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• 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...

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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The answer is: It depends on the facial anatomy and sex of the patient.

(Sorry--nothing in life is easy!) Here are my thoughts on the proper placement of facelift scars:

I always discuss the exact location of the scars with my facelift patients. In most patients, a few months after the surgery, these scars are barely visible. But especially in men, or women with short hair, they can be visible.

The Lifestyle Lift has become very popular over the past few years and I have had several patients ask me about it. I love that more and more surgeons are performing facelifts under local anesthesia. Remember, local anesthesia is all that is needed. I have been doing my Tuliplifts under local anesthesia since 2000.

One of the things that sets the Tuliplift apart is that the area under the neck is also addressed. Excess skin and fat is removed and the neck muscle (Platysma) tightened...

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.

Of all the things you will be decorating this holiday season, none is more important than the neck and upper chest – this is where your best jewels will sparkle and they deserve an attractive and smooth background.  Fortunately, there are some relatively quick solutions to help make this area glow with health...

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.

During a recent Radio show I was asked about improving acne scars.  Subcision is one of the procedures I use to improve depressed acne - or traumatic scars. The procedure is quite simple and very effective.

One reason you can see depressed scars is that fibrous bands pull the skin inward. I use a a small NoKor needle to cut the fibrous bands from inside. All that is needed is a small amount of local anesthesia (cream or lidocaine solution), steady hands, and a thorough knowledge of skin anatomy. Here is how it works....

My practice is in Southern California and a large percentage of my patients have a darker skin complexion. Asian and African American patients with a history of keloids or unsightly scars are often hesitant to have a facelift.

Often I'm asked--in regards to the sagging of the jowels and neck area--if there is a more conservative approach one can take: a solution not requiring "any cutting". Here is the answer...

YES! There is a facelift which is well suited for men. Men are generally more hesitant than women to have a facelift. They often worry about visible scarring extending into scalp or forehead, a pulled look, and a long recovery period. It does not have to be like that. My trademarked Tuliplift, which is performed under mild sedation, addresses all the above concerns. It doesn't give men a pulled or artificial look, recovery is usually 10-4 days, and scars are both limited in length and do not extend into hair bearing scalp.

As many of you know from my other blogs, I am not a great fan of permanent injectable fillers. The body and face will change over time; whereas a permanent filler cannot. This important difference can lead to serous problems, and as such I tend to discourage the use of permanent injectible fillers whenever possible.

Artecol is a filler of this type, which consists of little solid microsheres (PMMA) suspended in a solution containing bovine collagen. It is widely used in Europe and will eventually become available in the United States. Given its popularity, one might assume Artecol poses less risk than other permanent fillers, however that is not the case. Recently, I came across an article in the Archives of Dermatology which exposes some long-term risks associated with Artecol and I'd like to share its substance with you.

Cosmetic surgery inherently involves some level of risk. On occasion, one can encounter rare symptoms such as bleeding, infection, or scars that just won't heal right--all symptoms that can complicate the recovery for months to come. When considering cosmetic surgery, it is important to factor in these unpleasant risks, so that you are equipped to handle them should they arise.

Last year I was asked to consult on a patient who had undergone a facelift procedure in Mexico. The immediate post-operative period had been uneventful, and she had returned to Los Angeles to recover. Four weeks after the surgery the scars in front of her right ear started to thicken. Over the next few months, these scars developed into unsightly and painful Keloids, which required several corrective treatments. . .

A few weeks ago I was asked to evaluate a patient with irregular fat deposits resulting from a fat transfer. She had undergone repeated fat transfers into the lips, cheeks, and nasolabial folds with less than perfect results.

Although the transferred fat had been applied relatively regularly, the ensuing hematoma (bleeding/bruising) had resulted in a significant shift of the applied fat and deep scarring.

All things being equal, Fat Transfer is very successful; however infections, seroma formation (collection of fluid under the skin) and irregular absorption of the fat can lead to a lumpy appearance.

Solution: Once again, we need to use a comprehensive approach to correct this problem. I usually start by breaking the excess fat and scarring down with repeated intralesional cortisone shots (ILTAC 2.5mg/cc). This is followed by subsicion of the deep fibrous bands, and lymphatic drainage. Finally, the excess fat can be gently suctioned by hand.