February 14th, 2012
Computer Imaging by Dr. Delgado
There are many things San Francisco Bay Area patients need to consider when deciding to have cosmetic surgery. One is to be very selective in choosing a surgeon. Most patients understand the importance of picking a Board Certified Plastic Surgeon, but then what? If possible try to see at least three surgeons in consultation and determine who you feel most comfortable with. Look closely at before and after pictures you may be presented with of the surgeon’s own patients and determine if you like the results. Many surgeons now offer computer imaging; this is a great opportunity to see if you and the surgeon are on the same page!
If you are not familiar with computer imaging, it is a wide field that includes digital photography, scanning and manipulation of bit-mapped graphics. In plastic surgery this is an excellent tool to aid the surgeon in communicating with the patient the desired goals and realistic outcomes.
Many patients have a hard time visualizing the outcome of possible cosmetic surgery, computer imaging enhances the consultation by allowing the surgeon to show a patient a unique three dimensional view of changes the plastic surgeon recommends, which otherwise would be hard to express by non-visual means.
The process is fairly simple; the surgeon takes photographs of the patient and can then project the photos onto a computer screen. Dr. Delgado uses a specialized computer program called “Canfield Mirror Imaging Systems” which allows him to manipulate the image to give the patient an idea of what the surgical goals are. Imaging works best for facial procedures such as: eyelids, facelift, nose reshaping and chin enhancement. Conservative results can be demonstrated for liposuction. Computer imaging does not work well for breast surgery, gynecomastia surgery or tummy tucks.
The computer cannot provide a guarantee of a specific result but is used more as a tool to demonstrate anticipated surgical changes. Imaging is just an approximation. But Dr. Delgado’s patients have found it to be very valuable in helping them to consider their options during the decision making process.
Posted in Home | No Comments »
January 20th, 2012
There have been a lot of reports in the news lately about a French manufacturer of defective breast implants used for breast augmentation surgery. It was discovered that Poly Implant Prothese (PIP) a now defunct company had been using industrial grade silicone instead of the more expensive medical grade for their silicone implants. According to Wikipedia, industrial grade is only 10% of the cost of medical grade.
In 1996, PIP was selling their saline implants in the United States including the San Francisco Bay Area, but saline and silicone implants were distributed to many countries worldwide. All silicone implants were banned in the United States from 1992-2006 due to health concerns but reintroduced after extensive testing proved them to be safe. Only two breast implant companies are approved by the FDA, Mentor and Allergan. 
PIP became the third largest breast implant company in the world before being shut down in 2010 when the discovery was made. A Dutch company rebranded the implants with the name Rofil M-implants, and is also at risk as the contents are the same. In 2000 the FDA sent an inspector to the PIP manufacturing company and found many substandard practices thereby banning all PIP implants for the United States.
The American Society for Aesthetic Plastic Surgery (ASAPS) recommends women have the implants removed due to the high rupture rate and also due to the fact that the adverse effects of the impurities used in industrial grade silicone are unknown. The International Society of Aesthetic Plastic Surgery (ISAPS) supports this recommendation. Different countries have different recommendations. Several countries recommending removal besides the United States are; France, Germany, Venezuela and the Czech Republic. Some countries are setting up registries and hotlines but not recommending removal at this time.
Dr. Delgado recommends that women who have had breast augmentation surgery outside of the United States to get in touch with their surgeon to verify what type of implants they have. Dr. Delgado also stresses the importance of all women to know the brand, size of their implants and if they are saline or silicone.
For a limited time, Dr. Delgado is offering a reduction in surgical fees to San Francisco Bay Area women who wish to have their PIP implants removed. For more information please contact the office.
Posted in Home | No Comments »
December 15th, 2011
A compression vest is essential in the healing of the chest after male breast reduction surgery for the man who suffers with moobs (gynecomastia). The purposes of the vest include:
• Helping the skin to contract 
• Reduces swelling
• Stops tissue from oozing excess fluid
• Helps the chest tissues to properly bind together
The vest applies gentle pressure to keep tissue from moving as it heals, it is important the the vest is snug but not tight so it does not interrupt blood flow. The excision of the gland leaves a “dead space”, to collapse it drains are used to cause a negative internal pressure and remove fluid. Once the drains have been removed the vest can be removed only to shower. The vest is to be worn 24/7 for six weeks. The patient may wear a t-shirt under the vest for comfort. At the six week point when the vest is removed, then the gynecomastia surgery patient is able to resume all normal activities.
Many San Francisco Bay Area patients are concerned about wearing the vest, and while it is somewhat cumbersome, it does not show under regular clothing and the advantages it gives far outweigh the temporary minor discomfort.
Posted in Home | No Comments »
November 7th, 2011
The Food and Drug Administration advisory panel has recommended setting up a nationwide registry to track safety problems for women with silicone breast implants for ten years. 
It is not believed that the implants might not be safe; in fact in 2006 the FDA broke a 14 year moratorium on silicone implants by approving two new implants, one made by Allergan and one made by Mentor. But critics of the approval wanted more evidence for long term use.
The FDA required the two manufacturers to have follow-up studies of 40,000 patients each, ending in 2016. But the manufacturers have had a hard time complying. Allergan so far has about 60% follow-up and Mentor about one in four patients of their original 40,000. The manufacturers need to get the doctors to comply who in turn need to get the patients to comply. It is difficult to get women to continure to come in for yearly follow-up visits and filling out long questionnaires when they aren’t haven’t any issues. The idea of the breast registry is still in its beginning stages and the idea of having incentives for doctors and their patients is being considered.
The panel also discussed the current recommendation that women have an MRI (to look for a silent leak) three years after implantation and then every two years thereafter. They pointed out that most insurance companies don’t cover an MRI if there isn’t a problem, and most women are reluctant to pay out of pocket. Therefore the panel recommended not requiring future post-approval studies to mandate women who are not having issues undergo an MRI.
Posted in Home | No Comments »
October 12th, 2011
In 2001 when Dr. Delgado moved his practice to the Sutter Novato Medical Campus, he also opened his own private surgery center, “Marin Cosmetic surgery Center” (MCSC). Realizing many of the disadvantages of performing surgery at a hospital, he chose to invest in the building, operation and maintenance of his own surgery center. MCSC is fully accredited by Medicare and the American Association for Accreditation of Ambulatory Surgery Facilities, Inc. (Quad A) which means it meets the highest standards of safety. This has benefited him and his patients in numerous ways. 
Having one’s own private surgery center allows for the utmost privacy for all surgical patients. MCSC has a private entrance which allows patients to come and go without having to go through the main waiting room. Dr. Delgado’s facelift, gynecomastia, breast reduction and all cosmetic patients appreciate this additional privacy. With only one operating room there is less in and out traffic which in itself reduces probability of infection. Infection is one of the greatest risks in surgery.
Another huge benefit to a private surgery center is quality control. From choosing one’s own staff to determining what medical supplies and equipment shall be used. Dr. Delgado has always been on top of cutting edge technology keeping his center “state of the art”. Many of his staff have been with him since it opened in 2001. This includes his Board Certified anesthesiologist, Dr. Randy Gaynor whose reputation with the patients is outstanding. For Dr. Delgado to be able to go into surgery with a team that is “in sync” and knows his techniques is a great advantage. When a surgeon operates in a hospital setting, the staff and anesthesiologist can be different on different days. Having continuity with staff allows Dr. Delgado to focus on the patient.
The surgery center is set up to accommodate overnight patients with care provided for by no less than two caregivers, one being a Registered Nurse with post operative training including Advanced Cardiac Life Support (ACLS)certification. In the rare circumstance of a medical emergency, Novato Community Hospital is contiguous to MCSC.
Posted in Home | No Comments »
September 7th, 2011
Bridalplasty was the controversial American reality TV show that had 12 engaged women competing to win their “dream” wedding and multiple cosmetic surgery procedures. The idea is not as farfetched as it may seem. Most women dream of their wedding from the time they were small girls, and wanting to look their absolute best is not unreasonable.
“Bridalplasty” has been around for a long time, but just recently became a popular topic of conversation since the “new buzz word” was coined by the reality show. For years women have done whatever they could to make their
“special” day perfect. Many go on diets or change the color and length of their hair, or have a makeup artist do their makeup. And many have a surgical procedure. The most popular cosmetic procedures for brides, have been; Botox and fillers, breast augmentation, liposuction and rhinoplasty.
It is important to plan ahead so healing can be complete. And it is highly recommended that the “husband to be” is in agreement. A new look is not the kind of surprise most men appreciate.
If the surgical procedure is something the bride has been wanting a long time, such as breast enhancement or a nose job, then why not proceed before the biggest day of her life? The photographs of the wedding are something that will be shared for years to come, and if an aesthetic change is to be made, most women would want it to show up in the photos.
But if the surgery is a decision made on a whim, then further consideration should be given. This is something the bride should be sure she is doing for “herself” and not outside influences.
Posted in Home | No Comments »
August 14th, 2011
Cosmetic surgeons recognize cellulite as a condition that many San Francisco patients seek to find a cure, however the medical community does not see cellulite as a disorder but a normal condition for many women and some men.
Cellulite is a term first used in the 1920’s and became a “buzz word” when used in a Vogue magazine article in the 1960’s. According to the Mayo Clinic 8 out of 10 women have some degree of cellulite; it does not seem to affect men very much, probably because estrogen makes fat and testosterone breaks down fat. Men with elevated estrogen have the propensity to develop gynecomastia (male breasts).
The physical cause of Cellulite is caused by fibrous cords that connect the skin to underlying muscle with fat in between. When fat cells increase they push up toward the skin and the cords are pulling down causing a dimpling effect. 
Some causes of Cellulite are:
• Hereditary
• Inactive lifestyle
• Stress
• Use of hormonal contraceptives
• Weight gain and an unhealthy diet
• Aging and the loss of skin elasticity
Many San Francisco patients come in to see Dr. Delgado with the hopes that liposuction will remove cellulite; it won’t, and in some cases can make the condition worse. Liposuction is for body sculpting not for removing fat under the surface of the skin.
What about all the creams and lotions that are advertised to remove the unwanted dimpling? Save your money, there has not been any conclusive evidence that this can cure or improve cellulite.
Endermologie uses vacuum rolling and radio waves to break up fat and help increase circulation. There have been many patients that claim they get results with this method but they have to have frequent treatments and if they stop the cellulite may return.
But due to demand, research continues and perhaps there will be a permanent cure for cellulite one day.
Posted in Home | No Comments »
July 17th, 2011
Medical tourism dates back thousands of years. Greek pilgrims traveled to the Sacronic Gulf to a territory called Epidauria, considered the first medical tourist destination, for medical treatments and mineral waters for healing not unlike our spas today. Medical tourism seems to be gaining resurgence with elective surgeries. The lure of a tropical 
vacation package in a far off land which combines the cosmetic procedure of your choice with sunshine, beaches, rest and relaxation away from family, friends and home at a reasonable cost is a tempting proposition to some San Francisco Bay Area patients. There are many countries that are marketing themselves as medical tourist destinations, including; Thailand, India, Brazil, Costa Rica, Mexico, South Korea and more.
There are some very important things to consider that may not seem apparent at first look. Language and cultural barriers make communicating with doctors and nurses frustrating. Doctors in some countries are regarded as authority figures who often are not questioned. Many countries have infectious diseases that Americans and Europeans would not have built up a natural immunity to such as mosquito transmitted diseases, influenza and tuberculosis. Standards of post operative care can vary dramatically depending on the hospital and the country. Accreditation and other measures of quality vary widely across the globe. Traveling a long distance after surgery can be dangerous for possible blood clots in the legs.
Many countries and doctors have lower fees because they do not have protection for patients such as liability insurance. Or they may be using inferior products for such popular surgeries as breast augmentation or breast augmentation with a lift. French made silicone P.I.P. breast implants have a high rupture rate and were eventually recalled. Consultant plastic surgeon Douglas McGeorge of the British Association of Aesthetic Plastic Surgeons (BAAPS) said PIP implants were not used by members of the Association. He said “These are cheap products that tend to be used by commercial companies and could well be used in women who have gone abroad for surgery. They are attracted by cut-price deals but as ever, you get what you pay for”. The recalled implants resurfaced and were rebranded as M-implants putting even more women at risk. This would not be the case in the United States where implants are closely monitored by the FDA for safety.
If you should be awarded a mal practice suit by a court, the doctor or hospital may not have insurance and collecting may be impossible. If a medical complication should arise, your personal medical insurance will probably not cover you while you are out of the country so additional costs could result. If you have a complication once you return home you then either have to return to the foreign country or find a local doctor willing to take on a case with complications which can be very expensive.
Relaxing on the beach to recover is not a good option, it is important to stay out of the sun and the water to avoid scarring and infection. Being close to home where you may have a friend or family member to watch out for you is optimal. And most importantly having your surgeon nearby is the safest situation. After healing is a good time to plan and enjoy a trip to a far off destination.
Posted in Home | No Comments »
June 25th, 2011
Tummy tuck and liposuction are completely different procedures that solve different problems. Liposuction will only remove fat under the skin and above the abdominal muscles, where a tummy tuck removes fat, skin and tightens the abdominal wall. If the patient has good muscle tone, and probably has not had children, the result with liposuction body sculpting alone can be quite dramatic.
The incisions are very small and in time fade to almost invisible. I have had San Francisco Bay Area patients come in thinking that they wanted a tummy tuck or abdominoplasty only to find out that they are excellent candidates for liposuction alone. When possible, liposuction is a great procedure with excellent results, allowing the patient to return to work or regular activities within just a few days. Even though age is not a factor, older patients tend to have less elasticity in their skin which means they will not get an optimal result.
�
For women who have had children, or patients that have had a significant amount of weight loss, liposuction will not give them a smooth, flat stomach. In fact liposuction alone can make the condition worse by removing the foundation on which the skin rests (the underlying fat) and end up with even looser skin. To get the best result, they will need to have excision of fat, skin and tightening of lax abdominal muscles, which the tummy tuck procedure includes. In most cases, the tummy tuck procedure also includes some liposuction. There are some tradeoffs though when opting for a tummy tuck that the patient needs to be aware of. First of all the incision from the tummy tuck generally goes from hip to hip. It is placed low on the abdomen so that it is hidden in the panty line. When tightening the abdominal muscles, the belly button will need to be repositioned. The tummy tuck is one of my favorite cosmetic procedures with one of the highest ratings in patient satisfaction. Many patients find that they have an even flatter abdomen than before childbirth or weight gain. And an additional bonus is removal of a majority if not all stretch marks.
Posted in Home | No Comments »
May 17th, 2011
San Francisco patients feel the brow lift is one of the most exciting procedures done for rejuvenation of the face. There are several different approaches to doing a brow lift, but for those who would be a candidate, the “brow-pexy” is one of the newest, with great advantages in that it is a much less invasive procedure. This procedure does not lift the entire brow but the lateral aspect or “tail” of the brow. 
The Brow-pexy is most often done in conjunction with upper eyelid surgery as the access incision line is the same, which is in the natural crease of the eyelid. “Pexy” means to secure or fix. Through the incision, there is removal of excess muscle and fat and a bit of skin, using hidden stitches; the eyebrow is “fixed” at a higher, more desirable position. This prevents the brow from dropping below the superior bony ridge and creates a sculptured upper eyelid. This procedure has more direct control of the final shape and position of the lateral eyebrow. This has proved to be an excellent procedure for Bay Area men who are concerned about visible scars on their scalp.
Many Marin patients opt for an additional procedure that can easily be done at the same time. This would be the “corrugator muscle excision”. The corrugator muscle is the muscle that allows the eyebrows to squeeze together forming worry or frown lines. By removing a part of this muscle the patient will not be able to create the line between the brows, having a similar effect as Botox injections except the results are permanent.
Posted in Home | No Comments »
