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:
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.
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”.
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.
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.
May 15th, 2013 Miguel A. Delgado Jr, MD
San Francisco, California-
Have you heard the “buzz” about the latest skin rejuvenation procedure? Not a Facelift, but an Uplift! Ultherapy is the only FDA approved non-invasive procedure for skin lifting of the face and neck. In one 60 to 90 minute treatment, Ultherapy uses ultrasound to heat up the subcutaneous and SMAS layers which then stimulate growth of new collagen over a 2 to 3 month period. Some patient’s may see continued improvement of lax skin for up to 6 months. With no downtime, the patient is able to continue with regular activities.
The skin tightening procedure has been televised on many popular shows such as; The View, 20/20, Good Morning America and featured in many magazines such as; W Magazine, Prevention, New You, Elle, Oprah and many more!
If saggy skin on the face and/or neck has been bothering you, call Dr. Delgado’s office for a complimentary consultation at (415) 898-4161, to see if you are a candidate for Ultherapy.
March 15th, 2013 Miguel A. Delgado Jr, MD
American Society of Plastic Surgeons
2012 Annual Statistics
The latest statistics on cosmetic plastic surgery procedures for 2012 were released by the American Society of Plastic Surgeons (ASPS). Surprisingly breast augmentation is not the fastest growing procedure as it has been in the past. Cosmetic plastic surgery procedures show a 5% increase over 2011. This increase is fueled by the significant uptick in minimally-invasive procedures enjoyed by many San Francisco Bay Area patients such as; Botox, Dysport, Juvederm, Restylane and Radiesse.
Facelifts increased by 6%, and eyelid surgery was up 4%. There are several different theories as to why facial rejuvenation is seeing such an increase. Some believe that facelifts became less popular during the economic downturn, but people seem to be feeling better about the economy and are more optimistic about the future. Also, it is believed as the “baby boomer” generation is growing older many are opting for methods to maintain their youth. They are staying active longer and remaining in a competitive work place much longer than even a decade ago.
The top 5 procedures were:
• Breast augmentation (286,000 procedures, down 7 percent)
• Nose reshaping (243,000 procedures, no change)
• Liposuction (202,000 procedures, down 1 percent)
• Eyelid surgery (204,000 procedures, up 4 percent)
• Facelift (126,000 procedures, up 6 percent)
Note that while breast augmentation remains the #1 procedure, it was down 7% from 2011. Interestingly for men, male breast reduction surgery increased by 5%, this is believed to be attributed to increased awareness and acceptance of the procedure.
January 30th, 2013 Miguel A. Delgado Jr, MD
Excess skin at the lateral brow is a common complaint of patients that have had upper eyelid surgery. Having a lateral Browpexy at the same time as upper eyelid surgery addresses this issue. This combination of procedures rejuvenates not only the upper eyelid but the outer aspect of the brow. The lateral Browpexy does not lift the entire brow, only the outer third. For those Marin County patients that would be a candidate for the Browpexy, it is a great procedure as it is less invasive than traditional brow lifts with a faster healing time.
San Francisco Bay Area women love this procedure; they like to combine it with “corrugator muscle excision”, this is the muscle that allows the eyebrows to squeeze together forming frown lines between the eyes. With excision of this muscle, the effect is similar to Botox treatments, except the results are permanent.
January 15th, 2013 Miguel A. Delgado Jr, MD
Before and After Neck Lift
The neck seems to be one of the first places that show signs of aging. It is definitely an area that disturbs most San Francisco Bay Area people, with descriptive terms such as turkey neck or turkey waddle. In order to tighten this area, a neck lift is performed. This is where the cosmetic plastic surgeon makes incisions under the chin or behind the ears or both, in order to access the neck muscle called the platysma.
The platysma is a broad based flat thin muscular sheet, covered with fat that originates from the fascia of the pectoralis major and deltoid muscles. It reaches from the neck to the inferior border of the mandible (lower jawbone). As we age, the neck forms platysmal bands, this is when the platysma tends to separate in the mid-line and lose elasticity, and it thickens forming prominent folds of skin in front of the neck.
Platysmal plication is where the surgeon sutures the ends of the platysma muscle back together; this is usually done in combination with a lower facelift.
November 30th, 2012 Miguel A. Delgado Jr, MD
Before and After Facelift Surgery
The pro-active rhytidectomy (face lift) patient can speed up the healing process by following a few before and after surgery recommendations.
Decide if you are at your goal weight or close to it. You do not need to lose weight prior to surgery if you are at a weight you can comfortably maintain. It is not a good idea to try to lose a significant amount of weight after surgery as you may end up with loose skin on your neck and jowls.
It is mandatory to stop smoking 2 to 4 weeks prior to surgery. Studies show that smoking increases inflammation which increases the risk of infection, cardiac arrest, heart attack and stroke. Smokers also usually suffer with a higher level of pain. You must wait 2 to 4 weeks after surgery to resume smoking. If you have managed to quit for 8 weeks, one of the best things you can do for your health and skin is never start smoking again.
If you color your hair, try to do that prior to face lift surgery or you will need to wait 4 weeks after surgery.
Eat healthy foods, lots of fruits, vegetables, fiber and protein. Drink lots of fresh water. Dr. Delgado encourages his patients to take a high quality multivitamin, both before and after surgery. Dr. Delgado has found Vitamedica to be a superior vitamin supplement that does not contain vitamin E, which must be avoided due to its blood thinning qualities.
Many Marin County patients begin a good skin care regime before surgery and continue it for life. To maintain their rejuvenated new face, they get products and maintenance skin care from the esthetician at cosmetic plastic surgery specialist, Dr. Miguel Delgado’s office at 165 Rowland Way Suite 300 Novato, CA, by calling (415) 898-4161 for an appointment.
October 16th, 2012 Miguel A. Delgado Jr, MD
San Francisco Bay Area Baby boomers are now in their 50’s and 60’s. They are leading the way for the quest in keeping their youthful appearance. Besides an active lifestyle that includes exercise, and healthy eating, they are seeking cosmetic treatments that include both surgical and lesser invasive procedures. According to statistics from the American Society of Plastic Surgeons (ASPS) there were over 3.4 million cosmetic plastic surgery procedures on patients 55 and older, and of those 1.3 million were Botox treatments.
Botox is a muscle relaxer that helps erase frown lines from the forehead, between the eyebrows and the corners of the eyes. From the time of injection, the results will show up in just a few days. The treatment isn’t permanent but can last for several months.
Each year more men are getting cosmetic procedures. According to ASPS, between the years of 2000 and 2011 there was an increase of 286% for men getting Botox.
September 16th, 2012 Miguel A. Delgado Jr, MD
Before and After Facelift Surgery without TCA Peel
Before and After Facelift Surgery with TCA Peel
Face lift surgery is an exciting improvement for San Francisco Bay Area patients for facial rejuvenation, turning the clock back many years. Surgery improves the jowls, loose neck skin, eyelids, a heavy brow, etc. but does not change the skin.
The TCA (trichloroacetic) Acid Peel is a medium to strong chemical peel and an excellent addition to facelift surgery that is applied while the patient is asleep. The peel promotes skin smoothness, vitality, improves superficial discoloration and eliminates fine wrinkles. It is a wonderful treatment for sun damaged skin, but not all patients are candidates and will require an evaluation by Dr. Delgado.
Sonoma County patients noticed for the first few days their face felt like it was sunburned, but not uncomfortable. In 3 to 4 days, the skin turns dark and in 3 to 7 days starts peeling. It is very important to follow specific directions given prior to surgery for post operative skin care to get the optimal results.