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Cosmetic and Plastic Surgery-SanFrancisco Bay Area|Marin County

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.

Temporal Brow Lift Versus Full Brow Lift

June 16th, 2013 Miguel A. Delgado Jr, MD


This is a 47-year-old female from Marin, CA presented for evaluation of her eyebrows. She underwent endoscopic eyebrow lift only. She had elevation of the right side 6 millimeters and her left side 7 millimeters. Note how the upper eyelids look more exposed due to the elevation of her eyebrows.

San Francisco, CA-As the effects of gravity, aging and sun damage take place, one of the first places to show the effects is the eyes and the brow. The brow lift has one of the highest rates of patient satisfaction. Having just a brow lift can refresh the face with a subtle yet elegant result.

Depending on the patient, there are different variations to the brow lift. It is not uncommon for some men and women to have eyebrows naturally at different heights, with a brow lift they can be made more symmetrical. The brow lift can be combined with other procedures such as a facelift, eyelid surgery, nose reshaping and some patients choose to have it combined with breast surgery or tummy tucks.

The least invasive brow lift would be the temporal brow lift, also known as the lateral brow lift. This procedure is more for the patient that has mild to moderate descent of the brow. The incisions are small and made at the temple region of the forehead and scalp, some of the scar may be visible on the side of the forehead, not always as hidden as desirable. There isn’t any muscle reconstruction involved, only tightening and excising some skin.

The temporal brow lift only addresses the outer third of the eyebrow. When aging causes the brow to sag, it gives the face a sad, tired or surly appearance. Ideally the tail of the brow should be a little higher than the medial end (next to the nose) with a gentle arch in the middle.  Recovery is faster with less bruising and swelling, but it will not correct wrinkles of the forehead or the glabellar frown lines between the eyes.

The coronal brow lift (also known as the “open brow lift”) is considered the gold standard of brow lifts and has been around the longest. This procedure is made with an incision that goes across the top of the head from ear to ear within the hairline. This approach allows the surgeon full access to the forehead musculature for complete elevation of the brow and forehead. This procedure is the best for patients that have high foreheads, so they are not made even higher. The coronal brow lift is also considered the longest lasting. There are some downsides to the procedure, the scar on the top of the head can widen, there can be hair loss, and with the cutting of nerves on the top of the head there may be permanent numbness.

Then we have the evolution of the endoscopic brow lift. The goal was to have a procedure that could get the same result as the coronal approach without the invasiveness.This is my preference for brow lift procedures when all aspects have been considered; I have been doing it since its beginning, with the exception being the patient with an already high forehead, then the coronal approach is best.  The endoscopic brow lift is along the same incision line as for the coronal lift except that instead of a long incision there are five small incisions about ½ inch in length behind the hairline. The hair is parted, not shaved for the procedure. The endoscope is an instrument with a tiny camera that is inserted through small incisions allowing the surgeon to see images on a TV monitor.

You will find that different surgeons have different preferences based on what procedures they are trained in and feel comfortable with. I recommend that first you make sure you are seeing a Board Certified Plastic Surgeon and request to see many before and after pictures of that surgeon’s actual patients.

Many people are fearful of the brow lift procedure after seeing many celebrities that have had it done and have a surprised or startled look.  This is unfortunate because if the surgery is done properly it is one of the most rewarding procedures done. My goal is for the patient not to have an “operated” look if anything I’d rather mildly under correct than over correct the brow, and I achieve this by making precise measurements pre-operatively.

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.