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I truly believe that symmetrical faces have a distinct advantage when it comes to getting the best that life has to offer.  Consciously or un-consciously we all discriminate. We begin judging people the minute they enter a room. A first impression is made and it is often very difficult to change this impression.

An article recently published in the Proceedings of the National Academy of Sciences confirms that “People’s assessment of physical beauty is mostly about symmetry”.

Early this year I lost a dear friend to Malignant Melanoma. It was a terrible thing to see a good friend and fellow physician lose the battle with this terrible condition.

Melanoma rates are rising very fast; it’s an epidemic.  According to the most recent National Cancer Institute in 2009 there were 68,720 newly diagnosed cases of invasive melanoma and 53,120 cases of in situ (very early and confined to top layer of the skin) melanoma in the United States. These numbers are expected to increase in 2010.

The skin on the chest and the back of the hands are an often neglected and can give away your age. Until very recently the number of options to treat the chest and back of the hands were very limited. Now there is renewed hope….

I have devoted an entire section on my website to the rejuvenation of hands:

Age spots can be lasered, rough spots and pre-cancers can be frozen or cauterized, fine lines can be treated with the application of various acids and microdermabrasions and hollowness on the back of the hands can be filled with Radiesse or fat grafting.

Now we have a new tool in our armamentarium to treat the aging skin of the chest and hands:

The Mixto Fraxel.

Many of my patients ask me questions about touch ups on their facelift. Here are some of the commonly asked questions and their answers:

Will I have more scarring from a touch-up facelift?

The answer is NO. I usually take the old scars out, tighten the muscle from inside, remove excess fat and skin and place the incision inside the ear to achieve a near-invisible scars (see my before and after results). Facelift scars can also be treated with a chemical peel of Fraxel (CO2 Resurfacing) to reduce their appearance.

When should I consider getting a touch-up on my facelift?

Generally speaking facelifts need to be touched up every 10 years or so. In some people they last much longer. Excessive sun exposure or dramatic weight changes can loosen the skin and result in hanging neck and jowl area. In those instances, an earlier touch up may be needed.

Am I too old for a touch up Facelift?

You can have a touch up Facelift if you are in good health and have 2 weeks down time to heal. Age is usually not a limiting factor. A physical exam by your primary care doctor and a medical release is always performed to make sure that you can tolerate the procedure. I often talk with the internist if my patient has diabetes or is suffering from any chronic conditions. We also perform routine blood work before the procedures to check your kidney, liver and blood clothing status.

Hope to see you soon for a private and confidential consultation.

A. David Rahimi, MD, FAAD.

• I encourage my male patients not to shave too close in the neck area. In fact switching to an electric Razor often helps.
• Reducing the bacterial count on the skin also helps; this can be achieved by the application of prescription topical or oral antibiotics (Erythromycin and Clindamycin solution, oral Tetracycline, Minocin, Dynacin, Doryx, Oracea etc).
• Benzyl Peroxides (BP): Application of BP to the skin causes a significant decrease in the number of bacteria and helps lighten residual brown spots from previous ingrown hairs.
• Retin A, Tazorac and Differein Gel: These 3 classes of topical agents decrease sebum production and loosen up the clogged hairs. This, in turn, reduces ingrown hairs and smoothens the skin. The drawback is that they make the skin more sensitive to the Sun and getting facials.
• Microdermabrasions and light chemical glycolic peels help improve impacted pores and those white bumps called Milias.
• Scrubs: Neutrogena makes a great facial and body scrub. Once a week under the shower helps exfoliate the dead layers of the skin and reduce bacteria counts.
• Stronger acids such as Jessner and TCA (Tri-Chloro-Acedic Acid) can also be judiciously used to treat scarring and clogged pores.
• Lasers and Light sources: Resistant cases can benefit from Phodynamic Therapy and lasers such as the Cooltouch laser (see our menu of services).

Many patients with a darker skin complexion (Hispanic, Asian, African American, Armenian, Middle Eastern) are told that they have to simply live with their acne scarring and that nothing will help them.

There is hope and We can help...

The truth about aging of the skin is that both nature and nurture play a role. Everyone agrees on that! So, whats the contraversy?

Here is the real question: To what degree is the aging of the skin ingrained in our genes and what is the role of the environment we live in.

Well; its complicated (like most worthwhile things in life)...

Here are some facts; you decide.

I live and practice in Los Angeles, California. A significant portion of my patients have darker skin complexion. On a routine day I may see patients with varied ethnic backgrounds.  Asian, African American, Hispanic, Middle Eastern, Armenian and American Indian patients make up more than half of my prcatice.

Over the past 10 years I have developed special techniques to treat patients with a darker skin complexion. I usually use a combination of nutritional and lifestyle advice, topical and oral medications, chemical peels, and lasers to achieve my goals.

Here are 5 things you can do to make your darker skin even more beautiful...

Patients often ask me if drinking a lot of water or eating certain types of food can really make you look and feel younger?

The answer is YES.

Drinking clean water is very important. Recent data shows that 3 or 4 glasses a day, in conjunction with a healthy diet, is of paramount importance. The 6-8 glasses of water receommended in the past was not really based on any scientific data.

Certain foods are also high in vitamins A, D, and essential elements can promote a healthier appearing skin. I tell my patients that life is short and tommorrow is not promised to anyone. Eat everything in moderation but make sure to include fresh fruits and vegatables.

Here are some of my favourites:

Grapefruit, Sweet Potatoes, Spinach, Almonds and Raisons. Fresh Youghurt with live culture is a great way to get plenty of protein, vitamins, and Calcium. The pro-biotic benefits are immense.

Green teas and even Coffee in moderation has now been shown to decrease the risk of heart disease and certain cancers.

Most importantly: A great meal is not complete without a piece of dark Chochlate.

Zei Gesund

Dr. A. David Rahimi

Over the past ten years there has been a drastic increase in the number of my male patients who are either having or are considering having a facelift. Many men consider facelifts to remain competitive in their work environment. Others want to look healthier or feel more confident in their personal relationships.

Unlike other medical specialties which focus on one area of the body, with skin it’s everywhere and each portion of it carries its own problems.  The legs are especially vulnerable to certain disorders – as well as all the other conditions.  A common and often hereditary complaint my patients have is spider veins, varicosities, broken capillaries or sunburst vessels. These veins do not actually serve a purpose, so can be removed without posing a health problem. The procedure used to treat spider veins is called sclerotherapy...

One thing you can say about the entire subject of self improvement is that there is certainly no lack of options – but sometimes that becomes a problem on its own.  With so many choices – each one claiming to be the best, it’s hard for patients to know who to believe.  Obviously, your trust in your doctor is the important key to finding out the real truth – the inside scoop, yet there is a tendency to be swayed by media – both print and TV.  When celebrities undergo a treatment and it’s subsequently splashed in the media it seems to carry its own validation...

With so many different options – and so many of them called “facelift”, it’s hard to know what a true lift is – when is it needed – and how invasive does it have to be.  I’ve discussed the Tuliplift before, and why it is an ideal solution for certain types of aging, yet I find many of my patients still have either unrealistic expectations of some procedures or frightening misconceptions about facelifts.

Introduction

I would like to sum up my entire book in two pages for you. If you only have 5 minutes you can read these pages and understand my motivation for writing this book and the message it entails.

After my dermatology residency at Mount Sinai Medical Center in New York I embarked on a year-long fellowship program to learn the different aspects of cosmetic surgery. I worked with brilliant surgeons from a variety of disciplines: facial plastic surgeons, general surgeons, plastic surgeons and ENT specialists. I received my training at a large and busy outpatient surgical clinic with two operating rooms, two recovery rooms, two hyperbaric oxygen chambers, ten examination rooms, staffed by forty nurses, physician assistants, and estheticians.

It was a rich and amazing experience that taught me a great deal of surgery. During the latter part of my training I witnessed what was going to become a life changing event. A patient undergoing a simple fat transfer procedure by another surgeon developed an adverse reaction to the general anesthesia and crashed. She stopped breathing and her heart had to be re-started by the emergency medical personnel pouring into the operating room. The surgeon hadn’t even started the surgery; the event was caused by an adverse reaction to the administered anesthesia.

The next 10 days were amongst the most difficult of my life. To see this young patient on life support fighting for her life changed the way I approach cosmetic surgery. I truly believe that her strong faith in God and the capable doctors at the Local Hospital saved her life. Miraculously, she fully recovered. I had to make a choice: give up my passion of becoming a great cosmetic surgeon or find a different and better way of doing surgery.

My salvation came in my understanding of Tumescent Liposuction which at that time had recently been introduced by Jeffrey Klein, MD. I believe that Dr. Klein single-handedly changed the entire field of cosmetic surgery and deserves endless credit. I learned that local anesthesia with or without a minimal amount of sedation can be used to do all types of cosmetic and plastic surgery.

I have spent the past 9 years perfecting just this: less invasive is better, local anesthesia and mild sedation is all that is ever needed. Patients want to look their best self, not someone else.

Most patients will choose local anesthesia if the surgeon spends the time and effort to explain why it is better, safer, and more cost effective. I truly believe that all types of cosmetic surgery can and should be performed under local anesthesia. In this book I will describe and show you results from thousands of procedures performed this way over the past 9 years. Many lives can be saved by performing cosmetic surgery under local anesthesia. There are still risks with administration of local anesthesia and the surgery: bleeding, infection, unsightly scars, etc. I believe these risks are much smaller and more manageable.

Finally, I want to mention that this book is not a criticism or attack of any group or society of surgeons. I understand that questioning the status quo will bring with it criticism of my surgical skills and me as a surgeon. I will be put under the loop because it will appear as if I am criticizing my fellow colleagues. This book, in no way, is meant to do that.

In this book I discuss liposuction, fat transfers, face and eyelifts, lasers, chemical peels, sclerotherapy and a variety of other procedures performed completely under local anesthesia. I do not discuss breast surgery, tummy tucks, or nose surgery. I do not perform these procedures but have seen them performed under local anesthesia as well. It takes longer for the surgeon to perform any surgery under local anesthesia and one can not do too may procedures at once. The patient is awake and care must be taken to numb the surgical area well. It also limits how much one can do at any given point. I discourage patients who want to do too much at the same time. I explain that a second or even third surgery may be necessary to address all their needs.

With this book I want patients to understand that they have a choice and can have most, if not all, cosmetic procedures under local anesthesia. I hope that my fellow colleagues will be open minded enough to give this approach a chance.

I urge you to proceed and read this book if what I have said has intrigued you. Thank you.

A. David Rahimi, MD, FAAD

'Tulip' Mini Face Lift

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Just like all renovations – one improvement often leads to or warrants another.  Depending on the procedure, there may be two or three additional steps in order to   attain the desired effect.  This is not an up-sell technique but an important part of re-balancing and achieving symmetry...