
Breast Implant

Allergan’s Natrelle, which is a cohesive implant, was approved in February 2013, and Sientra has a cohesive implant that was approved in March 2012. Mentor is the only breast implant company that manufactures their implants in the United States, but the other companies follow the same strict guidelines.

Mentor is the manufacturer of “MemoryShape” a highly cohesive breast implant, also known as the “gummy bear” implant. The implants firmness and gel consistency are similar to the “gummy bear “candy. Even though it has been available for 10 years in 70 countries, it has only just been approved by the FDA as of June 2013 and now is available in the United States. It has been in great demand, and Dr. Delgado is happy to announce that it is now being offered to his patients.

MemoryShape implants have a natural teardrop shape, which are thinner at the top and gently slope to a fuller projection at the bottom. The implants have a textured design which helps keep the implants in position.

Some of the advantages of these new implants that are appealing to women are; the firmer, perkier look plus the implants are less likely to ripple, leak through the breast tissue or rupture.  The downside is that some more mature women do not want the firmer implants, preferring the softer more natural feel and look that the standard gel implants give.

All of the cohesive gel implants vary in shape, firmness and dimensions. Due to their anatomical shape, all manufacturers have used textured shells to help keep the implants from rotating. Breast implant companies have their own specifications as to how cohesive their implants are and how much gel is placed in them, so there is varying degrees to the firmness.

Predicting that the FDA would approve silicone implants once again, manufacturers began clinical trials with different types of silicone implants, in particular the cohesive gel implants in 2001. Clinical trials are still ongoing today, but getting needed feedback from patients and surgeons is extremely challenging as many woman who are satisfied with their surgery do not return for their follow up visits.

Breast augmentation remains the number one cosmetic procedure for women in the United States, with over 286,000 performed in 2012 according to the American Society of Plastic Surgeons. It is unknown how many breast enhancement procedures are done around the world, but the popularity is such that manufacturers are extremely competitive in trying to grab the majority of the market share. Each company has its own philosophy regarding the amount of cohesiveness, anatomical shape, dimensions, and design of the shell. It is recommended that women seek out a Board Certified Plastic Surgeon that specializes in breast surgery to help them make a decision as to which breast implant is best. For a woman to try to make this decision on her own would be daunting.

In addition to the new implants, Dr. Delgado continues to bring the latest innovative cosmetic treatments to his patients which includes CoolSculpting,  a non-invasive treatment for reducing  pockets of fat mainly for the abdomen, waist and hips. For men an additional area could be for their chest if they suffer from pseudo-gynecomastia which is man boobs caused by fat. The other new treatment available at the “Non-surgical Center of Excellence” is Ultherapy an exciting non-surgical tightening of skin for the face and neck.  Schedule a consultation with Dr. Delgado to find out what options may be of benefit to you by calling (415) 898-4161 or email.

Tummy Tuck Surgery, Exparel for Pain Control

October 21st, 2013 Miguel A. Delgado Jr, MD

Before and After Tummy Tuck

This is a 45-year-old resident of Napa County, California who presented to the Novato office in Marin County for evaluation for a tummy tuck. She is 5 feet 5 inches tall and weighs 135 pounds. She is a mother of two children. She underwent a full tummy tuck and tumescent liposuction of her flanks. Her surgery was performed at Marin Cosmetic Surgery Center in Marin County, California. Note the nice, thin, natural appearance of her midsection and the nicely proportioned belly button















San Francisco, CA-Abdominoplasty, also known as a tummy tuck, is one of the most patient pleasing surgeries performed. The long hip to hip resulting scar, for most women, is a small tradeoff for their new flat stomach. The only other downside to the procedure is the discomfort for the first few days. The tummy tuck procedure is not just for women, it is a very popular procedure for men as well, usually after substantial weight loss and many will have the procedure done in conjunction with gynecomastia surgery.

In the past, to ease the pain after surgery, a pain pump was used. At the end of surgery, the surgeon would place; two small catheters through the skin of the upper abdomen. The pump disperses local anesthetic directly into the surgical site and lasts for about three days. The pumps are fed by a supply of local anesthetic that is in a bulb about the size of a tennis ball. The device is kept in bag with a strap that goes around the neck. The pain pump provides relief, but the device is somewhat bulky and freedom of movement is somewhat restricted as the patient is tethered to a machine.

Miguel Delgado, M.D.

Plastic Cosmetic Surgery Specialist,
Dr. Miguel Delgado

Always looking for the best treatment for his patients, Dr. Delgado is now using Exparel for tummy tucks instead of the pain pump. Exparel is not a narcotic but an injectable slow release numbing agent injected at the close of surgery. It is a onetime injection lasting up to 72 hours, which is usually as long as the most intense post-surgical pain.

Exparel is an anesthetic that blocks the nerve impulses that send signals of pain to the brain. Exparel contains bupivacaine which is commonly known as Marcaine, and it is suspended in liposomes, which are a delivery vehicle for pharmaceutical drugs over a period of time.

Most patients tolerate the anesthetic well, but your surgeon will need to know if you have; liver, kidney, or heart disease, heart rhythm disorder or history of seizures, also if you have had a reaction to any type of anesthetic.

Patients who have had surgery using Exparel may still need some narcotic pain relief following surgery, but in clinical trials patients took about a third less narcotic pain relievers than non-Exparel patients and they seem to recuperate faster with a lot less discomfort.

The cost for Exparel is about the same as the cost for a pain pump so it is not deemed worthwhile for less extensive surgeries such as breast augmentation or breast reduction. However, for the patient who has a low pain threshold or is overly anxious about upcoming surgery, a discussion with Dr. Delgado about pain control is recommended.

In keeping abreast of the latest innovations for his patients, in addition to Exparel, Dr. Delgado now has the exciting non-surgical fat reducing “CoolSculpting” available.  See September’s blog for more information and schedule a consultation with Dr. Delgado to see if you may be a candidate.

CoolSculpting Now Available for Dr. Miguel Delgado’s Patients

September 25th, 2013 Miguel A. Delgado Jr, MD

coolsculpting logo




Many San Francisco Bay Area patients complain about difficult problem areas of fat, especially for the waist “love handles” and abdomen that do not seem to respond to dieting or vigorous exercise. Previously, the only solution for removing fat other than dieting was by liposuction surgery. For many patients, liposuction is not an option due to required time off work for post-operative recovery and then there are some patients that just do not want to have surgery. CoolScuplting patients are thrilled that there isn’t any downtime, needles, scalpels, suction hoses or scars. The cost of CoolSculpting is significantly less than a surgical procedure.

Now, thanks to research done by doctors at Massachusetts General Hospital in Boston, CoolSculpting was developed. Doctors had noted that children were losing fat in their cheeks that were eating a lot of popsicles and many even developed dimples. This lead them to discover that fat cells treated with intense coldness died and then were naturally eliminated from the body. It is not a fast process, but the results are permanent.

Doctors found that fat is destroyed when it is cooled down to a certain temperature while not harming surrounding tissues and muscles. A machine (CoolSculpting) was developed that has an applicator that pulls an area of fat into the cooling panels, making the area numb from the intense coldness. In order to protect the skin during treatment, a pad with gel is placed over the area to be treated.  Patients claim that the treatment is not painful but that they feel a small amount of pressure and coldness from the plates. Side effects are minimal, if any, and would consist of some; numbness, redness and possible minor bruising and swelling which is only temporary. Each treated area takes about an hour, and about 20% of the fat cells in a treated area are destroyed.CoolSculpting Machine

Results will begin to be noticed after 2 to 3 weeks and will continue for about 2 to 3 months. For many patients, the initial treatment is all that is needed, however, some patients want to  shrink and sculpt problem areas, and may opt for more treatments, but they need to wait 2 to 3 months between treatments.

Many more patients are learning about CoolSculpting, which is now FDA cleared, from friends and television shows featuring the body sculpting benefits. Each year as cosmetic plastic surgery procedures increase, CoolSculpting seems to be gaining a lot of notoriety with both men and women. Cosmetic procedures for men are increasing every year, with liposuction and gynecomastia surgery  high on the list. Now with CoolSculpting targeting the abdomen and love handles, the number of men seeking the procedure is gaining significant popularity and women are thrilled to see their “muffin tops” disappearing.  CoolSculpting Machine

Advantages of CoolSculpting over liposuction would be; no prescription medications are needed, no pre-operative lab tests, no special recovery garments and no time off work. The skin will retract better since the fat doesn’t go away quickly.

CoolSculpting is not for everyone; it is for people with those stubborn areas of fat, but it is not considered a weight loss program. If you should gain weight in the future, the remaining cells will grow and store additional fat. The ideal candidate is no more than 20 to 30 pounds overweight. For the patient that adheres to a normal diet and exercise program maintaining long term results should not pose a problem.

The best way to determine if you are a candidate for CoolSculpting is to schedule a consultation with cosmetic plastic surgeon specialist, Dr. Delgado at either his 450 Sutter Street San Francisco, CA office or his 165 Rowland Way, Novato, CA office. Dr. Delgado will be able to help you determine if your goals can be obtained with CoolSculpting.

Once you are scheduled for treatment, you will be asked to arrive in comfortable loose fitting clothing. You may bring a book to read or IPad or Laptop for the duration of the treatment, some patients choose to take a nap!

The Different Types of Breast Lifts (Mastopexy)

September 2nd, 2013 Miguel A. Delgado Jr, MD

San Francisco, CA-Women may lose fullness and shape of their breasts due to pregnancy, breast feeding, aging, and weight fluctuations. In order to regain a youthful looking breast, many women consider a breast lift. There are different types of breast lifts (also known as mastopexy) to address different issues women may have. Breast lift surgery costs can vary as there are different ways of doing the procedure depending on the patients amount of breast droop.

There are generally 3 degrees of breast sagging or ptosis.

             Minor ptosis is where the areola lies even or slightly above at the inframmary fold of the breast.

             Moderate ptosis is where the areola is 1 to 2 centimeters below the inframmary fold.

             Severe ptosis is where the areola is 2 to 3 centimeters below the fold.

Peri=areolar Lift

This is a 37-year-old, female resident of San Francisco, California who presented for evaluation for a breast lift. She is 5 feet 8 inches tall and weighs 165 pounds. She is the mother of two children. She underwent a peri-areolar augmentation breast lift with 275 cc Mentor normal-saline breast implants inflated up to 300 ccs. The procedure was performed at Marin Cosmetic Surgery Center in Marin County, California. The approach was peri-areolar with the implants being placed sub-muscular. She went from an A+ size to a C+. Note the larger right breast having asymmetry before surgery and, postoperatively, an improved balance.

With minor ptosis, the peri-areolar mastopexy is a great technique as the incision heals to almost invisible. The incision goes around the areola, and a doughnut shaped piece of skin is removed and is closed with a purse string type suture. Since this procedure tends to flatten the breast and not reshape the underlying breast tissue, many women choose to have a breast implant to give fullness to the breast. This is a very desirable procedure, but not all women are candidates for this as the amount of ptosis to be corrected needs to be minor.

For the woman with moderate ptosis, the vertical mastopexy, also known as the short scar or lollipop breast lift is a good choice and widely used. The nipple/areola complex is repositioned, and the incision extends down to the breast crease giving a youthful conical shape. With the vertical mastopexy, an implant is not needed unless there isn’t enough breast tissue.

Vertical Breast Lift

This is a 29-year-old, female resident of Sonoma, California who presented to the Novato office in Marin County for evaluation for a breast lift. She is 5 feet 3 inches tall and weighs 135 pounds. She underwent a short-scar vertical breast lift at the Marin Cosmetic Surgery Center in Marin County, California. She also underwent a full tummy tuck and liposuction of her flanks.

The patient pictured here that had the vertical breast lift agreed to have her procedure documented. The BBC had contacted Dr. Delgado as a Board Certified breast surgery specialist, to see if he would be interested in collaborating in the production of a video showing the journey of a patient going through a Mommy Makeover procedure, a Mommy Makeover is a combination of procedures including a full tummy tuck, breast surgery and usually some liposuction.  Dr. Delgado agreed to the venture and the BBC brought a full production company to film at Dr. Delgado’s private Marin Cosmetic Surgery Center. The video was hosted by Louise Rednapp, a British pop star and the video focused on the stages one goes through for Mommy Makeover surgery; before, during and after the recovery. In addition to her breast lift, she had a full tummy tuck and liposuction of the flanks. Notice the beautiful result of her vertical breast lift that was achieved without the need of an implant. You can see the BBC video here.

The woman that has severe ptosis will most likely need the Inverted T or the Anchor Mastopexy. This procedure has been around the longest and is considered the Gold Standard with a high success rate. The Inverted T allows for the greatest removal of skin and reshaping of the breasts, with maximum lift. The incisions, however, are the most visible, with the addition of an incision that follows the natural curve of the breast crease, thus referred to as an Inverted T or Anchor. The incisions of the Inverted T usually heal well over time.

At the time of a breast surgery consultation at either the San Francisco, California or Marin County, California office, Dr. Delgado will be able to make recommendations as to which procedure will give the best outcome.

How Can I tell if My Breast Implants are Ruptured or Deflated?

July 31st, 2013 Miguel A. Delgado Jr, MD

Before and After Breast Revision

Marin, California – This is a 55-year-old, female resident of Marin, California who presented to the Novato office for evaluation for revisional breast surgery. She underwent bilateral silicone breast implants in 1975. She developed bilateral ruptures of both implants and severe capsular contractures. She underwent removal of silicone material with subpectoral placement of 300 cc, Mentor silicone- gel breast implants. Her procedure was performed at Marin Cosmetic Surgery Center in Marin County, California.

San Francisco, CA-Manufacturers of breast implants all state that implants are not lifetime devices, however, most companies including Mentor give free replacement of qualifying devices that have failed, for the lifetime of the patient. Most companies offer additional monetary compensation to help defer the cost of breast revision surgery for up to ten years.

Statistics show that the percentage for failure of an implant is approximately 1% per year. At 10% probable failure rate at 10 years, the manufacturers no longer offer to help with cost of surgery for replacement. This statistic has caused confusion for many (see the previous blog dated July 15, 2013). This does not mean that implants must be replaced at the 10 year point. Some women will have issues with their implants much earlier and some much later and for a lucky few maybe never. You should assume that you will need a revision at least once in your life and very possibly within the first ten years. If you are not having any issues with your implants, you do not need to have them replaced, but you should keep current with your breast exams with your doctor. See breast implant pictures before and after revision of some of Dr. Delgado’s patients here.

It is interesting to note that many people use the terms rupture and deflation interchangeably. Some say rupture refers only to silicone implants, and deflation refers only to saline implants. The FDA states that the term rupture can refer to any type of breast implant, but deflation will only be used to describe saline breast implants.

Saline implants are filled after insertion during surgery by a valve that can fail at some point or leak. Silicone gel implants are pre- filled by the manufacturer, requiring a somewhat larger incision for insertion, but they have less probability of rupture.

Saline breast implants can deflate very quickly or slowly over a period of a few days. The deflation will be very evident to the patient as the breast will have lost volume looking like a flat tire or a deflated balloon. The saline that leaks into the body is harmless and will come out in your urine. It is not a medical emergency requiring replacement surgery immediately, but the sooner the better as the pocket will start to shrink, and scar tissue may set in making revision surgery more difficult.

Silicone gel implants prior to 1992 were filled with a gel that was more of the consistency of thick honey. If an implant were to rupture, the gooey gel could migrate to other parts of the body, making the removal of the implants a challenging and tedious procedure for breast revision specialists. Suspicious health problems were surfacing, and the FDA placed a moratorium on silicone implants until major improvements and studies were conducted. After many years of trials, in 2006 the FDA approved the new silicone implants that are made of a more cohesive gel.  FDA logo

With the approval of the new gel implants came a warning from the FDA.  Besides only being available to women 22 years of age and older, the FDA recommends that women have a magnetic resonance imaging (MRI) of their breasts after 3 years of their original surgery, and then every 2 years after that, to monitor for “silent leaks”.  Due to the costs involved for this test, which can range from $1,000 to $2,000 depending on what part of the country you are in, many women choose have a MRI only if they have issues. Keep in mind that a MRI is not a perfect science; false positives have been known to occur. Any concerns that you may have with your breasts should be brought to the attention of your plastic surgeon who will help you determine the best course of action.

Some causes for deflation of breast implants are:

•    Capsular contracture, (the constricting formation of scar tissue around the implant)

•    Mammogram, (be sure to inform your technician that you have implants)

•    Implant age

•    Overfilling/under filling of saline implants(beyond what the manufacturer recommends)

•    Breast trauma (car accident, closed Capsulotomy)

•    Non-FDA approved incision site (the belly button)

•    Surgical instruments during surgery

•    Defective valve of the saline implant

Even with the possibilities of future breast revision surgeries, breast augmentation for women in the United States was the most sought after of all cosmetic procedures in 2012, according to the American Society of Aesthetic Plastic Surgeons (ASAPS). ASAPS reported that there were over 330,000 breast augmentation procedures performed with 72% of women choosing silicone implants over saline.

Do Breast Implants Have to be Replaced After 10 Years?

July 15th, 2013 Miguel A. Delgado Jr, MD

Mentor Implants

San Francisco, Mentor Implants

San Francisco, CA-Breast augmentation has been the number one cosmetic surgical procedure since 2006, according to the American Society of Plastic Surgeons. The evolution of the breast implant has changed dramatically since it was first introduced about 50 years ago in the 1960’s.

The first generation of breast implants introduced was a Cronin-Gerow implant in 1963. It was a tear drop shaped implant filling a silicone rubber envelope with a viscous silicone gel.

The 1970’s brought the second generation of breast implants, which had a thinner shell and low cohesion silicone gel filler, improving the size, look and feel of the implant. The second generation implants proved to be fragile with high rates of rupture and “gel bleed” where the silicone actually leaked through the shell, causing increased incidents of medical complications.

In the second technological stage, a polyurethane foam coating was used on the implant to reduce the incidence of capsular contracture. The third technological development was the double lumen implant which as a silicone implant inside a saline implant but the complex design proved to have a greater failure rate than the single lumen implant.

The 1980’s brought the third and 4th generation of implants with continued advances in technology that further reduced gel bleed and increased the cohesive gel.

The mid 1990’s brought the fifth generation of silicone breast implants that were made of a semi-solid gel practically eliminating filler leakage, with improved safety and lower rates of capsular contracture and device shell rupture.

In 1992, the FDA placed a moratorium on silicone implants allowing only women needing breast reconstruction or breast revision surgery to have them until further studies could prove their safety.

The breast implant manufacturers conducted many clinical trials, and in 2006, the FDA lifted its restrictions on silicone implants for women 22 years of age and older. The FDA does recommend that women have periodic MRI screenings to rule out “silent leaks”.

The manufacturers give a lifetime warranty on their implants should they deflate or rupture due to a malfunction of the implant. If this should happen within 10 years of the implantation, the manufacturers also give some monetary compensation to the patient to help offset the breast implant costs of surgery. This warranty has caused some confusion for women as to the life of their implants. Some believe that, after 10 years, they must have their implants replaced. This is not the case.

Napa, California - A 35-year-old resident of Napa, California who presents to the Novato office in Marin County for breast revision surgery. Her initial breast augmentation was with 300cc normal saline implants and developed early breast contracture and mal-position on her

Napa, California – A 35-year-old resident of Napa, California who presents to the Novato office in Marin County for breast revision surgery. Her initial breast augmentation was with 300cc normal saline implants and developed early breast contracture and mal-position on her.

It is true that breast implants are not lifetime devices and most women will have to have them replaced once and maybe more in their lifetime. As a general rule of thumb, 10 years is the average that women may need to have some type of revision surgery.

There are several different scenarios where a woman may need to have breast revision surgery, most commonly it may be a deflation or a rupture or capsular contracture. Sometimes revision is needed if the implant has shifted its position or a woman may desire to change the size of her implants. In addition, a need for revision could be the development of a “double bubble” where the implants rests below the natural crease of the breast or the implant has “bottomed out” where the nipple is sitting too high on the breast. Women’s breasts change after pregnancy and childbirth and/or with weight fluctuations causing many to need a breast lift. See before and after pictures of breast implant revision surgery cases of Dr. Delgado’s here.

Women who are not having complications do not need to have their implants replaced, and for some lucky women this may never happen. Women who are planning on having breast augmentation need to assume that they will need revision surgery at least once in their life. It is strongly recommended that women have periodic visits with their plastic surgeon to maintain the health of their breasts.

The Male Facelift, Hiding the Incisions

July 1st, 2013 Miguel A. Delgado Jr, MD


Male Face Lift

This is a 55-year-old resident of San Francisco, California who presented to the San Francisco office at Union Square for evaluation for facial rejuvenation. He underwent a facelift, temporal brow lift and fat injections to his face and a pre-jowl chin implant.His surgery was performed at Marin Cosmetic Surgery Center in Marin County, California.


San Francisco, CA-In February 2013, The American Society of Plastic Surgeons (ASPS) published their statistics for 2012.  The total number of rhytidectomy surgeries, better known as facelift surgery, performed in the United States was up 6% over 2011. Of the total 10% was for men. Men strive to look younger to remain competitive in the work place, but some are motivated to have a facelift after seeing how refreshed their wives look after their surgery.

During a consultation for a facelift, one of the most important issues discussed is the placement of the incisions. The goal, besides a more youthful refreshed face, is to have the incisions well hidden so that it is not evident that any surgical procedure has been done. Women want the choice to be able to wear their hair in any style, and men who don’t have many hair style options just want scars that don’t show. 

external ear

External Ear

The facelift procedure is very different for a man than for a woman just as other cosmetic surgical procedures can differ, such as female breast reduction versus male breast reduction. Great care needs to be taken not to feminize the male face. The incisions should be well hidden in the natural skin creases and shadow of hair. The incision can be in front of the ear (pre-tragal) or inside the ear (intra-tragal), but attention needs to be made regarding the hairline, side burns and the beard. The beard should not be pulled into the ear, and the side burn position needs to be preserved. Laser hair removal can be done if the hair is too close or in the ear.

Male Facelift Incision

Male Face Lift Incision

In the long term, the pre-tragal incision will heal the best and look more natural. The location of the incisions will depend on skin laxity, quality of the skin, how much sun damage there is, and color of the skin. Some men have a distinct change of color between the skin of the cheeks and the tragus; therefore, each patient needs to be evaluated individually. There is also an incision behind the ear and the surgeon must take care not to move the hairline. If the man has a brow lift and eyelid surgery at the same time as the face lift, great care needs to be taken to keep a natural look and not be too aggressive.

A face lift for a bald man or a man with thinning hair is more of a challenge but can be done with excellent results. The conventional incision for a male facelift cannot be done because without hair, the resulting scar will not be hidden. Instead, a surgical approach called circumauricular is preferred. This incision goes around the ear but not into the scalp, keeping the incision hidden in the creases and shadows of the ear.

It is important for the man to take care of the incisions until they are well healed. For the first few weeks, the incisions will be red, and the best way to hide them is to let your hair grow longer before surgery and/or the use of makeup. Our esthetician would be able to assist in choosing an excellent mineral based cover-up and show the patient how the application should be done to conceal the incisions. Use of sunscreen is highly recommended as the sun can make scars much more prominent, in fact it would be wise to stay out of the sun as much as possible for several weeks or months.

Continuing with a healthy diet is important in healing as well as taking high quality vitamins such as VitaMedica. Smoking is one of the worst things anyone can do before and after surgery as the nicotine and carbon monoxide starves the cells and keep them from delivering oxygen to the tissues. This prevents the incisions to heal properly, and in addition making the patient more susceptible to infections. Besides increasing inflammation, there is also an increase in risk of cardiovascular complications.

It is important for the patient to take an active role throughout the healing process in order to get the best surgical result.

Temporal Brow Lift Versus Full Brow Lift

June 16th, 2013 Miguel A. Delgado Jr, MD


This is a 47-year-old female from Marin, CA presented for evaluation of her eyebrows. She underwent endoscopic eyebrow lift only. She had elevation of the right side 6 millimeters and her left side 7 millimeters. Note how the upper eyelids look more exposed due to the elevation of her eyebrows.

San Francisco, CA-As the effects of gravity, aging and sun damage take place, one of the first places to show the effects is the eyes and the brow. The brow lift has one of the highest rates of patient satisfaction. Having just a brow lift can refresh the face with a subtle yet elegant result.

Depending on the patient, there are different variations to the brow lift. It is not uncommon for some men and women to have eyebrows naturally at different heights, with a brow lift they can be made more symmetrical. The brow lift can be combined with other procedures such as a facelift, eyelid surgery, nose reshaping and some patients choose to have it combined with breast surgery or tummy tucks.

The least invasive brow lift would be the temporal brow lift, also known as the lateral brow lift. This procedure is more for the patient that has mild to moderate descent of the brow. The incisions are small and made at the temple region of the forehead and scalp, some of the scar may be visible on the side of the forehead, not always as hidden as desirable. There isn’t any muscle reconstruction involved, only tightening and excising some skin.

The temporal brow lift only addresses the outer third of the eyebrow. When aging causes the brow to sag, it gives the face a sad, tired or surly appearance. Ideally the tail of the brow should be a little higher than the medial end (next to the nose) with a gentle arch in the middle.  Recovery is faster with less bruising and swelling, but it will not correct wrinkles of the forehead or the glabellar frown lines between the eyes.

The coronal brow lift (also known as the “open brow lift”) is considered the gold standard of brow lifts and has been around the longest. This procedure is made with an incision that goes across the top of the head from ear to ear within the hairline. This approach allows the surgeon full access to the forehead musculature for complete elevation of the brow and forehead. This procedure is the best for patients that have high foreheads, so they are not made even higher. The coronal brow lift is also considered the longest lasting. There are some downsides to the procedure, the scar on the top of the head can widen, there can be hair loss, and with the cutting of nerves on the top of the head there may be permanent numbness.

Then we have the evolution of the endoscopic brow lift. The goal was to have a procedure that could get the same result as the coronal approach without the invasiveness.This is my preference for brow lift procedures when all aspects have been considered; I have been doing it since its beginning, with the exception being the patient with an already high forehead, then the coronal approach is best.  The endoscopic brow lift is along the same incision line as for the coronal lift except that instead of a long incision there are five small incisions about ½ inch in length behind the hairline. The hair is parted, not shaved for the procedure. The endoscope is an instrument with a tiny camera that is inserted through small incisions allowing the surgeon to see images on a TV monitor.

You will find that different surgeons have different preferences based on what procedures they are trained in and feel comfortable with. I recommend that first you make sure you are seeing a Board Certified Plastic Surgeon and request to see many before and after pictures of that surgeon’s actual patients.

Many people are fearful of the brow lift procedure after seeing many celebrities that have had it done and have a surprised or startled look.  This is unfortunate because if the surgery is done properly it is one of the most rewarding procedures done. My goal is for the patient not to have an “operated” look if anything I’d rather mildly under correct than over correct the brow, and I achieve this by making precise measurements pre-operatively.

What is Scleral Show and How Can it be Corrected?

May 31st, 2013 Miguel A. Delgado Jr, MD

Scleral Show

After Correction of Scleral Show



Scleral show is where the white of the eye is visible under the iris that creates a round eye appearance. This can be caused by over resection of the skin from blepharoplasty surgery (eyelid surgery), trauma, sustained inflammation, thyroid disease or aging. The exposure can cause redness, discomfort, dry eyes and/or tearing. It is considered the most common complication from eyelid surgery, although many times it will resolve on its own within a few weeks of surgery.

There are different ways to restore the lower eyelid to an appropriate position, usually tightening a loose eyelid or in some cases may require a skin graft or canthoplasty surgery which is a procedure that reshapes the eye.

To find the best treatment for a patient suffering with this condition, would be to schedule a consultation with a Board Certified Plastic Surgeon who will be able to recommend available options.