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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...

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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Being prepared to learn more about yourself – not some case study in a magazine is not only enlightening but it’s the way we tailor the treatment to you. The reason so many procedures exist is because individuals pose challenges to doctors precisely because each face is unique – truly unique.  Part of my philosophy as well as training includes the ability to look for all those unique markers and match them to the latest innovations in treatment.

Every new year brings with it a chance for transformation.   The majority of our resolutions center on our appearance – losing weight, getting active, or improving the self in some way.  With cosmetic and surgical procedures the resolution to do something is often daunting and riddled with fear.  Even making an appointment for a consultation can be unnerving – and yet it’s the only way to know exactly what can and cannot be achieved.  The good news is – they can often be enjoyable.

Recently, I was interviewed by an LA Times reporter about Acne.org. I was asked if I believed that large quantities of Benzoyl peroxide, applied topically can controll/cure acne in almost every one.

My response was that "I am very skeptical" and "It is silly to believe that Acne can be cured with Benzoyl peroxide alone." Acne is a complex condition with many different causes. It can be a normal component of puberty or part of a debilitating condition such as Poly Cystic Ovarian disease or Acne Fulminans.

Basically a 30-minute interview that included explanations about the hormonal aspects of acne, the environmental component, infectious and bacterial component, the more than 200 available medications and classes etc. was reduced to and quoted as " It's silly..."

Axillary and Palmar Hyperhidrosis (Excessive Sweating) can be very distressing and interfere with daily living and ones career.

Axillary and palmar hyperhidrosis can be socially and professionally embarrassing. Here is how I approach patients with excessive sweating.

2008 marks the third year of out Cosmetic Surgery Fellowship Program. The first two years have been a great success and it gives me great joy to share my knowledge of Cosmetic Surgery with a fellow surgeon who is eager to learn.

I am reminded of my time as a Chief Resident at Mount Sinai Medical Center when I explain Cosmetic procedures to my fellow. Reviewing articles and explaining why I do a procedure in a certain way also allow me to stay on the cutting edge.

Teaching has become one of the greatest joys in my professional life. I am thankful for that.

Dr. A. David Rahimi

As happy as holidays are they're also stressful - and skin shows stress more quickly than your other body parts. The treatments that are made to help correct problems are also great stress relievers in two ways...

If it sounds too good to be true, It is.
Stay away from claims that sound impossible; ask to see the scientific papers supporting the claims. Ther is no such thing as a no-down time procedure, or scarless surgery, etc...

Plastic surgery can change your appearance, it probably won't change your life.
Make sure you do the procedure for yourself and not someone else.

Never make a hasty decision.
Do not allow the doctor or his staff push you into surgery. If you're grieving or facing another life crisis such as divorce, postpone decision on surgery.

Make sure you have realistic expectations.
Be wary if a doctor does not review possible complications and alternatives to the surgery with you.

Your doctor should always have time to discuss your concers and answer your questions. Period.

Ask to talk to patients who have had the same procedure recently.

Finally, make sure you feel comfortable with the doctor and the staff.
Complications such as infection and bleeding do happen, even in the best of hands. What sets an ordinary surgeon apart from a great one, is how these complications are treated and handled.

Whatever treatments you choose to improve and rejuvenate your skin - you'll want to keep your results by establishing care routines and using products to help maintain not just the aesthetics but the health of your skin. Our products are specifically formulated to address the damaging effects of sun and pollution, but also to help speed healing after a procedure...

Proper nutrition - everyone knows it's essential to health - here are some of the best foods for healthy skin. Keep in mind that when your diet is missing certain foods for healthy skin, other, even more serious skin problems can result. So as you are planning menus or when you’re browsing a holiday buffet table - choose some of these foods:

Over the past 10 years the list of facial "Fillers" has grown from one, namely Collagen, to over a dozen FDA approved products.

An intergral part of the consultation process is deciding which filler is perfect for you. Radiesse lasts 1-2 years but is too thick to use in the fines lines around the eyes or lips. Juvederm lasts about a year, but is more expensive. Fat is readily available but tends to resorb in certain areas (lips for instance) very qickly.

Here is how i approach a new patient...

I recently spoke at a small internet based radio program called: letstalkrecovery.com. It was a fun experience and even after the show was over I was receiving calls on a variety of cosmetic procedures. I was also asked about scarless surgery.

My practice is in Los Angeles and I see a lot of advertisements for "Scarless Surgery". I have over 10 years of experience in Dermatology and Cosmetic Surgery and can tell you with great cetainty that any surgical procedure which involves cutting the skin will (not can but will) lead to a scar. I usually convey that to my patients during the first consultation.

As a skilled surgeon one can do a lot to prevent unsightly or noticable scars, or reduce their appearence once they have already occured. Here is how ...

Acne Vulgaris is one of the most common skin disorders in the United States. It is estimated that over 20 million people suffer from this potentially debilitating condition. Acne can affect ones self-image, lead to social isolation and depression, and even cause physical and psychological scarring and disfigurement.