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Eye Surgery: Canthopexy Versus Canthoplasty

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.

Stem Cell Facelift Controversy Continues…

May 31st, 2013 Miguel A. Delgado Jr, MD

 

Centrifuged fat

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!”

Ultherapy – The New Non-surgical Facelift Now Available To San Francisco Patients

May 15th, 2013 Miguel A. Delgado Jr, MD

Ultherapy Ultrasonic Machine

San Francisco, California-Ultherapy is the new FDA approved ultrasound treatment that stimulates the deep structural support layers of the skin. The subcutaneous layer and the fibrous SMAS layer are heated up by ultrasound energy, which stimulates growth of new collagen over time to tone and tighten loose and sagging skin of the face and neck. This is achieved in most cases with one 60 to 90 minute office treatment. The patient has no downtime, no skin scabbing and the skin lifting results are seen over the course of 2 to 3 months, with some patients seeing continued improvement of lax skin for up to 6 months.

Ultherapy does not replace facelift surgery, but is a perfect skin tightening treatment for those Marin County patients that are not yet ready for surgery or for those who have had surgery and may need a little skin rejuvenation.

Featured on many TV shows such as 20/20, The View, Good Morning America and multiple magazine articles, Ultherapy is not a Facelift but an Uplift! To see if you are a candidate for this exciting new procedure call (415) 898-4161 for a complimentary consultation.

 

Haute MD Invites Dr. Miguel Delgado to Join Their Select Group of Doctors

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.”

What is the Cost of Breast Augmentation?

April 15th, 2013 Miguel A. Delgado Jr, MD

36 year old mother of 1 child, at 5’3″ tall and 120 pounds, had a bilateral breast augmentation using Mentor normal-saline breast implants with a base size of 300 ccs inflated up to 325 ccs. bilaterally. 

 

San Francisco, California-The cosmetic plastic surgery procedure breast augmentation or augmentation mammoplasty, remains the number one procedure and has been since 2006, according to the American Society of Plastic Surgeons (ASPS).

In 2006 when the FDA allowed silicone implants to return to market, 81% of women still chose saline implants. Today that has almost reversed, for 2012 72% of women chose silicone implants over saline according to the American Society of Aesthetic Plastic Surgeons (ASAPS). Most women prefer the more natural feel of silicone over saline. At the time of the initial consultation, Dr. Delgado reviews all the pros and cons of each breast implant, helping the patient decide which is best for her.

The cost for breast enhancement like any other surgery is affected by geographical area and the experience of the surgeon. In determining the surgical fee, besides the surgeon’s fee, is the fee for the implants, facility where the surgery is to be performed, garments, supplies, Keller Funnel if applicable and the anesthesiologist’s fee.

For Dr. Delgado, the fee for breast enlargement surgery with saline implants is $3000, with silicone implants it is $3500. The cost of saline implants is $1300, and the cost for silicone is $2000, plus $135 for the Keller funnel. The garment is $50, supplies $100. The surgery generally takes 2.5 hours at a cost of $1750 for Marin Cosmetic Surgery Center, and $750 for the anesthesiologist. The total then is $6950.00 or $8285.00 respectively.

Be sure to choose your plastic surgeon carefully, make sure he/she is Board Certified in Plastic Surgery as one or more revisions are likely through a woman’s lifetime. Revision surgery is more complicated than the initial surgery. Dr. Delgado has done hundreds of primary and revisional breast surgeries. About a third of his breast surgeries are revisional and in many cases he was not the initial surgeon.

How Long Will a Facelift Last?

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.

Cosmetic Procedures Increase for 3rd Year in a Row

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.

Alternative to Botox…Corrugator Muscle Excision With Brow Lift

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.

The Difference Between a “Mini” Tummy Tuck and a Full Tummy Tuck

February 15th, 2013 Miguel A. Delgado Jr, MD

Before and After Full Tummy Tuck

 

 

A frequent question San Francisco Bay Area patients ask during consultation for a tummy tuck, is can they get a “mini” tummy tuck? They are hoping for a smaller scar and less involved surgery.

Although the names sound similar, the procedures treat different issues. The mini treats patients with minimal skin laxity, mild to moderate abdominal fat and mild to moderate stretched or separated abdominal muscle. There is a limited amount of tightening of the abdominal muscle, and it is only tightened below the belly button. The removal of stretch marks with this procedure is also limited. The incision is much smaller than for the full tummy tuck. Patients that are within 10% of their ideal body weight may be good candidates for the mini.

The full tummy tuck is usually recommended for women who have had children and have completed their child bearing. The full tummy tuck tightens all of the abdominal wall skin and muscle above and below the belly button. The incision generally goes from hip to hip but is placed so that it is hidden in the panty line. There is also an incision around the belly button. For the optimal result, a waist enhancement procedure can be done to give more definition to the waist line.

Many Marin County women opt to have breast surgery done at the same time, this may be a breast lift with or without implants, or breast augmentation or in some cases a breast reduction to have what is known as a “mommy makeover”, one of the highest patient satisfaction procedures available.

 

Before and After Mommy Makeover

Facelift Scar in Front of the Ear Versus Inside the Tragus

January 30th, 2013 Miguel A. Delgado Jr, MD

 

External Ear

The best placement for rhytidectomy or facelift incisions is unique to each San Francisco Bay Area patient depending on facial anatomy, hairline and gender.

This is an important topic for the surgeon to discuss with the face lift patient as the goal is to have the resulting scars as invisible as possible. Sonoma, Napa and Marin women say they want to be able to wear their hair in any style.

Careful placement of the incisions by the cosmetic plastic surgeon are generally around the back of the ear in the natural folds, and inside the tragus which allows the scars to be hidden.  The little cartilage in front of the ear that covers the ear canal is called the tragus. Tension on the sutures needs to be avoided so that the result is not a “pulled” look and so that the scar can heal properly without becoming wide.

Men usually have their incision in front of the ear so as not to bring the beard in the ear but laser hair removal can take care of this.In addition to having well hidden scars, the surgeon’s goal in having a natural result is also to keep from distorting the hairline and the ears.