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The Critically Important Differences in Ptosis (Eyelid Muscle Function) and Excess Eyelid Skin
The Critically Important Differences in Ptosis (Eyelid Muscle Function) and Excess Eyelid Skin

A gentleman thinks he has excess tissue in the upper eyelid which is causing him to have asymmetry as well as a droopy and tired appearance. He wants to know if blepharoplasty is suitable for him.

Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon who has a background training in eye surgery followed by specialized training in plastic surgery of the eyes, assessed that this gentleman's upper eyelid looks a little bit lower than normal. He suspects that he has a condition called ptosis. Ptosis means drooping of the eyelid. To examine the eyelid, Dr. Prasad does a ptosis evaluation. He looks at the center of the pupil and how it relates to the upper eyelid called the marginal reflex distance. When it's above a certain level, there is no ptosis, but if it's below a certain level, there is ptosis. Ptosis is also graded: mild, moderate or severe.

Dr. Prasad noticed that the gentleman's creases are very high and there is a slight difference of skin between the two eyes. If that skin was removed, which is what is typically done in an eyelid blepharoplasty, Dr. Prasad thinks there would be no significant difference. He has seen many patients who had upper eyelid surgery where the plastic surgeon removed skin in the upper eyelids and yet the person still looked tired. A significant percentage of those cases were due to the fact that the patient actually had ptosis or drooping of the eyelid.

Before this gentleman moves forward with a procedure, Dr. Prasad thinks it's important that he get a proper diagnosis. In order to properly diagnose ptosis and come up with a treatment plan, there are some elements of the examination needed. It is important to assess the marginal reflex distance and then look at the activity of a muscle called levator muscle which is responsible for most of the function of elevating the eyelid.

Dr. Prasad explains that the next step would be to meet with an ophthalmologist or an oculofacial plastic surgeon to get an evaluation. A proper examination to diagnose the situation is critical or the patient may end up getting a cosmetic procedure that does not address the problem. He may need a combination of a levator muscle procedure, otherwise known as a ptosis correction, to help him improve that tired look. In addition, it's very important when evaluating ptosis that he look at his history such as old photos and determine if there is a change in his appearance.

For more information, visit our website:

http://prasadcosmeticsurgery.com/prasad-face-eyes/eyelifts/eyelid-ptosis-surgery/

How Under Eye Dark Circles and Hollows Can Now be Treated with a Combination of Fillers and PRP
How Under Eye Dark Circles and Hollows Can Now be Treated with a Combination of Fillers and PRP

A woman has hereditary dark circles even if she gets enough sleep and doesn't smoke or drink. She wants to know the treatment to remove dark circles.

Dr. Amiya Prasad, an oculofacial plastic surgeon, explains that genetic dark circles limit one's options on how to address them. It very common for a certain ethnic group and anyone with Mediterranean skin or darker to have dark circles under the eyes.

When Dr. Prasad looks at a patient with this concern, he breaks down the elements that contribute to the dark circles that can be addressed, and their contribution to the overall appearance of the eyes. In the lower eyelid, he looks at the pigmentation of the skin, the skin quality and the areas with relative hollowing. He pays particular attention to an area called the tear trough, where the edge of the eyelid meets the cheek area. He also looks at the under eye area for puffiness or under eye bags. Lastly, he looks at the area adjacent to the eyelid and cheek called the eyelid-to-cheek junction to look at the orbital rim or the bone under the eye as well as the cheek volume. There are many levels to approach and treat under eye dark circles.

As someone who has been in practice and performing oculofacial plastic surgery for over 20 years, Dr. Prasad can say that there were very few options years ago. Fortunately, these days there are more options. The hollowing component of the under eye circles means that it needs some type of volume enhancement. It is fortunate today to have a lot of fillers such as those in the hyaluronic acid family like Restylane. Restylane can be placed very strategically in the tear trough area. However, it is not done exactly the same between doctors. There's an art to filling that space to help soften the depth, darkness and shadow created by the relative hollow.

In addition, Dr. Prasad has been using a material that's derived from the patient's own blood called platelet-rich plasma. Platelet-rich plasma is using the components of their blood that are required for healing called platelets, and the plasma that is rich in growth factors that stimulate the quality of the skin. When there's a genetic dark circle under the eyes, platelet-rich plasma improves the circulation and triggers collagen production. In addition, he combines platelet-rich plasma with hyaluronic acid to have a synergistic benefit. Based in wound healing literature, the combination of platelet-rich plasma with hyaluronic acid enhances volume, blood supply and healing response. Although the response to these procedures varies from patient to patient, it has a long-term benefit which is superior to using a filler alone, and that's a very important distinction.

This type of work requires both the treatment and observation of the response and no two patients respond the same way. In this woman's situation, it is worthwhile to explore platelet-rich plasma, hyaluronic acid filler and the combination as a strategy to help improve the dark circles under her eyes. She should meet with qualified experienced cosmetic surgeons who perform these procedures and hopefully she will get a result that she is happy with.

For more information, visit our website:

http://prasadcosmeticsurgery.com/prasad-face-eyes/eyelifts/

Facelift Factors: Types of Facelifts, Surgeons' Style, Patient Expected Outcome, Others
Facelift Factors: Types of Facelifts, Surgeons' Style, Patient Expected Outcome, Others

A 47-year-old woman has jowls, mouth laxity and other issues related to gravity. She wants to know how to address these issues.

Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon and someone who specializes in facial aging, says that the challenge that he sees in his office everyday is making decisions on how to deal with the two factors that are related to the genetics of facial aging: One is volumetric loss or volume loss - the loss of bone, muscle, fat and soft tissue; the other factor is descent or sagging that requires a procedure that involves lifting.

A facelift is a procedure where the cheeks are elevated from the cheekbone down to the jawline in a predominant vertical direction. It's basically a combination of vertical and lateral or posterior directions, but a significant part of face lifting is to move sagging tissues upward. The necklift procedure deals with the banding of the skin of the neck that is sagging and tends to be more posteriorly oriented.

When Dr. Prasad does an isolated necklift for a patient, he first does a very thorough discussion. He lets the patient understand that the combination of jowls and sagging skin in the neck area is often contributed by both the descent of the face, as well as the sagging of the skin and loosening of the underlying soft tissue of the neck. That being said, a facelift procedure would involve some type of skin elevation as well as tightening of the underlying structure called the SMAS (superficial muscular aponeurotic system).

There are a number of types of facelifts that are being marketed, examples are: deep plane facelifts, extended SMAS facelifts, high SMAS facelifts, SMASectomy and composite facelifts. In addition, in the history of face lifting surgery in the cosmetic surgery field, there are many techniques. All these techniques are valid but they also depend on the individual surgeon.

When Dr. Prasad meets with his patients, he discusses what their desired outcome is and what it will take to get to that desired outcome. He does all those procedures mentioned. All those things in the hands of an experienced surgeon like him can be performed and customized. When someone is choosing a surgeon, what he always recommends is that they have to have very good communication and a clear understanding of their desired outcome.

Surgeons would often focus on what the surgery can do for patients, but in Dr. Prasad's practice he focuses on developing a comprehensive plan and identifying the areas of the face that can't be addressed by face lifting alone but rather by a combination approach. Sometimes he will combine things at the same time with the facelifts such as facial implants like cheek implants or chin implants. Sometimes he will combine fat grafting and other modalities to maximize what he can do surgically and what he can do that would overlap the surgery. They have to come up with a plan where sagging and volume loss can both be addressed to maximize the appearance. As someone enters the late 40s and 50s, there is going to be some maintenance that is going to be necessary that won't be necessarily surgical.

Dr. Prasad finds that a lot of people are not aware that these surgeries can be done under local anesthesia with LITE™ sedation. Dr. Prasad actually trademarked a name LITE™ anesthesia because in his practice, he developed a system to do all these procedures such as: eyelids, facelifts, liposuction, tummy tucks and breast augmentation all under local anesthesia with light sedation. He's not saying that general anesthesia is not appropriate, but he finds that in the spirit of quick recovery and better patient experience, he is doing full, extended face and neck lifts which are no different from anybody doing the same procedure under general anesthesia. A very important factor is that these are not shortcut procedures.

At this point, she's going to have meetings with some qualified experienced cosmetics surgeons and she should make sure that she feels that she is in sync with her doctor. Both of them should communicate well and she is comfortable with the type of procedure that is being recommended.

For more information, visit out website:

http://prasadcosmeticsurgery.com/prasad-face-eyes/facelifts/

The Stressors that can Cause Hair Loss in Women and the Importance of Diagnosis
The Stressors that can Cause Hair Loss in Women and the Importance of Diagnosis

A 35-year-old female has been losing her hair slowly for the past 6 years. She wants to know if a hair transplant would help her hair stay or will it just continue to fall out after the transplantation.

Dr. Amiya Prasad, a hair specialist, explains that when a woman loses hair, it is important to get a proper medical workup which includes hormonal and iron levels. Women are very sensitive to a lot of stressors that manifests in diffuse hair loss like telogen effluvium AKA shock loss. In addition, 30% of women under the age of 50 have some kind of hair loss which can be androgenetic alopecia and female pattern hair loss. It is also advisable to be evaluated for something called a scarring alopecia. These are also things which someone first does before they even consider transplantation.

Dr. Prasad is in a unique position where he has had patients who come to him from all over the world for a procedure he developed called Hair Regeneration. Hair Regeneration is a treatment where he combines platelet-rich plasma with a material called extracellular matrix. By doing this injection and this method of delivery, he has been able to help patients with male pattern hair loss, female pattern hair loss and even rare conditions such as alopecia areata and lupus related hair loss. When a patient comes to him with a history of unusual hair loss, it is first critical that before he does any type of treatment, the patient first gets a proper diagnosis.

Before moving for any type of medical or surgical procedure, Dr. Prasad advises that the patient sees their own physician and get the workup necessary to be sure what type of hair loss situation they have. A lot of times, people come to him after they already eliminated hormonal and autoimmune issues. They may even get a biopsy or see a dermatologist and learn that what they have is more of a female pattern hair loss or may even be a variant of an alopecia spectrum. A proper diagnosis is absolutely critical.

As advanced and remarkable Hair Regeneration is, there are still going to be limits. One of the limits happens to be scarring alopecia and if the hormonal situation is not under good control. It becomes very difficult if these are not diagnosed because again, women are very sensitive to a lot of different stressors in the body and it is often manifested as hair loss.

The lady should meet with doctors who would first evaluate her medical status, and also see a dermatologist to evaluate the scalp, the skin quality and what may be going on. She may even need to undergo biopsies. A proper diagnosis is important before she pursues any kind of non-surgical or surgical modalities.



For more information, visit our website:

http://prasadcosmeticsurgery.com/prasad-hair-restoration/

Why the 40s is LikelyToo Early for an Extensive Facelift and Addressing Facial Volume Loss
Why the 40s is LikelyToo Early for an Extensive Facelift and Addressing Facial Volume Loss

A 44-year-old woman has a slim body and her cheeks slope. She wants to know if a facelift is a right thing for her.

Dr. Amiya Prasad, an oculofacial cosmetic surgeon, wrote a book called "The Fine Art of Looking Younger" where he explained that facial aging is a combination of volume loss and sagging. Volume loss is in the bone, muscle, fat and soft tissue , while sagging has to do with the support of the skin itself and the underlying tissue of the skin called the SMAS (superficial muscular aponeurotic system).

The unfortunate reality is that when somebody is in their 40s, their facial volume diminishes. The roundness of the face becomes more angular. Ironically, when they exercise they don't necessarily lose the fat in the areas they want to lose typically in the mid section but rather, they keep losing a lot more in the face. In Dr. Prasad's practice, he also performs body contouring and his typical patient is someone who works out very well and their diet is perfect, but they have problem areas along the hips, the flanks and the bra roll area. So he basically contours those areas because losing even more weight would actually make them look older because they lose so much facial volume.

This woman's situation is a combination of a little bit of laxity as well as some facial volume loss. To self-evaluate, what some of Dr. Prasad's patients do is called the mirror lift where they gently lift up the skin. If she likes the way the jawline looks and where the cheeks are going, then she is probably a candidate for a limited facelift where she would get an improvement of the jawline but she doesn't necessarily have to have the high incision in the temple or the incision behind the ear that is typical of an advanced neck lifting procedure.

At the same time, volume loss cannot be ignored. Depending on what her desired look is, some people like more angularity and they are fine with it. If she feels like she needs more volume in her cheeks then she may be a candidate for a filler like Sculptra or other fillers that can provide some volume in the cheeks.

Physical examination is necessary. A lot of times when people are in their mid 40s come to Dr. Prasad, he notices that their skin is too tight so they are not usually a good candidate for a facelift. Areas that look like a jowl is because of the mandibular notch or the space right in the edge of the jaw dips inward. He can strategically address that by placement of fillers such as Radiesse and then adding volume in the cheeks with something called Sculptra. She can hold off the face lifting procedure for the future.

Dr. Prasad suggests that she meet with some doctors, learn about her options and really crystallize in her mind what her desired outcome is. If it's a combination of those things then maybe she needs to do both. Meeting with doctors and having physical examination is really critical for her to be able to make an informed decision.


For more information, visit out website:

http://prasadcosmeticsurgery.com/prasad-face-eyes/facelifts/

How Factors like Sinuses and Allergies are Considered in the Options of Eye Bag Surgery
How Factors like Sinuses and Allergies are Considered in the Options of Eye Bag Surgery

A 38-year-old woman always had dark circles under her eyes. However, she noticed that it worsened and that bags are forming. She wants advice on how to stop the bags from growing.

Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon, performs a lot of eyelid surgery and has a lot of experience with this type of situation. He has also been in practice for 20 years. Lower eyelid puffiness that is always present is something called lower eyelid fat prolapse. Lower eyelid fat prolapse is the fat pockets that are naturally around the eyes that push forward. It is often a genetic issue and it naturally happens. Often it is not something that is related to sinus, allergies and other things. However, the eye, the nose area, the sinuses and the orbit (the space around the eyes) all converge to a common area called the cavernous sinus where fluid drains. When there is sinus congestion and allergies, fluid tends to back-up into the soft tissue around the space around the eyes. In addition, ongoing progression of the fatty pockets will be related to some degree of the relapsing of fluid. Nonetheless, the basic anatomic issue is still the same which are fat pockets that are pushing forward causing the puffiness.

The typical solution that Dr. Prasad offers his patients is to first maximize all medical therapy to optimize the surgical procedure that he intends to do. Surgery naturally causes swelling and when people have issues with swelling prior to surgery, it has a significant role in how fast the swelling clears after the surgery. With that being said, the patient should go to the ophthalmologist to manage any eye allergies issue and staying in touch with their ear, nose, and throat doctor. They could also go to their allergen doctor to treat allergies and sinus to make sure everything is stable.

There are also options on how to address the lower eyelid fat prolapse which are surgical options: One is called a transconjunctival blepharoplasty which is a procedure where the fat pockets are addressed from the inside of the eyelids; the other procedure is called a transcutaneous blepharoplasty where the incision is made underneath the eyelashes from an external approach. From Dr. Prasad's experience, when people have issues with swelling, his goal is to minimize the trauma and respect the natural anatomy of the lower eyelid to optimize the circulation. The external approach tends to be more disruptive to the drainage system whether it's the venous system or the lymphatic system, which leads to a more long-term swelling after surgery. So in his practice, he would likely perform a transconjunctival lower eyelid blepharoplasty. In so many ways, this is such an elegant approach going from behind the eyelid, not disrupting any of the support structure of the lower eyelid and strategically reducing and repositioning the fat appropriately.

In addition, there are other options to help with the skin quality and any other changes that have occurred in the skin but doing that all in the context of the existing issue with swelling. Sometimes, this has to be a step-wise approach - Dr. Prasad would even consider doing an anti-inflammatory management prior surgery, during surgery and even after surgery to try to minimize the swelling afterwards.

Before strategically addressing lower eyelid fat prolapse, it requires a proper physical examination. Dr. Prasad suggests that she meet with qualified experience cosmetic surgeons who have extensive experience with lower eyelid surgery and discuss the plan and options on how to deal with issues that could come up afterwards. She has already done a lot of the baseline work to manage the sinus and allergies. These tend to be chronic conditions so it's not like she can resolve the entire sinus and allergy completely. She should meet with doctors with this level of experience and expertise tomake a decision to proceed in a way that she feels comfortable.


For more information, visit our website:

http://prasadcosmeticsurgery.com/prasad-face-eyes/eyelifts/

Clarifying the Different Facelift Terms and Techniques Using Illustration
Clarifying the Different Facelift Terms and Techniques Using Illustration

A woman had SMAS facelift at age 48. However, 17 years later, her skin became loose. She wants to know what procedure is best for her.

Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon also boarded in facial cosmetic surgery, performs face and neck lifts routinely in his practice. For 20 years, he has watched how the terminology has confused a lot of people and with the introduction of facial volume enhancement, it's given people even more cause of confusion as to what to do and when to do it.

A few years ago Dr. Prasad wrote a book called "The Fine Art of Looking Younger" where he explained that facial aging is composed of two things: volume loss which means loss of bone, muscle, fat and soft tissue; and there is sagging and loosening of the support structure under the skin as well as changes skin elasticity. He also talked about the difference between non-surgical physicians and surgeons, injectables versus lifting, plus these new heating devices.

When someone has a lot of extra skin in the jawline and neck and they have platysmal bands, then restoration of the structure is a better approach to address the facial changes, especially when that is a primary concern. From Dr. Prasad's perspective, adding volume to tissue that is loose has to be done in a conservative and limited way because too much volume results in this amorphous look referred to as a "pillow face".

There is some consistency between surgeons when it comes to the terminology. When Dr. Prasad talks about a facelift, he talks about the cheeks and the jawline with a limited amount of neck lifting. There can be some extra skin that gets moved up. A short scar facelift which is more of a limited jawline procedure. In the face and necklift, he makes the incision behind the ear to address the neck area because lifting vertically alone or just moving the face upward won't be enough, so he combines a face and neck lift plus an isolated neck lift.

Within these procedures, there are a lot of new terminologies such as high SMAS lift (superficial muscular aponeurotic system) and deep plane facelift. Reality is, the terminology is immaterial because no two surgeons do these procedures the same way. Every surgeon has their own style and their own way of doing this, and there are many ways to perform these procedures. It is not a monopoly of one or two doctors who only do one way and everybody thinks that's the best way. As surgeons and as artists, it's very important to customize and to understand how the individual's body, tissue, skin and underlying structure can be best approached to achieve the most successful result. It is important to have communication and a physical examination by your surgeon.

There have been a lot of popular short scar, mini-lifting procedures where physicians who have limited experience doing full face and neck lifts basically do a limited procedure. These procedures have been called revolutionary new approaches but really, they are all procedures which all who do facelift procedures know how to do. It's really about doing the right thing that works for the patient.

When Dr. Prasad does face and neck lifting surgery, he can make the incision as high as in the temples, behind the ear, or posterior going into the hairline in order to get as much lift as necessary. He'll also do deep plane, SMAS flap and do a platysmaplasty where he ties the muscle under the chin to create a nice angle and lift the platysma to the outer aspect. These are easier to explain when the patient is actually in front of the doctor and the doctor is able to show these specific areas. With that that being said, meeting with qualified experienced doctors who do a lot face and neck lifting surgery should help guide the patient as to which procedures are right for them, regardless of the name.

As far as fillers are concerned, this is a decision that the patient makes after the procedure is done. Surgery does not replace fillers. Volume loss can be addressed in many ways, for example in the central part of the face or the mid-face, Dr. Prasad would either do a sub-malar facial implant, or after the surgery is done, place fillers like Radiesse depending on what the patient is comfortable with and how they want to look. Again, a consultation or several consultations would probably help the patient become more educated as to what is available to us these days and help them make an informed decision.


For more information, visit us in our website:

http://prasadcosmeticsurgery.com/prasad-face-eyes/facelifts/

Why Thermal Device Treatment Can't Definitively Treat Hooded or Puffy Eyelids
Why Thermal Device Treatment Can't Definitively Treat Hooded or Puffy Eyelids

A woman wants to know the best treatment for her upper and lower eyelids. She is confused between Thermage and surgery.

Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon, explains that for many years, people have tried many different ways to avoid surgery through all kinds of heating devices. There is a tremendous amount of heating devices that improve upper eyelid hooding by trying to heat up the skin at the forehead to raise the eyebrows. One example of a heating device is Thermage. However, he has seen a lot of patients who try all of these heating devices and they have been disappointed.

People have always been excited about some type of new non-surgical device that's supposed to make surgery obsolete. And yet, hundreds of cosmetic surgeons still perform surgery everyday because there's a limit as to what these devices can do. Dr. Prasad happens to have a radio frequency device and certainly there is a benefit to it, but in a limited way for very specific things. When he uses his radio frequency device, it's to treat very fine lines, but with the application of high levels of heat to try to cause skin to contract often has a very paradoxical effect. It is his observation that these high levels of heat which many patients find intolerable and painful does not have any long-term effect. Since heating involves a series of treatments, many abandon their treatment. Many like the results of heating because the swelling makes the area look fuller. However, the swelling goes away and the skin goes back to normal, and in many cases the skin gets thinner.

In Dr. Prasad's practice, he has been very busy helping people who have gotten thermal energy treatment by trying to help rehabilitate their skin by using technology such as platelet-rich plasma Platelet-rich plasma rebuilds some of the collagen and blood supply that's been lost. People should understand that there is a critical amount of heat to tighten the skin in order to get a long-term benefit. Unfortunately, heating devices are sold so aggressively that patients end up being seduced. The results of these devices are nothing compared to more definitive procedures.

For your upper eyelids, Dr. Prasad would most likely recommend an upper eyelid blepharoplasty. In his practice, he does these procedures under local anesthesia with LITE™ IV sedation and it is extremely safe. It is not likely that someone will find an alternative that would do it any better than an actual definitive surgical procedure. By having his own facility within his practice, Dr. Prasad has made the whole surgical experience a lot easier for patients. It's not like going to a hospital with general anesthesia which can be a very intimidating situation. There are also risks to general anesthesia.

Dr. Prasad observed that this woman's lower eyelids are a little bit low. Based on a physical examination, if there's puffiness or bags under the eyes, he would address that surgically. If there are fine lines and wrinkles, there are options such as fractional CO2 laser. Heating is part of the story but the regeneration is what he actively pursues to try to build the quality of the skin. He combines fractional CO2 laser with platelet-rich plasma routinely to get this synergy because he wants to distinguish quality of skin versus quantity of skin. He has seen patients from all over the world who have skin removed in attempt to tighten wrinkles and invariably, the lower eyelids get pulled down and they develop lower eyelid retraction. In his practice, he is focused more on the qualitative improvement of the skin through the use of platelet-rich plasma which helps stimulate the blood supply and the production of collagen. It has a remarkable benefit to improving skin quality and it may require more than one treatment.

Dr. Prasad suggests that she meet with a surgeon who can give her a more definitive evaluation, and who can help her understand what her desired outcome is. Once she's defined that, then it would be clear that heating devices are not likely to deliver the results she wants.


For more information, visit our website:

http://prasadcosmeticsurgery.com/prasad-face-eyes/eyelifts/

Why Combining Fillers with Platelet-Rich Plasma for Hollow Eyes Improves and Lengthens the Effects
Why Combining Fillers with Platelet-Rich Plasma for Hollow Eyes Improves and Lengthens the Effects

A 27-year-old female is thinking about getting fillers to reduce the bags under her eyes. She is concerned about the long-term effects of fillers.

Dr. Amiya Prasad is a cosmetic oculofacial plastic surgeon practicing for 20 years, specializing in facial aging, particularly in complex procedures with the eyes. He explains that the puffiness under this woman's eyes is something called lower eyelid fat prolapse, which fat that is around the eyes that pushed forward. At the same time, there is some genetic or anatomic hollowing adjacent to the puffiness. This area often is referred to as the tear trough area, and the lowest part is called the V-deformity of the orbit.

This woman is more concerned about hollowness therefore she's thinking about a filler. The downside about fillers is that most patients are afraid that they will have to be committed to doing fillers forever. They are also concerned that they'd end up in a worse condition by virtue of just doing the fillers alone.

The fillers that are typically used are something from the hyaluronic acid family (HA fillers) like Restylane. The fat in the area, the level of volume loss and the viscosity of the material are all factors in how fillers is placed in the area. No two doctors do it the same way and certainly there are possibilities of issues such as bruising and swelling. There are even patients who come to Dr. Prasad who needed the material dissolved because the filler was too much compared to the adjacent area. In the long-term, it's not likely that someone is going to lose anything by doing a filler. The filler will be metabolized and the body will get rid of it. The anatomy will remain basically the same as if one never had the filler.

There are also other options such as platelet-rich plasma (PRP). Dr. Prasad will draw the patient's blood, spin it down and concentrate the part of the blood that has the platelets which are rich in growth factors and things that help improve skin quality. He combines the hyaluronic acid with platelet-rich plasma to get a more synergistic benefit so that there is an overall improvement of the skin and he have been very successful with that.

Finding the right doctor who the patient feels comfortable and confident with should be this woman's next step. Meeting with a doctor who can examine her will allow her to have a more rational approach to what she can have done and what the long-term plan is. When people come to Dr. Prasad, a large percentage of his patients stay with him because he performs a surgical procedure and also becomes their primary beauty doctor. It is important that she has a plan and that she understands that she needs to come 2-4 times a year. She should see how that fits into her budget and schedule and how she addresses the issues that concern her.

For more information, visit our website:

http://prasadcosmeticsurgery.com/prasad-face-eyes/eyelifts/

How Thickening Hair Non-Surgically Can Reduce or Replace a Hair Transplant
How Thickening Hair Non-Surgically Can Reduce or Replace a Hair Transplant

A 37-year-old male is approximately stage 3 to 4 on the Norwood scale. He was told he would require 2000 to 2500 grafts. He was also told that robotic and Neograph methods would not work due to the type of hair he has and that strip method is his only option. However, he wears his hair low and would prefer not to bear the resulting scars from this type of procedure.

Dr. Amiya Prasad, a hair restoration specialist, explains that a hair transplant improves the overall framing of the face by transplanting hair from a narrow area behind the scalp that are genetically resistant hairs, described as the permanent zone, to the front of the scalp. There are two different techniques: the follicular unit extraction method (FUE) that includes the robotic method, the hand-held vacuum method, and manually making little punches to take out the individual hairs; the other method is follicular unit transplantation or FUT, also called the strip method. FUT has been the traditional method for many years where a thin strip of skin is removed with hairs and individual hairs are cut.

At 37-years-old, this man has advanced hair loss and it's clear that the bridge, or the middle, of his scalp is thinning. One can assume reasonably that within a few years, that area is going to be too thin or probably gone and he would need additional transplantation. So Dr. Prasad advises an alternative method that he would offer with a similar issue to this man.

Dr. Prasad has developed a method called Hair Regeneration based on a wound healing mechanism. Hair Regeneration is extracellular matrix combined with platelet-rich plasma derived from the patient's own blood. This is an injection and not a transplant. By doing this, he has been able to reverse the hair thinning process, thicken up the existing hairs, and literally wake-up a lot of the dormant hairs which are the hairs on the skin that was relatively smooth and have remarkable growth. This is something different from traditional methods of medical treatments which include finasteride and minoxidil. Hair Regeneration uses the body's natural stem cells that we believe is based on clinical response that is restoring and protecting the hairs from being thinned.

Dr. Prasad is always ready to repeat the treatment on anyone, but he has 3-5 years of data showing that people didn't need additional treatment. This would be his choice given the limitations - a transplant is a single procedure, but it doesn't stop the ongoing progression of thinning. With an FUE, people are getting hairs outside of the zone of permanence, so the transplanted hair will eventually thin. These hairs are being moved but they're not going to grow after a certain period because they will naturally thin. This is an unfortunate reality for a lot of FUEs, especially in African-Americans where the curliness of the hair is great for coverage, but the density of hair in the donor area is usually significantly less than Caucasians or Asians, so the surgeon has to go wider to get more grafts. In a strip method, there can be some stretch on the skin, so when someone wears their hair so thin, that scar can be seen.

Dr. Prasad's strategy for him is to do Hair Regeneration first to save the hairs, thicken what he has got, and then maybe if he wants some more, do a limited transplant approximately a year to 18 months later to help him get what he wants, but with as little surgery as possible. With, someone like him, Dr. Prasad would talk him out surgery altogether because he wants to invest his resources and get the results in a very intelligent way. Dr. Prasad would recommend Hair Regeneration and to look for a provider in an area that's convenient for him.

For more information, visit our website:

http://prasadcosmeticsurgery.com/prasad-hair-restoration/about-a-cell-technology/

Why Hair Transplants are Ineffective in Female Pattern Hair Loss, & How Hair Thickening Works
Why Hair Transplants are Ineffective in Female Pattern Hair Loss, & How Hair Thickening Works

A 35-year-old female was diagnosed with thyroid disease 3 years ago post partum. Her disease is now regulated but her hair has not recovered, even though it has been over a year. She wants to know if she is a candidate for a hair transplant.

Dr. Amiya Prasad, a specialist in hair restoration, says that the photos this woman submitted are what many women notice if they have hair loss - the widening of the part. Unfortunately, there are limited options when it comes to female hair loss and these options have to be properly evaluated before a person makes a fully informed decision. He advises not do the transplant at this time. In male pattern hair loss, there is the recession of the temples, expanding crown, a bald spot area and eventually the areas meeting in the middle and progressing. With women, that hair loss pattern tends to be more diffuse. Hormonal issues also play a big role in hair loss for women. Lastly, genetics can also be major factor for female pattern hair loss.

In Dr. Prasad's practice, one of the things that he found particularly frustrating in transplanting in women is there's very small space between the hairs. In contrast to male pattern hair loss, an area can be smooth and bald and when he places the grafts, he's going through skin that doesn't have existing hair. Even if he places grafts between existing hairs, there is often very large gaps so he's not shocking the existing hair. He routinely uses a microscope in his examinations with hair. When he looks at women's hair that is thinning, the space between the hairs is often very limited. So even if he places a hair in between, she may lose one or two existing hairs from stress, also known as shock loss (telogen effluvium). Sometimes, even if the stress is over, they may not get back all the hair that you lost.

Dr. Prasad has been developing a method of treatment for female pattern hair loss called Hair Regeneration. This is a treatment using platelet-rich plasma combined with a wound healing material called extracellular matrix (ECM) by ACell. When ECM was used for hair transplant procedures to heal donor scars, it was noted that thin hairs became thicker. This is based on a wound healing mechanism that restores native stem cell activity that restores hair growth so it becomes thicker. In addition, it turns out that the thinned hairs that regenerate into thickened hair also comes back darker.

Dr. Prasad treats male and female pattern hair loss, as well as conditions such as alopecia areata with Hair Regeneration treatment. He does the Hair Regeneration treatment to 99% of his female patients rather than a hair transplantation, with the exception being a loss in the frontal hairline. If there is a loss of frontal hairline, then a hair transplantation makes a lot of sense. But if there is diffuse thinning, he would first do an evaluation, examination, review of hormonal status and a proper medical work-up to eliminate all other factors. In some cases, he would even do a biopsy in order to ensure that there is no scarring issue going on concurrently. A lot of patients that come to him have already done that groundwork by going to doctors locally or to major universities to make sure there are no underlying issues causing their hair loss.


For more information, visit our website:

http://prasadcosmeticsurgery.com/prasad-hair-restoration/

The Factors that Can Cause Temporary Lower Eyelid Retraction, & Repair Options from an Oculoplastic
The Factors that Can Cause Temporary Lower Eyelid Retraction, & Repair Options from an Oculoplastic

A woman is only one week post operation but one of her eyes is drooping more than the other. One eyelid is also hanging lower than the other. She wants to know if this lower lid retraction would get better.

Dr. Amiya Prasad, an oculofacial cosmetic surgeon, assumes that an external approach to the lower eyelid was done, meaning an was made incision underneath the eyelashes in a procedure called transcutaneous blepharoplasty. Part of her surgery involved removal of some skin. Once that is done, there is some loss of muscle tone in the orbicularis oculi muscle. This muscle is like a hammock and it supports the lower eyelid. Initially after this type of surgery, the muscle can have some swelling and the nerves that go to that muscle can also be affected. These different effects to the muscle can contribute to lower eyelid retraction.

It's hard for Dr. Prasad to make a full assessment as to what her situation will be once the swelling, fluid, bruising and the muscle heals because he doesn't have any information about her pre-operative appearance, as well as the details of her pre-operative consultation.

Patients come to Dr. Prasad from all over the world that have lower eyelid retraction, but come after considerable time after their initial surgery was done. Usually, the surface of the eye of somebody who has significant lower eyelid retraction is affected, and they will compromise their eye health despite the use of lubrication and other things. It is very important that if someone has any issues with tearing and foreign body sensations that they properly lubricate their eyes with artificial tear drops and lubricating ointments. These will help protect the eyes and allow healing.

If someone has significant lower eyelid retraction that they did not want as part of their surgery, they have to understand that a lot of people such as surgeons expect that eyes have a certain rounding appearance. Dr. Prasad practices in the Upper East Side of Manhattan and in Garden City, Long Island, and there is a frequency of patients and surgeons who would like that rounded look. He doesn't cast any judgment about that particular appearance if the patient and the doctor like it. His personal aesthetic is more about the lower eyelid in a position that is more in the limbus, or the point where the iris and the sclera, the white part of the eye, meet. He likes a more almond shape to the eyes as that's his personal aesthetic.

One principle from an ophthalmic perspective is that eyelids that look good function well. So, if the lower eyelids are in a good position, they will protect the eye well in the long-term. There will be better distribution of the tear film and there will be proper drainage of the tears into the tear duct. When the lower eyelids are down and displaced laterally, the tears tend to pool at the outer aspect rather than going towards the inner aspect.

In Dr. Prasad's practice, he deals with lower eyelid retraction by restoring and reconstructing the anatomy to improve it functionally as well as cosmetically. At this point it is important that she continue communicating with her doctor. This is most likely something that needs to be observed, and her surgeon may suggest to do some massaging to try to push the lower eyelid up. If she needs any ophthalmic care then she may have an ophthalmologist work with her to take care of any external eye irritation issues. In the short-term, it is important to just wait this out until things settle out and heal.

For more information, visit our website:

http://prasadcosmeticsurgery.com/prasad-face-eyes/eyelifts/lower-eyelift/

The Pre-Operative Factors that Can Affect Facelift Results, & the Importance of a Good Surgeon
The Pre-Operative Factors that Can Affect Facelift Results, & the Importance of a Good Surgeon

A woman is at 11 months after her SMAS facelift. She had terrible sagging under her neck after surgery. She also has marionette creases getting deeper as well as jowling. She wants to know if this is normal.

Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon, says it is possible that patients can have jowls, marionette lines as well as sagging neck skin after a facelift and this primarily depends on their genetics. Without the benefit of a physical examination and the full details of the actual procedure performed, it is difficult to assess if this is outside the norm.

The terminologies of a mid-face suspension and a superficial muscular aponeurotic system or SMAS lift can mean different things to different surgeons when they are implemented. Clearly, Dr. Prasad would suspect that when she chose her doctor, she has had done her research and she felt comfortable with her doctor's ability to perform this procedure. It is understandable if she is not seeing the results and that's why she's concerned.

Within the spectrum of facial cosmetic surgery, Dr. Prasad says from his 20 years of experience of doing these procedures that certain factors have an impact beyond the immediate post-operative period. So if she noticed immediately after surgery that her face and jawline looked very good, sometimes it's not just about the amount of lift but also the degree of swelling that has a factor in all of this process. Sometimes, people look a lot better while there's a little bit of swelling in the mid-facial area while they're healing.

If the jawline looked good then it descended, then Dr. Prasad can probably conclude that there's a certain degree of regression. That regression can be from skin elasticity or tissue elasticity that's deeper, or it can be from a variety of factors. He always explain to his patients that even though he can do a meticulous procedure and do some really good tightening, the human body can still change. If someone has a lot of volume and sagging under their chin then this degree of residual sagging may be expected. If someone didn't have as much, then it would be unusual.

Dr. Prasad thinks it is important that she maintain communication with her doctor and discuss these concerns. Most ethical cosmetic surgeons will be willing to do any enhancements that are indicated in whichever terms they agreed upon before surgery. Unfortunately, there are doctors who will tell people that they look fine even if though they don't look or feel fine. It is the patient's call to decide whether or not they're going to seek additional opinions. From Dr. Prasad's perspective, it is often best that she see the original doctor; they must be good and caring and technically skilled. They know the patient's anatomy and they're most likely comfortable with doing any revision surgery. If the patient is not satisfied for any reason, then they should get additional opinions.


For more information, visit our website:

http://prasadcosmeticsurgery.com/prasad-face-eyes/facelifts/

How Regenerative Medicine is Changing the Way Wrinkles and Skin Quality are Improved
How Regenerative Medicine is Changing the Way Wrinkles and Skin Quality are Improved

A woman had her eyes done 13 years ago. When she smiles, there are wrinkles she thinks are awful which Botox can't fix. She wants to know other ways to get rid of the eye wrinkles.

Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon performing surgery for over 20 years, says that one of the most challenging issues that he deals with is skin quality under the eyes. Eyelid skin is the thinnest skin in the body. It's half a millimeter in thickness and as people get older and with many environmental challenges, the skin quality becomes diminished.

Prior to the 90s, there were chemical peels. During the 90s, the solution was some type of thermal energy treatment. First it was the CO2 laser then it became the erbium laser. Then different types of lasers developed over the past several years until the advent of fractional lasers. The bottom line was that there was the use of heat resulting in collagen generation. Most recently, radio frequency has been the rage.

As people age, skin diminishes at many different levels. In Dr. Prasad's practice, he has been frustrated of not being able to heat the skin enough to get the quality he wants. Unfortunately, overheating the skin not only results in potential scarring but it has been Dr. Prasad's observation that many people who have had laser treatments have their skin become thinner. Because of this, he does not offer the typical laser solution for under eye wrinkles.

In Dr. Prasad's practice, he has been using a material called platelet-rich plasma. Platelet-rich plasma is from the patient's own blood where the growth factors that are critical for healing are isolated. It is done in his office by a simple blood draw and he spins down the blood and injects this platelet-rich plasma in the patient's skin. He has observed that the quality of the skin improves.

As long as someone is smiling or moving, they're going to have wrinkles under their eyes. Improving the skin quality with platelet-rich plasma stimulates new blood vessels, new collagen as well as improves the skin quality at a multiple levels. It activates their stem cells that are distinctively different from the effect of thermal energy. It has become Dr. Prasad's routine to actually do platelet-rich plasma for his patients prior to doing any thermal energy when it's appropriate.

Looking at the photo this woman submitted, Dr. Prasad can assess that her skin looks very thin. So, in the combination approach of a neurotoxin like Botox and the use of thermal energy like fractional CO2, Dr. Prasad would probably do a platelet-rich plasma and allow a gap of 3-4 months between treatments to see how much the skin quality can improve. That would be his approach as part of the overall game plan.

Youth and smoothness don't necessarily go together. Improvement of the quality of the skin and getting glow is very unique with platelet-rich plasma that Dr. Prasad has been able to achieve with his patients. As people do their research, they would have probably come across with a solution but they can at least learn to categorize what those solutions are. Too many people are chasing the latest most hyped laser. It is Dr. Prasad's opinion that too much heat is being generated these days in the pursuit of smoothing out skin. One must know that there are some alternatives that can hopefully guide them in making a decision that would helpful in the long run.

For more information, visit our website:

http://prasadcosmeticsurgery.com/prasad-face-eyes/eyelifts/

Why Stopping Further Hair Loss in Young People is Advised Before Limited Hair Transplants
Why Stopping Further Hair Loss in Young People is Advised Before Limited Hair Transplants

A 31-year-old male has been using Rogaine foam for 5 years. He wants his hair line fully restored and the tip of his scalp not to be visible. He wants to know the kind of hair harvesting approach would be appropriate.

Dr. Amiya Prasad, a hair restoration specialist, has observed that this man has a relatively advanced stage of hair loss. Hair transplantation is getting hairs from a relatively limited donor area - it's a narrow band where the hairs can be transplanted from. In fact, there's a very disturbing trend with a popular procedure called follicular unit extractions or FUEs where hairs are being extracted outside of the well-established donor area that is known to be permanent. This trend has become popular because people are concerned about the undesirable scars related to strip surgery. Ironically, it's called strip surgery even though prior to the strip, the grafts are larger than follicular unit extractions. If a person wants to wear their hair so short, it makes a challenge because whether a strip method or an FUE method, it is likely their scar will be visible.

Dr. Prasad has been in a leadership position with a procedure called Hair Regeneration. This is combining a material called platelet-rich plasma with another material called extracellular matrix originally intended for wound healing.

Hair Regeneration has been Dr. Prasad's solution for reversing the thinning hair. He does a microscopic examination to identify that although an area may look smooth or without hair, there are a lot of miniaturized hairs. Hair just doesn't disappear - it goes through a process called miniaturization. Dr. Prasad has developed a way of doing this injection treatment which he does only once. He has 3-5 years of data to support the long-term benefit of the injection. He has created a wound healing mechanism that restores this stem cell activity necessary for hair growth. What he ends up doing for most of his patients these days, especially in the same age range as this man, is he recommends first doing the Hair Regeneration treatment to restore as much as the thinning hair and to reduce or halt the progression of the hair loss. If he wants to improve the areas that are too far gone from the advancement of the hair loss process, then he can do conservative strategic transplant. This is a different approach from the traditional model for transplantation.

Even if a person decides to do follicular extractions once, if they do it again, the scars from the procedure are going to start to coalescence and they'll have a lot more. Dr. Prasad has patients that come from all over the world who are exactly in that situation. Some patients would be taking a drug called finasteride. Unfortunately, in recent years, a lot of younger males will not take finasteride because of its sexual side-effects. In addition, a lot of younger males who are losing hair tend to not respond as well as men who are in their 40s who have a crown thinning pattern.

Someone like this man would have been committed having to go back every few years until he has run out of donor area to transplant the hairs. And a lot of people, particularly those who wear their hair short, eventually shave their hair and now they now have to deal with the marks left from transplantation. Dr. Prasad would advise that he does his research before he moves forward with the transplantation and learn about Hair Regeneration. Unfortunately, hair transplants are sold very aggressively and a lot of people realize what kind of commitment it is until it is too late. So the best option for him is to learn more and meet with doctors to learn about his options, what the future will be if he were to move forward with the transplantation, and be strategic with what he decides to do.

For more information, visit our website:

http://prasadcosmeticsurgery.com/prasad-hair-restoration/

Mother and Daughter Facelift Diary - Natural-Looking Results + Quick Recovery = Happy Patients
Mother and Daughter Facelift Diary - Natural-Looking Results + Quick Recovery = Happy Patients

A mother and her daughter both decided to facelifts, eyelifts, and a chin lift and neck lift by super-specialist oculofacial plastic surgeon Dr. Amiya Prasad at his Manhattan, New York clinic. While both ladies had different reasons for undergoing cosmetic surgery, both did agree that they were not expecting to look like twenty-year-olds. Both ladies felt that it was important to look like themselves, with a refreshed, energetic and younger look.

Dr. Prasad believes in maintaining the unique character of each patient that comes to his practice. His cosmetic surgery philosophy is based on natural-looking results, without any telltale signs of plastic surgery.

The 72-year-old mother still feels energetic, but her facial appearance does not match her vitality. She loves keeping up with her twin grandchildren and being outdoors gardening. Several years ago, people remarked that she looked too young to have grandchildren. In recent years, people no longer questioned that she was a grandmother. She also gets comments about how tired she looks, even if she consistently gets a good night's rest.

Her 50-something-year-old daughter gets the same comments about looking tired, but her challenge is compounded by her job search. After losing her job, she had a tough time in a marketplace where people are looking for experienced workers, but at the same time, they want someone who looks younger. She has faced interviews where potential employers asked if she was tired due to her appearance. Being up against younger candidates for jobs she wasn't hired for has not helped her confidence.

The 72-year old lady had her upper and lower eyelid surgery, a facelift, neck lift, and chin lift. Only 6 days after surgery and still bruised, she went on camera telling how terrific she felt after her cosmetic surgery procedures. She did not even require an over-the-counter pain reliever during the early recovery period.

Her 50-something-year-old daughter also went in front of the camera without any make up 10 days after surgery. She also had her upper and lower eyelids (blepharoplasty) enhanced, and a facelift (rhytidectomy) and neck lift (platysmaplasty). Her quick recovery was one of the reasons why she chose Dr. Prasad who does all his cosmetic procedures under local anesthesia with light IV sedation, which he trademarked as LITE™ IV. Local anesthesia ensures a faster post-operative recovery time.

4 months after, and the mother and daughter duo describe each other as looking amazing. Both are receiving compliments about how young and great they look. 50-something Violet had a friend specifically ask if she underwent cosmetic surgery because she couldn't find any visible signs such as scars in the ear area. Violet only admitted to some filler application to her curious and amazed friend. What's more, Violet was able to find a great new job shortly after her cosmetic surgery. She felt that having a fresh face added to her confidence in starting a new career. 72-year-old Dee was asked if she was the same age as people in their 50s, and only agreed without revealing her actual age.

Both women were ecstatic about their results, and their genuine smiles and laughs are enough proof of how happy they are. Both are vocal about their gratitude and love for Dr. Prasad, and went on record of how they would not trust their faces to anyone else.

For more information, visit our website:

http://prasadcosmeticsurgery.com/prasad-face-eyes/facelifts/

Asian Eyelid Surgery Expertise: Differences of Ethnic Anatomies & Variety of Surgical Techniques
Asian Eyelid Surgery Expertise: Differences of Ethnic Anatomies & Variety of Surgical Techniques

A woman has double eyelids which have always hung low. It is getting noticeable and she wants to correct them. She wants to know the right type of surgery for her.

Dr. Amiya Prasad, an oculofacial cosmetic surgeon, explains that the Asian eyelid anatomy is very unique and has very distinct characteristics. Many years ago, when he began his career in the early 90s, he was very aware about the specific anatomic differences not only between Asians and non-Asians, but also between many different ethnic groups. This made him write an article years ago called "Ethnic Considerations in Eyelid Surgery" and he was also featured on Chinese World TV and World Journal. For a long period, he was focused a lot in doing revisional eyelid surgery for Asians because a lot of them had surgery where their incisions were too high or too low. There were also suture materials that would rub against the eyeball itself causing eye problems.

When Dr. Prasad does an assessment of a person of Asian descent whether they're Chinese, Japanese or Korean, he looks at several different factors before he makes a decision on the type of surgery they need. These factors include the skin quality and skin type, the presence or absence of extra skin, the presence or absence of fat, the anatomy of the epicanthal fold, the relative age of the patient and the other factors that have to do with the health of the eye itself.

From Dr. Prasad's perspective and experience, he feels that the desire for a double eyelid fold or a crease is based on a certain amount of flexibility that is intrinsic to the anatomy that nature allows. He had many patients who came to him for revisional surgery whose incisions were way outside of the natural crease if they were born with the crease. If they look at themselves without the crease and even if you have age-related changes, then they could also understand what would be natural if they were born with an eyelid crease or a double fold. 50% of Asians have a crease and 50% do not. Culturally, there is a clear desire for Asians as a lot of people and this is based a lot on fashion and entertainment and there are a lot of people who have these procedures. It is considered desirable but it is important to understand to try to have a natural appearance.

This woman should find a doctor who has a lot of experience with different types of Asian eyelid surgeries in all age groups as well as who knows different techniques. Once she meets with a doctor that she is comfortable with and once she has looked at the before and after pictures and examples of different scenarios, then she should move forward and go ahead with the surgery.

For more information, visit our website:

http://prasadcosmeticsurgery.com/prasad-face-eyes/eyelifts/asian-eyelid-surgery/

How to Address Puffy Eyes Temporarily or Permanently & a Combination Treatment for Dark Circles
How to Address Puffy Eyes Temporarily or Permanently & a Combination Treatment for Dark Circles

A 28-year-old woman is noticing purplish, bluish dark circles under her eyes and it makes her look tired. She uses concealer to mask the darkness but it make the puffiness under her eyes more obvious. She wants to deal with her concerns to make her look refreshed.

Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon, explains that puffiness under the eyes is called lower eyelid fat prolapse. Lower eyelid fat prolapse is the presence of fatty pockets around the eyes that pushes forward and creates a bulge under the eyes resulting in this puffy appearance. People will assume that this is result of fatigue, allergy or other factors like lack of sleep. They use topical treatments like creams that they buy over-the-counter. Unfortunately, that approach doesn't work. Lower eyelid fat prolapse is a specific volume of fat that can't be addressed with topical creams.

Discoloration under the eyes is mostly caused by genetics especially people of Indian, Arab and African descent. These ethnicities will have some form of pigmentation under the eyes commonly called dark circles. There are times that those dark circles look even darker when there is a loss of volume and there are external factors such as a sun exposure. The eyelid skin is very delicate and there a lot of things that can prematurely affect the quality of the skin. For people who smoke, the skin quality of the eyes looks almost gray or ashen. From a holistic approach, they can modify their habits to try to protect the skin and maximize its quality just from their own habits of diet, exercise and things that are good for their heart and skin.

After an appropriate physical exam, if there's a slight degree of fat prolapse then Dr. Prasad can improve the appearance by using a filler to treat the hollowness adjacent to the fat to make the fat less obvious or less of a bulge. In most cases scenarios, he deals with the fat prolapse with a more definitive method called transconjunctival blepharoplasty. Transconjunctival blepharoplasty means that he addresses the fat pockets from the inside of the eyelid. This way, there's no external scar and he is able to reduce or reposition as appropriate. He is also able to reduce the fat pockets definitively for a long period of time. In his practice, it is done in local anesthesia with LITE™ IV sedation. It's relatively a minimally invasive from that perspective in contrast from doing it in general anesthesia. People will try non-surgical solutions but they'll keep maintaining them as opposed to surgical procedures which are more definitive.

For discoloration under the eyes and to improve the skin quality, Dr. Prasad has been doing a lot of work with something called platelet-rich plasma. Platelet-rich plasma is the use of the patient's own blood to get the healing and growth factors which are separated. This improves the circulation, the collagen and the skin quality.

When there is a hollowness issue, he has been able to combine the platelet-rich plasma with a hyaluronic acid filler such as Restylane. There is a synergistic benefit of combining platelet-rich plasma with hyaluronic acid to get more permanent or long-term benefit of the tissue underneath the skin. The synergy between them is that platelet-rich plasma stimulates new blood vessel growth and new collagen formation, while hyaluronic acid acts like a scaffold to allow this new tissue growth to occur.

Every patient has to be treated as an individual so Dr. Prasad always customizes the plan. If the patient wants to go for lower eyelid blepharoplasty, very often he would combine it with platelet-rich plasma. If there is hollowness, then he uses platelet-rich plasma and hyaluronic acid. At this point, Dr. Prasad would recommend that she meet with qualified specialists in cosmetic eyelid surgery who have a lot of experience with darker skin. They should also know the complexities of the different surgical procedures and the types of treatment available to minimize the risks whether they are surgical or non-surgical.

For more information, visit our website:

http://prasadcosmeticsurgery.com/prasad-face-eyes/eyelifts/

Fox 5 News New York Features Dimple Creation Surgery by Dr. Amiya Prasad
Fox 5 News New York Features Dimple Creation Surgery by Dr. Amiya Prasad

The creation of dimples (dimpleplasty) is a popular and relatively simple cosmetic procedure. People are drawn to having dimples created because of how they look on the smiles of celebrities like Jennifer Garner and Mario Lopez.
Dimple creation surgery is popular in men and women, and tends to have a lower age range than other cosmetic surgery - in the mid 20s-30s. According to oculofacial plastic surgeon Dr. Amiya Prasad, a common reason for undergoing the procedure is to appear that some weight was lost as dimples add angularity to the face.
In this video, Dr. Prasad performs the surgery on Lisa Williams, who wants a more memorable smile. Before the operation, Dr. Prasad measures Lisa's face to find the area where naturally occurring dimples would be, by measuring the corner of the eye down, then the intersecting point from the mouth which is about 3 centimeters. There is a sweet spot where the skin allows for a fold, which makes the dimple look natural.
The entire dimpleplasty procedure is done from the inside of the mouth, so there is no external scar or visible sign of any surgical procedure. The procedure consists of manipulating a particular muscle, and attaching a stitch to the skin from the inside of the mouth. The surgery takes about 30 minutes, and causes minimal temporary swelling and soreness. The new dimples on Lisa are shown a mere 3 days after the surgery.


For more information, visit our website:

http://prasadcosmeticsurgery.com/prasad-face-eyes/dimple-creation-surgery/

How Eyelid Surgery Done with Local Anesthesia Makes it Easier on Patients and Quickens Recovery
How Eyelid Surgery Done with Local Anesthesia Makes it Easier on Patients and Quickens Recovery

A 52-year-old woman is disgusted with her eyes. She wants to know the least invasive procedure to correct her under eye bags and saggy eyelids.

Dr. Amiya Prasad, an oculofacial plastic surgeon practicing for 20 years, wrote a book called "The Fine Art of Looking Younger" where he explained that facial aging is a combination of volume loss and sagging. One factor that can cause aging is genetics.

This woman has extra skin over the eyelid which is called dermatochalasis. She also has puffiness under the eyes which is referred to as lower eyelid fat prolapse. Dr. Prasad thinks that the ultimate solution after reviewing her photos is a surgical solution. In the modern world, a lot of procedures are marketed that propose or claim to do less invasive procedures which result the same as surgical procedures.

As a specialist in this area and whose practice is mainly cosmetic surgery, Dr. Amiya Prasad sees patients who come from all over the world who had too much skin removed from the upper eyelids and the lower eyelids are pulled down. A certain amount of those patients have a preventable situation. This means that understanding the support structures of the eyelid to provide multiple levels of anatomic restructuring or repair is very important. So it is important the surgeon is able to evaluate the patient before a procedure like pulling down the lower eyelid and looking at the tone, resilience, strength and elasticity of the eyelid.

In Dr. Prasad's practice, he developed a quick recovery method that includes several components. One is natural and artistic-looking surgery. Years ago, many surgeons were doing surgeries in a very invasive way which meant that the patient will go under general anesthesia. Ultimately, Dr. Prasad thinks that the least invasive procedure is a combination of a certain level of expertise, artistry and avoiding unnecessary anesthesia. He does all procedures using local anesthesia with light sedation called LITE™ anesthesia. This means a little injection of anesthesia and having the patient wide awake throughout the procedure. Over the years, he mastered a certain style of doing sedation so that the patient doesn't have significant trauma in contrast to having a tube in their throat and put under general anesthesia where the body is fully paralyzed.

Dr. Prasad thinks that she would also need an upper lower eyelid blepharoplasty. This procedure is a very long lasting procedure. He has seen many of his patients that as they got older, they tell him 10 years later that their eyes have held up very well. In his practice, he does other things such as the application of platelet-rich plasma. Platelet-rich plasma is a very advanced concept among doctors who perform surgery which is very used commonly in orthopedics and oral surgery. It is using the patient's own blood and separating the platelets and the serum which have the growth factors. This helps a lot of his patients to have better results with their eyelid surgery with having rejuvenated and improved quality of skin and getting that nice luster and volume to the skin.

Dr. Prasad advises against the so-called non-invasive procedures which technically is equally invasive as surgery. Heating devices ,whether it's from ultrasound, radio wave or laser, can have a permanent affect by thinning the skin. One simply cannot address upper eyelid or lower eyelid skin with just a heating device alone. In addition, when the skin is sagging or has diminished elasticity where the structure has changed, then adding volume with the use of an injectable would actually stretch that structure and create various irregularities.

At this point, Dr. Prasad advises she meet with several experienced qualified cosmetic surgeons who really know their way around eyes and get a sense of their experience, their ability with technical skills and their results. One should look at the before and after pictures of their actual patients and get comfortable of how to have this done.

For more information, visit our website:

http://prasadcosmeticsurgery.com/prasad-face-eyes/eyelifts/transconjunctival-blepharoplasty/

Time needed for Hair Transplant Results, and How to Limit Shock Loss and Stop Future Hair Loss
Time needed for Hair Transplant Results, and How to Limit Shock Loss and Stop Future Hair Loss

A gentleman had 2000-3500 hairs transplanted. However, they started to fall out 5-10 days post surgery. He wants to know if it is normal that the hairs are falling out this early.

Dr. Amiya Prasad, a hair specialist, explains that a hair transplant is the movement of an entire hair follicle into a small slit. The skin and tissue heals well enough the majority of the time, and the dermal papilla, the part of the hair necessary for growth, can remain intact even if the grafts continues to fall-out. The general term used for grafts falling out during the early post-operative period is shock loss. Shock loss happens to both the grafts as well as the adjacent hairs that are subjected to the swelling and trauma of the actual procedure.

As a specialist in hair loss treatment, he has been in a remarkable leadership position with a technology he developed called Hair Regeneration. He has been doing transplants with materials extracellular matrix and platelet-rich plasma that show significant improvement in the rate of shock loss to make the difficult transition period a little easier. Even with advanced healing technology, the patient can still have a certain period where the existing hairs can look a little thinner, the grafts are not growing and aren't seen anymore. Somewhere in the early 4-6 month period, one wonders if they lost all the grafts. Fortunately, the hair is remarkably resilient. This is clearly demonstrated from the field of laser hair removal where people come for multiple laser hair treatments to suppress hair growth for a long period of time. Also, several studies have demonstrated that the hairs that are transplanted, even if the dermal papilla or the base is not intact, the middle part of the hairs or the hair shaft can still grow.

Dr. Prasad noticed in his photos the level of his receding frontal hairline. He may want to discuss with his doctor the use of some type of oral medications such as finasteride. In Dr. Prasad's practice, many people come to him for Hair Regeneration treatment which is a non-surgical injection that helps reverse the thinning process of hair. This is through a method that restores critical stem cells as part of a wound healing mechanism that stops the thinning process. Many people who had a transplant and would try to avoid a second transplant actually benefit from this because it keeps the hairs.

In other hair transplants, a surgeon restores hair to keep the appearance of hairs in areas which are actively healing. So a person who wants to get one transplant will need a second transplant, a third or even a fourth depending on how much donor area they have. Unfortunately, there's a limit of how much donor area a person has. Fortunately, the Hair Regeneration has been able to balance out hair transplant very well so that it improves the transplant procedure and also prevents the progression of hair loss, thicken hair and reverse thinning hair.

At this point, this gentleman just has to wait this out. He has to follow-up with his doctor and the final results are somewhere in a year to 15 months. There is a lot of variability between the hair growth cycles of individuals. Some people's hair grows faster while others slower. Ultimately, at the one year point, a person is close to a 90% zone of recovery. There are also people in 15 months, a combination of shock loss where there are grafts or the native hairs eventually synchronizes to the point where the growth and density match to give the person a better sense of the final result.


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How to Personally Determine if a Facelift is Right For You, & Natural Vs. Over Pulled Look
How to Personally Determine if a Facelift is Right For You, & Natural Vs. Over Pulled Look

A woman wants to know if she is a candidate for a face, neck and eye lift. She feels her skin is droopy.

Dr. Amiya Prasad wrote a book a few years ago called "The Fine Art of Looking Younger" where he discusses that facial aging is the loss of bone, muscle and fat and how sagging of the skin or a change in the eyes can cause one person to age. As a specialist, he can't restore everything because there are many changes in facial aging. His philosophy has been that every face has a certain character, and he works very hard to preserve that character. He always explains to his patients what they should anticipate after a facelift is looking how they did 5-10 years ago.

A natural looking facelift versus the over pulled look is a matter of style and then understanding what level surgery needs to be done. A lot of other doctors, particularly in Upper East Side of Manhattan and certain areas of Long Island, they prefer and their patients prefer a hyper look where everything is very tight and pulled. The brows are lifted, the eyes are slanted upward and the face is tight.

When Dr. Prasad does an evaluation, he looks at patients in an orderly manner. He first assesses the eyes and using a Q-Tip, he pushes back the upper eyelid skin to show the definition of the upper eyelid. If it is too heavy, he determines if an upper eyelid blepharoplasty would be appropriate. If there is puffiness in the lower eyelids, he looks at the relative tone and with a few manipulations, it would give the patient an idea of what they will look like.

To evaluate the face, Dr. Prasad assesses the descent in the cheek, jawline and neck. A lot of people assess themselves by lifting the skin up and he calls that the mirror lift. Usually, they lift very aggressively. But if a modest amount of tension is placed on the skin and they like the way the jawline and neck looks, then they are a candidate for a face and neck lift.

For this woman, Dr. Prasad would recommend a conservative upper eyelid blepharoplasty because it looks like she has relative fullness so she doesn't want to have a lot of skin and fat removed. With the lower eyelids, she probably wants the lower eyelid puffiness addressed. The outer corner can also be tightened since it is sagging a little bit. As far as the face is concerned, she would want some definition in the jawline. A surgeon can't pull enough to make someone look younger, but he can reposition enough to make a fine structure. If there is still hollowing after the surgery he can address that with volume correction.

Dr. Prasad would also recommend a type of anesthesia. He has been advocating for 20 years that essentially, every procedure that he does in cosmetic surgery from hair transplantation, breast augmentation, liposuction, tummy tucks, facelifts, are all done under local anesthesia with sedation. He trademarked it LITE™ anesthesia. He would have her consider that in contrast to general anesthesia where there's a tube in the throat, their body is paralyzed and they're put on a respirator.

At this point, Dr. Prasad recommends that she meet with a qualified experienced cosmetic surgeon and learn about her options. She should think about all these in her decision making process because that has an impact on the overall trajectory of her healing.


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Why Unusually Severe Female Hair Loss Should Be Diagnosed Before Any Restoration Procedure
Why Unusually Severe Female Hair Loss Should Be Diagnosed Before Any Restoration Procedure

A 26-year-old female has tried everything for her hair loss such as hair transplant, PRP, mesotherapy and taking multivitamins, but with no positive results. She wants to know if stem cell therapy is the right treatment for her.

Dr. Amiya Prasad, an oculofacial cosmetic surgeon and hair specialist, explains 95% of hair loss is either male pattern or female pattern hair loss. 30% of women under the age of 50 have female pattern hair loss, while 50% of women over the age of 50 have it. Female pattern hair loss is not widely publicized and is a reason for limited solutions for the problem.

One of the things Dr. Prasad would do first for someone like this woman, if not done so already, is take several biopsy points in the scalp. He then sends the sample to a respected university pathology department who is familiar with hair to ensure a correct diagnosis. Once the diagnosis has been confirmed, he would proceed to options for treatment. The most common diagnosis in hair loss is androgenetic alopecia which is manifested with patients having thick hair progressing to thinner hair.

Dr. Prasad's practice has developed a method of hair loss treatment called Hair Regeneration which he uses for male and female pattern hair loss as well more complex issues like androgenic alopecia, alopecia areata, systemic lupus erythematosus and other immune diagnoses. Hair Regeneration treatment is composed of extracellular matrix designed originally for wound healing, derived from pig bladder, combined with platelet-rich plasma taken from the patient's blood. When used in male pattern hair loss, there is about 99.9% success rate. In female pattern hair loss, success rate is 70%-80%, while in alopecia areata and lupus, there's about 50% success rate. Unfortunately, there are certain conditions that cannot be treated with this stem cell-based therapy which includes the scarring type of alopecia and conditions like lichen planopilaris.

The term stem cell therapy has been overused and abused. A lot of people who offer this are basically offering a questionable treatment for very desperate people. It's very important that patients do their research and understand what it means to have stem cell therapy. There are stem cells derived from plants that are being injected and other people are deriving stem cells after doing liposuction. There is some legitimacy to that - there was a study where placing fat under the scalp derived from liposuction actually helped hair growth. It has to do with the stem cells and growth factors that initiate hair growth, but that's a discussion outside the scope of this question.

Dr. Prasad suggests that she gets a right diagnosis then consider proper treatment. Hair Regeneration is something that she can learn about and then she can decide if this something worth pursuing. She should find a provider that can offer her that that in an area that may be convenient for her.

For more information, visit our website:

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The Intricacies of Highly Specialized Ptosis Surgery and How to Treat a Hollowed Sub Brow
The Intricacies of Highly Specialized Ptosis Surgery and How to Treat a Hollowed Sub Brow

A woman had ptosis surgery combined with Asian eyelid surgery 7 months ago but her results left her very asymmetrical. She wants to know if a revisional surgery will make her right eye match her left.

Dr. Amiya Prasad, an oculofacial plastic surgeon, explains that the position of the eyelid crease is dependent on particular fibers that come from a muscle called the levator muscle. The levator muscle is the muscle that is responsible for lifting the eyelid and for most of the eyelid function. In a routine Asian eyelid surgery, the levator muscle is not involved and the fixation of the crease can be relatively straightforward and stable. However, when doing a procedure such as such a ptosis surgery, the surgeon is manipulating the levator muscle. When ptosis surgery is performed, the surgeon will typically open an area called the orbital septum and deal with some fat. Some surgeons will resect the fat to allow for access and better definition of the muscle and other surgeons will push the fat back. It depends on a case-by-case basis and is based on the style of the individual surgeon and the anatomy they find.

Sometimes, ptosis surgery will result in a lot of swelling in the pretarsal area located between the eyelid crease and the lashes. That swelling can linger for months, even up to a year and can make the crease look artificially high. If there is fullness in the sub-brow area, it may be related to the volume of fat that is present in that space. A ptosis correction or revision would hopefully elevate the eyelid to the desired level or shape and contour. In addition, the crease may be situated closer to its ideal location once all the swelling and everything is resolved.

In Dr. Prasad's experience, if there is relative volume deficit and a patient wants more volume in the sub brow area, he would do something called microfat transfer. Microfat transfer is taking fat from another part of the body by doing a specific method of liposuction, reception assisted lipectomy, and take that fat and place it the sub brow skin. The sub brow area is different from the orbit and the skin of the eyelid. This is an essential discussion with the surgeon who performed the ptosis surgery.

Dr. Prasad recommends that she meet with her surgeon who performed the initial procedure and discuss these concerns. It is usually best to go to the original surgeon when it comes to a specialized procedure such as a ptosis they know the anatomy and will be able to guide her as necessary. If for any reason is not her satisfaction, she certainly can get additional opinions.

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Clearing the Confusion of Facelifts - Detailing Different Procedures and Areas of Treatment
Clearing the Confusion of Facelifts - Detailing Different Procedures and Areas of Treatment

A 61-year-old woman is considering a lower facelift. She has lines around the eyes and doesn't like her neck. She wants to know if this is the right decision for her.

Dr. Amiya Prasad, an oculofacial cosmetic plastic surgeon practicing for 20 years, has done a lot of facelifts and has a lot of experience in this area. In his book, "The Fine Art of Looking Younger", he explains that facial aging is a combination of volume loss and descent. When someone reaches a certain age, facial aging can be variable in different people. The youngest patient he had for a facelift was 37-years-old but it was a small scar limited facelift. His oldest patient was around 87-years-old. There is a wide spectrum of people and a lot of it is about genetics and environmental factors such as stress on your skin.

The choice of the procedure is going to vary based on the surgeon and the anatomy of the patient. However, there was a time where a lot of people were marketing short scar, and small incision facelifts claiming they had the same benefits of full facelifts. Doctors have different definitions of what a facelift is.

A lower facelift usually means that the incision just goes behind the ear up to a point. By this way, the jawline is improved but the sagging cheek is not addressed. What Dr. Prasad does in his consultations is that he educates his patients by showing them the directions a face can be lifted and where the incisions has to be placed strategically in order to access the anatomy correctly for effective results.

In Dr. Prasad's practice, if a patient is concerned about their jawline, their jowls, the neck and sagging cheeks, he recommends two ways to address this are through a facelift and neck lift. Facelift involves an incision that begins above the ear, into the temples, goes down to the inside of the ear and lastly behind the ear. A facelift can also improve the neck definition because of the vertical elevation. A neck lift involves an incision that goes into the hairline to address the definition of the neck. The combination of both would address the whole skin, the platysma muscle and the muscle under the skin referred to as the superficial muscular aponeurotic system or SMAS. The SMAS is the muscle tightened in a facelift. There are also other methods such as SMAS placation, deep plane facelift, plastysmal plasty for tightening the neck.

In making a decision, the patient also has choices when it comes to anesthesia. When Dr. Prasad does face lifting in his practice, he does it under local anesthesia with LITE™ IV sedation. He has found out that the related issues when it comes to recovery are significantly diminished by doing it this way. His patients recover faster, and still have the wonderful long-term benefit of a full facelift.

The next step is that she meet with a qualified experienced cosmetic surgeon and learn about the different options. There are many different doctors with different specialties who do this work and certainly she's going to find different opinions. So Dr. Prasad recommends a doctor who has an aesthetic style that matches hers. She can tell that by looking at before and after pictures. In Dr. Prasad's practice, his patients look very natural. He believes in is maintaining the character and the look that a person is recognized like the way they look five to ten years ago.


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How Scars from a Previous Hair Transplant (FUT) Can be Improved with Regenerative Medicine
How Scars from a Previous Hair Transplant (FUT) Can be Improved with Regenerative Medicine

A gentleman had a hair transplant which left him with a scar. He wants to get rid of the scars but doesn't know the best option.

Dr. Amiya Prasad, a hair transplant surgeon explains that hair transplantation, whether it's the strip method or the follicular unit extraction, will both result in scars. As a full body cosmetic surgeon as well, he has discussions about scars is something he does all day long whether it's for tummy tuck, facelift or breast surgery.

Wound healing is a process that takes six months to a year. Even with the best closure and with the most advanced technology in terms of biomaterials, the patient could still get a scar that's undesirable. The scar can be a widened, thickened or irregular. If the patient doesn't have the best healing, the surgeon can potentially revise the scar but it's about how the body heals and that's something we can't always predict.

For hair transplant scars, Dr. Prasad explains to his patients that he uses cosmetic surgery techniques to make the incisions as close as possible, and also uses a material called extracellular matrix and platelet-rich plasma. These two natural regenerative materials are used to enhance the healing process and reduce scar formation, and is also used in a treatment called Hair Regeneration to thicken existing hair and stop further hair loss.

There are some options like tattooing or a new technology that is being used for wound healing for burns. However, Dr. Prasad cautions patients about medical tattooing. Although it can look good in pictures, three dimensionally, it might not look right for them. The reality is that the scar is at a deeper level and what's responsible for the thickening is more about the type of scars sometimes people refer to as a hypertrophic or keloid scar.

In Dr. Prasad's practice, if someone has a thickened scar, he employs injections of material such as 5-Fluorouracil (5-FU)and Kenolog. He also had very nice results with injections of platelet-rich plasma. Platelet-rich plasma is from the patient's own blood wherein the healing factors are taken and injected to the area. It has been very successful for areas of hypertrophic or thickened scars to soften them and ideally allow some hair growth to occur through those scars.

If someone had a transplant, they are somehow committed to have their hair length a little bit longer to make sure the scars are covered. If they are aware that the scars are obvious when their hair is wet or if someone is noticing it, then they may want to consider a surgical scar revision or treatment with injections, but Dr. Prasad doesn't think any topical treatment will do that much. He suggests doing some consultations with cosmetic surgeons who have a lot of experience with scars and understand what their options are. Someone can't erase a scar, but they can make a bad scar look better.


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How Specialized Ptosis Surgery and Epicanthoplasty Can be Performed Simultaneously, but with Caveats
How Specialized Ptosis Surgery and Epicanthoplasty Can be Performed Simultaneously, but with Caveats

A gentleman had Asian double eyelid surgery before. He does not like the droopy eyelid look. He wants to know if ptosis surgery and epicanthoplasty can be done simultaneously.

Ptosis means drooping of the eyelid in terms of its position relative to the center of the eye called the pupil. When Dr. Amiya Prasad, an oculofacial plastic surgeon, does ptosis surgery it involves a muscle called the levator muscle. When he does the procedure, he lets the patients cooperate for the most critical part which is getting the right height, position and contour. The surgery has its own set of risks and benefits. Although he has been doing this for over 20 years, he still has occasional patients who need enhancements if the eyelid is too high or too low. The levator muscle is very sensitive to any adjustment so the patient must be prepared for a second procedure.

Epicanthoplasty is another procedure that involves the epicanthal fold which defines the Asian eyelid anatomy. Some people want that fold reduced to make the eyes look closer together, wider apart and more open. However, even done with experienced hands, there is a possibility of scarring. This is because epicanthoplasty involves several very small incisions in the inner corner skin of the epicanthal fold. Even if it's flat, it might be visually perceptible. So that requires evaluation of skin quality and the discussion about the predictability of what kind of scars the patient is willing to accept.

Although there are many procedures that can be combined with ptosis surgery including an epicanthoplasty, the patient really needs a physical exam to get an opinion that will be of any value. It is possible that ptosis surgery and epicanthoplasty can be done simultaneously, but the patient must understand that there is a possibility that he may need enhancement after the surgery. Dr. Prasad recommends that he meet with specialist such as an oculoplastic cosmetic surgeon who does a lot of Asian eyelid surgery and is experienced with epicanthoplasty.

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The Causes of Projected Upper Cheeks (Malar Edema) and How to Improve this Difficult Issue
The Causes of Projected Upper Cheeks (Malar Edema) and How to Improve this Difficult Issue

A woman has puffiness around her lower eyelids and cheekbones. The bags look like there's fluid or fat that hangs over and stops at the cheekbone. She wants to know the treatment for her case.

Dr. Amiya Prasad, an oculofacial plastic surgeon explain that chronic elevation in the cheek area is referred to as malar edema or malar festoons. Based on the woman's photos, she doesn't have festoons. Festoons are like bags that hang over the cheeks. Mostly likely, that area in her cheek has edema or swelling wherein there's fluid within the tissue. This is mostly caused by smoking, allergies, sinus problems and genetics. The first three causes area manageable. Unfortunately, the type of swelling which is caused by genetics is difficult to address surgically. As a facial plastic surgeon practicing for 20 years, Dr. Prasad has seen many methods that have been tried such as CO2 laser and cauterization under the skin. However, a lot of those methods can worsen the problem.

There are selected patients where Dr. Prasad tries different things to shift the focus away from those lines by a strategic use of various fillers. He also uses platelet-rich plasma which is drawn from the patient's own blood, then spun down to concentrate the vascular growth factors. These factors improve circulation of the skin in that area.

Ultimately, it is a matter of how to improve the appearance but not definitively removing the swelling in that area. Surgeons are all constantly looking for solutions for this. If one has any of the mentioned risk factors, then they should personally address them. Until then, Dr. Prasad would advise to avoid surgery and meet with some doctors to get some opinions. The thing that he can't do with photos alone is a 3-dimensional appreciation of the volume and projection of this area and how it impacts on the patient. So he suggests a good assessment through physical examination to know how to address their situation.

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How Wrinkles are Perceived Differently By the Person Who Has Them, and By Those Around Them
How Wrinkles are Perceived Differently By the Person Who Has Them, and By Those Around Them

A woman has wrinkles and crepiness under her eyes when she smiles. She wants to know the best approach to remove them.

Dr. Amiya Prasad, an oculofacial cosmetic surgeon, wrote a book years ago called "The Fine Art of Looking Younger" where he discussed that even if the muscles around the eyes are injected with Botox, lines still form when the person physically moves the cheek upward. This is because there is a unit movement effect when one part of the face moves.

They are basically two types of wrinkles: static wrinkles - the wrinkles around the eyes at rest, and dynamic wrinkles - the wrinkles that occur when there activation of a muscle. Even with Botox, the dynamic activity of the muscle around your eyes will still cause wrinkling of the skin.

There are a lot of people who have lines under their eyes such as actors or models but they are still attractive. There are also younger people who have lines under their eyes but they don't look bad. This is because people look at other people's faces as a whole and not the small aspects. Unfortunately, people tend to look at themselves too critically that they notice even the smallest details of their appearance. They pursue the holy grail of smooth, tight, flawless skin to the point that they get laser thereby making their skin thinner but not younger.

As a surgeon, Dr. Prasad evaluates patients by their overall facial aesthetics. He starts at the basics such as the impression their eyes make. He noticed that at rest, there is some puffiness under this woman's eyes. This is probably due to lower eyelid fat prolapse. From his experience, puffiness under the eyes is a big factor in the overall impact on the perception of the individual. When someone has puffiness under their eyes, people think they're tired, older or lacking energy.

Dr. Prasad addresses crepiness caused by thinning of the skin using a regeneration technique rather than some type of heat stimulation. He used to do all types of laser techniques however he has modified his approach for years. Presently, he uses something called platelet-rich plasma. It is basically the patient's own blood that is spun down to concentrate the active healing factors called platelets as well as the serum which have growth factors. These are manipulated and injected in a very specific way under the eyes to help improve skin quality and volume. With platelet-rich plasma, it restores loss of collagen and vascularity which normally happens in aging skin. In addition, from the top part of the skin, he employs fractional CO2 laser and microneedling. The activity of the muscle around the eyes can also be addressed with neurotoxins such as Botox and Dysport.

Dr. Prasad suggests that she take a step back and look at her face as whole. She must know how the puffiness and wrinkles on her face play a role in the overall appearance of her face. It is good to get opinions from her friends and family to get a sense of how people perceive her look.

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Why Weight Gain to Add Facial Volume After Illness is Not Advised, & Why a Healthy Lifestyle Helps
Why Weight Gain to Add Facial Volume After Illness is Not Advised, & Why a Healthy Lifestyle Helps

A 54-year-old woman lost a lot of weight through illness resulting in a sagging lower face, lip lines and deep wrinkles around eyes. She wants to know if putting on weight would help get rid of sagging face.

Dr. Amiya Prasad, an oculofacial cosmetic surgeon discussed in his book "The Fine Art of Looking Younger" that the essence of facial aging is a combination of volume loss and sagging. As a specialist having offices in Manhattan and Long Island, this type of question comes up a lot. A lot of people who underwent illness unfortunately lose a lot of fat in their face more than any other part in their body. That is why a lot of his patients are fit people who chose liposculpture to help them get rid of problem areas in their bodies.

In addition, physical and emotional stress accelerates aging. However, Dr. Prasad would advise against gaining weight to fill the face. In a country where there is a high rate of obesity, being overweight is never to someone's advantage. Adding weight to the face is also sacrificing the appearance of the body, and there are also medical consequences.

Before someone pursues surgical procedures, it is very important to restore some of the foundation of the physical by having a healthy lifestyle. They can choose to get fillers, but before doing that, find the right group of professionals such as a fitness instructor or a gym, exercise and maintain a healthy diet. Dr. Prasad also advocates the use of supplements such as omega 3, fatty acids and antioxidants. In terms of lifestyle, he also does in his own personal life the same things he tells his patients that if someone lives a healthier lifestyle then the quality of their skin and facial appearance will improve.

In terms of addressing the areas the this woman feels will benefit by her gaining weight, there are fillers such as Radiesse, Sculptra, hyaluronic acid like Restylane, and the use of Botox to lax some of the muscles. If she's not quite ready for facelift and she just wants to fill out the areas then by all means consider the less invasive option. Consider doing that in conjunction with adopting a healthy lifestyle and doing things that are good for her heart and lungs.

In addition, most of Dr. Prasad's patients feel real wonderful from just straightforward skin care. In his practice, he has a medical spa and he'll do something called Hydrafacial. Hydrafacial uses water technology to work like the crystals do in microdermabrasion. This helps make the skin glow and this ultimately helps patients feel wonderful about their appearance. He's not negating any benefit of a lifting procedure but if patients want to push off that lifting procedure for a while, they can try all these things. If they feel that they want to improve their jawline and neck skin, then a lift will be appropriate.

For more information, visit our website:

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The Options to Correct a Pixie Ear from a Previous Facelift Performed a Decade Ago
The Options to Correct a Pixie Ear from a Previous Facelift Performed a Decade Ago

A woman had a facelift 10 years ago which resulted in a pixie ear deformity. She wants to know if this can be corrected.

Pixie ears do happen in face lifting surgery. When Dr. Amiya Prasad evaluates a patient with pixie ear deformity, he basically looks at a couple different factors. Pixie ear deformity after a facelift is because of a very aggressive skin removal at the lower part of the facelift flap. This results in the pulling of the skin and eventually pulls the ear. Unfortunately, there's also skin shortage that goes with that so there's a compromise to make that look better, but that is usually a different procedure.

In a scenario where someone is 10 years after a facelift, there are basic two options: one is involves another facelift procedure and the other doesn't. However, it's not the same procedure that the patient had 10 years ago but a limited procedure. The skin is lifted up and the pixie area can be rotated inward and sutured in a way so it can be rounded back to normal. The face can be placed in a proper position thereby eliminating that downward pull.

If the patient is not ready for another facelift procedure, the pixie ear deformity can still be treated. What is essentially done is that the earlobe is detached from the skin and then through a straightforward suturing technique, the ear lobe is rounded and reattached. This leaves a little bit of skin defect which is closed with a couple of stitches. Fortunately, this is pretty easy to hide.

That second procedure is the minimal repair and is done under local anesthesia. If the patient wanted to do a more extensive procedure like another facelift, then it can certainly be corrected at that time. However, a proper physical examination will help determine what direction the patient will be heading.

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Why a Hair Transplant is Not Recommended for People Who Prefer a Short Hairstyle like Military Cuts
Why a Hair Transplant is Not Recommended for People Who Prefer a Short Hairstyle like Military Cuts

A 25-year-old gentleman is tired of shaving his hair. He wants to be able to comb his hair and be able to get a proper military haircut. He wants to know what are the options for him.

Dr. Amiya Prasad explains that when someone first notices they are losing hair, it is established that more than 50% of their hair has already been lost. When someone has their most hair in their early teens, they have about a hundred thousand hairs. This means that when the first notice their hair loss, they are already down to fifty thousand or less hairs. A surgeon needs tens of thousands of hairs to replace the lost hair and get the density they want. Unfortunately, the realities of hair restoration surgery limit the actual number of hair one would get to meet their objective. The problem is that the donor area is limited to only several thousand hairs.

A lot of surgeons offer all kinds of numerical manipulations that they can deliver the maximum number of grafts, but the end point or desired result is not likely to be achieved based on the degree of the advanced nature of their hair loss. According to the Norwood classification of hair loss, the more hairs lost the higher their number on the scale. This gentleman would fall in the late numbers like the Norwood 6 or even 7 classifications. There is a lot of bald scalp that he needs to cover.

If someone would decide to keep their hair longer, then Dr. Prasad could strategically place hairs in a way where the patient can be able to comb their hair and allow some length of hair to cover the scalp. However, the specific desire for a military haircut which is very short may not be realistic in this gentleman's case. This is because he has to consider where the hair is being harvested from. The hair is harvested from the back so whether the surgeon does a strip method or follicular hair extraction, when the hair is cut very short, it will always show scars. It's a running myth right now that follicular unit hair extractions are scar-less. Unfortunately, this is not true. Follicular unit hair extractions actually create more scars and potentially create a wide area of diffuse dots within just one session. That can be very apparent when you wear your hair short.

Unfortunately, Dr. Prasad explains that this gentleman is too far advanced for a technology that he developed called Hair Regeneration. This technology has been successful to treat people who are younger and are losing hair at younger age. He is able to help them with that injection to thicken hair. Ironically, Dr. Prasad would say that this gentleman is probably better off not pursing any type of surgical procedure if he desires to have the appropriate haircut while in the military. If he decides to go back to civilian life, then he can make decisions at that point for transplantation and how long his hair has to be in order to make enough grafts placements in a way that looks natural.

As one gets older, society basically accepts a certain amount of hair loss is normal for men. It's a rule of decades that in their 20s only 20% have hair loss. Dr. Prasad thinks that this is clearly one of the factors this gentleman is dealing with. He is surrounded by people with his age and 80% of them have thick hair. But as he gets to his 30s, 40s and 50s, that number of men suffering from hair loss gets higher. So at that point, he may decide if he wants to do a shaved look and certainly many men are able to pull it off and live with it. Dr. Prasad suggests that he hold off from considering any transplantation and just stay tuned to developments in the next several years.

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Why a Patient's Skin Quality and Skin Thinness can be Uncontrollable Factors in Facelift Results
Why a Patient's Skin Quality and Skin Thinness can be Uncontrollable Factors in Facelift Results

A woman had a full endoscopic browlift, full face and necklift with tightening 7 months ago. She wants to know if it is normal to have saggy skin in the lower face and neck.

Dr. Amiya Prasad, an oculofacial plastic surgeon and who is also boarded in facial cosmetic surgery, has a lot experience with doing facelifts. He always teaches his patients that face lifting surgery can be done really well. However, there are factors that the surgeon cannot control like skin quality and elasticity of the patient's tissue. Even if the surgeon is using any of the techniques such as SMAS (superficial aponeurotic muscular system) tightening or deep plane facelift, he must consider factors besides the technical execution. An experienced cosmetic surgeon ,regardless of board certification, will most likely be capable of doing every type of facelift variation, appropriately individualized to maximize the patient's results.

In this woman's case, mostly likely her skin is a little bit thin. As the swelling resolved, her skin probably didn't spring back as well as she hoped it would. In addition, factors such as her age, the thickness of the skin, blonde hair, blue eyes and lighter skin are all factors why she developed sagging skin. However, this doesn't mean that the surgery needs to be redone. When her primary surgery was done, a fair amount of repositioning and tightening has already been accomplished. If someone looks at themselves and see that 90% of the desired result has been achieved, sometimes it is not worth it to go and pursue every last millimeter. Understand that no matter how well and how tight the procedure was done, there will always be some degree of regression, regardless of who performed the surgery.

In Dr. Prasad's practice, he allows the full wound healing process to be completed which is about 6 months to a year. Once he reaches that point, he knows that things have settled down and decide if it is appropriate to do some enhancement. Also, he has my own operating facilities so he has the flexibility of doing the enhancements whenever he needs to. Every surgeon has to do enhancements as it is part of the nature of plastic or cosmetic surgery.

Dr. Prasad suggests that she meet with her doctor. This is a scenario that every surgeon is familiar with and both of them should discuss the options as to how to improve the results that she already has. Sometimes, minimally invasive procedures will also be beneficial. Injectables like Botox and improving the skin quality by radio frequency heating devices with a limited application can all be helpful.

For more information, visit our website:

http://prasadcosmeticsurgery.com/prasad-face-eyes/facelifts/

Why Hair Transplants are Not Done on Teenagers, and How to Stop Loss and Thicken Hair
Why Hair Transplants are Not Done on Teenagers, and How to Stop Loss and Thicken Hair

An 18-year-old gentleman has hair loss which has left him with low self-confidence. He wants to know if hair transplantation is the right option for him

Dr. Amiya Prasad explains that hair transplantation is the use of a limited number of genetically resistant hairs to strategically fill areas in the scalp where there is hair loss. Unfortunately, it is generally ill-advised for someone young with an aggressive hair loss pattern. When someone is losing hair rapidly, most ethical hair transplant doctors would not perform a hair transplant. However, some doctors would do a series of aggressive transplantations which would not look very natural in your age.

If somebody is in their 30s, 40s or 50s then the conversation would be very different because the expectation in the degree of hair loss allows the surgeon to transplant hair in a way to frame the face. There is a general rule of decades - in their 20s, 20% has hair loss. That means 80% of men have good hair that time. Transplantation can't give that full volume that so many of their contemporaries have right now and will have in their 20s.

The medical options he can consider are two drugs: minoxidil and finasteride. Minoxidil is a topical application. In Dr. Prasad's clinical experience, minoxidil doesn't make much of a difference for younger men who are losing hair so quickly. Another drug is finasteride which is a one mg tablet taken once a day. It is based on the understanding that a certain group of men have male pattern hair loss because of the androgen sensitivity of hair follicles to dihydrotestosterone or DHT. Finasteride inhibits an enzyme called 5 alpha reductase which converts testosterone to dihydrotestosterone. Unfortunately, people who are losing hair at this young age tend to not respond very well with finasteride. In addition, there are concerns about the sexual side-effects of finasteride so most of Dr. Prasad's younger patients do not want to take it.

Dr. Prasad suggests a technology that he developed for the past couple of years called Hair Regeneration. This is based on the serendipitous discovery of a wound healing material called extracellular matrix and its remarkable ability to thicken thinning hair. He developed a combination of extracellular matrix and platelet-rich plasma taken from the patient's own blood. The blood is spun down to concentrate the plasma with platelets that have growth and healing factors. This is different from a transplant - it's a series of injections that are done one time. He has observed a significant improvement in the regression of thinning. In fact, there is a reversal of thinning and thickening of those thinning hairs. The more recently thinning hairs respond very well and the older thinning hairs respond not as well so timing is important when doing these injections.

In Dr. Prasad's clinical experience, this injection has helped a lot of people. For 3-5 years, he has not any significant trends of needing to repeat injections. He periodically repeated injections as he developed the formulation and he has worked in enhancing results that he has already gotten. He thinks that this is a great opportunity for someone young to at least to save and thicken their existing hair.

For more information, visit our website:

http://prasadcosmeticsurgery.com/prasad-hair-restoration/hair-transplant/

How a Facelift Can Address Sagging and Descent, While Other Procedures Add Volume Lost in Aging
How a Facelift Can Address Sagging and Descent, While Other Procedures Add Volume Lost in Aging

A 59-year-old woman had Botox for her forehead creases and Radiesse for volume to her cheecks and reduction of nasolabial creases. Her eyelids are droopy and her lower face has saggy skin. Her nasolabial folds are very prominent and there are many vertical lines above her lips. The skin on her neck has also started to sag. She is considering a facelift and would like input for help with her decision.

Dr. Amiya Prasad, a oculofacial cosmetic surgeon explains that there a lot of non-surgical modalities and injectables to combat facial aging. As what he described in his book "The Fine Art of Looking Younger", facial aging is a combination of volume loss which is bone, muscle and fat as well as sagging which is the loosening of the deeper tissues and skin.

Dr. Prasad thinks that a facelift would be a benefit for someone who has facial aging. The purpose of a facelift is to reposition sagging skin and cheek tissue and also to improve the neck. However, it does not restore volume. His approach to someone who has facial aging and volume loss is he first does the face and neck lift and then he can create a strategy to enhance the volume. Sometimes he combines a face and necklift with the placement of sub-malar or cheek implants. It is remarkable how much this improves the volume in the cheek area. In addition to someone who has a weak chin, he can add a chin implant.

The patient must understand that surgeons don't do a procedure the same way. The surgeon's role is to inform the patient the many different options and if the additional procedures such as the cheek implants and other things are worth considering. Some people are afraid of implants because of a lot of bad-looking implants. If someone can tell that someone has a cheek implant, that's not a good thing. When a surgeon tries to restore volume that's lost, it's more of a correction than an enhancement. For example, a breast augmentation is an enhancement while a cheek implant for facial aging is a correction.

The other part of the strategy after the face and necklift is considering injectables such as Radiesse, Botox and Restylane. There are a lot of ways to enhance the appearance for someone to look their best at the age they are at. A surgeon can never make a 70-year-old look like a 30-year-old, but he can make a 70-year-old look really great for their age range. Typically, they'll look 5-10 years younger. More often than not, they feel great when they see themselves in the mirror and still recognize themselves.

Her best option right now is to meet with several surgeons and understand that there are many different specialties which provide care and surgery as well as non-surgical solutions to the face. Once she meets a surgeon she is comfortable with then she should move forward with her procedure.

For more information, visit us in our website:

http://prasadcosmeticsurgery.com/prasad-face-eyes/facelifts/

Why Volume Loss in the Eyelid-Cheek Area is Likely Caused by Aging and not by Previous Surgery
Why Volume Loss in the Eyelid-Cheek Area is Likely Caused by Aging and not by Previous Surgery

A woman wants to know other options besides fillers to reduce hollowing after her eyelid surgery.

Dr. Amiya Prasad, an oculofacial cosmetic surgeon, assesses from the photo this woman submitted that the lower eyelid position looks very good. He thinks that the goal of the lower eyelid blepharoplasty was accomplished - take away the negative of the bulges of fat underneath the eyes.

In Dr. Prasad's practice, he first gives the patient a general overview of the overall changes that happen in one's lifetime. He wrote a book a few years ago called "The Fine Art of Looking Younger" based on the idea that facial aging or genetic changes are a combination of volume loss and sagging or descent. When someone has bags under their eyes, they happen to have cheeks that look flat or look like there's a lot of sagging. This is more common in people who are in their 30s or beyond where volume loss can play a significant part of the overall look of the person's appearance.

When someone has bags under their eyes, Dr. Prasad brings this to the attention of his patient. He also explains that if there is relative hollowing under the eyes after surgery, he can address certain key anatomical elements that are associated with the perception of hollowing including the tear trough area. Another element is the area of the eyelid-cheek junction sometimes called the V-deformity which is at the rim at the lower part of the eyelid. When someone is younger, that area has volume and a layer of fat cushion. Genetically when people are young or with age, that area becomes depleted and starts to efface revealing the bony structure. The last element is the malar or the sub-malar space which tend to be very flat.

Dr. Prasad's typical strategy for the tear trough and V-deformity area is to combine hyaluronic acid such as Restylane with platelet-rich plasma. Platelet-rich plasma is derived from the patient's own taken from a typical blood draw. He spins the blood down and concentrates the platelets and growth factors that are responsible for healing. He has seen a very nice synergy in the quality of the skin, the volume correction and the overall look with this combination. Sometimes, his patients are a little frustrated to do this as a maintenance procedure but when someone is dealing with facial changes, not everything is surgically correctable. That's why there's role for fillers and other things to correct volume. In the malar and sub-malar area, he can do fillers such Radiesse or fat transfer or an even more permanent procedure such as placement of sub-malar implants.

Dr. Prasad would also advise not to do anything to treat the concavity or the area from the eyeball to rim which she may feel as hollowed. A lot of people have tried procedures such as fat transfer in this area. Unfortunately, because of the variability of healing, fat transfer can result in chronic swelling and a lot of irregularities. People have come to him from all over the world with fat transfer and they had the appearance of nodules and bumps.

Dr. Prasad recommends that she communicate with her doctor who did her surgery and discuss her concerns about the healing.

For more information, visit us in our website:

http://prasadcosmeticsurgery.com/prasad-face-eyes/facelifts/

How to Determine if Blepharoplasty or Ptosis Surgery is Needed for Asymmetrical Eyelids
How to Determine if Blepharoplasty or Ptosis Surgery is Needed for Asymmetrical Eyelids

An Asian man, 18-21 years of age feels that his left eye is unnatural and his eyelashes curl inwards. He wants to know if blepharoplasty can be performed to correct asymmetrical eyelids.

Dr. Amiya Prasad, an oculofacial cosmetic surgeon, has had a lot of experience in eyelid surgery especially ptosis surgery. When he assesses a person who is concerned with asymmetry, there are two critical aspects when deciding whether blepharoplasty is the right thing for the patient. First is determining the eyelid height. When someone has a lot of skin overhanging the eyelid, it can increase the width or the height between the margin of the lower eyelid and the margin of the upper eyelid. This height is called the interpalpebral fissure. By measuring the height, he is able to determine whether or not there's a condition called ptosis or drooping of the eyelid.

Eyelid ptosis is a different surgery from blepharoplasty. When someone has eyelid ptosis, Dr. Prasad evaluates the levator muscle. He has to do something to advance the muscle or shorten the muscle to get the height to be equal. In addition, he looks at the eyes in the primary gaze as well as forward, downward and upward to determine the muscle function.

The other part of the equation is the skin fold. The man mentioned that his eyelids are turning inward. This is relatively a frequent condition of people from the Asian descent. This condition is called epiblepharon where there's a fold of skin that pushes the eyelashes. When the eyelashes already touch the eye, a correction has to be done to prevent irritation of the eye itself.

When people are concerned with asymmetry, it is not only limited to the soft tissue of the eyelids such as skin and levator muscle. Sometimes it is related to the natural underlying bone structure. The human face is not perfectly asymmetric. If someone looks at their face long enough, they can notice the subtle asymmetry of the two sides. Specifically, with this man's issue, there sounds to be a real difference with the skin fold of her eyelid.

This man might be well served with limited blepharoplasty to address the fold of skin that is causing his eyelashes to turn inward. Although he submitted a question about the asymmetry and he has a relatively descent photo, the photo does limit how much opinion he can get without a proper examination. Dr. Prasad recommends that he meet with a qualified experienced surgeon. Typically if there's an issue with ptosis, someone would be going to an oculofacial plastic surgeon and get an evaluation of all the things mentioned. Get the proper evaluation of ptosis and the fold of skin over the eye. Once they are comfortable with the doctor they meet with then they can make a decision of proceeding with his surgery.

For more information, visit our website:

http://prasadcosmeticsurgery.com/prasad-face-eyes/eyelifts/eyelid-ptosis-surgery/

Why Surgical Extensiveness, Quick Healing, & Surgeon Flexibility are Important in Facelifts
Why Surgical Extensiveness, Quick Healing, & Surgeon Flexibility are Important in Facelifts

A woman asks the difference between a traditional and composite facelifts. She wants to know what is best for her.

Dr. Amiya Prasad, a facial cosmetic surgeon practicing for 20 years, explains that there are risks and long-term benefits of facelifts. The art of doing face lifting starts with communication. In his practice, he always teaches his patients that they first have to understand what a facelift accomplishes. People believe that face lifting corrects everything from the top of the head to the neck. However, a facelift only addresses sagging tissues of the cheeks, jawline and the neck. With that being said, the goal is to elevate the cheek, improve the quality and sharpness of the jawline and improve the angularity of the neck.

A lot of doctors feel passionate about their particular method because they have developed their own particular style in doing a procedure. The name of the procedure is not as important as the doctor's way of doing it. Unfortunately, it is easy to become confused with the terminology and the different methods of doing a procedure, which doctors use to claim superiority over the other.

Dr. Sam Hamra is one of the people who developed the concept of composite facelift. He also wrote a textbook about it and wrote many articles. It is well known that the composite procedure can give nice results, but many people have significant swelling afterwards.

In Dr. Prasad's practice, he has had patients who are extremely wealthy and people who work really hard and save their money. The one common denominator for all is the need for quick recovery. Quick recovery means getting back to normal life somewhere in a 1-2 week range. There should be a balance between level of surgery, time of recovery and ultimate desired outcome to get this result. In his practice, it's very critical for him to deliver consistent long-term natural results and get people back to work fast.

The anatomic part of the face called the SMAS or superficial muscular aponeurotic system is an area of tissue that translates the movement of the facial muscles to the skin above it. In a facelift procedure, the surgeon tightens the SMAS and the extension of the face called the platysmal muscle. This muscle originates from the clavicles, and as one gets older they get these bands called the platysmal bands. The surgeon must be flexible in dealing with these structures than what they advertise. The surgeon also evaluates the tissue to know if it is properly meant for a SMAS flap or a deep plane approach. The key is whether or not they're doing the necessary procedures to maximize the benefit and get the results the patient is looking for.

When Dr. Prasad performs facelift surgery, he does some type of SMAS elevation procedure. This will restore the foundation of the face so that the skin doesn't stretch. If the surgeon pulls the skin alone, it can stretch and regress. There's always a certain amount of regression no matter what, but if the surgeon lifts the SMAS, they are able to maximize the foundation.

It's best for her to do some consultations and meet with some surgeons. She should learn from the surgeon and the staff in the office about what the typical recovery is and the level of patient satisfaction. It's not so much about the technical abilities but it's more about the communication, the artistry and the understanding between the patient and doctor about the ultimate desired result.

For more information, visit our website:

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How to Correct Lower Eyelids Pulled Down from Previous Surgery with an Oculofacial Specialist
How to Correct Lower Eyelids Pulled Down from Previous Surgery with an Oculofacial Specialist

A woman in her late 60s has hollows in her lower eyelids and some rounding due to a previous surgery done many years ago. She is asking if AlloDerm and fat transfer may help correct it.

Dr. Amiya Prasad is an oculofacial plastic surgeon practicing for about 20 years. He is boarded with facial cosmetic surgery as well as body, breast and extremity surgery. He does everything from head to toe including hair restoration. So with no limitations with his scope of surgical procedures, he explains the different things he has done to patients who come to him who have the same issue known as lower eyelid retraction.

The lower eyelid has three essentials parts that helps its position: the lateral canthal tendon which is the attachment of a very important connection between the lower eyelid and the bone of the orbital rim; the internal support of the lower eyelid which are like pillars - these support underneath the eyelid is referred to as the posterior middle lamella; last is the amount of skin available to physically move upward. A lot of people have come to Dr. Prasad who had too much skin removed from their lower eyelid resulting in the combination of eyelid retraction or a rotation of the eyelid away from the eye called ectropion. When a patient comes to Dr. Prasad, he'll do an assessment to evaluate all of these factors. He assesses if they have enough skin and if they have enough support in the lower eyelid. He also assesses if their eye is projected outward and the strength and position of the lateral canthal tendon. These make up the dynamics and physics of the way the lower eyelid is positioned.

Dr. Prasad has had experiences using posterior middle lamellar grafts such as hard palate mucosa and Alloderm but what he has been doing in his practice for the past couple of years is using a material called Enduragen. Enduragen is a material derived from pig dermis. This doesn't mean that Alloderm is not an acceptable choice; every surgeon has their own ideal way of combining their procedures and materials with what works with them.

Fat transfer can also be a good option. However, Dr. Prasad doesn't do fat transfer as part of his primary procedure which is to restore the anatomy. He would reposition the lower eyelid into its proper anatomical position. Lower eyelid position is very important for proper eye function such proper distribution of the tear film. A bowed eyelid cannot contribute to good ocular health. Since this is a more advanced and complex procedure and there's grafting involved, there is a time frame for things to heal. After the eyelid has healed and is in proper position, then fat transfer may be appropriate.

Dr. Prasad also does adjuvant therapies such as the use of platelet-rich plasma and extracellular matrix for improvement of wound healing. This is a type of procedure that requires a lot of initial care after the surgery. At this point, it is best that she meet with several oculofacial plastic surgeons and get some opinions as to what will be their approach. After that, she can move forward with choosing one she is comfortable with.


For more information, visit our website:

http://prasadcosmeticsurgery.com/prasad-face-eyes/eyelifts/lower-eyelift/

How Puffy Eye Bags are Removed Permanently, & Why the Procedure Doesn't Leave Sagging Skin or Scars
How Puffy Eye Bags are Removed Permanently, & Why the Procedure Doesn't Leave Sagging Skin or Scars

A 27-year-old woman has bags under her eyes which never go away. She wants to know the definitive procedure for this

Dr. Amiya Prasad, an oculofacial cosmetic plastic surgeon practicing for about 20 years in Manhattan and Long Island, says that this is probably the most common thing that he deals with. When people have puffiness under their eyes, people often think it's because of lack of sleep and diet. Certainly, those factors can have an impact, but when someone always has puffiness under their eyes, it is called lower eyelid fat prolapse. This is a situation where the fat that is normally around the eyes, pushes forward and creates a bulge referred to as herniated fat. Some people will use the approach of using topical creams and even use fillers to try to camouflage the puffiness under the eyes. Fillers such as hyaluronic acid can help camouflage lower eyelid fat prolapse but in Dr. Prasad's experience, it is usually minimal lower fat prolapse that is amenable to this type of treatment.

In Dr. Prasad's practice, the typical procedure that he recommends is called lower eyelid transconjunctival blepharoplasty. This is a minimal surgical procedure done from the inside of the eyelid so that there's no external incision or scar. He is able to sculpt and reposition the fat so that the eyelids have a nice natural contour as if the patient never had fat pockets. A large percentage of his patients had barely any swelling or bruising of any significance after a week. Sometimes the patient can get a little bruise under the eyes in a week, but it easy to hide with makeup. By two weeks, most of the bruising is gone. Dr. Prasad would often argue that people who are trying to avoid surgery and subject themselves to multiple types of fillers and injections can get more traumatized with the injections than with this very delicate and precise approach to reducing the fat pockets.

Dr. Prasad would combine transconjunctival blepharoplasty with platelet-rich plasma injections which is derived from the patient's own blood. He will inject platelet-rich plasma to people with very crêpey skin or hollowing in the tear trough area to help stimulate the collagen and increase the vascularity or blood supply of the skin. This is a very leading edge technology borrowed from orthopedic and oral surgery for wound management.

As far as the question about sagging skin, Dr. Prasad has done transconjunctival blepharoplasty in their 70s. When there is no excess skin, the skin will retract inward and this is because of the muscle around the eyes. The muscle called the orbicularis muscle will actually push inward. Genetics, environment and medical stresses are all factors of how the eyelid will age. Dr. Prasad suggests that she take care of herself from a foundational perspective such as having a good diet, doing some exercise and having enough sleep.

For more information, visit our website:

http://prasadcosmeticsurgery.com/prasad-face-eyes/eyelifts/transconjunctival-blepharoplasty/

Approaching Puffy Eyes and Hollow Tear Troughs With a Combination of Procedures
Approaching Puffy Eyes and Hollow Tear Troughs With a Combination of Procedures

A 28-year-old woman has noticed her eyes becoming bulgier in the past 3 years. She wants to know if she needs fillers or should she consider surgery to removed the herniated fat.

Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon, deals with this kind of issue every day of his practice. The puffiness under the eyes is called lower eyelid fat prolapse. Lower eyelid fat prolapse, especially if one is younger, is more of a genetic condition. The fat that is normally around the eyes goes forward, causing the eyes to appear bulgier. Factors that can play a role in this condition are smoking and allergies. Unfortunately, the tear trough area can look so deep and hollow because of the volume of the adjacent fat that is pushing forward and creating a mountain.

In Manhattan and Long Island, a lot of non-surgeons are trying to help people without surgery by placing ridiculous amounts of fillers in order to hide this fat prolapse. As a cosmetic surgeon, Dr. Prasad can do all these procedures so he tries to advise his patients in a way that will help them get the best results with the least amount of expense and something that's as definitive as possible.

Dr. Prasad's typical recommendation for a young person like her is to undergo a procedure called transconjunctival blepharoplasty. This is a procedure where the fat pockets are addressed from the inside of the eyelid. This way, any external scar can be avoided. This type of procedure not only addresses the puffiness but can sometimes really make a difference in the relative hollowing of the tear trough. That doesn't mean that a lot of his patients have a certain amount of volume loss in the tear trough area. In fact, a lot of women who are physically active can have relative hollowing in their late 20s or 30s. The loss of fat can result in effacement or revealing of the bone of the eye and you see the hollowing.

Dr. Prasad's typical strategy for someone who has lower eyelid prolapse is to address the fat pockets first and then assess whether or not it makes sense to make any kind of volume enhancement in the tear trough area. He usually uses fillers such as Restylane and combines it with platelet-rich plasma. Platelet-rich plasma borrows technology from the orthopedic and oral surgeons, and Dr. Prasad has been successful in helping skin quality and volume loss in the tear trough area in a very synergistic manner by combining with Restylane.

Dr. Prasad thinks that a blepharoplasty is a more definitive procedure for her. He also recommends that she meet with a qualified experienced surgeon who performs a lot of eyelid surgery. It is important that she resonate and feel comfortable with the doctor she chooses.

For more information, visit our website:

http://prasadcosmeticsurgery.com/prasad-face-eyes/eyelifts/transconjunctival-blepharoplasty/

The Causes of Temporary Multiple Creases and Indentation after Asian Double Eyelid Surgery
The Causes of Temporary Multiple Creases and Indentation after Asian Double Eyelid Surgery

A woman had Asian double eyelid surgery. She is very concerned about the multiple creases that formed after the procedure. She wants know if this is normal or should she be concerned.

Dr. Amiya Prasad, an oculofacial cosmetic surgeon explains that swelling and wound healing after eyelid surgery are processes that take some time. He performs both incisional and non-incisional Asian double eyelid surgery and he can say that swelling is certainly a factor that isn't always easy to predict.

During surgery, Dr. Prasad asks the patient to open their eyes to see how it looks and how well the eyelid creases inward. This determines the ultimate result of the surgery. Whether it's an incisional or excisional surgery, multiple folds can be caused by the shifting of fluid not only under the skin but also behind or adjacent to the eye. In order to create a crease in someone who has a single eyelid fold, the surgeon needs to enter a space around the eye called the orbit to reduce the fat. In a very conservative way, some fat is removed to allow the connection between the eyelid and the muscle that lifts the eyelid called the levator muscle. Since this is a space that is more than skin deep, swelling can play a significant role in the normal wound healing process.

After eyelid surgery, there will be some fluctuations in the next few weeks. In some days, one eye is more swollen than the other and the next day it may be the opposite. Sometimes the side the person sleeps on can actually affect the fluid shifts. Most of Dr. Prasad's patients can go back to work after a week but there can be swelling between the eyelash and the crease called the pretarsal space. It can also be elevated making the crease look high. And when the patient had some fat removal, there can be some variability.

Dr. Prasad can't say by her photo that her concerns are not to be taken seriously but she anticipates that there will be changes as time goes on. The bottom line is that she should communicate with her doctor and observe the healing process. She should also understand that full eyelid healing is really somewhere between 6 months to one year. In fact, a majority of Dr. Prasad's before and after pictures were taken somewhere in that time frame.

For more information, visit our website:

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The Causes of Temporary Shedding after a Hair Transplant, & a Treatment to Stop Further Hair Loss
The Causes of Temporary Shedding after a Hair Transplant, & a Treatment to Stop Further Hair Loss

A gentleman had hair transplant surgery. However, he is very concerned after seeing some hairs that fell off. He wants to know if this is a normal process of hair growth.

Dr. Amiya Prasad say that there are a lot of factors that affects the amount of growth a patient will have after hair transplant surgery. This gentleman's condition is still very early in the course of his hair growth after the transplant. In his practice, even with a lot of advanced methods and hair regenerative technology that he employs, he still says that the full result is seen approximately one year after the transplant.

When hair is grafted, whether it's a follicular unit extraction or strip method, it takes the whole hair including its root and places it in another place - when this happens, shock loss occurs. Shock loss can be due to the impact of the swelling, or trauma of actual surgery resulting in shedding of the part of the hair. The shedding of the hair can apply to the grafts and also the existing hair adjacent to the transplanted area, which can result in an area looking barer than it was prior to the transplant. Fortunately, the root of the hair or the dermal papillae and the complex around it is intact.

In Dr. Prasad's practice, one of his standard approaches of helping minimize that transition phase has been the use of Hair Regeneration technology which he developed. Hair Regeneration is a combination of a wound healing material called extracellular matrix (ECM) and platelet-rich plasma (PRP). Extracellular matrix is derived from the pig's bladder and is combined with platelet-rich plasma drawn from the patient's own blood. With this advanced regeneration technology, the hair grafts tend to heal a little bit faster and the growth starts a little bit sooner. In addition, not only it is protecting the existing hairs from the shock loss (telogen effluvium), it is also helping these thinning hairs become thicker.

Hair transplant surgery is ultimately limited by the donor area in terms of the number of hairs one can place. It is also limited to the area that is being treated in terms of how fast the existing hair is going to thin out. Dr. Prasad takes all these in consideration when performing a hair transplant and using Hair Regeneration to help the surgery.

As far as this gentleman's question is concerned, Dr. Prasad thinks it's very important that he speak with his doctor or speak with the staff at his doctor's office. In Dr. Prasad's practice, he sees his patients very frequently. Understanding that even though full hair growth will not occur to its fullest extend until about a year, it's important that he sees his patients every 3 months minimum and the door is very much open for them to come in within that time frame. He will also do microscopic examinations and see how things are progressing so that the patient understands that this is a natural process. Ultimately, the success of the surgery will be determined after approximately one year.

For now, Dr. Prasad thinks it's fine that he is using the minoxidil. There are some evidences that minoxidil topical will help synchronize the hair growth cycles. But he should understanding that throughout the process, there are hairs that will shed and hairs that will start to grow in until he reaches that equilibrium somewhere at the 1 year point.

For more information, visit our website:

http://prasadcosmeticsurgery.com/prasad-hair-restoration/hair-transplant/

How to Address a Lax Lower Eyelid and Improve the Health and Texture of Eyelid Skin
How to Address a Lax Lower Eyelid and Improve the Health and Texture of Eyelid Skin

A gentleman has a very pronounced tear line and hollow eyes. A month ago, the eyelid and skin suddenly dropped and suddenly loose skin is making the line of tear line worse. He wants to know how to solve his problem.

Dr. Amiya Prasad, an oculoplastic cosmetic surgeon practicing for 20 years and who is also boarded in facial cosmetic surgery, performs a lot of facelifts and cheek implants. He recognizes how challenging it is to help people understand the basic issues about facial aging. Often, the same symptoms that one has are things that happen to younger people as well. This means that genetics plays a very big role.

The eye area is very sensitive to the effects of environment and stress. Dr. Prasad wrote a book called "The Fine Art of Looking Younger" where he explained that facial aging has to do with two basic issues: volume loss and descent or sagging. Volume loss is impacted in some people in ages 30s or 40s and sagging tends to occur a little bit later. Volume loss doesn't only mean hollowing under the eye. It also affects bone, muscle, fat, skin and soft tissue. With all these areas being affected, it is understandable that laxity can be interpreted as excess skin.

When Dr. Prasad evaluates a person, he does a few things to understand what the situation is. First, he looks at the anatomy and structure of the lower eyelid. The lower eyelid is connected to two parts of the bony part of the eye and sometimes there is an area of laxity, particularly in the lateral area called the lateral canthal tendon. If that's the case, then tightening procedures such as canthoplasty or canthopexy, lateral tarsal strip and orbicularis muscle strap are all good options.

To address skin quality under the eyes, Dr. Prasad uses something called platelet-rich plasma. Platelet-rich plasma is from the patient's own blood that is centrifuged or spun to concentrate a part of the blood called the serum platelets and plasma. This has tremendous benefit in improving skin quality in the eyelid area, in the face for acne scars and for wrinkles. Athletes are also using injections of platelet-rich plasma for joint and chronic injuries. Sometimes he combines this with conservative thermal treatmen because from his experience, he found out that excess thermal energy has resulted in thinned skin. That being said, a technology that he uses called fractional CO2 laser has been very advantageous for a lot of his patients because there is a certain resurfacing component when the top layer of skin is freshened up.

To add volume in the tear trough or under eye area, fillers such as Restylane or something in the hyaluronic acid family can be very effective. Dr. Prasad has also seen synergy in the combination of hyaluronic acid with platelet-rich plasma. Unfortunately, there is some variation. Just like everybody can exercise and develop muscle differently, the response to the hyaluronic acid and the platelet-rich plasma has to be observed to determine the frequency of repeat treatments. He would not recommend fat transfer directly into thin eyelid skin area. He has had patients who have come to him from all over the world requesting excision and removal of fat that didn't turnout well. That is, unfortunately, the reality of a lot of fat transfer because fat and fatty tissue can heal in an irregular way and the skin is not very forgiving.

There is no perfect solution which is a singular, surgical and one-time one when people talk about volume loss. There is a strategy, finesse, artistry and clinical observation. At this point, it's best that he meet with some qualified experienced doctor who is very familiar and comfortable in this area.

For more information, visit our website:

http://prasadcosmeticsurgery.com/prasad-face-eyes/facelifts/

How Hair Loss Affects People Differently at Specific Age Ranges and How to Stop Further Hair Loss
How Hair Loss Affects People Differently at Specific Age Ranges and How to Stop Further Hair Loss

A 33-year-old male has a high hairline and has thinning in the crown area. He wants to know if he is a candidate for a hair transplant.

Dr. Amiya Prasad says that it is relatively clear in the photo that the crown in the central area of the man's scalp appears to be thin. It is possible that hair products like gel can make hair look a bit thinner because of the clumping, but it's also not unusual for someone in their early 30s to start losing hair. There is a general rule of thumb that people use in the hair restoration world called the rule of decades for male pattern hair loss: in the 20s, only 20% of men are losing hair; in their 30s, 30% and it increases every decade. Something that someone cannot predict is the rate of the progression. Male pattern hair loss is bewildering and there are rumors about how to predict one's own future like the "rule" of the maternal uncle as being the person to determine someone's hair loss (untrue). It's actually a set of genes that are variably expressed that determine hair loss. Within the same siblings, they can have different patterns of hair loss.

There are a lot that people don't know about the behavior of the hair follicle and that is what makes the hair loss treatment process so limited. For several decades, universities and private companies have been working in identifying the keys and signals responsible for hair growth. There's a lot of research going on and every two years or so, you hear something new that is found. Unfortunately, the dream of hair cloning and transplanting it is not yet possible.

There are many options for male pattern hair loss. Specifically in the United States, there are two drugs which are FDA approved. Minoxidil with the trade name Rogaine is a topical that can improve hair that is thinning. It doesn't reverse the hair loss but appears to thicken some hairs as well as prolong the growth cycle of the hairs. The other drug is finasteride (trade name Propecia). It is a drug that inhibits an enzyme called 5-alpha reductase which is responsible for the conversion of testosterone to dihydrotestosterone. This is based on the understanding that hair follicles have androgen receptors and are sensitive to dihydrotestosterone.

Currently, there are a lot of concerns about the sexual side effects of finasteride so a lot of younger men who are coming to Dr. Prasad in their 20s and 30s don't want to take it. Ironically, he has seen some men in their 50s and 60s who have been taking finasteride since it first came out and they have had no side effects.

In Dr. Prasad's practice, he has had a great opportunity to develop a process called Hair Regeneration. This happens to be a serendipitous discovery where a material called extracellular matrix was used to help improve the healing of a transplant area and improve the growth of the transplant follicles. At the same time, it appeared to thicken thin hair. He developed an injection method where he is able to treat hair loss or thinning using this extracellular matrix and platelet-rich plasma. Platelet-rich plasma is from the patient's own blood which is spun and concentrating the areas called platelets and plasma to maximize the effects of extracellular matrix.

Many of Dr. Prasad's patients who are in their 30s who don't want to take finasteride and are balancing the options of choosing transplant ultimately choose Hair Regeneration as their preferred option. One reason is that it's an injection and it's not a transplant surgery. There's also an understanding that hair transplantation does not stop progression of hair thinning. Dr. Prasad has seen men who have had multiple hair transplants and they've lost their existing hairs. They are left with only their transplant and they have this pluggy look. It keeps a lot of people from even considering a hair transplantation.

With 2-3 years of data, Dr. Prasad has generally not needed to repeat the Hair Regeneration injection. There are occasional patients that he must repeat the injection but he evaluates them very carefully. He follows them with microscopy as well as with the digital photography to watch their progression after he does the injection. By saving the hairs, one is able to thicken those thin hairs that will fill a lot more effectively that any hair transplant can.

For more information, visit our website:

http://prasadcosmeticsurgery.com/prasad-hair-restoration/understanding-hair-loss/

The Causes of a High Female Hairline, and the Factors & Options in Lowering It
The Causes of a High Female Hairline, and the Factors & Options in Lowering It

A woman wants to match her temples with her hairline. She wants to know how many grafts she would need.

Dr. Amiya Prasad explains that a woman's hairline can be genetically high or from a receding hairline. For some people, that's part of their genetic hair loss pattern and for some other people, it's related to wearing very tight pony tails which is called traction alopecia. One first needs to be sure that their hairline is stable in order to do an accurate and effective treatment, and also so that they can anticipate what will happen in the future.

If this woman's family tends to have stable hairlines, and don't recede, then she can make a decision about how to strategize the hairline lowering process. One option is a hairline transplant. However, the number of grafts is based on the donor area otherwise known as the permanent zone. This is located at the back of the scalp where the hair never goes away and it's genetically resistant. This means that the hair transplantation is limited to the number of hairs that can be moved from one area to another. Sometimes in a hair transplantation where the hairline was made too low, the hair gets thin and you can see their grafts or plugs after 10-15 years.

When Dr. Prasad does a transplant, he tries to place 20-40 hairs per square centimeter. If the patient wants to make it look thick, they may require 60-70 hairs per square centimeter. In his practice, he works from the back to the front. Unfortunately, there are doctors who work from the front to the back and this can tend to make the grafts look wide apart, sparse and artificial. So Dr. Prasad takes the maximum amount of hair he can one at a time whether by a strip method or follicular unit extraction and counts the amount of grafts. Then he'll work at the beginning point of the hairline and build forward. This way there's a feathering effect and it doesn't look as obvious. If the goal is to move the hair one inch down, he might be able to accomplish a bit but the patient may need to anticipate a second transplant if they want to get the maximum density they desire.

In Dr. Prasad's practice, he tries to maximize the yield of the transplant through a method of Hair Regeneration technology using extracellular matrix and platelet-rich plasma. In hair transplant surgery, it's not just about how many hairs one can move, but also how many hairs that will actually thrive. This is because a graft has been removed from its blood supply then placed into a new area. One must not assume that if they move 1500 grafts, they'll get 1500 grafts growing. He has seen the full range from people coming to him from all over the world where they can get anywhere from 10% loss to over 90% loss of transplanted hair. So what he does to maximize the results is employ excellent surgical technique and also Hair Regeneration technology.
Often there are actors and people in the public eye that have an unnatural look because the hairline looks too straight. A natural hairline is variable, feathered and curved. One can't tell a good transplant when you see it because it looks very natural. Dr. Prasad suggests that this woman meets with some qualified experienced hair restoration specialists and learn about her options. She should consider the range of what would make her satisfied with the results what she would ultimately get. In addition, density, donor area and the thickness of hair are some of the factors that Dr. Prasad considers when he examines a patient. If hair is thin, it covers less scalp than thick, coarse hair. Dr. Prasad does measurements and make drawings to show how much he can cover so it's communicated well to his patients.

For more information, visit our website:

http://prasadcosmeticsurgery.com/prasad-hair-restoration/about-a-cell-technology/

Why Hair Graft Survival is an Important but Often Overlooked Factor in Hairline Lowering/Transplants
Why Hair Graft Survival is an Important but Often Overlooked Factor in Hairline Lowering/Transplants

A 29-year-old woman wants to lower one side of her hairline to make it more symmetric with the other. She wants to know the best procedure for her.

Hair transplant surgery to lower the right side of your hairline requires achieving a certain amount of density and space to be covered. From Dr. Amiya Prasad's clinical experience, she'll need about 2 sessions a year apart in order to get the maximal density and volume that she desires. She'll also get a few different opinions from other doctors about what is ideal for her. One thing that is overlooked during these consultations is that it is not about the number of grafts, but the number of grafts that will survive after the transplant. Some people measure results by the number of hairs doctors would place per square centimeter. In reality, it's not about the doctor's ability to do the surgery because any competent doctor can place as many hairs that he wants. The real measure of a successful hair transplant is the number of hairs that survive. With this understanding, patients are able to appreciate their game plan when it comes to hair transplantation surgeries.

Dr. Prasad has seen patients who have come to him from all over the world who had very large number of hairs transplanted but had up to 90% of the hair grafts lost. So in his practice, he has been able to help a lot of his patients with something relatively new to the hair field called Hair Regeneration. This is a procedure using a material called extracellular matrix (ECM)by ACell combined with platelet-rich plasma (PRP). Platelet-rich plasma is derived from the patient's own blood that is spun down to concentrate the healing factors in the plasma called platelets. ECM and PRP have wound healing properties. He is using this technology he developed for these past several years to enhance and maximize the survivability of the hairs that are transplanted.

When Dr. Prasad does his transplantation procedures in cases like this woman's, he actually starts from the back and feathers forward. This way, as the patient heals and the hairs grow, it doesn't look so sparse. Even if the transplanted hair appears very close together during surgery, compared to what nature creates, these transplants can look artificial until a second procedure.

This woman's situation has a lot in her favor. Since she's dealing with a limited area and she doesn't have an issue with hair loss at this point of her life, she has more than enough donor area in order to transplant the hairs. But Dr. Prasad would advise her to look very critically at the opportunities to maximize every procedure she has. Even if she has two procedures, it is best to maximize the survival of the grafts. In addition, she also has to consider if she has a family history of hair loss.

For more information, visit our website:

http://prasadcosmeticsurgery.com/prasad-hair-restoration/about-a-cell-technology/

The Causes of Malar Bags and Puffy Eyes and How they Can Be Treated
The Causes of Malar Bags and Puffy Eyes and How they Can Be Treated

A 39-year-old male has puffy bags on his cheek bones. He asks for suggestions on how to fix them.

Dr. Amiya Prasad, an oculofacial cosmetic surgeon, explains that malar bags are caused by: sinuses, allergies and smoking. These conditions drain fluid in an area behind the eyeball called the cavernous sinuses. Through time, they become static at the malar area. If these are not the issues that cause the malar bags, then most likely it's a genetic problem.

When patients who have malar bags come to Dr. Prasad, he first assesses their face especially their eyes so that he can maximize the improvement of their appearance. Malar bags may bother this man so much but he must also observe that he has puffy areas around his eyes. This is called lower eyelid fat prolapse. However, since this is not his concern as of the moment, Dr. Prasadcould only point that out to him.

A person's eyes tell so much about how one feels. There is certain type of non-verbal communication when someone looks at a person's eyes. When a person has puffiness under their eyes, they are often perceived as being tired or even old. This has a tremendous impact on social and professional life, leading people to look for some type of solution.

The options that have been used for malar bags and festoons are lasers and peels. In Dr. Prasad's practice, he tends to avoid anything that adds heat to an area. Clinical studies and pathology reviews have showed that there's fluid in the malar area because of inflammation or inflammatory cells, so interventions where heat is used can actually make the problem worse. Sometimes, the easiest way to treat festoons is to remove them. He also uses fillers to try to soften the transition of the appearance of the malar festoons, but because of the complexity of the area, the use of fillers can be frustrating.

Dr. Prasad suggests that he take some full-faced photos and ask people how his eyes look, not merely focusing on the malar festoons but also look at the under eye bags. If he is motivated, then he should pursue the things that would yield a more predictable result.

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