A new study recently published in JAMA clearly shows that Derma Rollers have the potential of significantly improving Acne scarring. I have included the study below for you to read. The results are quite impressive. There are several points to consider. Treating the skin with Derma Rollers is quite tricky and I have seen both infections and scarring when non professionals and patients have tried to treat their own skin. It can also be quite painful and result in moderate to severe swelling and bruising. I also perform them under sterile conditions in an operating room and use mild oral or IM sedation when needed. Three to five sessions over 4 months are needed and can result in significant and lasting improvement in the appearance of acne scars, fine lines, pores, discolrations, and more. 

Cost can range from $500 to $1500 per treatment 

Dr. David Rahimi 

JAMA Dermatol 2014.

I always tell my patients about the well know association between numerous skin tags under the breast and neck area and polyps in the colon. These polyps can at times become or turn into colon cancer. Here is another association worth noticing.

Number of moles may be a predictor of breast cancer

Zhang M. PLOS Medicine. 2014. doi:10.137/journal/pmed.1001659.

• June 12, 2014

The number of cutaneous nevi, or moles, on the body may be a reflection of plasma hormone levels and help predict patients’ risk for breast cancer independently of other known factors, study results have shown.

Using the Nurses’ Health Study, researchers prospectively analyzed the relative risk of breast cancer among 74,523 female nurses based on the number of cutaneous nevi reported. The participants were followed from 1986 to 2010.

Participants reported the number of cutaneous nevi on their left arms, from shoulder to wrist, that were 3 mm or greater in diameter. The researchers grouped the women into four categories based on the number of reported nevi: none, one to five, six to 14 and 15 or more.

Invasive breast cancer was documented in 5,483 cases. Women with more cutaneous nevi had a significantly increased risk of developing subsequent breast cancer, according to the researchers (P = .003).

During the 24-year follow-up, absolute risk of developing breast cancer increased from 8.48% among women without cutaneous nevi to 8.82% for women with one to five nevi, 9.75% for women with six to 14 nevi, and 11.4% for women with 15 or more nevi. Every five additional nevi found was reported to increase breast cancer risk by 8%.

The researchers also reported that the number of nevi seemed to be associated only with the risk of estrogen receptor-positive tumors. Women with more nevi had higher levels of estradiol and testosterone (P = .02 and P = .06, respectively).

Attention to detail is the key to a successful procedure

I think in Cosmetic Surgery, much like in day to day life, attention to detail can mean the difference between mediocre results versus great results. Allow me to elaborate. I often sit in front of a patient for a cosmetic consultation. Patients in their late 40s and 50s come to me for my advice on how to look younger and feel better. A brief glance allows me to evaluate their face on 6 or 7 different levels. I see signs of sun damage from their early youth indiscretions, signs of weight gain and loss, stresses of life, poor eating habits, bone erosion, and effects of smoking and smog here in Los Angeles. The question I often get asked is : What do I need Doc?”

I often sit back and say with a calm voice: you don’t need anything. Then I ask their permission to share with them what I see and Analyze their face or body. At times I take photographs with my 3D Vectra Camera and show them their sun damaged skin, asymmetrical volume distribution and eyebrow locations. It is quite amazing how little people actually know their own skin and faces. My simple goal is to make them look the way they did 10 or 20 years ago.

Very few patients have noticed these subtle changes. At times I can see my patients becoming defensive and almost upset at me for pointing out the things I see.

I then put a program together for them that address these changes on several levels.

Tightening the skin without cutting, thickening the skin and removing blood vessels and blemishes, and filling the irregular contouring is only part of this program. Good nutrition and exercise is the second half.

Looking younger and healthier without cutting surgery is a reality in 2014. Please see us for a complimentary consultation and discussion on how to achieve our goal of making you look and feel 10-15 years younger.

Yours,

Dr. A. David Rahimi

Subcision

How does it work and how effective is it?

Treating deep acne scarring is one of the most challenging dilemmas in dermatological cosmetic surgery. Most patients with deep acne scars are also people with darker skin complexion i.e. Asian, African American, Hispanic and Middle eastern.

As a dermatologist and cosmetic surgeon I have a number of modalities at my disposal. Each procedure or device has a purpose and helps a small subset of patients with acne scarring the type, size, depth and location of the scarring often dictates the type of procedure or device used by me:

During the consultation he I often discuss all the procedures that may be beneficial to a patient, including TCA peels, Jessner Peels, Needling, Subsicion, Punch grafting, Erbium and CO2 fractional laser resurfacing, Cooltouch lasers, Diolite laser, Dermabrasion, Saline injections, Ultherpay (Ulthera) , Pelleve Radiofrequency treatments, and much much more.

In this blog I want to briefly discuss Subcision:

Subcision refers to a procedure whereby deeper bound down scars are treated with various size needles. These needles often have small blade-like ends and cut the fibrous bands that pull the skin down and cause deep puckered indents. The trick is to use the right size needle (I often use a NoKor needle with 16 to 22 gauge diameter) and to apply the needle to the right depth of the scar. The needle used too superficially or too aggressively can cause the skin to break down (slough off) and cause an even deeper scar. The Subcision needle applied at the wrong depth can also cause minimal improvement. The philosophy behind breaking these fibrous bands are as follows: The bands are severed with thin needles and the body secreted platelets, growth factors,  and causes new Collagen synthesis. This, in turn, results in improvement of the deeper scars. A few of the fibers invariable re-adhere. This results in some of the scars to reappear. 

An experienced Surgeon should also be able to combine Subcision with a deep chemical peel or CO2 resurfacing.

Please visit our Facebook page and watch our videos on Mixto laser, Subcision, and more.

https://www.facebook.com/pages/How-To-Treat-Acne-Scarring/187751721248937?ref_type=bookmark

Dr. A. David Rahimi

The landscape of Acne Scarring treatment modalities is to say the least very colorful. This week I had a patient who applied a topical garlic paste and herbs to his face and who presented with a severe allergic reaction and redness. Needless to say that the Acne scars remained unaffected.

The Gold standard for the treatment of Acne scarring is still CO2 laser. Mixto fractional CO2 laser in combination with Ultrasound or Radiofrequency treatments, Subcision, and more can result in a significant improvement (%50-%70 with 1-2 sessions) of acne scars.

TCA cross is a treatment modality that has its advocates. The treatment does not require sophisticated lasers or equipment, is inexpensive, and appears to help some patients with very deep acne scarring. I will try to describe my experiences with TCA cross.

TCA cross refers to the application of highly concentrated TCA (Tricloroacetic Acid in the 70-100% concentration) with a toothpick or broken q-tip to the base of deep Icepick scars. The idea is that the TCA will cause an inflammatory reaction and Collagen synthesis over the ensuing 2-3 month. This, in turn, lifts up the base of deep Icepick scars and fills them in from within. It is generally accepted that this procedure does not help deep atrophic and rolling scars. So in summary the 2 assumptions are that TCA can be applied to the base of icepick scars and this in turn results in selective Collagen synthesis and lifting of the scar.

I urge you to do the following experiment: take a tooth pick and dip it in water. Now step in front of the mirror and try to apply the water to the base of an ice-pick scar. It is virtually impossible. Try this with ink so that you can see where the liquid was applied. The water (or TCA in the hand of an experienced Dermatologist) invariably touches the sides of the depressed icepick scar. Even if the base is fully treated the TCA can and at times does dissolve away the sides of the depressed icepick scars. The patient ultimately may ends up with a wider and sometimes even deeper icepick scar defying the purpose of the procedure.

In my opinion deep Icepick scars need to be punched out with a 1mm or 2mm or 2.5 mm punch or even excised with a #11 blade. TCA cross can at times result in improved cosmetic appearance if the surrounding skin of the scar is slightly elevated and can be planned down with the TCA. In my hands the results are erratic and not uniform for every patient.

I still discuss TCA cross and offer it as an option to some of my patients that have generally good skin peppered with a few deep scars and who don’t want punch excisions or lasers. I also perform this procedure a few weeks before a deep Dermabrasion or CO2 laser to prep the skin and minimize deep scars.

In summary: TCA cross is tricky to perform, does not cause uniform results, and is not the first choice treatment for many of my patients. Judicious use in combination with Subcision, Fat grafting, Co2 fractional Laser  can results in improved appearance of deep icepick scars.

A. David Rahimi,MD,FAAD,FAACS

CO2 laser with radiofrequency offers more effective acne scar treatment

Cameli N. Dermatol Surg. 2014;40(5):553-561.

• May 22, 2014

I am a strong supporter of Accutane.

It can be life changing and prevents severe scarring and a lifetime of pain and stigma.

Please read this article. Those Lawyer ads you see on TV labeling Accutane "A Bad Drug" are not based on science. Reports of Depression and IBD are wildly exaggerated and are associated with severe Acne itself and not with Accutane.I have personally treated hundreds of patients with accutane since 1999. It is not the first drug I prescribe and I do monitor my patients regularly. Having said that; it is a great drug for severe inflammatory and scarring acne: