Interview with Dr. Delio Ortegon
Dr. Ortegon, when did you decide on a career in medicine and how did you achieve it?
At 7 years old, I already knew that I wanted to be a doctor. I was exposed to doctors and the work that they did and it was clear to me that they were able to “fix things.” I wanted to be someone who could solve problems like they did. This early influence held and becoming a doctor was the goal I had from that point forward.
I graduated from the University of Texas with a Bachelor’s degree in Microbiology and then went on to complete medical school at the University of Texas. I grew up in a small town and just assumed I would be a family practice doctor. But my first rotation in medical school was in the Plastic Surgery Department where, in a single day, I was able to observe reconstructive surgery, hand surgery, and breast surgery. I was fascinated… and right away I realized that this was what I wanted to do.
I completed both my General Surgery and Plastic and Reconstructive residencies at the University Hospital in San Antonio. When I look back and realize how many years I was in school – including 7 years in general surgery residency and an additional 3 years in plastic surgery – I’m somewhat amazed. I was 36 years old when it was all said and done, and I hadn’t had a summer off since I was a child! But my goals were clear and I am practicing the kind of medicine I want to practice. It was worth the time and effort that it took to do the work that I continue to find meaningful and satisfying.
In the early years of my practice, I wanted to do every type of plastic and reconstructive procedure, but over the years I’ve refined my practice. I specialize more in breast and body surgery now, and it’s consistently rewarding - helping my patients and seeing their happiness when a problem that bothered them has been corrected.
Are you a long-time resident of San Antonio?
Yes, I’ve lived here for many years and am deeply committed to my community. I’m also very familiar with the environment and the culture of the San Antonia area, and with the people who live here. I’m fluent in English and Spanish, and enjoy practicing medicine in a place where there is so much diversity. San Antonio is my home.
Describe the patients that you see in your practice.
About 80% of my patients are female, and my patients typically range in age from around 22 to the early 60’s. Former patients refer most of those who come to me, which is gratifying. I also see many military dependents, due to the proximity of the military base in this area. Many of these individuals are seeking breast reduction surgery, as they carry insurance coverage that accommodates it if it can be justified as a medical procedure. In most cases, this is exactly the case, because overly large breasts lead to a host of physical problems that cannot be solved by exercise and weight loss alone and quality of life is definitely impacted.
How do you define beauty or physical appeal?
There is no single definition of beauty, as people with widely varying faces and bodies can be appealing to the eye. It has more to do with the way all parts of a person are assembled together – how they flow together – that’s what I find compelling. The eye takes a person in and sometimes a single feature or area of the body doesn’t seem to “fit.” There’s a lack of overall balance and this is what generally brings patients in for physical enhancement surgery.
Of course, there are certain qualities that add to an overall pleasing appearance – skin quality, for instance. An individual can have a beautiful face, but if the skin is sun damaged and the pigmentation and quality of skin is uneven, it takes away from their overall attractiveness. Likewise, the figure can be fine with the exception of excess fat in the abdominal area or hips that takes away from their overall symmetry. These are the types of concerns that can easily be addressed with the right aesthetic surgery technique.
Sometimes, a patient believes that they need surgery when, in fact, a combination of laser treatment and a good skin care regimen chosen by my aesthetician will be enough to give them the outcome they desire. Each patient has to be considered individually, and the course of treatment must be designed specifically for her or him.
What is your focus during a patient’s initial consultation visit?
My consultations are typically at least 45 minutes long, because I’m striving to really understand what my patient is looking for, what concerns them, and which procedures will be best for them to consider. I am evaluating not only how my patient appears externally, but also analyzing the underlying structure of the face and body. We talk about this, and then we discuss what can be done bring the face or body into better balance and harmony. It’s a process of exploration and education, and a time to develop a rapport that will enable my patient to feel safe, secure, and comfortable with the surgical experience and the outcome they can expect.
I use photos of the patient - which are taken at the start of the consultation - to ask questions, to show them what I see, and to help them visualize how improvements can be achieved. It may be that the cheekbones are too narrow or the face needs more volume that can be added with fat grafting. Or the patient may request liposuction to address excess skin when, in fact, a tummy tuck is what they need to get the result they want. It can work in reverse, as well; if the skin tone is good and the problem is excess fat, liposuction may give the best result without the need for more invasive surgery. I often make drawings during this process of discovery and explanation, as well, to give my patient yet another way to understand the improvements that can be made and what they can expect.
What’s your viewpoint on the Internet as a source of education for those interested in cosmetic surgery?
First of all, I never forget that, although I’ve done hundreds of the procedures they are requesting, for my patients it’s the only procedure of this kind that they will undergo. In general, my patients – and particularly my weight loss patients – have done their homework. They’ve researched aesthetic surgeries, they’ve spent time thoughtfully considering them, and they tend to have realistic expectations about what can be accomplished. On the other hand, there is a good deal of misinformation on the Internet, so it’s important for me to provide my patients with accurate, clear information. I want them to make good choices and to feel comfortable and positive about the choices they make.
In addition, the online message boards often post letters from patients who are displeased with the outcome of an aesthetic surgical procedure. One of the reasons for this has to do with the fact that a lot of non-plastic surgeons are performing major plastic surgery procedures. This is particularly true with regard to tummy tucks and breast augmentations. I encourage my patients to check the credentials of any surgeon they are considering. It’s important to make sure that the surgeon is properly trained to perform plastic surgery procedures. In addition, it’s often the disgruntled individual that takes the time to post messages in these venues; the vast majority of plastic surgery patients are pleased with their outcomes and they don’t necessarily feel the need to write about it online.
Dr. Ortegon, you are recognized for your surgical expertise in body contouring for patients who have lost extraordinary amounts of weight.
I perform many body contouring surgeries for patients who have lost a significant amount of weight and are left with sagging or hanging excess skin. My patients usually have a long checklist of corrections they want in order to restore their bodies to a more normal and attractive appearance. Of course, body contouring can’t safely be done in one surgery: it has to be done in stages for the safety and well being of the patient. In general, I perform abdominoplasty with liposuction in the first stage, removing excess skin and resculpting the torso. During the recovery stage, I see them often: after a tummy tuck, for instance, I will see them once a week for the first six weeks post-op.
Once the healing process is complete and the patient is physically and emotionally ready to move forward (typically 3 to 6 months after the initial procedures are done), we go to the second stage. At this time, patients often opt to undergo a breast lift – or a breast augmentation and lift. During that surgery, I will do their upper arm lift at the same time, if it’s indicated. These two procedures go well together, and the recovery process is confined to the upper body. Some of my patients are very happy with this treatment plan and consider their surgical journey to complete, but others will choose a third and final phase, which addresses the face and neck. It depends on the patient’s needs, of course, but a common course of action at this point involves a neck and/or facelift. To achieve the best outcome, I will also add liposuction of the neck.
For patients who have had the discipline and strength to lose a massive amount of weight, the results of body contouring surgery are nothing short of dramatic. These are some of the happiest patients you can imagine, because they’ve given themselves a second chance to look and feel wonderful now and in the future. It’s gratifying for them and certainly for me as a surgeon to be part of this transformation and to witness their markedly increased self-confidence. After years of feeling badly about their appearance, they can wear normal clothing and engage in the normal activities of life that many people take for granted.
Although there are a variety of methods for doing abdominoplasty, do you prefer a particular tummy tuck surgical technique?
Yes. To begin with, I almost always do a combination of liposuction and tummy tuck. Together, these procedures allow me to optimally reshape and refine the contours of the body and get the best results. I use a technique called a high tension lateral abdominoplasty, a procedure that enables me to remove as much excess skin as possible without compromising the patient’s blood supply. Most of the work is done below the naval, and I confine the procedure to a small area above the belly. The advantage of this technique is significant: less numbness, far fewer wound complications, and more rapid healing.
You also have a reputation of excellent as a breast surgery specialist. Please say more about the breast procedures you perform.
Breast augmentation surgery increases breast size and enhances the overall shape of the body, making it more proportionate. My patients tell me that they feel more feminine, more self-confident, and more able to choose from a wide range of clothing styles. But many people are still unaware aware that breast augmentation can do more than enlarge the breasts. Enhancement surgery also corrects a loss of breast volume – commonly experienced after significant weight loss, after breast-feeding, or as a result of time and gravity…the normal aging process.
Another excellent reason to seek breast augmentation is to correct breast asymmetry. Most women have asymmetrical breasts, but some women have a noticeable difference between the size or shape of one breast and the other. One breast may also be positioned higher or lower than the other, or have more or less projection than the other, and augmentation will bring the breasts into symmetry. Reconstructive breast surgery is also a life-changing procedure, restoring the body to a normal shape after mastectomy.
With the breasts, I’m evaluating the size, shape, projection, and position of the breasts in relation to the rest of my patient’s body. Sometimes a breast lift is all my patient needs; for others, a lift and augmentation will give them the outcome they desire. Still others want to have more fullness in their upper breast area, and fat from their own bodies can now be injected just beneath the skin to pad that area. Fat is versatile, and the results that can be achieved are excellent. For women who want larger breasts, the choice of saline or silicone implants depends, in part, on her preference, and also dependent upon other factors that sometimes make one a better choice than the other. This is something I discuss at length with my patient during the first consultation visit.
In terms of breast reduction surgery, I can’t say enough about this procedure and the many benefits it gives to women who have dealt with overly large, heavy breasts since puberty. It’s difficult for the average person to understand the experience of a woman who is a good candidate for breast reduction surgery. These women live with numerous challenges – back pain, poor posture which results in undue stress on many muscle groups in the body, bras that dig into their skin, self-consciousness, and restrictions in certain types of physical activity, just to name a few.
This procedure liberates them from the restrictions and physical discomforts they’ve lived with for so long and it’s a pleasure to witness the happiness of these women who can now live more normal lives, enjoying their new-found abilities to move with comfort, dress the way they want to dress, and feel good about the way they look.
Thank you very much, Dr. Ortegon.