May 14th, 2012
There have been wonderful advances in cosmetic plastic surgery through the years, and for most people the benefits are very rewarding. Sonoma patients notice the boost in self confidence and self esteem saying it can be life changing.
Consider the young patient who has ears that stick out or a large nose, or the young boy who has developed male breasts (gynecomastia) at puberty. Teasing is cruel and can have long term harmful effects. For the wise parent who seeks an evaluation from a Board Certified Plastic Surgeon, their child may be able to have corrective surgery ending the torment.
Then consider the woman who has had children and is left with droopy skin in the stomach and breasts. Even with all the rewards of motherhood, most women are frustrated with the changes their body has gone through. For her the “mommy makeover” can make a dramatic difference as to how she feels about herself, which is not only a benefit to her but her family as well.
For the aging patient who is trying to compete in the workforce, a facelift can make a dramatic difference. Not only does the patient look better, the boost in self esteem may give the patient the extra confidence needed to land that new job.
San Francisco Bay Area women claim breast reduction surgery is one of the most rewarding procedures, not really considered cosmetic surgery but an elective procedure. Sometimes insurance will cover most of the cost if certain criteria are met.
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April 4th, 2012
Many San Francisco Bay Area patients are confused as to what procedures are included in facelift surgery, also known as a rhytidectomy. A “facelift” can mean different things to patients and surgeons alike. You want to be sure that you and your surgeon are in agreement as to what is included.
For the practice of Miguel A. Delgado, M.D. a detailed quote is given to the patient at the time of consultation to avoid any misunderstandings. For Dr. Delgado, a “lower facelift” includes the lower face, jowl and neck. A “facelift” can and is different for almost everyone depending on their needs. A full face lift can include a brow lift, upper and lower eyelids or just upper or just lower eyelids.
Many patients opt to have additional procedures done as they plan to have surgery only once. Some of these procedures could include:
• Chin implant
• Lip augmentation
• Fat injections
And many patients want to include other procedures because they will be asleep, such as:
• Medium to deep skin peel
• Botox injections
• Fillers such as Restylane, Sculptra or Juvederm
Beware of advertised procedures that claim they can be done in an hour, they are short cuts that will not give lasting or satisfactory results.
Depending on age and genetics a limited facelift, such as a “short scar facelift” may provide adequate rejuvenation and still have facial harmony for those who choose to have less surgery. This is where the patient and the surgeon need to discuss expectations, and the patient needs to understand the surgeon’s recommendations. Dr. Delgado finds that computer imaging that he offers at the consultation helps clarify goals for the patient.
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March 27th, 2012
Thoughtful preparations prior to face lift surgery for the San Francisco Bay Area patient can lead to reduced discomfort and promotes faster, successful healing. Many patients ask what they can do to get ready for surgery, and surprisingly there is much that can be done.
Planning ahead one should decide if they plan to lose weight in the near future. Being at one’s goal prior to surgery will allow the surgeon to tighten any resulting loose skin. It is not necessary to lose weight prior to surgery if one is stable and satisfied with their weight.
If a patient smokes, it will be necessary to quit 2 to 4 weeks prior to surgery and not resume for 2 to 4 weeks after. A nicotine patch is not an acceptable alternative as nicotine constricts the flow of oxygen to treatment areas greatly impeding the healing process. It is hopeful that a patient that has quit smoking for 1 to 2 months for their surgery will be able to quit for good.
If you color your hair you should do it just prior to surgery or you will need to wait at least a month afterward.
Being at optimal health is best for going into surgery. If you don’t already have a healthy diet this is a good time to consider making smart changes. Lots of fruits and vegetables and lean protein are recommended. After surgery be sure to eat lean protein which assists in healing and avoid sodium as it increases swelling. Prepare frozen meals in advance that are healthy and easy to fix. Plan on soft foods for the first couple of days, again foods that are high in protein and low in sodium. Drink lots of water. Avoid alcohol. There are excellent vitamin products and homeopathic remedies that help with bruising and healing, Dr. Delgado’s patients will be advised of these prior to surgery.
Plan where you will recuperate. If you have a recliner chair, they are the most comfortable for elevating the feet, knees and head. Some Marin County patients have gotten a chair at a garage sale and then donated it after recovery. If you do not have a recliner, be sure to have lots of pillows available to prop up your head and knees. If possible have a speaker phone by your bed and a remote control for the T.V.
Decide what you will be wearing for the first few days, pick items that open in front and do not have to be pulled over your head. Same for what you wear the day of surgery. Wear slip on shoes. You must have someone pick you up as you will not be able to drive as long as you are on pain medication. Plan to have someone stay with you for the first 24 hours or even a couple of days if possible.
Have ice packs or a couple of bags of frozen peas for the first few days. Be sure to get plenty of rest and plan on not doing any housework, heavy lifting or exercise, avoid hot showers, hot tubs and saunas for 2 to 3 weeks or until you get clearance from Dr. Delgado. Brush hair gently and do not tug at the hairline.
The cost of a face lift can vary greatly as each surgery is individual to the patient’s needs. To obtain an accurate personal quote, see Dr. Delgado in consultation. View Dr. Delgado’s vast collection of face lifts before and after in the photo section of this site.
You may choose to meet with Dr. Delgado’s esthetician prior to surgery for camouflage makeup tips to hide bruising and to get on a good skin care regimen.
Dr. Delgado’s cosmetic face lift surgery patients will receive a preoperative surgery packet of information at their visit prior to surgery that will describe the prescriptions that will be given. Be sure to fill prescriptions in advance and write down the time they are taken, it is easy to forget. The packet will have an extensive list of medications and herbs that must be avoided 2 weeks before and two weeks after surgery as they can cause bleeding issues.
In order to go into surgery as relaxed as possible, it is important to address any questions or concerns with Dr. Delgado and Dr. Gaynor the anesthesiologist. Their goal is to keep you comfortable and have your surgery experience be positive.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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