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Wednesday, June 11. 2014

Category : Acne Scarring Treatments

Wednesday, June 11. 2014

Subcision; How does it work and who is a candidate?


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, stem cell fat 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 stem cells 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. O often used Subcision in conjunction with fillers such as Juvederm or fat and/or PRP (Plasma Rich protein).

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.


Dr. A. David Rahimi

Thursday, June 5. 2014

Category : Acne Scarring Treatments

Thursday, June 5. 2014

Does TCA Cross work? Who is a good candidate?

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 and PRP (Plasma Rich Protein) can results in improved appearance of deep icepick scars.

A. David Rahimi,MD,FAAD,FAACS

Tuesday, June 3. 2014

Category : Acne Scarring Treatments

Tuesday, June 3. 2014

Acne Scarring? CO2 laser and Radiofrequency combination works better-here is the study

We often combine our treatrments and perform Mixto CO2 laser and PRP (Plasma Rich Protein) and Subcision in combination with Radiofrequency (pelleve or Thermage) or Ultherapy (Ulthrasound). Here is a 2014 study that shows scientifically that this lead to better results:

CO2 laser with radiofrequency offers more effective acne scar treatment

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

  • May 22, 2014

CO2 laser plus radiofrequency was found to be more effective in the treatment of acne scars than traditional CO2 laser alone, according to researchers.

The treatment including radiofrequency also required fewer sessions and resulted in fewer side effects.

Ten patients (7 female, 3 male) with either clinical photoaging symptoms or acne scars were included in the study. Patients’ mean age was 39.2 years.

All patients were treated in a single session using both CO2 laser plus radiofrequency and CO2 laser alone. The investigators took digital photographs, dermatoscopy and in vivo reflective confocal microscopy before and immediately after treatment, and at 1 week and 3 months after treatment.

By 3-month follow-up, clinical improvement was seen in patients with boxcar and rolling acne scars, according to the researchers. In patients treated with CO2 laser plus radiofrequency, 50% categorized their results as excellent, 50% were categorized as good, and none were considered sufficient. In those treated with CO2 laser alone, results were classified as excellent in 30% of cases, good in 40% and sufficient in 30%.

Category : Acne Scarring Treatments

Tuesday, June 3. 2014

Accutane or Isotretinion is still the GOLD STANDARD for treatment of severe acne

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:

Continue reading "Accutane or Isotretinion is still the GOLD STANDARD for treatment of severe acne"

Saturday, May 31. 2014

Category : General Advice

Saturday, May 31. 2014

Can smoking cause wrinkles or even skin cancer? YES

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)

Continue reading "Can smoking cause wrinkles or even skin cancer? YES"

Friday, May 30. 2014

Category : Non Surgical Lifts

Friday, May 30. 2014

Quadrafecta? What is it and how does it relate to Cosmetic Surgery?

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


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

Fat Transfer- with Plasma Rich Protein and Stem cells

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


Forever Young, Inc.

Los Angeles CA: 6333 Wilshire Blvd suite 409 LA CA 90048

323 653 7700

Westlake Village CA:


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

Click to Replace

Category : Acne Scarring Treatments

Friday, May 30. 2014

Latest News on treating Acne scars with Lasers, PRP, Pelleve and more

More and more I understand that CO2 laser alone is often not enough to completely remove all acne scars. The addition of PRP (Plasma Rich Platelets) and skin tightening procedures such as Ultherapy and Pelleve can significantly improve the final results. I will include a recent video here (YouTube link). Please watch the video and also visit our FB site: How To Treat Acne Scarring? For more information.


Dr. David Rahimi

FB site:


and video link:


Tuesday, May 27. 2014

Category : General Advice

Tuesday, May 27. 2014

ALERT- Creams from Mexico may contain Mercury and lead to poisening

Dear Physicians,


Alert Message

This is a message from the LA County Department of Public Health. 

The California Department of Public Health issued a health alert on May 21; "Mercury Poisoning Linked to Use of Skin-Lightening or Acne Creams from Mexico".  The CDPH communication can be found below. The full text of the health alert is attached.

The California Department of Public Health (CDPH) Environmental Health Investigations Branch has issued a health alert due to multiple cases of mercury poisoning caused by certain skin-lightening or acne creams from Mexico. The CDPH Food and Drug Laboratory found these creams to contain very high levels of mercury-up to 210,000 parts per million (ppm), or 21 percent. In the United States, it is illegal to sell skin cream products that contain 1 ppm or more of mercury.

The products under investigation come in plastic containers that have either no label or a hand-made label. They were purchased on the street in California cities through informal networks of friends or brought into the United States from Mexico. The creams are non-commercial and are used for lightening the skin; fading freckles, blemishes, and age spots; and treating acne.

CDPH is asking medical providers to consider mercury poisoning when diagnosing patients with any of the signs and symptoms listed on page 1 of this health alert, which is available at http://www.ehib.org/pa pers/Health_Alert%20_Mercury_Poisonings_from_Mexican_creams_5_2014.pdf and attached here. The entire health alert includes summary information; signs and symptoms of inorganic mercury poisoning; examples of cases in California; sources and examples of products; information about mercury absorption and toxicity; information about home contamination; guidance for medical testing, medical treatment and follow-up, and disposal; additional background information; and links to further information.

A comprehensive list of resources, including multi-lingual fact sheets and public service announcements, is available at http://www.ehib.org/paper.jsp?paper_key=MSKC.

If you have any questions, please contact your local HAN Coordinator. You may also email the CAHAN Team at cahaninfo@cdph.ca.gov or call, toll-free, (877) 376-4767.

Thursday, May 22. 2014

Category : New Treatments

Thursday, May 22. 2014

Coolsculpting works-CBS News

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

it really works


Please call us for a free consultaion

Dr. David Rahimi

Friday, May 9. 2014

Category : General Advice

Friday, May 9. 2014

Skin Cancer is Real; Hugh Jackman has basal cell Cancer



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

Hugh Jackman, Instagram 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.

Hugh Jackman, Man Bags 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."

Monday, April 21. 2014

Category : New Treatments

Monday, April 21. 2014

Voluma by Allergan may make surgical cheek implants obsolete.

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.

What is JUVÉDERM VOLUMA™ XC injectable gel?

JUVÉDERM VOLUMA XC injectable gel is the first and only filler FDA-approved to instantly add volume to the cheek area. It gives you a subtle lift, helping to restore contour and a more youthful profile, for up to 2 years, in patients over the age of 21. It's different than JUVÉDERM® XC and works on a different area of the face. JUVÉDERM® XC smoothes out moderate to severe wrinkles and folds around the nose and mouth, like parentheses. JUVÉDERM VOLUMA XC, however, adds volume to the cheek area.

What else should you know about JUVÉDERM VOLUMA XC?

  • First and only Hyaluronic Acid (HA) filler FDA-approved to instantly add volume to the cheek area, resulting in a subtle lift
  • Clinically proven to last up to 2 years with optimal treatment
  • JUVÉDERM VOLUMA XC is from the makers of the #1 family of fillers
  • After 24 hours, you should be able to resume your normal activities
  • Side effects are moderate and generally last 2 to 4 weeks. Common side effects include temporary reactions at the treatment site such as tenderness, swelling, firmness, lumps/bumps, bruising, pain, redness, discoloration, and itching.

Hyaluronic Acid (HA) is a naturally occurring, hydrating substance found in your skin. As you age, you start to lose HA, which causes the skin to lose structure and volume.

Category : General Advice

Monday, April 21. 2014

You can not control where you lose your fat; here is the proof.

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?

By Steve Steinberg, upwave.com
updated 8:41 AM EDT, Thu April 17, 2014
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 <a href='http://www.health.com/health/lose-weight' target='_blank'>lose weight</a>. Beat the battle of the bulge with the following cozy eats. <!-- -->
</br><!-- -->
</br><a href='http://www.health.com/health/gallery/0,,20475957,00.html' target='_blank'>Health.com: Best superfoods for weight loss </a> 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.

Tuesday, March 25. 2014

Category : New Treatments

Tuesday, March 25. 2014

Forever Young, Inc. APP available soon

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.

Category : New Treatments

Tuesday, March 25. 2014

More exciting news on Stem Cells and cancer treatment

AAD Annual Meeting News 

Understanding of stem cell development helps produce skin cancer therapies

Anthony Eugene Oro, MD, PhD, discusses the effect of stem cell factors on cancers during his Marion B. Sulzberger Memorial Award and Lectureship address.

Anthony Eugene Oro, MD, PhD, discusses the effect of stem cell factors on cancers during his Marion B. Sulzberger Memorial Award and Lectureship address.

The ability of stem cells to develop in a variety of ways has led researchers to use them to inhibit cancers, but those same qualities can cause stem cells to mutate and lead to the development of cancers. Researchers, though, are overcoming that obstacle by learning more about the factors that influence stem cells so skin cancer therapies can be more effective.

“There are different kinds of hair around the body and different pigments, and the question is, ‘What determines that precise patterning?’ Cancers arise from inappropriate signaling from these key stem cell factors that pattern the body. We want to understand more about how these stem cell factors operate both normally and in cancer and use that understanding to develop novel therapies — both cell-based and small-molecule therapies,” said Anthony Eugene Oro, MD, PhD.

Dr. Oro, a professor of medicine at Stanford University Medical School, discussed these factors when he presented the Marion B. Sulzberger Memorial Award and Lectureship, “Heal Thyself: Using Stem Cell Biology for Skin Diseases,” on Sunday.

Two areas of focus for Dr. Oro and other researchers in the drive to develop cancer therapies have been the much-studied Hedgehog pathway and lesser known Polarity pathway, sometimes called an “escape pathway.”

“The mutations in the Hedgehog pathway are incredibly important for hair follicle formation in the skin — where hair follicles are and the number of hair follicles,” he said. “We spent a lot of time understanding how the body uses Hedgehog to stimulate hair follicle stem cells to grow. We also found that when you have too much of it, you get basal cell carcinoma.

“Over the past few years, we have done clinical trials with a number of companies to help put in place the first Hedgehog pathway inhibitor for advanced metastatic basal cell carcinomas as well as unfortunate patients with Gorlin’s syndrome.”

However, the molecule developed to inhibit basal cell carcinomas (BCCs) sometimes did not work because the stem cells changed.

“The cells evolve and generate resistance to the pathway. We are studying the resistance, how the tumors evolve over time, and how to develop new therapies as the cancer stem cells change,” Dr. Oro said.

A key finding in this quest was the discovery of the Polarity pathway, which helps BCCs escape the treatment.

“It is a great example of how the body uses different types of molecules on a stem cell to cause it to grow, but then in cases where it gets stressed, the body can change the stem cell and evade inhibition of a cancer. The Polarity pathway, and in particular protein kinase C (PKC) lambda, is the target for additional products we are developing to treat resistant BCCs,” Dr. Oro said, adding that his team is working to develop small peptides to block the pathway.

Another solution being studied is to remove the stem cells, purify them, and grow them for tissue regeneration. A promising complement to this research is a recent discovery that has been in the news in which mature tissue was changed to a stem cell-like state for possible tissue regeneration.

“If you don’t have the stem cells you need, you can use these stem cell pathways to make them, or if you can purify the cells you need, you can use those to return to tissue as well,” Dr. Oro said. “That is all in this concept of stem cell biology.”

For now, the focus of much cancer research is on the roles of the Hedgehog and Polarity pathways, he said. In particular, Hedgehog is linked to BCCs, medulloblastoma brain cancer, pancreatic cancer, and lung cancer.

“In the phase II clinical trials we showed that pathway inhibitors will work well in locally invasive and metastatic basal cell carcinomas,” he said. “More recently, other investigators at Stanford have used this as a surgical adjuvant for bigger, surgically difficult BCCs. The Hedgehog inhibitors may be most useful in normal practice as a surgical adjuvant for Mohs. If you have a big tumor on the face and you don’t want to have a major surgery, you can shrink the tumor quite effectively, and then have a smaller Mohs procedure. We are trying to find other drugs that can be equally or more effective for our patients.”

Wednesday, March 5. 2014

Category : General Advice

Wednesday, March 5. 2014

Interview with Dr. David Rahimi on Lush.com

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


Thank you