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:

I am often surprised that my patients don’t know the relationship between smoking and wrinkles. The plus 4000 carcinogenic and mutagenic chemicals in tobacco smoke cause degradation of Collagen. The skin loses its elastic fibers and skin laxity ensues. Please read the Mayo article below by Dr. Dale.

I live in a large metropolitan city (Los Angeles) and see the smog and dirt in the air and on my skin. Adding smoking to this will shave off 5-10 years off your life AND make you look another 5-10 years older! Is it worth it?

Dr. R.

Is it true that smoking causes wrinkles?

Answers from Lowell Dale, M.D.

Yes. So if you need another reason to motivate you to quit smoking, add premature wrinkles to the list.

(read more)

"The whole is greater than the sum of its parts.”

Aristotle

Quadrafecta refers to a technique of choosing 4 different procedures or devices to achieve the desired result. The emphasis is on “minimally invasive” and “natural appearance”.

During the consultation process we chose from the following procedures and devices the 4 that will suite you best. Occasionally a fifth procedure is needed to address all the aspects of the aging face.

Ultherapy (Ulthera)- Ultrasound deep Face, eye and neck lift

Pelleve- superficial Radiofrequency face and neck lift

Mixto Laser _ Co2 fractional laser for fine and deep lines

Fillers- Sculptra, Radiesse, Juvederm, Restylane, Perlane

Chemical Peels- TCA and Jessner Peels

Smartlipo Triplex- fat removal and skin tightening with Smartlipo Laser

IPL Photofacial- Light source to remove brown spots and Blood Vessels

Diolite Laser- Laser to remove larger blood vessels

COOltouch Laser- Non ablative laser to tighten pores

Clear and Brilliant Laser- to remove fine line and brown spots

Thermage CPT- Body lifting with Radiofrequency

Relume- Removal of light scars with focused UVB light

YAG 5 laser- Removal of discoloration and irregular pigmentation

Dr. A. David Rahimi will chose the best 4 treatment modalities to be performed in one session and under light oral sedation to achieve the best cosmetic result with minimal downtime Cost: $4500-$7500 www.foreveryoung.net Forever Young, Inc. Los Angeles CA: 6333 Wilshire Blvd suite 409 LA CA 90048 323 653 7700   Westlake Village CA: www.laserandaesthetics.com 3825 East Thousand oaks Blvd Suite 409 Westlake Village CA 91362 805 497 7546 Dr. A. David Rahimi is Board Certified in Dermatology Fellowship trained in Cosmetic Surgery and has performed over 100000 laser treatments since 1999

Dear Physicians,

We have been offering Coolsculpting to freeze away the fat for almost 3 years now

it really works

http://www.cbsnews.com/videos/freezing-fat-cells-coolsculpting-claims-to-remove-fat-without-surgery/

Please call us for a free consultaion

Dr. David Rahimi

News/ 

 http://www.eonline.com/news/540248/hugh-jackman-reveals-another-skin-cancer-scare-no-more-sun-for-him

Hugh Jackman Reveals Another Skin Cancer Scare—No More Sun for Him!

by Natalie Finn Thu., May. 8, 2014 5:07 PM PDT

Instagram

We hate to see Hugh Jackman's face going through all this.

But the multitalented Australian actor did his fans yet another good turn by revealing that he needed to have yet another Basal-cell carcinoma removed from his nose.

"All out now. Thanks Dr. Album and Dr. Arian. PLEASE! PLEASE! WEAR SUNSCREEN!" Jackman reminded via Instagram, to which he posted a pic of his bandaged, bearded visage.

A Basal-cell carcinoma is the most common form of skin cancer and is usually entirely treatable, though it can spread and cause damage to surrounding tissue.

Humberto Carreno/startraksphoto.com

Jackman also had one removed in November, and he also turned his trip to the doctor at the time into a lesson for us all about the necessity of a good SPF.

The repeat Men's Health cover hunk just made the NYC high-society scene with wife Deborra-Lee Furness on Monday at the Met Gala, Jackman in a Tom Ford tux almost getting the white-tie theme right, minus his black bow tie.

Still in New York, the X-Men: Days of Future past star stopped by Good Morning America today with costars Ellen Page, James McAvoy, Patrick Stewart and producer Lauren Shuler Donner, whom Jackman credits with ensuring that he got the part of Wolverine in the first X-Men, 14 years ago.

The latest film "felt not only like a great reunion but all of us had this great sense of gratitude," he said. "That 14 years later we could play these great parts in a movie which is entertaining but also has something to say. A real blessing."

It has been about 12 months now since I have been treating my patients with Voluma. This Hyaluronic acid based filler has drastically transformed my filler practice. The results look natural and last for 2-3 years. Even more importantly; unlike traditional cheek implants there is no downtime or risk of infection or migration as there is with traditional silicone implants.

This is a really important article

Please read

I see this all the time in my practice. Patients that lose too much weight still suffer from disproportionate fat deposits in the hips. The other extreme is that diets and weight loss cause wasting of the face and hollowness that makes the person appear older.

The solution is judicial laser liposuction with Smart Lipo.

Can you really control where you lose fat?

They're called "comfort" foods for a reason -- they bring back warm memories, tickle your taste buds, and soothe your soul. Though some comfort foods are deep-fried, covered in cheese, or packed with sugar, some can actually help you lose weight. Beat the battle of the bulge with the following cozy eats.

Editor's note: upwave is Turner Broadcasting's new lifestyle brand designed to entertain the health into you! Visit upwave.com for more information and follow upwave on Twitter, Facebook, YouTube, Pinterest and Instagram @upwave.

(upwave.com) -- The rumor: You can spot-reduce to lose body fat

Legend has it that, by targeting specific parts of your body through exercise, you can laser-focus where your body burns fat.

Heck, the guy in the TV commercial for that abs thing lost 60 pounds around his midsection by doing three minutes a day on what looks like an assisted twerking machine. And popular wisdom says there's no problem getting washboard abs if you do enough crunches.

But are the rumors true?

The verdict: You can't control where you lose fat

Sorry, but where your body loses fat has more to do with genetics than with that weekly "Six-Pack-A-Palooza" class at your gym.

"Asking your body to lose fat in one area is like trying to remove a cup of water from one corner of a filled bathtub," says personal trainer Lecia Whitlock, an instructor at The National Personal Training Institute. "The overall water level will go down, but there won't be a divot in one corner of the tub."

A 2013 study measured the effects of exercise on the fat mass of a targeted body area. Subjects did a ludicrous number of leg presses using their nondominant leg over the course of 12 weeks.

Despite performing between 960 and 1,200 reps (!) three times a week against very light resistance, participants saw no significant change in fat mass in the exercising leg. There was a decrease in fat mass in the upper body, but nada in the leg that did all of the work.

upwave: The best fat-loss workout

So, where does this leave you if you want to lean out through the middle?

First off, we just saved you anywhere from $19 to $199, because now you won't be tempted to go out and get the latest "fat-burning" abs gizmo. And that's only the beginning of the good news.

If you're serious about losing your gut and are following a sound exercise and diet program, there are some things you can do to decrease the appearance of your waistline while your body leans itself out.

"Strength training the muscles of the upper body -- especially the shoulders and back -- will improve your posture and change your body's proportions," says Whitlock. "This will make your waistline appear smaller."

Your improved posture will get you standing taller and appearing thinner, and the added muscle you'll be building will help increase your overall metabolism and speed up the rate at which your body is burning calories and shedding body fat.

upwave: Quick 5-minute upper body workout

Ultimately, the key to a more ripped midsection isn't doing a zillion crunches. It's working the entire body and eating correctly.

Strength training will increase the calories you burn 24/7. High-intensity cardio will let you burn big chunks of calories in a small amount of time. And a healthy diet will ensure that you're taking in the proper number of quality calories.

You might not lose three pants sizes in a week like the guy in the ad, but you will eventually reach your goal. "And as a bonus," says Whitlock, "the rest of your body will look and feel better as well."

This article was originally published on upwave.com.

I am delighted to announce that the Forever Young, Inc. APP is almost ready to be released.

We are waiting for Apple App store to give us clearance to go live! Google Play and Android App versions are ready as well.

Putting this APP together was quite challenging.

We had to incorporate 4 websites (www.foreveryoung.net, http://www.tuliplift.com, http://www.ultheracenter.com  and www.laserandaesthetics.com  , hundreds of pages of relevant clinical information, hundreds of photos, 20 different laser and light sources, my blog, and much much more.

My desire is for the APP to be educational and make the process of making appointments easier. The next step is to incorporate e-commerce and give my patients an easier option when choosing their skin and hair care needs.

Great way to start Spring 2014.

A. David Rahimi,MD,FAAD,FAACS.

Watch Dr. David Rahimi discuss Skinceuticals products for Lush.com

http://youtu.be/dvphbM-v_FY

Thank you 

A perfect fit for today’s aesthetic practice, the VECTRA M3 delivers extraordinary performance in an advanced 3D imaging solution. High resolution capture assures photorealistic rendering of the finest details, while the elegant design complements any setting. The VECTRA M3 is a complete solution including all necessary hardware, software, installation and training.

• Instantly capture detailed 3D images of face, neck and decolletage
• 36 megapixel color capture for highest quality image data
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http://www.canfieldsci.com/imaging_systems/facial_systems/VECTRA_M3_Imaging_System.html