March 15th, 2014 Miguel A. Delgado Jr, MD
San Francisco, California-The American Society of Plastic Surgeons (ASPS) has reported their statistics for cosmetic and reconstructive surgery for 2013. Each year the report comes out around the end of February after the numbers have been tabulated from the Board Certified Members. It is interesting to see which procedures are the most popular and how they compare to previous years.
This is a 35-year-old resident of Sonoma County, California. She is the mother of two children. She presented to the Novato office in Marin County for an evaluation for breast enhancement. She is 5 feet 2 inches tall and weighs 115 pounds. She underwent bilateral breast enlargement using 300 cc, Mentor High Profile, silicone gel breast implants. The procedure was performed at the Marin Cosmetic Surgery Center in Marin County, California. The approach was a peri-areolar incision with sub-muscular placement for the breast implants. She went from a size A cup to a C cup.
ASPS reported that breast augmentation is once again the number one cosmetic plastic surgery procedure; it even increased over 2012. It is interesting to note that there has been a 37% increase for breast augmentation surgery since the year 2000, and the number one procedure since 2006 when it surpassed liposuction. It is not known why there was an increase for 2013, but it is believed that it may be due to new technology and approval by the FDA of form stable breast implants. Form stable implants are teardrop shaped silicone implants, also known as the “gummy bear” implant.
Taking a look at surgery trends over the last seven years (after breast augmentation), the number two procedure has been nose reshaping every year, except 2007 when it was liposuction. The third and fourth positions are fairly equal between liposuction and eyelid surgery. Fifth position had been tummy tuck surgery for six years and then for the last two years facelift surgery surpassed tummy tuck surgery taking the number five spot.
Patients have an increasing desire to look and feel their best, many come to their plastic surgeons complaining how they appear on Skype and Face Time on their phone. It is believed that competition in the work force is also a factor that has lead to an increase in all facial procedures.
In addition to cosmetic surgical procedures, the minimally invasive procedures have seen quite an increase for 2013. Botox remains in the number one position with an increase of 3% over 2012, with an amazing overall increase of 700% since 2000. The soft tissue fillers have seen an increase of 13% over 2012.
ASPS predicts that cosmetic surgical procedures will continue to see steady growth in the coming years, and especially the newer non-invasive body sculpting, (such as CoolSculpting), will see a dramatic increase.
Dr. Delgado is an expert in his field of cosmetic plastic surgery and has been since 1988, serving the greater San Francisco Bay Area, including San Jose and Sacramento.
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.
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.
March 15th, 2013 Miguel A. Delgado Jr, MD
The American Society of Plastic Surgeons (ASPS) has reported statistics for 2012 stating that cosmetic plastic surgery procedures performed in the United States has increased 5% since 2011. This makes three consecutive years that there has been an overall growth.
The significant rise in the plastic surgery industry is fueled by minimally-invasive procedures, where the cosmetic surgical procedures remained fairly stable. Many patients who start with the minimally-invasive procedures advance to more invasive ones as needed.
ASPS reports that the top five minimally invasive procedures were:
• Botox and Dysport (6.1 million procedures, up 8 percent)
• Soft tissue fillers, such as Restylane, Juvederm, Radiesse, etc. (2 million procedures, up 5 percent)
• Chemical peel (1.1 million procedures, up 2 percent)
• Laser hair removal (1.1 million procedures, up 4 percent)
• Microdermabrasion (974,000 procedures, up 8 percent)
For cosmetic surgical procedures, there was an overall decrease of 2 percent, with nearly 1.6 million procedures in 2012. The top five surgical 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 the large increase in eyelid surgery and facelifts, most believe this is attributed to the ongoing competition in the workforce and the high number of retiring baby boomers.
Interestingly the number one surgical procedure, breast augmentation is down 7% while male breast reduction (gynecomastia) shot up 5% for 2012.
February 28th, 2013 Miguel A. Delgado Jr, MD
Before and After Brow lift, eye lift and corrugator release
Botox has been used for treatment of the glabellar frown lines since 1992. The glabellar frown lines are the moderate to severe frown lines between the eyebrows. Marin County patients have asked if there is a more permanent treatment available other than repeated Botox treatments every 3 to 4 months or for some 6 to 8 months. The answer is yes, the corrugator muscle excision. The corrugator muscle excision can be done in conjunction with a brow lift or upper eyelid lift.
The corrugator muscles are used frequently when we laugh, frown, squint, concentrate, and show surprise or anger, causing the skin and tissue to wrinkle and stretch. Botox temporally weakens or relaxes the muscle allowing the frown lines to disappear. If the corrugator muscle is surgically removed, Botox injections will no longer be needed.
San Francisco Bay Area patients may be interested in discussing the corrugator muscle excision with Dr. Delgado at the time of their consultation for any cosmetic facial procedures.
April 4th, 2012 Miguel A. Delgado Jr, MD
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.