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.
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.
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.
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.
May 31st, 2013 Miguel A. Delgado Jr, MD
San Francisco, California-If you Google “stem cell facelift”, you will see an abundance of advertising for this catchphrase which is considered to be a pure marketing gimmick that is not medicine. The “stem cell facelift” is actually a misnomer; it is a nonsurgical procedure involving fat injections to plump up the face, not a surgical procedure like a conventional facelift that requires cutting, lifting and sewing.
Most physicians who advertise are taking advantage of the latest marketing ploy, by using fat which already contains stem cells for their “stem cell facelift procedure”. There are a few doctors who are adding stem cells to the fat claiming the “enriched fat” is what gives superior results. It is not proven that fat grafting with added stem cells gets any better results than fat grafting without the added stem cells, and fat injections or fat grafting, is a well-established procedure that has been around for two decades and is an excellent procedure for facial volume replacement.
A recent abstract published in The Aesthetic Journal states that; “Despite encouraging data suggesting that adult stem cells hold promise for future applications, the data from clinical evidence available today do not substantiate the marketing and promotional claims being made to patients. To claim that the “stem cell facelift” is a complete facial rejuvenation procedure surgery is unethical.”
Stem cell technology for aesthetic purposes is exciting and perhaps very promising. However, the jury is still out, scientific evidence does not support the safety and efficacy at this time. The American Society of Aesthetic Plastic Surgery (ASAPS) and American Society of Plastic Surgeons (ASPS) request their Board Certified Plastic Surgeon members only use this procedure in clinical studies under institutional review board approval and report their findings.
There will always be practitioners that are quick to take advantage of new trendy procedures, see the blog on the “Vampire Facelift” dated June 22, 2012. Do your homework, and “let the buyer beware!”
March 30th, 2013 Miguel A. Delgado Jr, MD
This is a 60-year-old female who presented for evaluation for a facelift. She had undergone a lower facelift, including the neck, upper and lower eyelid lift and an endoscopic brow lift.
A popular question with Marin County patients is, “How long will a facelift last?” A facelift, technically called a rhytidectomy, won’t last forever but it will have lasting results. You will always look younger than if you did not have one, but the aging process is ongoing.
There are several factors that contribute to how long a face lift lasts, some in your control others that are not. Genetics and skin quality are important factors, but the experience of the surgeon and the technique used plays the biggest factor.
The lifestyle lift, thread lift or mini facelift last the least amount of time with the most disappointing long term results. A modern facelift including a neck lift using a SMAS advancement and plication will last the longest, usually 8 to 10 years.
Patients who take care of their skin by; using good skin care products, avoid the sun as much as possible, and use good sun screen protection, do not smoke, and keep a stable weight, are able to prolong the great results of their facelift surgery. Many San Francisco Bay Area patients opt to have a chemical peel and/or fat injections at the time of their facelift surgery at Marin Cosmetic Surgery Center, which helps extend their results.
At the time of a consultation with Dr. Delgado at 450 Sutter Street San Francisco, or 165 Rowland Way, Novato in Marin County, you will learn what results you can expect from your facelift surgery.
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.
November 25th, 2012 Miguel A. Delgado Jr, MD
Before and After Facelift
Some patients have asked Dr. Miguel Delgado during consultation at 450 Sutter Street, Suite 2433, San Francisco if it is a good idea in preparing for facelift surgery to lose weight. When you gain or lose weight, your face can change dramatically. It is good to be close to your ideal weight prior to surgery, a weight you are comfortable with and that you can maintain.
If prior to a rhytidectomy (face lift) you were to lose a substantial amount of weight, you may end up with a loss of volume in the face that can make you look sick or gaunt. During a face lift procedure, loose skin is tightened, but in some cases it may be recommended to have facial fillers or fat transfers to restore volume giving a more youthful appearance.
After a facelift if one loses 10 to 15 pounds, it probably won’t make much difference to the face, but if you were to lose 20 pounds or more you may end up with loose skin as the volume decreases. Patients are encouraged to speak directly to Dr. Delgado at (415) 898-4161 for any concerns they may have regarding facial rejuvenation.
October 23rd, 2012 Miguel A. Delgado Jr, MD
There were 5.7 million treatments of Botox given in 2011, which is up 5% from 2010. This is an increase of 621% since 2000 according to the American Society of Plastic Surgeons (ASPS). It is not surprising that there are individuals that are trying to cash in on this phenomenon, even at the risk of the patient.
California governor, Jerry Brown, has signed a new law that will increase supervision on “medi-spas” in Marin County and all of California, that offer cosmetic treatments such as Botox and injectible fillers. The new law will increase fines on the facilities if it becomes known that there is a lack of medical supervision and some may be shut down. Some facilities or “Spas” have a doctor’s name attached to it, but it may be in name only. Should a problem occur, there would not be a trained physician to take over. These physicians will face legal action if they are only lending their name.
Recently CNN reported the story of a woman in Florida who ended up admitted to a hospital for a month, due to receiving some unknown injection to her face from a local Spa. She got a serious infection that led to 5 different surgical procedures that have left her scarred and still swollen.
ASPS encourages all patients who are considering Botox or other non-invasive treatments to be sure to see a Board Certified Plastic Surgeon who operates out of an accredited facility.
June 22nd, 2012 Miguel A. Delgado Jr, MD
Many cosmetic plastic surgery patients have been inquiring about the “Vampire Facelift” more out of curiosity than anything else. Recently Dr. Delgado published a Press Release to clear up misconceptions as to what it is and what it is not. You can see the entire article here.
Basically some doctors are using a patient’s own blood that has been separated by a centrifuge and mixed with calcium chloride that makes a gel like substance and then used as an injectible filler to increase volume of the face. Orthopedic doctors have been using this substance for years for the purpose of tissue repair. To date the aesthetic use as facial filler has not been FDA approved. Doctors that are using it for this purpose are using it “off label”.
With the popularity of vampire books and movies, the name “vampire facelift” gets a lot of attention. A doctor actually trademarked the name and claims it is how he does the procedure, not the actual filler itself.
It is claimed that the filler can last up to 18 months. Dr. Delgado prefers using a patient’s own fat when possible and for many, the volume has decreased very little over several years. Dr. Delgado states, “We must separate marketing from real medicine”.