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Cosmetic and Plastic Surgery-SanFrancisco Bay Area|Marin County

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.

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.


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

The “Non-Surgical Nose Job”

September 15th, 2011 Miguel A. Delgado Jr, MD

With the advance of dermal fillers, such as Radiesse, more options are becoming available to cosmetic patients such as the “non-surgical nose job”. Nose reshaping can be achieved with a filler instead of a scalpel. It is possible to correct broad nasal bridges, nasal bumps, nasal asymmetry or change the angle of the tip of the nose.

This is done as a quick office procedure, usually in 30 minutes or less with no down time, allowing the patient to return to work or social activities immediately. Radiesse has been known to last for 10 months to a year, and in some patients even longer. By not being permanent, the patient can see what the results are and then determine at a future date if they want rhinoplasty surgery. Also, it allows many patients to have a procedure at a fraction of the cost until a time that surgery would be affordable.

Radiesse is FDA approved; it has similar chemical characteristics as human bone. It is made of calcium hydroxyapatite particles and has lidocaine mixed with it to significantly reduce injection related pain. Radiesse acts as a scaffold under the skin, providing structure and stimulating your own natural collagen to grow.

What is the Rice Test and What is it For?

August 22nd, 2011 Miguel A. Delgado Jr, MD

One of the biggest dilemmas that San Francisco breast augmentation patients face is what size breast implant they want. It is a choice that they will have to live with unless they want to go through another breast surgery, so most try to make the right choice the first time. Breast augmentation specialist, Dr. Miguel Delgado helps his patients determine the correct size by showing them how to do the “rice test”.
The materials you need for the rice test are:
• a bag of uncooked rice
• a measuring cup
• a soft bra, without padding or under-wire
• a pair of pantyhose cut off above the ankle or a pair of knee highs
One cup of uncooked rice equals 250cc’s of volume. So you might want to start with 1 ¼ to 1 ½ cup of rice for each stocking, do not tie off too tight, you want the rice to be able to move around a bit. Then lay a bra on a table top facing you, set each bag of rice into a cup of the bra, lean over and fasten the bra. Stand up and move the rice around your breast as evenly as possible. Now put on a tight fitting T shirt and see if this is the look you want for your breast enhancement. Adjust the amount of rice if you want bigger or smaller. Try on several different outfits to see how you will look in your clothes. When you have the size you want try wearing the bra with the rice when you go out and about for a couple of days and see if you are still comfortable with the breast enlargement size. Once you have determined the size, measure the rice for each breast and your surgeon will be able to determine what size implant it would be equal to. See breast augmentation before and after pictures on Dr. Delgado’s main website:


Breast Augmentation by Autologous Fat Injections

July 22nd, 2011 Miguel A. Delgado Jr, MD

Many San Francisco Bay Area women have asked about the potential of breast augmentation by fat injections. Breast augmentation by use of the body’s own fat has been around since the 1980’s. But augmentation by fat grafts has multiple side effects, such as tissue scarring, calcification and oil cysts. The American Society for Aesthetic Plastic Surgery (ASAPS) and the American Society of Plastic Surgeons (ASPS) caution its members against the technique.

According to one study of 48 women who had autologous fat injections for breast enhancement between 1999 and 2009, eight of the women’s mammograms showed “clustered micro calcification”. Micro calcifications can be regarded as highly suspicious for breast cancer. Biopsies showed no presence of cancer but the necroses of the fat cells are indistinguishable from abnormalities associated with breast cancer.

The new generation of mammography, in particular digital mammography seems to be better in distinguishing cancer cells from benign ones in dense breast tissue. The method for harvesting and injection has improved greatly over the years, which may increase the survival rate of fat cells, but equally important is the skill and experience of the surgeon. But a debate continues on how long these fat cells will last. Frequently they do not survive and may be absorbed by the body or become liquid and form a cyst that can mimic or obscure breast cancer.

To have breast enlargement by fat transfer takes several sessions making for an expensive treatment and usually will only increase breast size by up to one cup. Recovery is longer than with traditional breast augmentation with saline or silicone implants. The final result will not be evident for about six months, whereas with implants about six weeks.

At this time fat grafting is an accepted procedure for facial and hand rejuvenation, and corrective breast surgery for breast defects or reconstruction. The societies (ASAPS and ASPS) do not recommend fat injections for breast augmentation until there is more clinical evidence that documents safety and efficacy.


Arm Liposuction versus Arm Lift

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

Liposuction of the arm can help trim arms and create a more youthful appearance, which can provide motivation for regular exercise to maintain fitness. As with other areas of liposuction and body contouring, the skin needs to be in good condition with good elasticity for smooth and even contraction over the area after removal of fat.
Wearing a compression garment for 4 to 6 weeks will reduce swelling and will hold arms in the new shape until the tissues have adjusted. Most patients that have been self conscious about their heavy arms find they enjoy wearing sleeveless clothing and other styles after liposuction. For the cannula to remove unwanted fat, tiny incisions are made in the crease of the armpit and/or near the elbow. The incision sites will fade with time and be almost undetectable.�

For the patient that has a large amount of hanging skin and fat, liposuction alone will not correct this problem but will cause even more redundant skin. This patient could benefit from an arm lift also known as a brachioplasty. As aging takes place, the skin and tissue go through changes and lose elasticity, thickness and adherence to underlying tissue. It is also affected by gravity and at the same time, the deep layers of fat, muscle and bone thin. The amount of elastic tissue and collagen present in the deep layer of the skin decreases. The upper arm is an area of the body where this can be very apparent. The upper arm lift surgery entails an incision usually from the armpit to the elbow; the resulting scar is unavoidable but usually fades over time. San Francisco Bay Area patients are thrilled with their results allowing them to wear clothing that previously they were unable to.

Dr. Delgado performs the arm liposuction or arm lifts procedures under general anesthesia at his Marin Cosmetic Surgery Center in Northern California, an accredited outpatient surgery center.

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.

Tummy Tuck Belly Button

April 18th, 2011 Miguel A. Delgado Jr, MD

 Tummy Tuck (Abdominoplasty) is a highly successful surgical procedure with an extremely high satisfaction rate for Dr. Delgado’s San Francisco, Bay Area patients. One of the tell-tale signs of a great surgeon with a wonderful artistic eye is how he reconstructs the belly button. The belly button is an exposed anatomical feature, which is attractive in the female abdomen. The goal for a tummy tuck belly button should be an “inny” opposed to”outy”. It should not be too big, it should not be too small but it should be in proportion to the size of the abdomen and the height of the patient. The scar should be of good quality and if it is not this is something that the surgeon can trim and revise to make look very nice and natural. The major component to make a nice belly button is the amount of fat that surrounds it. If there is a large amount of fatty tissue then the belly button will be deep and have a circular configuration and less attractive in general. During the tummy tuck technique Dr. Delgado does liposuction around the belly button and excises tissue and fat, however a certain amount of fat must remain due to potentially compromising the skins health. Therefore it is easier to get an attractive belly button when there is a thin fatty component around it. A good test to determine if your surgeon does a good job; look at the belly button in before and after pictures of other patients, this is a great indicator if your doctor has an artistic eye, knowledge and patience to construct a nice belly button as Dr. Delgado does.

Tummy Tuck with Waist Enhancement

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

There is almost nothing as joyful as the addition of a child to a family, but many California women are discouraged with the look of their abdomens after childbirth. It is no wonder they turn to their plastic surgeon for help, and the good news is there is a lot of help available. Once a woman has finished having all the children she plans to have, a tummy tuck is a wonderful solution to help her get her pre-pregnancy body back into shape. The tummy tuck is one of the most popular procedures among San Francisco Bay Area women.

Along with the tummy tuck, Marin plastic surgeon, Dr. Delgado offers an additional optional procedure that he calls “the waist enhancement”. This is where he tightens additional muscles, the external oblique fascia, around the waist, giving great definition!! Not only does this pull in the waistline, it improves the shape of the upper buttocks as well. Not all surgeons do this additional procedure but Dr. Delgado has found that this procedure is the “icing on the cake” for most women. For many their result is even more impressive than their pre-pregnancy shape, with the ultimate result of the body of someone who has spent hours at the gym! Compare the photos above that do not have the additional “waist enhancement” procedure, to the photos below that do.