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Cosmetic and Plastic Surgery-SanFrancisco Bay Area|Marin County

HA Fillers are Great but They Have Their Limitations

August 30th, 2012 Miguel A. Delgado Jr, MD

Many San Francisco Bay Area patients have expressed confusion over the many types of facial fillers that are on the market. Two of the most popular are Restylane and Juvederm, both are made of a clear gel of hyaluronic acid (HA). HA is not derived from animal sources, making it compatible with the human body and, therefore, it does not require a skin test.

HA is a naturally occurring sugar found in all living organisms. Before use as a cosmetic treatment, it has been used for several decades for medical treatment for joint pain, treating wounds and eye surgery.

Injecting the nasal labial fold

The benefit is immediate and results last about 9 months or more. To keep the desired result, continued injections will be necessary.

Fat injections from one’s own fat (usually taken from the tummy) have proven to be the best natural filler with a good percentage of it becoming permanent. Fat injections are especially good for filling in large amounts, such as during a facelift for patients who have hollow looking cheeks from aging or weight loss. For the patient who is not sure how they will like the result, using a temporary filler first will allow them to see what the result can be. If the patient does not like the look of the HA filler, hyaluronidase can be injected to the site and it will disolve the filler.

The best way to determine which dermal filler is best for you would be to schedule a consultation with Dr. Delgado who has been an expert injector for many years. Dr. Delgado will be able to discuss all the different aspects of each product and help you reach your facial rejuvenation goals.

The Longer You Wait for Facial Surgery the More You Will Need to Have Done

June 26th, 2012 Miguel A. Delgado Jr, MD

A very common question San Francisco Bay Area  facelift patients ask is, “When do I need surgery?”  The answer is different for each individual, and it is a personal decision. The cosmetic plastic surgery patient needs to determine what their priorities are.

Determining When to Have Facial Rejuvenation

For some patients, they want to address issues as they occur with aging. Their goal is to have corrections be as subtle as possible so that friends and family are not sure they had anything done. Many times this may start with an eyelid lift and/or a brow lift in their 30’s or 40’s, but this varies with each patient as everyone ages differently.

Then there are patients that want to have surgery only once, so they wait as long as possible perhaps into their late 50’s or even 60’s and have all done at one time. For this patient, the result is much more dramatic. View before and after pictures of Dr. Delgado’s patients.

Both of these choices are completely acceptable, it depends on what the patient wants. The only bad choice would be for the patient that has waited and needs to have a full face lift, brow lift and eyes, but chooses to have only one area done, this will give a result that will have the face out of balance. When only one area is of concern to the patient, say loose skin on the neck, they may wish have a neck lift only. What happens though once the neck area is corrected the age won’t match with the rest of the face, and then the focus will go to another area that looks older such as the eyes….  Dr. Delgado is an experienced Board Certified Plastic Surgeon serving Marin County and Sonoma County in cosmetic and plastic surgery.

“Chinplants” the Fastest Growing Cosmetic Plastic Surgery Procedure

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

Before chin implant

Before chin implant


After chin implant

After chin implant












According to the American Society of Plastic Surgeons, the chin implant (genioplasty) is the fastest growing cosmetic plastic surgery procedure. The increase from 2010 to 2011 was an amazing 71%, with almost an equal amount of men and women. Chin augmentation even has a new trendy name, the “chinplant”.

Evidence suggests that video chatting may be the reason for the increase of the procedure. With the popularity of Skype and Face Time, people are now seeing themselves while talking. It is one thing to see a picture of yourself, but rarely before would you see yourself talking. Many are not happy with what they see, with the head tilted downward, the chin and neck tends to double up. The chin and jaw line are among the first areas to show signs of aging. The silicone chin implant extends the chin which pulls the skin of the neck tighter giving it a thinner look.

The procedure tends to make a dramatic but subtle improvement. Friends and family may notice an improvement but can’t really identify what the change is.

The increase in chin augmentation procedures is more than the increase in breast augmentation, Botox and liposuction combined. For more information on chin implant surgery, see the blog dated January 31, 2012


Before chin implant

Before chin implant

After chin implant

What Age is a Face Lift Appropriate?

April 4th, 2012 Miguel A. Delgado Jr, MD



When to have a facelift(also known as a rhytidectomy) is a very popular question among San Francisco Bay Area patients. The short answer is when you feel ready. There isn’t a particular timeline because there are many variables to consider such as:

• The elasticity of the skin
For some patients they may start noticing the skin in the jowls and neck are starting to sag. This is usually the most disturbing condition that prompts many to seek solutions. The sagging of the skin is not age specific, for some it can start as early as the mid thirties and for some fortunate ones maybe not until their fifties! This is more of a genetic issue and not something you can control.

• The condition of the skin
This is something that is part heredity but how the patient cares for their skin can make a big difference. Being very careful in the sun from an early age is important. Sunburns can do a lot of damage but usually do not show up until later in life. Using sun screen, hats and sunglasses is recommended. There are many good skin care products on the market that can help keep the skin clean and moisturized. Drinking lots of water will help keep skin hydrated.

• Patient’s mental attitude
Deciding to have a facelift is very personal, for those who just are not sure if they are ready should wait. But if someone is determined and if their surgeon is in agreement there is no reason not to proceed and age should not be a factor.

• Expectations and desires
Everyone wants perfection, including the surgeon, but that is not realistic or possible. Having good communication with the surgeon is very important so that a patient understands what to expect from the results of the surgery. Many times patients only want to correct what is bothering them such as the neck. This can make the rest of the face look unnatural having one area youthful and another area aged. Having facial harmony is the ideal and experienced Board Certified Plastic Surgeons will explain this to their patients. Patients must consider downtime for recovery, risks from surgery and costs.

• Finding the right surgeon
An experienced facial plastic surgeon will be able to guide the patient in making the right decision as to when they are ready for surgery by asking all these important questions. Seek out a Board Certified Plastic Surgeon who specializes in facelifts and be sure to see many before and after pictures of the surgeon’s patients. It is reasonable to ask to speak to patients of the surgeon to hear first hand of their surgical experience.

For the patient that wants to start early, they will find that their results are more subtle leaving them with a refreshed look. This is the preference of many who wish to keep their surgery unobvious and having revisions or secondary surgery later when things start to relax in order to continue to look great. But some patients want to delay as long as possible not minding a more dramatic look as they only want to have surgery once. There isn’t a right or wrong answer; it is what the patient feels most comfortable with.

When is a Chin Implant Appropriate?

January 31st, 2012 Miguel A. Delgado Jr, MD

Chin augmentation is usually done to balance the face by making the chin longer or more protruding. Men and women with weak or receding chins are the best candidates as long as they have a normal dental bite.

When balancing the face with a chin implant, along with rhinoplasty (nose surgery) or a facelift, it may give a “finished” look with a strong profile more in line with what is considered classically attractive in our society. Many patients who seek rhinoplasty may not realize that they may benefit from  chin surgery (mentoplasty). Computer imaging is a wonderful tool that allows a surgeon to show patients how they might look with the added chin implant with or without a rhinoplasty.

Chin implants come in a variety of shapes, sizes and made of different materials.  Some implants are made of Teflon, Dacron or Silicone, and in some cases real bone or fat tissue is used. Dr. Delgado prefers silicone implants that are made of a solid consistency. They have a proven safety record and in most cases are good for life. Implants made from fat or bone can sometimes be reabsorbed.

The incision is usually made either inside the mouth or outside under the chin. A pocket is made in front of the chin bone and under the muscles and the implant is placed in the pocket or it can be affixed to the jaw bone. Dr. Delgado prefers the incision under the chin instead of inside the mouth as it decreases the risk of infection. The scar is well concealed and barely visible.

A liquid or soft diet will be necessary for the first few days. Most of the swelling will be gone in six weeks. After several weeks of healing the implant is practically undetectable to the patient.

Remarkable subtle changes are obtained by adding balance and definition to underdeveloped features. Many of Dr. Delgado’s San Francisco Bay Area patients have benefited from his refined judgment, skill and good aesthetic eye.

Skin Care After a Facelift

December 9th, 2011 Miguel A. Delgado Jr, MD

Skin care after a facelift is a little more complicated than less invasive cosmetic procedures because you need to treat your wounds, manage swelling, and keep up with everyday skin care for the best result.

Dr. Miguel Delgado advises his Marin County cosmetic patients that they need to minimize swelling with the regular use of ice or cold compresses, especially the first three days after surgery. To avoid an increase in swelling overnight, sleep with your head elevated above your heart.

Arnica Montana, is an herbal supplement and may help minimize bruising or discoloration. It is usually started before cosmetic surgery and taken for a few days after.

Your face will be sore after facelift surgery, but you need to cleanse your skin regularly to help with healing and avoid build-up in your pores which can lead to breakouts. Wash with mild astringent pads gently. Then apply a gentle moisturizer that is non-comedogenic (something that won’t clog the pores). The goal is to keep the area clean and moist.

It is best to avoid direct sun for the first few days after a facelift, if you go out be extra vigilant about sun protection, use a sunscreen that blocks alpha and beta sun rays. SPF 30 or 40 is good; the ones with higher SPF tend to block the pores. Wear a hat and sunglasses for further protection.

It is extremely important to keep the skin hydrated. Drink six to eight glasses of water a day to rejuvenate your skin from the inside out and flush any toxins from your system.

Once your skin is healed and you get the go ahead that you can start using makeup, use a mineral based line such as Jane Iredale. Mineral based makeup is gentler on your skin and provides excellent coverage. If you have red skin or purple bruising after your facelift, a green base will help balance those colors and give a more natural looking skin tone. For the best result, top this base with a powder about one shade darker than you usually wear.

To maximize your facelift result be sure to follow a good skin care regimen with the highest quality of products. Dr. Delgado’s esthetician Alise Hassler assists his San Francisco Bay Area patients to get on a program that is individualized for their skin type. Alise is very knowledgeable of all the products available at Dr. Delgado’s office and the store on his website. The products include; Jane Iredale makeup, Dr. Delgado’s exclusive Preferred Line, Obagi, Skinceuticals and various prescription strength skin care products.

On the Horizon: Botox Gel for Treatment of Crow’s Feet

October 11th, 2011 Miguel A. Delgado Jr, MD

Presented at the American Society of Plastic Surgeons annual meeting this September, were the promising results of ongoing clinical trials for the treatment of crow’s feet. Botulinum toxin gel, referred to at this time as RT001 is a topical gel to be applied only in a doctor’s office. It will not be available over the counter for home use as it is a drug. The gel will penetrate the skin and cause the muscles to relax thereby reducing wrinkles.

This is a very exciting development for the patient that wants the benefit of Botox but has previously shied away due to the use of needles. The application of the gel will be painless, and without bruising, as sometimes an injection can cause. 

So far over 500 patients have been tested in eleven different trials with successful results. Still in clinical trials and not yet approved by the FDA, phase 11 testing is being finished and phase 111 must be completed before it goes to market. As reported in an article in the Cosmetic Surgery Times, the results seem to last as long as the injectible version.

Botox has an interesting history for different applications besides wrinkle reduction. It has been used for treatment of chronic migraines, profuse sweating, muscle spasms and more. We will keep you informed of any new developments and especially when the gel will be available

What is a SMAS Face Lift?

May 26th, 2011 Miguel A. Delgado Jr, MD

There are different face lift techniques available, depending on a patients age and condition of skin, Dr. Delgado evaluates which face lift procedure is appropriate for each individual patient.

SMAS is an acronym for: Superficial Musculo-Aponeurotic System, which is the fibrous network of tissue that lies under the skin but over the facial muscles. The SMAS is a membrane composed of fibro-elastic connective tissue and muscle that attach through the subcutaneous fat to the superficial epidermal-dermal layer of the skin allowing them to move together as a unit.

Plastic surgeons modify the SMAS during a face lift procedure by lifting it up to hold the face in different positions. If you only lift the skin it will stretch, as skin is meant to, and everything will return as it was. By lifting the SMAS, which is the deepest (third) layer, it will reduce the appearance of sagging jowls, cheeks and neck without putting tension on the skin. Putting tension on the skin is what gives the “windblown” look that so many San Francisco and Northern California Bay Area patients are concerned about.

The SMAS face lift is far more advanced than a skin or endoscopic face lift and can give excellent long lasting results for 10 years or more. The ability to perform the SMAS face lift procedure requires fundamental knowledge in facial nerve, plastic surgery and microsurgery.

How Long Does a Facelift Last?

January 10th, 2011 Miguel A. Delgado Jr, MD

This question comes up often from my San Francisco and Marin patients, and while it is a good question there isn’t an easy answer. When a patient has a facelift , it is possible that the patient will look 10 to 15+ years younger after surgery. But the patient will continue to age and not be frozen in time. So in 10 years time the patient may look 10 years older. There are other factors in the aging of the skin, such as heredity and the laxity of the skin that cannot be controlled. However, there are measures the patient can take to help maintain their new face. First of all the most aging thing to the skin is the sun. So I recommend a good sun screen or sun block and also wearing sun glasses to protect the eyes and a hat while out in the sun. Secondly a good skin regimen with a high quality product is very important. This is  a good investment in maintaining the facelift.

There are a couple of procedures I recommend to my Bay Area, California patients that can also give them the optimal result from their facelift or their mini-facelift. The first would be a light skin peel to be done at the end of the surgery while the patient is still asleep. There is virtually no discomfort and the healing time will go along with the healing time of the surgery. A skin peel can remove many skin imperfections and give the face a very fresh look. The other procedure that some patients may be a candidate for would be fat injections. As we age we lose fat in our face which can give a sunken look. A facelift can soften this but it is not possible to pull the skin enough to get a good result on some patients with very deep lines, but will end up with an overdone look!

The patient below had her facelift and brow lift at the age of 60. She had a skin peel and fat injections done at the same time.

The results speak for themselves.



Fat Injections, the Panacea of the Facelift?

September 27th, 2010 Miguel A. Delgado Jr, MD

Fat Injections used in conjunction with the facelift…..

A new topic in cosmetic surgery is “Facial Volumization”. This procedure utilizes a patient’s own fat to add fullness. We have realized over the years that facial aging is a loss of volume and fat in the face. Therefore, to rejuvenate the face it is not just a matter of lifting skin due to gravitational change, but it also involves restoring the fullness of the face. This greatly enhances the youthfulness of the facial appearance and for some unknown reason it greatly enhances the texture and quality of the skin. Dr. Delgado has done this technique for over eight years and follows the Sydney Coleman technique of fat injection which entails a complex preparatory process of the fat.

For some patient’s, fat injections alone may be all that is needed for rejuvenation. But for most facelift patients, the addition of fat injections may give the optimal result. The fat helps fill in deep creases that can only be softened with a facelift, such as the nasal labial fold (crease from corner of the nose to the corner of the mouth). This crease can add years to a patients look, and while a facelift will make a great improvement, some people have such deep lines there that it is not possible to “pull” enough to make a dramatic change without the patient ending up with an unnatural look. Having a “pulled” look is unacceptable to Dr. Delgado, and he has found the “Facial Volumization Procedure” has been a great solution for many of his patients. You may wonder where the fat comes from, almost everyone has a donor site where the fat can be taken and never missed. This area would be unique to each patient, when you consult with Dr. Delgado he can show you what would be best for you, if you are a candidate for this procedure. A common area is the tummy. Many patients are thrilled with the reduction of a small amount of fat in the belly and some opt to have even more than needed removed.