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.
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.
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.
April 30th, 2013 Miguel A. Delgado Jr, MD
San Francisco, California-Haute MD is an upscale internet publication with current articles on health and beauty trends. This trusted online publication offers readers concierge access to premiere cosmetic specialists around the country. Dr. Delgado was selected for his exceptional reputation and talents in plastic surgery, with emphasis on surgical procedures of the body, such as; breast augmentation, breast reduction, tummy tuck, mommy makeover, and gynecomastia.
Along with a referral to top physicians, Haute MD includes a detailed profile with the doctor’s before and after pictures of actual patients, videos (if submitted) and testimonials.
The informative website offers San Francisco Bay Area men and women fascinating reading with articles like:
· “Cupping Celebrity Health Fad: Groundbreaking or Totally Useless?”
· “Benefits of Dead Sea Salt”
· “Power Juice and How it Helps You”
“Haute MD connects the most trusted doctors and specialists with the country’s most discerning affluent audience. The network is an exclusive, invite only membership circle with only one representative per market for each of the nine medical specialties.”
December 15th, 2011 Miguel A. Delgado Jr, MD
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.