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Cosmetic and Plastic Surgery-SanFrancisco Bay Area|Marin County

Tummy Tuck Surgery, Exparel for Pain Control

October 21st, 2013 Miguel A. Delgado Jr, MD

Before and After Tummy Tuck

This is a 45-year-old resident of Napa County, California who presented to the Novato office in Marin County for evaluation for a tummy tuck. She is 5 feet 5 inches tall and weighs 135 pounds. She is a mother of two children. She underwent a full tummy tuck and tumescent liposuction of her flanks. Her surgery was performed at Marin Cosmetic Surgery Center in Marin County, California. Note the nice, thin, natural appearance of her midsection and the nicely proportioned belly button















San Francisco, CA-Abdominoplasty, also known as a tummy tuck, is one of the most patient pleasing surgeries performed. The long hip to hip resulting scar, for most women, is a small tradeoff for their new flat stomach. The only other downside to the procedure is the discomfort for the first few days. The tummy tuck procedure is not just for women, it is a very popular procedure for men as well, usually after substantial weight loss and many will have the procedure done in conjunction with gynecomastia surgery.

In the past, to ease the pain after surgery, a pain pump was used. At the end of surgery, the surgeon would place; two small catheters through the skin of the upper abdomen. The pump disperses local anesthetic directly into the surgical site and lasts for about three days. The pumps are fed by a supply of local anesthetic that is in a bulb about the size of a tennis ball. The device is kept in bag with a strap that goes around the neck. The pain pump provides relief, but the device is somewhat bulky and freedom of movement is somewhat restricted as the patient is tethered to a machine.

Miguel Delgado, M.D.

Plastic Cosmetic Surgery Specialist,
Dr. Miguel Delgado

Always looking for the best treatment for his patients, Dr. Delgado is now using Exparel for tummy tucks instead of the pain pump. Exparel is not a narcotic but an injectable slow release numbing agent injected at the close of surgery. It is a onetime injection lasting up to 72 hours, which is usually as long as the most intense post-surgical pain.

Exparel is an anesthetic that blocks the nerve impulses that send signals of pain to the brain. Exparel contains bupivacaine which is commonly known as Marcaine, and it is suspended in liposomes, which are a delivery vehicle for pharmaceutical drugs over a period of time.

Most patients tolerate the anesthetic well, but your surgeon will need to know if you have; liver, kidney, or heart disease, heart rhythm disorder or history of seizures, also if you have had a reaction to any type of anesthetic.

Patients who have had surgery using Exparel may still need some narcotic pain relief following surgery, but in clinical trials patients took about a third less narcotic pain relievers than non-Exparel patients and they seem to recuperate faster with a lot less discomfort.

The cost for Exparel is about the same as the cost for a pain pump so it is not deemed worthwhile for less extensive surgeries such as breast augmentation or breast reduction. However, for the patient who has a low pain threshold or is overly anxious about upcoming surgery, a discussion with Dr. Delgado about pain control is recommended.

In keeping abreast of the latest innovations for his patients, in addition to Exparel, Dr. Delgado now has the exciting non-surgical fat reducing “CoolSculpting” available.  See September’s blog for more information and schedule a consultation with Dr. Delgado to see if you may be a candidate.

The Different Types of Breast Lifts (Mastopexy)

September 2nd, 2013 Miguel A. Delgado Jr, MD

San Francisco, CA-Women may lose fullness and shape of their breasts due to pregnancy, breast feeding, aging, and weight fluctuations. In order to regain a youthful looking breast, many women consider a breast lift. There are different types of breast lifts (also known as mastopexy) to address different issues women may have. Breast lift surgery costs can vary as there are different ways of doing the procedure depending on the patients amount of breast droop.

There are generally 3 degrees of breast sagging or ptosis.

             Minor ptosis is where the areola lies even or slightly above at the inframmary fold of the breast.

             Moderate ptosis is where the areola is 1 to 2 centimeters below the inframmary fold.

             Severe ptosis is where the areola is 2 to 3 centimeters below the fold.

Peri=areolar Lift

This is a 37-year-old, female resident of San Francisco, California who presented for evaluation for a breast lift. She is 5 feet 8 inches tall and weighs 165 pounds. She is the mother of two children. She underwent a peri-areolar augmentation breast lift with 275 cc Mentor normal-saline breast implants inflated up to 300 ccs. The procedure was performed at Marin Cosmetic Surgery Center in Marin County, California. The approach was peri-areolar with the implants being placed sub-muscular. She went from an A+ size to a C+. Note the larger right breast having asymmetry before surgery and, postoperatively, an improved balance.

With minor ptosis, the peri-areolar mastopexy is a great technique as the incision heals to almost invisible. The incision goes around the areola, and a doughnut shaped piece of skin is removed and is closed with a purse string type suture. Since this procedure tends to flatten the breast and not reshape the underlying breast tissue, many women choose to have a breast implant to give fullness to the breast. This is a very desirable procedure, but not all women are candidates for this as the amount of ptosis to be corrected needs to be minor.

For the woman with moderate ptosis, the vertical mastopexy, also known as the short scar or lollipop breast lift is a good choice and widely used. The nipple/areola complex is repositioned, and the incision extends down to the breast crease giving a youthful conical shape. With the vertical mastopexy, an implant is not needed unless there isn’t enough breast tissue.

Vertical Breast Lift

This is a 29-year-old, female resident of Sonoma, California who presented to the Novato office in Marin County for evaluation for a breast lift. She is 5 feet 3 inches tall and weighs 135 pounds. She underwent a short-scar vertical breast lift at the Marin Cosmetic Surgery Center in Marin County, California. She also underwent a full tummy tuck and liposuction of her flanks.

The patient pictured here that had the vertical breast lift agreed to have her procedure documented. The BBC had contacted Dr. Delgado as a Board Certified breast surgery specialist, to see if he would be interested in collaborating in the production of a video showing the journey of a patient going through a Mommy Makeover procedure, a Mommy Makeover is a combination of procedures including a full tummy tuck, breast surgery and usually some liposuction.  Dr. Delgado agreed to the venture and the BBC brought a full production company to film at Dr. Delgado’s private Marin Cosmetic Surgery Center. The video was hosted by Louise Rednapp, a British pop star and the video focused on the stages one goes through for Mommy Makeover surgery; before, during and after the recovery. In addition to her breast lift, she had a full tummy tuck and liposuction of the flanks. Notice the beautiful result of her vertical breast lift that was achieved without the need of an implant. You can see the BBC video here.

The woman that has severe ptosis will most likely need the Inverted T or the Anchor Mastopexy. This procedure has been around the longest and is considered the Gold Standard with a high success rate. The Inverted T allows for the greatest removal of skin and reshaping of the breasts, with maximum lift. The incisions, however, are the most visible, with the addition of an incision that follows the natural curve of the breast crease, thus referred to as an Inverted T or Anchor. The incisions of the Inverted T usually heal well over time.

At the time of a breast surgery consultation at either the San Francisco, California or Marin County, California office, Dr. Delgado will be able to make recommendations as to which procedure will give the best outcome.

The Male Facelift, Hiding the Incisions

July 1st, 2013 Miguel A. Delgado Jr, MD


Male Face Lift

This is a 55-year-old resident of San Francisco, California who presented to the San Francisco office at Union Square for evaluation for facial rejuvenation. He underwent a facelift, temporal brow lift and fat injections to his face and a pre-jowl chin implant.His surgery was performed at Marin Cosmetic Surgery Center in Marin County, California.


San Francisco, CA-In February 2013, The American Society of Plastic Surgeons (ASPS) published their statistics for 2012.  The total number of rhytidectomy surgeries, better known as facelift surgery, performed in the United States was up 6% over 2011. Of the total 10% was for men. Men strive to look younger to remain competitive in the work place, but some are motivated to have a facelift after seeing how refreshed their wives look after their surgery.

During a consultation for a facelift, one of the most important issues discussed is the placement of the incisions. The goal, besides a more youthful refreshed face, is to have the incisions well hidden so that it is not evident that any surgical procedure has been done. Women want the choice to be able to wear their hair in any style, and men who don’t have many hair style options just want scars that don’t show. 

external ear

External Ear

The facelift procedure is very different for a man than for a woman just as other cosmetic surgical procedures can differ, such as female breast reduction versus male breast reduction. Great care needs to be taken not to feminize the male face. The incisions should be well hidden in the natural skin creases and shadow of hair. The incision can be in front of the ear (pre-tragal) or inside the ear (intra-tragal), but attention needs to be made regarding the hairline, side burns and the beard. The beard should not be pulled into the ear, and the side burn position needs to be preserved. Laser hair removal can be done if the hair is too close or in the ear.

Male Facelift Incision

Male Face Lift Incision

In the long term, the pre-tragal incision will heal the best and look more natural. The location of the incisions will depend on skin laxity, quality of the skin, how much sun damage there is, and color of the skin. Some men have a distinct change of color between the skin of the cheeks and the tragus; therefore, each patient needs to be evaluated individually. There is also an incision behind the ear and the surgeon must take care not to move the hairline. If the man has a brow lift and eyelid surgery at the same time as the face lift, great care needs to be taken to keep a natural look and not be too aggressive.

A face lift for a bald man or a man with thinning hair is more of a challenge but can be done with excellent results. The conventional incision for a male facelift cannot be done because without hair, the resulting scar will not be hidden. Instead, a surgical approach called circumauricular is preferred. This incision goes around the ear but not into the scalp, keeping the incision hidden in the creases and shadows of the ear.

It is important for the man to take care of the incisions until they are well healed. For the first few weeks, the incisions will be red, and the best way to hide them is to let your hair grow longer before surgery and/or the use of makeup. Our esthetician would be able to assist in choosing an excellent mineral based cover-up and show the patient how the application should be done to conceal the incisions. Use of sunscreen is highly recommended as the sun can make scars much more prominent, in fact it would be wise to stay out of the sun as much as possible for several weeks or months.

Continuing with a healthy diet is important in healing as well as taking high quality vitamins such as VitaMedica. Smoking is one of the worst things anyone can do before and after surgery as the nicotine and carbon monoxide starves the cells and keep them from delivering oxygen to the tissues. This prevents the incisions to heal properly, and in addition making the patient more susceptible to infections. Besides increasing inflammation, there is also an increase in risk of cardiovascular complications.

It is important for the patient to take an active role throughout the healing process in order to get the best surgical result.

What is a Keller Funnel?

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

Keller Funnel

Dr. Delgado has been using the Keller Funnel for his San Francisco Bay Area patients for quite some time now. Always wanting the best possible results for all of his cosmetic surgery patients, he is on top of all new procedures and devices.

The Keller Funnel was brought to market in August 2009. It is a device designed for easier insertion of silicone breast implants for cosmetic plastic surgeons performing breast augmentation surgery. Patients seem to heal faster and adjust to their implants easier.

The funnel is a nylon pouch shaped like an icing bag with an interior coating of a special lubricant, allowing any style or size implant up to 800cc’s to be inserted. The narrow end is placed into the incision, and the surgeon squeezes the implant into the breast. The traditional delivery system for augmentation mammoplasty,  the surgeon uses his finger tip to guide the implant through the incision into the pocket.

The Keller funnel is a one use “no touch” disposable device. It allows the surgeon to make a smaller incision with less stress on the implant; in fact an independent study claims the method reduces force applied on an implant by 95%.

Another advantage of a “no touch” technique is that it greatly reduces possible contamination. The breast is not a sterile organ; there is colonized bacteria living in the nipple ducts. Even with proper surgical preparation there is no guarantee of a completely sterile surgical field. Bacterial contamination is believed to be one of the leading causes of capsular contracture.

Vitamins Speed Healing

December 14th, 2012 Miguel A. Delgado Jr, MD

Getting San Francisco patients back to normal life as quickly and safely as possible after cosmetic plastic  surgery, has always been a goal of Dr. Delgado’s. In observing patients for many years, Dr. Delgado noted that his patients that followed his advice in taking high quality vitamin supplements healed faster and had less discomfort than those who did not.

It then became a high priority for Dr. Delgado to find the best available product to recommend to his patients. After extensive research, he discovered that his patients who took VitaMedica healed the best after cosmetic plastic surgery procedures such as; liposuction, breast surgery, facelift, tummy tuck, and gynecomastia.

VitaMedica offers many high quality products; Dr. Delgado found their “Surgery Program” exceeded his expectations. It is difficult to find a good multi-vitamin that does not contain any vitamin E, vitamin E acts as a blood thinner and can be dangerous during surgery. VitaMedica superior multi- vitamin “Clinical Support” both for AM and PM does not contain any vitamin E and contains extra vitamin C which aids in healing. VitaMedica Surgery Program includes both the Clinical Support for AM and PM along with Arnica Montana and Bromelain with Quercetin which reduces inflammation and bruising.

Due to the exceptional healing results that Dr. Delgado noted in his post-operative patients, he includes the VitaMedica Surgery Program for all his surgery patients.

How Safe is Face Lift Surgery?

March 27th, 2012 Miguel A. Delgado Jr, MD

Many San Francisco Bay Area patients are concerned about the safety of their rhytidectomy( face lift) surgery. If it is an elective procedure, how much of a risk is it? With tremendous advancements in medicine and anesthesia the risk factor for all surgical procedures is greatly reduced.

The greatest risks for face lift surgery which is the same for most surgical procedures include:

• Bleeding (hematoma)
During recovery it is possible a hematoma may form. A hematoma is when blood collects under the skin with increasing swelling and pressure. In most cases the surgeon would insert a tube to remove excess blood. Typically a hematoma will not impact the result of the surgery. The likelihood of this risk is only about 1% to 5%.

• Infection
Infection from a facelift is rare. Patients are placed on antibiotics before, during and after surgery. Having surgery in a private surgery center such as Dr. Delgado’s “Marin Cosmetic Surgery Center” greatly reduces exposure to infection due to the limited amount of patients, staff, and strict quality control.


• Blood Clots – Deep Vein Thrombosis (DVT)
Air travel, inactivity and other conditions may increase the incidence of blood clots. The use of compression stockings can help prevent clots from forming in the veins of the leg.

• Neurological Dysfunction (nerve injury)
After face lift surgery it is very common to experience numbness around the neck and ears. This will improve over the course of a few months as the nerve branches grow back. If a nerve branch is severed during a face lift procedure, permanent interference with muscle animation of the face can occur. In choosing a well qualified Board Certified Plastic Surgeon this complication is extremely rare.

• Anesthesia Complications
Today anesthesia is remarkably safe, there have been dramatic improvements in anesthetic medications, technology and training. The anesthesiologist begins with a thorough pre-operative evaluation checking a patient’s medicalcondition and history. During surgery the anesthesiologist uses several different drugs that are individualized for each patient taking into consideration a patients age and weight among other factors. Having  Board Certified


Anesthesiologist, Dr. Randy Gaynor at Marin Cosmetic Surgery Center insures the patient is getting optimal care.

• Loss of Hair at Incision Site
It is possible to have some hair loss on the areas where the incisions are. Dr. Delgado is very precise in making incisions in natural folds of skin where there may not be hair to cover it.

 Asymmetry (unevenness between the two sides of the face)
Swelling can temporarily make the face look uneven; choosing an experienced Board Certified Plastic surgeon will greatly reduce any likelihood of permanent asymmetry.

There are many things that a patient can do to prepare for face lift surgery, see the blog on our main surgery site here.



The Danger of Smoking for the Surgery Patient

November 29th, 2011 Miguel A. Delgado Jr, MD

Many San Francisco Bay Area patients ask “How critical is it to stop smoking before surgery, such as a facelift, tummy tuck or breast surgery?” My answer is that it is extremely important for all surgeries; smoking can increase inflammation and cause severe skin healing issues including skin loss and necrosois of the skin resulting in significantly more healing.

Smoking increases carbon monoxide and nicotine in your blood. Nicotine closes the blood vessels responsible for bringing oxygenated blood to the tissues. Besides its healing power, oxygen also fights infection and helps to keep tissue alive, as well as delivering important medications like antibiotics. Furthermore, smoking clogs the lungs, and thus increases risk of pulmonary infection such as pneumonia. Nicotine also contributes to increased platelet adhesiveness which can increase the risk of blood clots.

Studies show that nicotine gum is not an alternative as the nicotine can interfere with healing the same way it does with cigarettes. Second hand smoke may also delay healing.

At the 2010 annual meeting in San Diego, California of the American Society of Anesthesiologists a study was presented that showed smokers were:

1. 50% more likely to develop pneumonia
2. 57% more likely to have cardiac arrest
3. 80% more likely to have a heart attack
4. 73% more likely to have a stroke

For patients planning elective surgery such as breast reduction, liposuction and breast augmentation, this is an exciting event. Having surgery can be somewhat stressful, and trying to quit smoking when under stress is even more difficult. For most patients I require them to be smoke free for a minimum of two weeks before and two weeks after surgery, but prefer a month. All precautions are taken to ensure the safety of the patient. If you are a smoker and are considering surgery, try to stop smoking as soon as possible then reward your efforts with the surgery you desire.