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.
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.
December 29th, 2012 Miguel A. Delgado Jr, MD
Due to the massive advertising on television for the Lifestyle Lift (LSL), many San Francisco Bay Area women ask what it is and how is it different than the traditional facelift.
Even though, it is advertised as something new and unique, it is not. It is basically a mini-facelift that has been around since the 1960’s. The mini facelift is for the patient with simple facial laxity. It is not for the patient with large amounts of loose skin and fat.
The aggressive marketing practices target women that are looking for a less expensive solution for their aging face than the traditional face lift procedure. Lifestyle lift claims that the procedure can be done in an hour, pain free, under local anesthesia, and it is possible to go back to work the next day. Some patients have been pleased with their results, but many are not.
Do your homework, Google “lifestyle lift controversy” and see for yourself. CBS 46, an Atlanta TV station, did a 3 month investigation; the results can be viewed in a 9 part video on You Tube, which shows interviews with former employees and patients. Some former employees stated they had quotas to meet and were pressured to “close the deal” no matter what. They also were to wear white lab coats even though they had no medical training. CBS 46 points out that many companies that have reported unhappy patients have been sued, including CBS 46. Evidently LSL is quick to sue to try to silence their critics including WebMD. Cases have either been settled or dismissed by the judge. LSL reached a settlement with New York State over claims that LSL had posted false customer endorsements on third party websites including realself.com.
Most of the surgeons performing the surgery are not board certified plastic surgeons; in fact many are not even plastic surgeons but osteopath doctors.
December 14th, 2012 Miguel A. Delgado Jr, MD
Due to patients busy lifestyle; many are concerned with the amount of time for recovery after a cosmetic surgical procedure, such as a facelift, breast surgery for men and women, tummy tuck and liposuction. Dr. Delgado has noted a marked advantage in the recovery of those patients who followed his advice by taking high quality vitamins both before and after their surgery.
Dr. Delgado wanted to find the best product available for him to recommend to his San Francisco patients. He believes he found what he was looking for with VitaMedica. VitaMedica has a specific Surgery Program that starts two weeks before surgery and continues until two weeks after surgery. The Surgery Program includes; Clinical Support both AM and PM, which is an excellent multivitamin that does not contain vitamin E (a blood thinner dangerous for surgery patients) with higher doses of vitamin C. In addition, the program includes, Arnica Montana and Bromelain with Quercetin, which reduces bruising and inflammation allowing the patient a faster healing time.
The results for patients taking the VitaMedica Surgery Program were so encouraging to Dr. Delgado that he now includes them for all of his surgery patients.
VitaMedica Surgery Support Program
July 23rd, 2012 Miguel A. Delgado Jr, MD
Face Lift surgery
Most surgeries involve some discomfort. Surprisingly rhytidectomy (facelift) surgery is not particularly painful but depends on how much is done and the technique of the surgeon.
Most patients experience limited pain due to the numbness caused by nerve blocks given at the time of surgery, head elevation and no pressure issues such as tight head garments or a hematoma. For those patients that have moderate pain caused by swelling and bruising, the pain can be controlled by ice packs and prescription pain medication.
If you feel over the counter medication would control your discomfort, be sure you do not take any blood thinners such as aspirin for a minimum of two weeks after surgery. Tylenol is an acceptable remedy.
Dr. Miguel Delgado a Board Certified Plastic Surgeon serving Marin and Sonoma Counties advises patients to be sure to contact their surgeon if there is a sudden onset of pain or pain that is not controlled by pain medication.
March 27th, 2012 Miguel A. Delgado Jr, MD
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.
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.
October 12th, 2011 Miguel A. Delgado Jr, MD
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.
July 17th, 2011 Miguel A. Delgado Jr, MD
Medical tourism dates back thousands of years. Greek pilgrims traveled to the Sacronic Gulf to a territory called Epidauria, considered the first medical tourist destination, for medical treatments and mineral waters for healing not unlike our spas today. Medical tourism seems to be gaining resurgence with elective surgeries. The lure of a tropical vacation package in a far off land which combines the cosmetic procedure of your choice with sunshine, beaches, rest and relaxation away from family, friends and home at a reasonable cost is a tempting proposition to some San Francisco Bay Area patients. There are many countries that are marketing themselves as medical tourist destinations, including; Thailand, India, Brazil, Costa Rica, Mexico, South Korea and more.
There are some very important things to consider that may not seem apparent at first look. Language and cultural barriers make communicating with doctors and nurses frustrating. Doctors in some countries are regarded as authority figures who often are not questioned. Many countries have infectious diseases that Americans and Europeans would not have built up a natural immunity to such as mosquito transmitted diseases, influenza and tuberculosis. Standards of post operative care can vary dramatically depending on the hospital and the country. Accreditation and other measures of quality vary widely across the globe. Traveling a long distance after surgery can be dangerous for possible blood clots in the legs.
Many countries and doctors have lower fees because they do not have protection for patients such as liability insurance. Or they may be using inferior products for such popular surgeries as breast augmentation or breast augmentation with a lift. French made silicone P.I.P. breast implants have a high rupture rate and were eventually recalled. Consultant plastic surgeon Douglas McGeorge of the British Association of Aesthetic Plastic Surgeons (BAAPS) said PIP implants were not used by members of the Association. He said “These are cheap products that tend to be used by commercial companies and could well be used in women who have gone abroad for surgery. They are attracted by cut-price deals but as ever, you get what you pay for”. The recalled implants resurfaced and were rebranded as M-implants putting even more women at risk. This would not be the case in the United States where implants are closely monitored by the FDA for safety.
If you should be awarded a mal practice suit by a court, the doctor or hospital may not have insurance and collecting may be impossible. If a medical complication should arise, your personal medical insurance will probably not cover you while you are out of the country so additional costs could result. If you have a complication once you return home you then either have to return to the foreign country or find a local doctor willing to take on a case with complications which can be very expensive.
Relaxing on the beach to recover is not a good option, it is important to stay out of the sun and the water to avoid scarring and infection. Being close to home where you may have a friend or family member to watch out for you is optimal. And most importantly having your surgeon nearby is the safest situation. After healing is a good time to plan and enjoy a trip to a far off destination.