February 28th, 2014 Miguel A. Delgado Jr, MD
San Francisco, California-Liposuction patients are choosing to freeze their fat that has been removed during liposuction surgery. Saving the harvested fat allows the patient to use their own fat for future use for cosmetic enhancement.
Fat cells contain a substantial amount of stem cells. Clinical trials using stem cells are showing promise for degenerative disease such as rheumatoid arthritis and multiple sclerosis. Tests to date are very preliminary but in the next few decades who knows what might be discovered, having stored stem cell loaded fat cells could prove to be very beneficial as fat can be stored for decades and be thawed as needed. By storing the cells now, the youngest possible cells are being preserved which have more proliferation than older cells.
The cells are cryopreserved in liquid nitrogen and should remain useful indefinitely. When the fat cells are frozen, the metabolism is greatly slowed down preventing deterioration and preserving the cells for future use.
Today, women are having breast augmentation and butt enhancement with their own fat. Many patients choose to have the cheek area filled out during a facelift, or aging hands smoothed out. Imagine taking more youthful fat cells that have been stored for years, thawing them out and using them to regenerate areas that have lost their fullness due to aging. Having youthful stem cells for applications that haven’t been discovered yet is like having an insurance policy with your own autologous fat. Fat transplants don’t always take, but if they fail, the body will reabsorb the cells without any incident.
This is a 35-year-old, female resident of Napa, California who presented to the Novato office in Marin County, California for evaluation for liposuction. She is 5 feet 6 inches and weighs 140 pounds. She underwent liposuction of the abdomen, flanks, inner and outer thighs at Marin Cosmetic Surgery Center in Marin County, California. She had a total of 5500 cc of fat extracted from these areas. Her photographs were taken one year after surgery. Note the much slimmer body appearance.
Fat injections and fat grafting have been around for a long time and have been used for cosmetic and reconstructive procedures. In addition to augmenting the body where fat loss has happened due to aging, it has been invaluable for reconstructive procedures such as correcting a “crater deformity” caused by too aggressive fat and/or tissue removal during a male breast reduction (gynecomastia) surgery. It can be the optimal choice as a dermal filler as the body will not reject it.
Realizing the incredible benefit to his patients, Dr. Delgado has arranged to have the option available for those having liposuction to have their fat banked through a company called AdiCyte. The costs for storage are dependent on the amount stored.
AdiCyte’s state of the art laboratory is at the University of Arizona Health Sciences Center in Tucson, Arizona. AdiCyte is registered with the FDA and is in full compliance as a tissue processing bank. The collection kits, transportation, processing and storage procedures insure optimal viability of the tissue.
Dr. Delgado is a Board Certified Plastic Surgeon, treating patients in the San Francisco Bay Area, San Jose and Sacramento, since 1988. Call today (415) 898-4161 for a consultation to discuss your fat banking options along with your liposuction surgery.
February 14th, 2014 Miguel A. Delgado Jr, MD
San Francisco, California-As evidenced by the many different results of facelifts, also known as rhytidectomy, the skill of the surgeon is critical. Beyond ascertaining that the surgeon of choice is Board Certified in Plastic Surgery, you want to know the surgeon’s experience and techniques for facelift surgery.
As a layperson, it can be difficult to know what you are looking for. Observing the surgeons before and after pictures, in many cases, will reveal the quality of work. Arming yourself with good questions can help you determine the level of skill. In addition to asking if the surgeon tightens the underlying muscle (SMAS), uses fat injections in areas that may need volume, ask the surgeon if the effect of the buccal fat pad is taken into consideration in surgical planning. The herniated buccal fat pad is one of the most common missed causes of the jowl. The jowl or jawline is one of the most bothersome areas of the aging face.
This is a 54-year-old, male resident of San Francisco who presented to the San Francisco office at Union Square, California for evaluation of his aging face. He underwent an eyebrow lift and lower lid eyelid lift with a lower facelift. He had buccal fat excision, or cheek fat excision, of his cheeks and he also had 7 cc of fat injected into his right and left upper cheek. He underwent a prejowl chin implant.The lower facelift included a SMASectomy excision, which is excision of the deep tissue to thin his face as opposed to a SMAS plication, which would give more volume to his face. He had liposuction in the jowl region and a complete platysma transection in his neck. He had the eyebrow lift with 11-millimeter elevation bilaterally. His procedure was performed at Marin Cosmetic Surgery Center in Marin County, California. Note the herniated cheek fat that has caused a significant fullness in the jowl location.
The buccal fat pad is an area of fat located just below the cheekbone area, in the mid face. It can be as large as a golf ball or as small as a grape. Fluctuations in weight will cause a change in volume. The effects of aging may also cause the size to reduce. If the buccal fat pad descends or herniates inferiorly, it will add to the size of the jowl. If it is not removed during a facelift, the jowl will only be partially corrected.
It takes an experienced cosmetic plastic surgeon to diagnose and recognize the herniated fat pad in order to get the best result for the jawline.
Removal of the fat pad is most often done from the inside of the mouth. Sometimes during the facelift procedure it may be removed from the outside when the SMAS layer is exposed, however, this can be a little riskier due to the facial nerves in the area.
Right Buccal Fat Pad being removed
Today more men are seeking cosmetic procedures than ever before, along with facelifts, popular procedures for men are: liposuction, gynecomastia (male breast reduction) and rhinoplasty (nose reshaping).
Dr. Delgado is a highly experienced top cosmetic plastic surgeon who has been in practice since 1988, performing the most up to date facelift procedures. Serving the greater San Francisco Bay area, including Sacramento, San Jose, and Los Angeles. Call or email today for a phone or virtual consultation at (415) 898-4161.
January 31st, 2014 Miguel A. Delgado Jr, MD
San Francisco, California-Drainage tubes are placed at the end of several different major types of cosmetic plastic surgery, including but not limited to: gynecomastia (male breast reduction), tummy tuck surgeryand breast reduction, also known as reduction mammoplasty.
The purpose of a drain is to remove blood and lymphatic fluid from the operative site. This will help prevent infection and eliminate dead space created by removal of fat and breast tissue. Removing the accumulated fluids will also promote healing and recovery.
Jackson Pratt is the type of drain used after breast reduction surgery. It has a clear tube that runs from the surgical site to a bulb or reservoir. When the bulb is emptied it is gently squeezed when reattaching to the drain tube causing a low negative pressure suction that helps remove fluids. You will be asked to keep a log to measure output and color of the fluid.
Prior to surgery, Dr. Delgado’s patients are given a detailed instruction booklet with extensive pre and post-operative instructions. In addition, prior to being released from Marin Cosmetic Surgery Center, in Marin County, California, the nurse will review all post op care, including a demonstration of measuring and emptying the bulb to you and your overnight caretaker. The amount of drainage and color of the fluid will determine when the drain can be removed, usually within 3 to 5 days.
If the patient notices: an unusual increase of fluid collection, bright red blood, fever and/or tenderness it must be reported immediately. It is possible for the drain tube to get blocked with a small blood clot. This can be remedied by pinching the tube above the blockage and sliding with a pinching of the thumb and forefinger of the other hand down the tube to the bulb. This will also be demonstrated.
The removal of the drain may cause some discomfort of a burning or stinging nature. Taking pain medication prior to removal is possible as long as the patient has someone to drive her home.
After removal of the drains, the small incision site will close up within 24 to 48 hours. Once they have closed up they are now waterproof and the patient may resume regular showers. However, while the drains are still in place, only sponge baths are allowed, and the incision site must remain dry to avoid infection.
Even with the minor discomfort that the drains may cause, they serve a great purpose in not only reducing the chance of infection, speeding up healing and recovery; they prohibit the buildup of fluids in the surgical site which would be much more painful.
Dr. Delgado has been serving the greater San Francisco Bay Area, Sacramento, San Jose and Los Angeles since 1988. Call or email today at (415) 898-4161 for a personal or virtual consultation with Dr. Delgado for breast reduction surgery.
December 30th, 2013 Miguel A. Delgado Jr, MD
This is a Marin County, California 45 year old mother of two children. She is 5’5″ tall and weighs 135 pounds. She had a full tummy tuck with liposuction of the flanks at Marin Cosmetic Surgery Center.
San Francisco, California- Abdominoplasty or tummy tuck surgery is noted as having one of the highest satisfaction rates for cosmetic surgery. For women the most popular procedures are: breast surgery, liposuction and a tummy tuck, which can be combined making for a “mommy makeover” procedure. For men the most popular procedures are: male breast reduction (also known as gynecomastia), liposuction and abdominoplasty. The only downside for the tummy tuck procedure is the long hip to hip scar and discomfort from the first few days of healing.
Most men and women find the scar is an easy tradeoff for their new flat tummy, and in fact, most are pleased to find that after about a year of healing the scar fades to white or silver and is much less noticeable.
In the past, the pain has been managed quite well by a pain pump. The pain pump is a device that disperses an anesthetic to the surgical area by way of a couple of tubes, positioned by the surgeon at the end of surgery, through the skin of the upper abdomen. The anesthetic solution is stored in a bulb about the size of a tennis ball and is automatically dispersed over a period of about three days. The system has worked quite well in keeping the patient comfortable, however, the device is in a bag worn by the patient with a strap going around the neck, proving to be somewhat cumbersome and restricting the patient’s movements.
In keeping up to date with the latest innovations, Dr. Delgado now uses Exparel for his tummy tuck patient’s pain control.
Exparel is a slow release numbing agent that is a onetime injectable done by the surgeon at the end of surgery. This injectable lasts for about 72 hours, which is the duration of the worst part of the post-surgical pain. Exparel allows the patient the freedom of not having the pain pump tethered to them.
When the brain receives signals of pain, Exparel will block the nerve impulses, providing relief to the patient. The anesthetic used in Exparel is bupivacaine, more commonly known as Marcaine, which is suspended in liposomes that slowly release the drug.
Dr. Delgado’s anesthesiologist, Dr. Randy Gaynor, will need to know if you have had any problems in the past with anesthesia. Most patients tolerate Exparel very well, but it is important to know if you have any history of; kidney or liver problems, any history of seizures, heart rhythm disorders or heart disease.
It is not unusual for tummy tuck patients to need some narcotic pain relief in addition to the Exparel. However, studies show that patients that had the Exparel injections took about a third less pain relievers than the non-Exparel patient, and the Exparel patient had a faster recovery time with less discomfort.
Exparel is comparable in cost to a pain pump, so it is mostly used in extensive surgeries. For the patient with a low pain threshold or for one who is overly anxious about an upcoming surgery, it would be worthwhile to discuss pain management with Dr. Delgado.
To schedule a consultation, call (415) 898-4161 or send an email.
November 30th, 2013 Miguel A. Delgado Jr, MD
Reception for Dr. Miguel Delgado
Marin County, Novato CA
San Francisco, California-Always forward thinking, Dr. Delgado makes available to his patients the latest and most innovative procedures that he has determined are safe and give the best results. Not all patients desire cosmetic plastic surgery for various reasons such as: corrections are only minor, taking the time out of a busy schedule, fear of surgery and/or anesthesia, or financial limitations.
There are many non-surgical options for patients that can reduce signs of facial aging, sculpt the body, and refresh the skin. Subtle changes can increase self-confidence and one’s perspective on life. With this in mind, Dr. Delgado continues to expand procedures offered to his patients at his “Non-Surgical Center of Excellence”.
Many patients are confused as to what procedures may benefit them when they see so many treatments available that are showcased on television talk shows, the internet, and all forms of media. It is recommend that patients schedule a consultation with Dr. Delgado to discuss problem areas that patients find disturbing and with Dr. Delgado’s expertise, he can recommend the optimal treatment for the best result.
The latest procedure that Dr. Delgado has added to his practice is “CoolSculpting”. CoolSculpting is the exciting non-surgical solution to removal of those stubborn areas of fat that dieting and exercise will not eradicate. For details on this procedure see the previous blog or the section on this website.
CoolSculpting is in good company with other procedures that Dr. Delgado offers, also added this year is “ Ultherapy” a FDA approved procedure. Ultherapy is a non-surgical facelift that tightens the skin by ultrasound which stimulates new collagen growth. One 60 to 90 minute treatment will continue to show improvements for up to 6 months. This is the perfect treatment for patients who are not ready for a facelift but would like a little tightening, or for facelift patients that need a little touch-up.
Ultherapy Now Offered in Marin County is
Featured in” New You”
Fat injections continue to gain popularity as an excellent filler for the face where some fat loss has occurred. Using one’s own fat loaded with stem cells has proved to be the longest lasting correction. In addition to the face, fat injections or fat grafting can correct such defects as “crater deformity” in the male chest from over resection during a gynecomastia or male breast reduction procedure. Many cosmetic surgery patients are choosing to take advantage of a service that Dr. Delgado provides through “AdiCyte”, which is a company that stores a patient’s fat for future use, known as fat banking.
According to the American Society for Aesthetic Plastic Surgery (ASAPS), non-surgical procedures have increased 356% over the last 15 years, with Botox the number one injectable every year. In 2012, Botox increased another 24%! Botox works by blocking the nerve muscles. The wrinkles will then soften and relax when the muscles can’t contract. The most popular areas treated are the glabella, (the area between the eyebrows), crow’s feet (the corners of the eyes), and the forehead.
As an expert injector, in addition to Botox, Dr. Delgado offers Dysport (similar to Botox), Restylane, Juvederm, Radiesse, Sculptra and Artefill. Each has different advantages, so it is recommended that you discuss your options in consultation with Dr. Delgado.
To complete the offerings of the “Non-Surgical Center of Excellence”, are Diolite, Photo-facial, and laser hair removal.
Diolite is a laser that treats age spots, skin tags and red vessels of the face. Photo-facial will treat brown spots, shrink pores and even out skin tone. One of the top cosmetic procedures in the United States is laser hair removal, requested by both men and women.
You can be assured that as new procedures become available, Dr. Delgado will be offering them once he is convinced that they are safe and may be of benefit to his patients and not just another marketing hype.
Consultations are offered at both the Union Square San Francisco office, and Marin County’s Novato office. Call (415) 898-4161 for a complimentary consultation for your non-surgical desires or email.
October 26th, 2013 Miguel A. Delgado Jr, MD
Dr. Miguel Delgado
San Francisco, CA
San Francisco, CA-According to the statistics of the American Society for Aesthetic Plastic Surgery, the two most popular cosmetic surgical procedures, are breast augmentation and liposuction. Liposuction is very popular with men looking to get rid of love handles and reduce the abdomen. Women love it for reduction of their: “saddle bags”, abdomen, thighs and more. Liposuction has been available in the United States since the early 1980’s and the popularity continues to grow.
Fat reduction is big business, which is very evident by the multiple choices of the many types of fat reducing devices available. Competition is intense for market share between manufacturers, but competition is always good in a free market society encouraging manufacturers to continue to produce more effective and higher quality devices. There have been many liposuction machines introduced, but most are just variations with small differences.
Liposuction is surgery requiring: pre-operative lab tests, surgical and operating room fees, prescription medications, compression garments and downtime for recovery. To find a way of fat reduction that does not involve surgery, has been a dream of many, for years. That dream is now a reality! Doctors from Massachusetts General Hospital in Boston noted that children who consumed many popsicles were developing dimples in their cheeks due to fat loss. Through testing, the doctors discovered that intense coldness killed fat cells, and the fat cells were then eliminated naturally by the body. Even though it is a somewhat slow process, it is permanent. This discovery led to the development of CoolSculpting. With CoolSculpting, there are not any needles, scalpels, scars or downtime.
CoolSculpting has hit the market with great reviews; the demand for the procedure shows how many patients embrace the idea of a non-surgical fat reduction option. CoolSculpting will not replace liposuction as it is not as aggressive. CoolSculpting is not meant for large areas of reduction; it is more for those difficult localized pockets of fat that diet and exercise will not remove such as: the abdomen, love handles and for some men with pseudo-gynecomastia it will reduce the fat on their chest.
You are born with a certain amount of fat cells, if you consume more calories than your body can use, the extra calories will be stored as fat, and the cells will grow larger. If you lose weight the cells will shrink, but they will not go away unless they are removed by liposuction or CoolSculpting. CoolSculpting only removes subcutaneous fat, fat that is attached to the skin. It does not affect visceral fat, which is deeper and surrounds the organs.
The ideal patient is within 20 to 30 pounds of ideal body weight, if you can pinch more than 2” you may want to lose weight first or consider liposuction.
For treatment, the patient arrives in comfortable clothing and lies or sits on the treatment table. Most patients read, use their laptop or take a nap. The targeted area is placed between 2 cooling plates that are held into position by a vacuum. The fat is then subjected to intense coldness, which will kill the fat cells but does not affect the blood vessels, nerves or skin. The treatment lasts for about an hour per area. Most patients claim the procedure is not painful, but they feel the initial coldness and some pressure. The side effects are minimal, and if any would include: some redness, numbness, swelling and minor bruising.
Results will not be evident right away, the destroyed fat cells can take up to 2 to 4 months to be shed by the body. Many patients state that they first start seeing results after 2 to 3 weeks when they noticed the difference in how their clothes fit. In general, one treatment will reduce an area by 20%, if a patient desires to have more removed additional treatments can be done.
Success for permanent results will be based on lifestyle changes of a healthy diet and exercise program.
To find out if CoolSculpting is for you, schedule a consultation with Dr. Delgado in either his Marin County office in Novato or his Union Square office in San Francisco. Ask about other procedures available through the “Non-Surgical Center of Excellence”such as: Ultherapy for skin tightening, Botox, fat injections, and facial fillers.
July 31st, 2013 Miguel A. Delgado Jr, MD
San Francisco, CA-Cosmetic plastic surgery procedures for men have increased 106% since 1997, and increased 20% from 2011 to 2012 according to “The American Society for Aesthetic Plastic Surgery” known as (ASAPS). ASAPS was established in 1967 and is one of the two prestigious societies for Board Certified Plastic Surgeons.
ASAPS mailed out 23,000 questionnaires to Board Certified Physicians to come up with the percentages. Men had almost one million procedures done in 2012 which accounts for one tenth of all cosmetic procedures performed. More men of all ages are seeking cosmetic surgery each year as heightened awareness and acceptability of surgical solutions increases.
According to ASAPS, the top five procedures for men for 2012 are:
2. Rhinoplasty (nose reshaping)
3. Blepharoplasty (eyelid surgery)
4. Gynecomastia (male breast reduction)
5. Otoplasty (ear surgery)
Liposuction for men has become increasingly popular as men learn of the benefits of body sculpting on many TV shows and news articles. The three most popular areas are; the neck, the abdomen and the flanks (love handles).
Many surgeons feel it is the treatment of choice for male breast reduction, however, without the inclusion of surgical excision the results are very disappointing for men with true gynecomastia.
Liposuction is an excellent treatment for fat deposits that do not respond well to diet and exercise, but for a man the surgeon has to take great care not to give a feminized look for the man keeping a more square appearance to the back and waistline. Men prefer etching of the abdomen to accentuate the abdominal muscles. Men also want their scars hidden, as do women, and they are usually in the belly button and the underwear line.
Rhinoplasty can be any time after the nose stops growing, usually between 15 and 18 years of age for males.
This is a 30-year-old, San Francisco, CA resident who presented to the San Francisco office at Union Square for evaluation for an external rhinoplasty.
A man’s nose should fit his face, which may mean a stronger dorsum and/or a more projected nasal tip. Women may seek a narrower nose while men may seek a wider nose.
Computer imaging is a great tool for the surgeon to show to the patient what the final result may be.
Blepharoplasty is surgery for the eyes; the eyes are one of the first places to show age and can make a person look tired, angry or old. Eye surgery is different for men than women, with different goals. Men have thicker skin and heavier facial muscles. Heavy upper eyelids can make a man look older. A low brow is attractive for the man, but if it is elevated during surgery, it must be done conservatively to avoid feminization of the male face.
Fat can accumulate in the upper and lower lids with the result of the upper lids looking puffy and hooding the eye and the lower lids can be puffy and saggy with dark circles. Some men may have enough drooping upper eyelid skin that it will interfere with vision and in some cases to such a degree that upper eyelid surgery may be covered with health insurance.
Gynecomastia surgery is up 5% over 2011 according to ASAPS. It appears that not only is the amount of surgery going up, but also
This 29-year-old San Francisco man suffers from adolescent gynecomastia. He underwent glandular excision and suction-assisted lipectomy of the chest, from which I excised 23 grams of glandular tissue from the right and 21 grams from the left side.
the incidence of gynecomastia cases being reported. It is believed that the increase in gynecomastia cases may be due to the use of many prescription drugs and well as many over the counter medications. Supplements and steroids are also linked to the development of male breasts, and as more hormones are introduced to the environment the increase in cases will continue.
Otoplasty, as noted in the previous blog can be done on boys as young as five years old, and is preferable so that teasing and psychological trauma can be avoided. However, as long as a patient is in good health, there is no age limit to having this surgery.
This procedure is popular for men due to the fact that their ears are more noticeable than women’s because they generally wear their hair short.
The American Society of Plastic Surgeons (ASPS) is the other prestigious society for Board Certified Plastic Surgeons. ASPS also reports statistics based on surveys taken from their members. The results are similar to ASAPS, but with a few variations.
ASPS reports that the top 5 procedures of 2012 for men are:
Gathering the statistics is not a perfect science, but the results do give us a trend and in both studies show the acceptance of men seeking a natural but improved appearance in the face and body.
July 15th, 2013 Miguel A. Delgado Jr, MD
Dumbo the Elephant
San Francisco, CA-As cosmetic surgery procedures increase year after year, it’s not surprising to see some strange developments, fads and marketing ploys. There are pet plastic surgeons that do many procedures on animals including facelifts, alter droopy ears and even give them Botox injections. There are braces for dogs called Rin Tin Grin and you may have heard of silicone implants called Neuticles that replace testicles on neutered dogs.
On a more serious note, parents are seeking measures to protect their children from the devastation that bullying can cause for their children and teenagers. There have been multiple stories in international news lately of children being tormented by classmates and cyber stalking leading to teen suicide.
Adolescent boys may be teased for gynecomastia, but for young children, the most notable condition that seems to cause teasing to the point of bullying is protruding ears. Children can be cruel by calling the afflicted child with names like; Dumbo, elephant ears and Mickey Mouse.
This can be (but not always) a hereditary factor and; therefore, many parents want to save their children from going through the torment they may have faced as a child. Ears that protrude can erode self-confidence in a child, and impact their emotional stability and eventually affect behavior. Adults also may experience extreme embarrassment from protruding ears to the point it may affect their everyday life.
The pinna is the outer ear and has a minor function in the aid of hearing. If there is too much cartilage in the pinna, there is a greater chance it will be prominent or protruding.
Normally the ear projects out about 20 degrees to 35 degrees from the side of the head, if the angle is greater than that it can be quite noticeable.
Another cause for protruding ears is when the edge of cartilage at the uppermost part of the ear does not bend down in the right position during development. Lastly, injuries to the ear can cause distortions.
About 30% of babies are born with malformations of the ear. Congenital conditions can be the cause, or it may occur during birth. Many of the deformities will correct themselves, but if they don’t by the time the baby is a week old, surgical intervention may be needed at some point.
For babies who are six months or younger, an ear splint may be used. Ear splinting is a safe and simple procedure where the soft cartilage can be reformed with the use of a splint. However, usually when the baby is six months old the cartilage will become hardened and not able to respond to a splint and cosmetic surgery may be needed for correction.
The technical term for ear surgery is otoplasty. Usually a child’s ears have finished developing by 5 years of age, and surgery should not be done before then. Plastic surgery can craft absent folds and also make the ear flatter against the head.
The three principal forms of otoplasties are:
1. Ear augmentation – this is where the external ear is undersized or doesn’t even exist.
Incision for Ear Pinning
2. Otopexy – is protruding ears that are flattened or pinned back.
3. Ear reduction – Is where the outer ear is too large.
For adults, the surgery often is done under local with IV sedation; general anesthesia is the preferred method for children. For the procedure itself, the plastic surgeon will take the necessary amount of cartilage and skin from an incision in the back of the ear. The scar will be hardly detectable after it heals.
Often otoplasty surgery can be done before the child starts school to avoid probable teasing, but it is important that this is something that the child understands and wants. The other procedure that is sometimes considered for older children (teenagers) is rhinoplasty or nose surgery. In some cases, reconstruction is necessary for breathing issues, and some cosmetic corrections can be done at the same time.
July 1st, 2013 Miguel A. Delgado Jr, MD
San Francisco, CA-When the FDA called a moratorium on silicone breast implants in 1992, the road back to approval for these implants was very slow. The scare that the implants might be causing autoimmune diseases and various other complications made the implants unavailable to all except patients undergoing breast reconstruction surgery or breast augmentation revision surgery. That left women who wanted breast augmentation, saline breast implants as their only choice.
Mentor’s MemoryShape Implant
After many clinical trials, silicone breast implants were deemed safe and returned to market in 2006 for women 22 years of age and older. The approval comes with the understanding that the FDA recommends (not requires) that women have an MRI after three years of implantation and then every two years after that. The MRI is to watch for what is referred to as “a silent leak”. Within just a few years, the popularity of silicone breast implants surpassed saline implants by 80%.
Conducting trials for breast implants is very challenging for manufacturers, surgeons, patients and the surgeon’s staff. Once the excitement of the surgery has worn off, it is difficult to keep patients that are not having any issues to come in for their yearly visits, even with incentives offered by the manufacturer. In many cases, the patient may have moved out of the area, or there may have been staff turnover in the surgeon’s office and compliance starts falling through the cracks, making consistent follow up for 5 to 10 years daunting.
In anticipation of future FDA approval for silicone breast implants, manufacturers continued to develop new types of implants and started to conduct clinical trials. The “gummy bear” which is a colloquial term to describe the firmer anatomical cohesive gel implant, had trials beginning in 2001.
The highly cohesive implant made by Mentor is called “MemoryShape” and has been available for the past 10 years in 70 countries but not in the United States, until now. The “MemoryShape” implant has a tapered “teardrop” shape. It is thinner at the top and gently slopes to a fuller projection at the bottom. The shell has a subtle imprint; “Siltex Texture” designed to keep the implant in place.
The appeal of the anatomical shaped cohesive breast implant for most women is for a more natural look, youthful firmness and due to the high cohesiveness, they are less likely to ripple, rupture or leak throughout the breast tissue. For the downside, many women do not like the firmness or the risk of rotation of a teardrop shaped implant leaving them looking deformed. Also, it is very difficult to insert the implant through an incision around the areola, the recommended approach is the inframammary fold which requires a longer incision. The breast implant cost goes up by approximately $1000. The anatomical shaped implant does not work well with breast revision surgeries or for the woman who desires larger and/or softer implants and for the woman having a breast reduction with a lift and implant, will most likely be happier with the standard gel implants.
Allergan got FDA approval for their “gummy bear” implant, Natrelle 410 in February 2013, and Sientra got approval for their anatomical cohesive gel implant in March 2012. Mentor is the only company that manufactures their implants in the United States, but all implants available in the United States are manufactured with the same strict guidelines.
The anatomical cohesive gel breast implants vary in; their firmness, their shape and dimensions. They all have a textured shell to help the implant from moving out of place or rotating. The different manufacturers made their implants with different degrees of cohesiveness and they vary on how much gel they put into the shell. The more cohesive the gel is and the more they fill the shell, the better it will hold its shape, and is more resistant to shell folds, but will not feel as soft.
Since FDA approval of silicone gel breast implants in 2006, women have many more choices. There is fierce competition amongst breast implant manufacturers. Each manufacturer has its own philosophy for advantages and disadvantages for the different possible aspects of breast implants.
In deciding to have breast augmentation surgery, the patient needs to review all risks and possible complications with her surgeon and understand that implants are not lifetime devices. It is important to be aware of the fact that revision surgery will most likely be necessary at least once in a patient’s lifetime, and maybe more.
Surgeons have their own preferences and experiences with different implants. It is more important to find a Board Certified Plastic Surgeon that you trust, to help you determine what type of implant is best for you. Be sure to request to see many pictures, before and after breast implants.
June 16th, 2013 Miguel A. Delgado Jr, MD
This is a 66-year-old female resident of Sonoma, CA presented for evaluation of her face. In addition to having other facial procedures, she underwent an upper and lower eyelid lift or blepharoplasty with a chemical peel of the eyelids. Note the drooping of the lower eyelids before surgery and after surgery a more youthful appearance with better lower eyelid position.
San Francisco, CA-It has been said, “The eyes are the windows to the soul”. When communicating with other people, we almost always have eye contact. Our eyes may be our most important feature. With facial aging, the eyes are usually the first to show signs with fine lines and wrinkles at the corners, commonly called “crow’s feet”. For years now Botox has been the most popular injectable for correcting “crow’s feet”, even with patients in their twenties.
According to the American Society of Plastic Surgeons, Botox and Dysport saw an increase of 8% in 2012 and eyelid surgery saw an increase of 4%. Eyelid surgery was the third most popular cosmetic surgery performed.
As we continue to age the skin starts to lose its elasticity, and along with sun exposure can result in drooping and sagging skin of the lower eyelids. The eyes may age well before the rest of the face, and may cause many to seek an eyelid lift at an early age. Whether eyelid surgery is done at an early age or along with a facelift (or both); it remains one of the most sought after procedures.
Generally we refer to eyelid surgery as blepharoplasty, which could mean upper and/or lower eyelids. For lower lid surgery specifically, there are two popular procedures, canthopexy and canthoplasty. Often the terms are used interchangeably, but they are very different.
“Pexy” means to fixate or make secure, and “plasty” means to restore, repair or replace. With both procedures, the goal is to strengthen the tissues at the lateral canthus, or the outer corner of the eyes, to give better support to the lower eyelids.
Canthoplasty is a surgical procedure whereby the surgeon actually cuts the canthal tendon, which holds the lower eyelid in place, makes it tighter and may remove excess skin, as well. Then the tendon is reattached to the orbital bone. This procedure changes the shape of the eye to more of a cat-like appearance.
Canthopexy is a less invasive procedure where the tendon is not cut, but the surgeon uses sutures to tighten it and stabilize it without reconstructing it. It does ot change the shape of the eye.
These procedures can also correct ectropion. Ectropion is where the lower eyelid is gaping open; this can cause dry eyes and eye irritation that may lead to infection. This gaping of the lower eyelid can be caused by trauma or previous surgeries, inflammation, thyroid eye disease or facial nerve palsy.
For patients with ectropion and dry eyes, it is possible medical insurance will cover the corrective surgical procedure, but if it is for cosmetic purposes it will not be covered. Similar to upper eyelid surgery for the patient with redundant skin that affects vision, which is also a situation that insurance may cover. Your surgeon will be able to advise you on your possible approval for surgery with your health insurance.
Eyelid surgery can be done with local anesthesia or with IV sedation. If it is combined with other procedures such as a brow lift or facelift, then it would most likely be done under general anesthesia.
As with any surgery there are some risks involved. For canthoplasty, the junction of the upper and lower eyelids may become rounded or retracted and may result in what is known as “round eye” or “scleral show” where the lower lid is pulled down and the white part of the eye below the iris shows. If overdone, the result may be an unnatural upward slant to the eyes.
Canthopexy, on the other hand, is a much less invasive procedure and not subject to the same risks as canthoplasty. Although complications are rare with these procedures especially if you have a Board Certified Plastic Surgeon and Board Certified Anesthesiologist, the possible risks and complications as with any surgery are; bleeding, infection, and complications with anesthesia.
This is a 62-year-old man from San Rafael, CA presented for evaluation for his eyelids. His complaints were the aged look around the eyes and the flatness around his lower eyelids. He underwent an upper and lower eyelid lift or blepharoplasty with fat injections to the mid-face region. Note the eyelid improvement and the natural appearance of the eyes.