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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...

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.

The most obvious answer is that for patients considering a Tulip Lift, we offer a free Oxygen Facial or Microdermabrassion with consultation.  A less obvious pleasure quotient is that very often you will learn that there are treatments you never considered – and they may prove to be more in line with your own desires for “quick and easy” solutions.  We all wish there really was an “Easy” button – but what we are all asking for when we say quick and easy – is really a more elegant and well thought out plan – something that has been so finely honed it seems to be magic. 

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.

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.

Even younger patients can have some degree of hollowness under their eyes. This hollowness, if pronounced, may gives the appearence of "fatigue" and "Poor- Health". Sometimes it is present in conjuction with dark circles, fine lines, or unsightly growth.

Many patients believe that surgery is the only option in treating these conditions. That is simply not true.

I believe that a facelift should achieve several specific goals. It should remove excess skin, remove excess fat from the neck and jowl area, replace lost volume in the cheek and jawline, tighten the muscles of the neck and face, and refresh the skin.

Lets discuss each of these seperately...

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..."

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.