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Cosmetic and Plastic Surgery-SanFrancisco Bay Area|Marin County

With Facelift Surgery, the TCA Peel is the Icing on the Cake!

September 16th, 2012 Miguel A. Delgado Jr, MD

Before and After Facelift Surgery without TCA Peel


Before and After Facelift Surgery with TCA Peel


Face lift surgery is an exciting improvement for San Francisco Bay Area patients for facial rejuvenation, turning the clock back many years. Surgery improves the jowls, loose neck skin, eyelids, a heavy brow, etc. but does not change the skin.

The TCA (trichloroacetic) Acid Peel is a medium to strong chemical peel and an excellent addition to facelift surgery that is applied while the patient is asleep. The peel promotes skin smoothness, vitality, improves superficial discoloration and eliminates fine wrinkles. It is a wonderful treatment for sun damaged skin, but not all patients are candidates and will require an evaluation by Dr. Delgado.

Sonoma County patients noticed for the first few days their face felt like it was sunburned, but not uncomfortable. In 3 to 4 days, the skin turns dark and in 3 to 7 days starts peeling. It is very important to follow specific directions given prior to surgery for post operative skin care to get the optimal results.

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.

What is a “Double Bubble”?

July 6th, 2012 Miguel A. Delgado Jr, MD

Silicone breast implant

There are different situations that require breast revision surgery for San Francisco patients. One is called the “double bubble”.  The double bubble is the result of a secondary crease caused by the  breast implant resting below the natural crease, also known as the inframammary fold.

 If the surgeon is aware of this during breast augmentation surgery, there are steps that can be taken to correct it. However, if the double bubble occurs after surgery and after the implant has settled, it will require revision surgery by an experienced Board Certified Plastic Surgeon such as Dr. Delgado who serves patients in  Marin and Sonoma counties.

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.

Patient Satisfaction Determines Surgical Success

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

The Journal of the American Society of Plastic surgeons, “Plastic and Reconstructive Surgery”, recently announced the results of a study of 360 patients treated with liposuction, lipoabdominoplasty, and abdominoplasty.  Lipoabdominoplasty is a term to describe liposuction of the abdomen and flanks combined with a tummy tuck.

This study was done to compare results of liposuction alone for reduction of the tummy compared to the cosmetic plastic surgery patient that had lipoabdominoplasty and just abdominoplasty from the patient’s point of view.

Before liposuction of the tummy

Before liposuction of the tummy

After liposuction of the tummy

After liposuction of the tummy


The results showed that liposuction patients recovered more quickly and had less pain that the lipoabdominoplasty and abdominoplasty patients. However, the levels of satisfaction with the results of surgery were much higher than for liposuction alone. Patients stated they had improved self esteem and improved quality of life, with 97.6% saying they would do it again and 99.2% would recommend the procedures to others.

Before abdominoplasty

Before abdominoplasty

After abdominoplasty

After abdominoplasty

Patient satisfaction is the most important factor of surgical success.


“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.

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.



Update on PIP Breast Implant Scare

February 21st, 2012 Miguel A. Delgado Jr, MD


In a Press Release dated January 17, 2012, Dr. Delgado explains the dangers of the French made Poly Implant Prosthese(PIP) breast implants. Starting in 2001 the manufacturer was using industrial grade silicone instead of medical grade for their gel breast implants. Use of industrial grade silicone makes them more prone to rupture and leakage.

The news media carried many stories starting in December 2011 warning women of the potential danger. Many countries recommended women to have the PIP implants removed, but some countries only recommend that women seek the advice of their doctor. Dr. Delgado points out that the American Society for Aesthetic Plastic Surgery (ASAPS) recommends that women with PIP implants have them removed.

For women in the United States, silicone implants were not available from 1992 to 2006 due to possible health issues but when they were proved safe, the FDA once again approved them. However PIP silicone implants were never approved for sale in the United States and therefore would not have been implanted in any American women unless they had breast augmentation surgery outside of the U.S. Dr. Delgado recommends that all women know; the size, manufacturer and if their implants are saline or silicone.

It is believed there are at least 40,000 women in the U.K. that have PIP silicone implants. Britain set up an expert committee to examine specific risks associated with the implants and to date they have concluded that if a woman is not having any symptoms that there is not enough evidence to recommend early removal. However the government is offering for women to have removal and replacement if they have PIP implants at no charge if the patient had the surgery by the National Health Service (NHS) ¸who routinely does reconstruction after mastectomy with implants. The government thinks that private clinics will follow suit. In the meantime, the NHS is warning women to watch for symptoms such as:

• lumpiness of the breast

• lumpiness or swelling in the area around the breast

• change in shape of the breast

• deflation of the breast

• redness

• tenderness of the breast

• swelling of the breast

• pain or sensitivity

Recently in a BBC news report dated February 15, 2012, a woman from Edinburgh, Scotland went in for a breast scan after hearing the warnings in the news. She was horrified to discover that one of her implants had indeed ruptured and silicone had gone into her lymph nodes. A further disturbing fact is that she had no symptoms, no pain and no change in the shape of her breast. She was totally unaware that she had a rupture.

Meanwhile, the Paris based International Master Course on Aging Skin (IMCAS) which represents plastic surgeons and dermatologists had their annual conference in Paris, January 27, 2012 and according to IMCAS the PIP affair seems to be having a short term impact. Beauty procedures including liposuction, breast augmentation, and Botox injections grew globally in 2011, up 10.1%, and set to grow 11.12% in 2012. It is believed that approximately 20 million women worldwide have breast implants, and PIP only represents 1.5% with about 400,000 women using the product.

If you think you may have PIP implants or Rofil M-Implants (rebranded PIP implants by a Dutch company) Dr. Delgado recommends that you get an evaluation by a Board Certified Plastic Surgeon.

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.