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What Causes Tired Eyes in Young People, and Eye Puffiness Treatment Options
What Causes Tired Eyes in Young People, and Eye Puffiness Treatment Options

A 20-year-old gentleman has prominent and tired-looking eyes. He wants to know the ways to fix them.

Dr. Amiya Prasad, a specialist in facial aging and a cosmetic oculofacial plastic surgeon, asks his patients about genetic factors - if their appearance runs in the family. He also asks them about lifestyle issues that could affect the eyes like: lack of sleep, smoking, environment factors such as sun exposure or a toxic environment, and about stress which also affects appearance. One of the most common reasons people come to him is when their friends and coworkers comment about their eye bags.

One thing that Dr. Prasad noticed from this gentleman’s photo is that there is a bit of a puffy area in the inner aspect of the lower eyelids. This is called lower eyelid fat prolapse. Lower eyelid fat prolapse means that the fat that is normally around your eyes slightly pushes forward and creates a bulge. Dr. Prasad has operated on a patient as young as 14 who had significant bags under their eyes. He became withdrawn from school because everybody thought he was on drugs, so his parents brought him in and Dr. Prasad took care of the bags under the eyes.

During consultation, one of the questions Dr. Prasad would ask is if the eyes are puffy all the time or do they have good and bad days. If there is variability on how puffy they look and the eyes are very puffy most of the time, then that’s a good time to consider a procedure such as a lower eyelid blepharoplasty. They can also consider some conservative methods such as topical creams that are good moisturizers and things that are holistically good for them such as better diet, sleep and exercise.

If they feel there are aspects that they just can’t deal with, then consulting with qualified and experienced cosmetic surgeons will be a benefit. When they are getting opinions, they should remember that surgeries can’t easily be undone or reversed, which is a decision they have to live with. Often Dr. Prasad tries conservative measures first such as topical creams or even injections like platelet-rich plasma and Restylane to help improve the appearance. The nice thing about these modalities is that they are not permanent. If the patient doesn’t like them, they just disappear. If he really wants to do something that’s more definitive beyond lifestyle changes then he can explore these options.

The Limitations of Hair Transplant Surgery in the Early 20s, and How to Stop Hair Loss
The Limitations of Hair Transplant Surgery in the Early 20s, and How to Stop Hair Loss

A 24-year-old gentleman has been losing hair for the past 5 years. He has been taking medications such as minoxidil but didn’t see any considerable change. He wants to know if he is eligible for hair transplantation.

Dr. Amiya Prasad, a hair transplant specialist, explains that male pattern hair loss is genetic and it runs in families. In the United States, there are two FDA approved drugs for hair loss: one is minoxidil which is a topical agent that prolongs the growth cycle of thinning hair making it last longer on the scalp; the other is finasteride which is known as a blocker of an enzyme called 5-alpha reductase with converts testosterone to dihydrotestosterone (DHT). Dihydrotestosterone is the causative agent for hair loss but a lot of younger people continue to have thinning hair despite taking it.

When a patient is in their late 20s, the expectation of hair transplantation is very different compared to people in their 40s and 50s. From Dr. Prasad’s 20 years of practice, the Rule of Decades says that in men in their 20s, only 20% have significant hair loss while 80% have a lot of hair. When they have a transplant, they need to cover a very large area. However, the donor area or the area where the hairs are grafted has a limited number of hairs.

Presently, a lot of people are doing follicular unit extractions or FUEs and making openings far above and below the donor area. Unfortunately, these FUEs that are transplanted are not going to stay because it’s genetically programmed to thin out and disappear. Hairs should be strategically placed in order to maximize the amount of hair in the donor area. Sometimes they are placed in the frontal hairline to define the face. In order to get a really good result, patients usually need more than one session in order to get the density of a natural appearance.

Dr. Prasad’s has been performing a non-surgical procedure for hair loss called Hair Regeneration. He uses a material called extracellular matrix which was intended for wound healing. It was an accidental discovery that when used in the incision sites of a hair transplant, the hair around that area began to thicken. In his practice, extracellular matrix is combined with a blood product called platelet-rich plasma. This combination of a formulation and a delivery method reverses thinning hair. Instead of transplanting hair, it stops the progression of hair loss and thickens remaining hair. With 5 years of data, 99% of patients do not need re-injection.

Dr. Prasad advises that he should learn more about Hair Regeneration. He must also consider the medical options such as finasteride and minoxidil and learn more about these options before he makes a decision to pursue a hair transplant. Dr. Prasad would do Hair Regeneration first to thicken hair. Somewhere around 18 months, he might consider a secondary injection.

Under Eye Dark Circle Treatment Using Platelet-Rich Plasma and Hyaluronic Acid Fillers
Under Eye Dark Circle Treatment Using Platelet-Rich Plasma and Hyaluronic Acid Fillers

A 26-year-old woman has dark under eye circles. She wants to know a permanent solution to get rid of them.

Dr. Amiya Prasad, an oculofacial plastic surgeon, explains that dark under eye circles are mainly caused by genetics. 20 years ago, he didn’t really have that many options to offer his patients who had dark under eye circles. He would do things like glycolic acids and retinoids to improve the skin quality but they were limited. With the introduction of hyaluronic acid fillers around 2005, he started to see some possible options even though they weren’t initially used for dark circles under the eyes.

Dr. Prasad first looks at the anatomy to determine if the cause is coming from relative hollowing. If that hollowing is genetic or volumetric loss from aging, it’s part of the decision-making plan. If there is volume loss, he uses a hyaluronic acid filler like Restylane to augment or to restore some volume under the skin at a level that’s closer to the bone called the tear trough. That has to be done very carefully and meticulously. Unfortunately, a lot of people don’t get the best results so they come to him to dissolve the hyaluronic acid filler with a material called hyaluronidase.

The second option is using platelet-rich plasma. This material is also used in orthopedic and oral surgery. It is derived from the patient’s own blood. He spins the blood to concentrate the growth factors and platelets which are the critical cells for healing. When platelet-rich plasma is injected under the skin in the appropriate candidate, it improves skin quality, blood supply and collagen. He follows his patients every three to four months and then he re-evaluates. If the skin quality looks improved and the patient is satisfied, then he just basically waits and sees how long this particular treatment lasts for them. There are some patients who come in for PRP treatments or platelet-rich plasma treatments once a year, others come twice a year, and others come three to four times a year. It’s very individualized because there are factors such as age and environmental factors.

Both hyaluronic acid and platelet-rich plasma are not permanent solutions. In a way, that’s an advantage because unlike surgery, it’s something that someone doesn't have to live with forever. The patient can see how they respond to it and then decide if they want to integrate it in their lifestyle.

For people with lighter skin types, Dr. Prasad also has other options including lasers. For somebody with a darker skin type, lasers are usually not an option because there’s a risk of hyper or hypopigmentation. In addition, he wouldn’t completely discourage moisturizers as a solution to dark under eye circles because moisturizes do have a role. They don’t completely resolve the problem but they work in combination with other solutions. For example, he has patients who benefit from hyaluronic acid injection, platelet-rich plasma and a good topical cream.

Dr. Prasad thinks it’s probably a good idea for this woman to meet with some doctors now that she has learned more about these options. She can actually ask more specific questions, look for examples of before and after pictures and see if it’s an option for her to try.

How Swelling after Ptosis Surgery Can Raise the Eyelid, and the Right Time for Enhancement
How Swelling after Ptosis Surgery Can Raise the Eyelid, and the Right Time for Enhancement

A woman had upper eyelid ptosis surgery. However, swelling changed the shape of her eyes. She wants to know if this is temporary or if she needs an enhancement.

Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon, explains that ptosis surgery is one of those types of surgery where predictability is sometimes tricky. When doing this surgery, he wants to achieve the appropriate height, contour, symmetry and the aesthetics of the eyelid. When he performs ptosis surgery, he allows the patient to be awake during the procedure. The patient won’t feel anything because the area is numb, but he’ll have them open and close their eyes and even sit them up during the surgery. This is the best way to predict the outcome because the muscle is very sensitive and the eyelid backbone and tissue are delicate and can easily be affected by a variety of factors.

In every ptosis operation, there is a possibility of under-correction where the eyelid is too low or overcorrection where the eyelid is too high. However, only the patient’s doctor knows what happened during the surgery. Sometimes, the surgeon would overcorrect because they anticipate that the eyelid will come down after some time.

When Dr. Prasad does a ptosis evaluation, he measures the function of the muscle that lifts the eyelid called the levator muscle to see how strong it is. When the muscle is weaker, he sometimes over-corrects because the muscle is weak and there’s a tendency for the eyelid to drop down a bit. When a person has a normal levator function, he usually tries to make the eyes relatively symmetric during the surgery because he expects that after the healing, there’ll be some stabilization.

In the normal human population, there is always about a 1-2mm difference between the height of the two eyelids. As long as the patient is within that range, it’s acceptable. In this woman’s case, her doctor will be able to guide her as to why she looks this way, and whether or not this is a case of someone who is over-corrected. If that’s the case, the timing as to when to make an enhancement is also something that her doctor will help her decide. In Dr. Prasad’s practice, he usually waits for swelling to resolve to a reasonable level so that he can work on tissue that isn’t swollen but he does his enhancements on a case-by-case basis. Clearly with this photo, there is a difference between the two eyes. The right eye definitely does look more open and round but in the absence of other information, it is difficult to make a prediction.

Sometime after ptosis surgery, a bit of massage will help stretch the tissue out and allow for a little of descent. Dr. Prasad had patients who initially looked overcorrected, but with a little time it came down to a point where it looked appropriate. Dr. Prasad thinks that she should keep the faith and maintain communication with her doctor. She should work with the doctor about moving forward with any other adjustments that may be required later on.

Possible Causes of Descent After Lower Face & Neck Lift, and Platelet-Rich Plasma for Skin Treatment
Possible Causes of Descent After Lower Face & Neck Lift, and Platelet-Rich Plasma for Skin Treatment

A woman had lower facelift but now her skin is loosening around her neck. She wants to know the procedures to remedy it.

Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon, explains that during face and neck lifting, there is a balance as to how much sagging skin and muscle could be tightened that doesn’t create excess tension. He explains that facelift scars are caused by stretching and by procedures such as mini-lifts where too much skin was removed. These types of procedures do not involve the deeper structures so surgeons try to pull the skin as tight as they can until the skin widens and stretches. Skin is elastic and stretchable only to a certain extent. When a patient has this procedure done, there’s always a little bit of swelling afterwards. As people get older, the skin gets thinner so interestingly, a lot of people look a little bit better when there’s a little swelling.

Dr. Prasad always explains to his patients that when he does surgery, he tightens, resects or trims and does everything to make things look really good. A certain percentage of patients will have significant regression where the skin will stretch. Every time a person turns their head and brings their chin up they are stretching the skin. He will do enhancements to try to maximize the improvement of the neck and jawline. Sometimes, the face descends a bit and the skin collects under the chin so more aggressive lifting is necessary. He always makes sure to differentiate skin quantity versus skin quality.

In Dr. Prasad’s practice, he enhances skin quality with procedures like the injection of platelet-rich plasma (PRP). Platelet-rich plasma is derived from the patient’s own blood. It is a concentration of the healing factors that stimulate healing. With this method, he actually improves skin quality that includes the backbone of the skin, the dermis with collagen, and blood supply to the skin so the skin looks healthier. Even the fatty layer of the skin will improve which is shown in studies with biopsies.

Dr. Prasad suggests that she look at her before pictures, have a sense of what is realistic and then make a determination. If the surgeon feels that they can really get something done, then she might be a candidate.

The Advantages of a Hair Transplant for Hairline Lowering with Hair Thickening Treatment
The Advantages of a Hair Transplant for Hairline Lowering with Hair Thickening Treatment

A gentleman had a high forehead since birth. He wants to know the benefits of a hair transplant and forehead reduction surgery.

Dr. Amiya Prasad, a hair restoration specialist explains that a “pluggy” appearance after a hair transplant is a result of loss of native hairs around the transplanted hair leaving the individual grafts. It is not because the hair transplant was not done properly. In addition, the patient may not have taken medication such as finasteride to try to slow down the hair loss progression. They might have never responded to the drug or had a drug side effect causing the further loss of hair.

Forehead reduction requires an incision that can be camouflaged very effectively when there’s hair. If the hair were to recede, then the incision could be apparent. For younger patients, they have to think of the future and be prepared for the consequences of making a decision. If their family history has lots of thick hair and no one recedes, then the discussion about their options should be a balance of what would happen if for any reason they did have some recession. They have to make a choice between an incision scar or the presence of grafts.

In Dr. Prasad’s practice, he tends to lean towards doing grafts. He uses a method called Hair Regeneration which has a vaccination effect and prevents the progression of hair loss in the area where the grafts are placed. In addition, Hair Regeneration maximizes the benefits of the grafts. During a hair transplant, not all grafts will survive and that’s a limitation considering the donor area is very limited. When he does a transplant, he combines it with Hair Regeneration to preserve existing hair as well as to maximize the survivability of the hair grafts.

If someone wants to lower their hairline, they should be prepared for two surgical procedures in order to achieve the optimum density that will give them the results that they desire. Nature creates a type of density which is fantastic and beautiful. From a surgeon’s perspective, recreating that with one transplant is challenging and it has to be done in a way that is natural and dense. Dr. Prasad has found that it takes two procedures to do that. This gentleman’s next step is to meet and have consultations with doctors who perform both procedures and learn about his options. He should think about the future possibility of hair receding and how it may impact his appearance.

The Extent of Different Facelift Procedures, and Revising for Better Neck Lift Results
The Extent of Different Facelift Procedures, and Revising for Better Neck Lift Results

A woman had a full facelift but was not happy with the results. She wants to know what type of facelift would be good for her after having a full facelift.

Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon, explains that initially after a facelift, an improvement of the jawline and the cheek and the neck means that the patient had good results. The results she is currently having may be a result of regression or relaxation. No matter who does the facelift, how well it’s done or how technically proficient the doctor is, there is always a certain amount of relaxation and elasticity.

The challenge with face lifting surgery which Dr. Prasad wrote in his book “The Fine Art of Looking Younger” is the sagging of tissue. There are two critical elements which cause the face to sag: one is that the skin gets thinner and stretches as we get older; and the is second, a deeper layer of muscle that is referred to the platysma or superficial musculo aponeurotic system (SMAS) is affected.

A facelift can mean anything from a short scar limited facelift to a facelift incision which goes from the temple to behind the ear. When Dr. Prasad does a face and neck lift, he extends the incision to behind the ear and into the hair so that he can address the band under the neck as well as the sagging skin. He also typically makes a small opening under the chin in order to do something called platysmaplasty. When Dr. Prasad looked at this woman’s photos, he noticed the two platysmal bands so something can be done to enhance the neck definition.

The definition of a facelift is often misinterpreted. Many think a facelift includes the brows where the incision is made on top of the head, but that is a brow lift. A facelift incision is at the temple to lift the cheek and the jawline. In contrast, a neck lift is more for sagging skin. Sometimes, a facelift will address a significant part of the neck depending on how old a person is. In a younger patient in their 40s or 50s, sometimes tightening the SMAS with limited platsymaplasty or release can give them really nice neck definition without making that incision in the back.

As far as the original procedure is concerned, they may want to discuss this with the original surgeon and ask what can be done in order to get the results that they desire. Often people want a conservative procedure where they have a 60-70% improvement in the jawline which in consultation they were willing to accept, but then they want more which is completely understandable. In Dr. Prasad’s consultations, he actually spends a lot of time discussing the details of what is involved to get optimal full correction.

Some patients end up with bad scars, pixie ears and a pulled down appearance when done by some of these people who do mini or shortcut procedures. Dr. Prasad ends up doing the full proper face and neck lift regardless of what their operative result state or the information they provide because it just doesn’t make much of difference when he is actually in surgery. The decisions are made in real-time during surgery with some projection and anticipation prior.

This woman is probably a candidate for either an enhancement from the prior procedure or a full face and neck lift based on the photos she submitted. The one thing that Dr. Prasad can’t do is a physical exam to feel how much tension there is and what the realistic expectations would be. Enough time has passed to allow for tissue swelling and other factors to be resolved. He recommends that she meet with her original surgeon and see if he can resolve this issue. If that’s not a viable choice for her, she can meet with additional doctors and consider the options of having a face and neck lift. She must avoid shortcut mini procedures as they tend not to work with this much platysmal banding and the amount of relative sagging that she demonstrated in her photos.

How to Reduce Dark Circles Under Eyes with PRP Treatment and Other Procedures
How to Reduce Dark Circles Under Eyes with PRP Treatment and Other Procedures

A woman has hereditary dark circles. She wants to know the best treatment to fix them.

Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon, explains that there are creams of various kinds and a tremendous number of solutions for dark under eye circles. However, they are all basically moisturizers some with some tint. Dark circles are difficult to treat because they are caused by different factors including genetics which means pigmentation within the skin that runs in families. There is darkness from the pigmentation from melanin. Another factor that causes dark circles is the skin quality. A lot of people have very thin skin which gives a bluish appearance or a little bit dark because of the vessels. Sometimes the shape and the bones around the eye and also the way the skin drapes it accentuates various areas of hollowing. Lastly, aging and environment such as excess sun exposure or wind causes collagen to break down. The skin becomes crêpier and the skin quality diminishes.

In Dr. Prasad’s practice, he looks at his patients to know if they are dealing with any other issues that are also contributing to the overall appearance of the eyes such as puffy bags under the eyes, skin quality and the volume effect of the skin quality in that area. If there is loss of volume, there is an option to use a hyaluronic acid filler like Restylane along the tear trough area and the rim. This adds some thickness to the tissue underneath the skin and in the hollow areas to improve the dark circles. This requires proper patient selection as well as finesse in the technique. As a cosmetic oculofacial plastic surgeon specialist with 20 years of experience, he sees people who had this treatment done elsewhere and he needed to dissolve it because they got too much or it became irregular.

Another option that Dr. Prasad had a lot of success with even for hereditary dark circles is the use of platelet-rich plasma (PRP). Platelet-rich plasma is derived from the patient’s own blood. He does a blood draw like a lab test and spins it in centrifuge to get the growth factors and the platelets. This improves collagen, skin quality as well as blood supply that will actually help dark circles caused by genetics. However, if someone is too young, the skin quality is very fine so it won't make much of a difference even if he treats the patient.

Dark circles can also be a multi-factorial issue where it’s not only genetics but there are also some other lifestyle-related and environmental triggers. For example, there are patients who do a lot of water sports and they’re out in the sun. They’re young but they get a lot of ultraviolet light exposure which results in breakdown of collagen. The skin becomes very dry and very crêpey and so they do benefit from platelet-rich plasma.

Dr. Prasad explains that there is still a role for proper hydration of the skin. Eyelid skin is only half a millimeter in thickness and a lot of patients who have dark circles wear a lot of makeup and then use a plenty of makeup removal solution to remove it. They’re traumatizing and drying their skin. A lot of astringents have alcohol and they can be drying and irritating. Moisturizer does play an important role. People would also benefit with the use retinoids but Dr. Prasad does it very carefully because a lot of people can be sensitive to the retinoids. In his own practice, he actually has a particular moisturizer called Eye Rescue which is a combination of a moisturizer and some active ingredients that would be helpful. This definitely gave him a lot of good feedback from his patients.

He recommends that this woman meet with experienced cosmetic surgeons or aesthetic physicians to learn more about these treatments.

Why Asian Double Eyelid Surgery Swelling Two Weeks After is Normal Part of Surgical Recovery
Why Asian Double Eyelid Surgery Swelling Two Weeks After is Normal Part of Surgical Recovery

A woman had double eyelid surgery 2 weeks ago. She wants to know why her eyes are still swollen after the surgery.

Dr. Amiya Prasad explains that swelling at this time is typical. He does a lot of Asian eyelid surgeries and he can certainly share over 20 years of doing this surgery that there is some degree of variability between patients regarding the amount of swelling they have. Asian eyelid surgery requires a particular type of method that involves the fixation of the eyelid crease to the muscle that lifts the eyelid called the levator muscle. In order to create that crease, there has to be a connection made between the skin and the levator muscle. This can be performed both with an incisional or a non-incisional procedure.

After surgery, there is crowding in the tight space. Fluid has the tendency to back up between the eyelid crease and the eyelid margin. That swelling can take time to resolve. Swelling is often the reason patients panic because they feel that the eyelid crease is too high. This type of swelling in two weeks is normal and that swelling can linger and be variable in the course of several months and can go on to as long as one year. True surgical healing can take up to a year to resolve.

Dr. Prasad explains that the swelling she is experiencing is likely normal and the only things that he suggests to his patients to help resolve swelling is to manage any allergies, particularly eye allergies. They should also manage any sinus issues, get adequate sleep and do things that are healthy.

Dr. Prasad recommends that she contact her doctor’s office and meet with her doctor. Judging by the photo she submitted, it doesn’t appear that there’s anything unusual about her situation. She must understand that the body takes it’s time to heal and swelling does eventually get better, but the time swelling lasts varies between individuals.

Why Some Hair Transplant Results Take Longer to Grow, and Stimulating Hair Growth After a Transplant
Why Some Hair Transplant Results Take Longer to Grow, and Stimulating Hair Growth After a Transplant

A gentleman had a hair transplant, but his hair growth is slow after normal shedding and wants to know the cause.

Hair restoration specialist Dr. Amiya Prasad explains that a hair transplant is the movement of genetically resistant hairs. These are hairs that are at the back of scalp in the limited space called the donor area. Little openings are made called stab incisions and grafts are placed individually where the scalp is losing hair. A graft is composed of skin, the hair, the root or the dermal papilla, and some of the tissue that surrounds it.

After a hair transplant is performed, a phenomenon called shock loss happens. This is when hair grafts and the existing hairs in the scalp temporarily shed. Although hair thinning can be to the point where there is barely any hair, using a microscope many miniaturized hairs are seen. Even the existing hairs can go into shock. A transition period for several months happens after hair transplant where there is no growth.

As a general rule of thumb, at one year most of grafts have grown in. However, from Dr. Prasad’s experience he has seen patients who have growth as late as 18 months. There are different factors that will affect the results in one year. One of those factors has to do with the rate of hair growth. In his practice, he does a procedure called Hair Regeneration that reverses thinning hair. When he does this treatment, he follows his patients every 3 months. Because of this, he is able to classify people as fast, medium and slow growers. People who have very advanced hair loss tend to be slow growers.

Dr. Prasad does a combination of Hair Regeneration treatment with extracellular matrix and platelet-rich plasma to maximize the survival and the yield of the hair transplant, and reverse the hair thinning concurrently. Patients who appear to have less hair or didn’t even have much growth at all at 12 months have robust growth of their thinning hair as well as their transplant at 18 months.

It is not unusual for people to come to Dr. Prasad who have had "mega sessions" where tremendous amounts of hair transplanted and not have any growth. Factors such as elevated blood pressure and manipulation of the grafts can make the patient lose up to 90% of the hair grafts. This is not a very encouraging thing to hear when someone has a limited donor space and amount of hairs. In this gentleman’s case scenario, he can just wait and see how he is doing for another 6 months or so, and then try to determine what the yield is.

The survival of grafts is critical for the success of a hair transplant. This means that although a surgeon may move 2000 or 2200 hairs, the yield may be 10%, 20%, 30% less than what the surgeon transplanted. In the popular method of FUE or follicular unit extraction, there is a very high rate called transection where the hair follicle gets cut and the important part of the hair doesn’t grow. Interestingly, some of those hairs will have enough stem cell activity present that they can grow. Unfortunately, a lot do not.

Dr. Prasad has been using Hair Regeneration as a way to help people who have had transplants done elsewhere. They come to him at 1 month after their transplant, and then have the Hair Regeneration treatment. As early as 6 to 7 months, they had robust growth of both their existing and their transplanted hair. Hair Regeneration has been of value to maximize the healing process and to accelerate the process where the hair grafts actually grow.

Dr. Prasad thinks that it is very important that he meet with his doctor, discuss the details of his surgery, have his doctor examine his scalp, and let him evaluate his situation with a microscope. Moving on, he is going to have limitations in his donor area his next hair transplant if he is going to consider it. This is why a lot of people who have had previous transplants continue to find Dr. Prasad. He does Hair Regeneration injection for them to thicken their thinning hair and for many people, they actually avoid a second transplant. That way, they can save the donor area and have that banked for later if they ever need it.

What to Expect after Ptosis Surgery and Proper Revisions for Eyelids Still Drooping
What to Expect after Ptosis Surgery and Proper Revisions for Eyelids Still Drooping

A gentleman had conjunctival Muellerectomy performed by an oculoplastic surgeon exactly 2 months ago on his left eyelid. However, his eyelid still has ptosis after surgery. He wants to know if anything can be done to correct it.

Dr. Amiya Prasad is a practicing oculofacial plastic surgeon for 20 years and has done a lot of ptosis surgeries. He explains that there are challenges with ptosis surgery that makes it unique which is why most plastic surgeons do not ever do ptosis surgery. It involves a muscle in the eyelid called the levator muscle. Behind it is a muscle called Mueller’s muscle. Both muscles contribute to the lifting of the eyelid. The gentleman's doctor did a Mueller’s muscle shortening or resection which brings both tissues together.

In Dr. Prasad’s practice, he routinely lets the patient open and close their eyes during surgery both in a lying and seated position. They never feel any pain or discomfort and it gives him an opportunity to try to real-time adjust the height of the eyelid. These muscles are very sensitive and trying to get the ideal contour, height and symmetric result make it uniquely challenging. Dr. Prasad assumes that his doctor did something similar to that during his surgery and was satisfied with the result.

With the photo this gentleman submitted, Dr. Prasad assesses that the left eye looks like it is still drooping. Certain factors such as swelling can contribute to eyelid position. In the absence of a physical exam, there doesn’t appear to have significant swelling at this point. In Dr. Prasad’s practice, if someone didn’t have the optimal result whether the eyelid is too low or too high after the surgery, he’ll go back and make an enhancement or a different procedure. Dr. Prasad would probably do a levator muscle enhancement to get that eyelid contour and shape to be more symmetric with the other eye.

Dr. Prasad thinks that the left eye does deserve to be enhanced. There is probably a need for a different procedure performed in order to achieve that result. Sometimes after a procedure, the suture and the tissue separate and the eyelid droops again. This isn’t in any way a judgment to the skills of his doctor. If his doctor is an oculofacial plastic surgeon then he has a long history of doing this type of procedure and has appropriate training. Dr. Prasad thinks that he needs to meet with his doctor again. In 3-4 months, most of the significant swelling that would affect the surgery is typically resolved and he can probably safely have a revision procedure.

Factors that Affect Asian Double Eyelid Surgery, and Revision Surgery Using the Suture Method
Factors that Affect Asian Double Eyelid Surgery, and Revision Surgery Using the Suture Method

A woman is having problems with allergies and swelling causing the crease in her left eye to disappear. She had incisional double eyelid surgery and wants to know if she needs a revision.

Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon, explains that the challenge of Asian eyelid surgery has to do with several factors. He says that when doing this type of procedure, no two surgeons are exactly the same. The factors that affect the outcome are whether or not there’s excess skin, if the skin is thick or thin, and whether or not there’s fat present. There are also intra-operative issues such as the connection made between the skin and the levator muscle and how well that holds.

Dr. Prasad says that placing a piece of tape on the eyelid margin will actually force the eyelid to crease inward. However, he would suggest based on the absence of a physical exam and not being able to tell what her skin quality is or if her eyelid will cooperate, the non-incisional method or the suture technique that her surgeon suggested is possible to achieve this type of result. However, if she closes her eyes and the eyelid skin pushes away from the underlying muscle, then that crease is not likely to hold very well. If with the tape in place and her eye moves well and her surgeon really feels that this is possible, then it is probably worth pursuing. As long as there is no excess skin, then a non-incisional approach or suture method can create a necessary fixation for the eyelid skin to fold-in in a desirable height.

Dr. Prasad thinks that the best case scenario now is that she discuss with her surgeon. He says that this is generally a low risk procedure because no skin is being removed and the eyelid is not being opened up fully. It just involves several little entry points along where the desired crease is placed then the sutures are placed in those entry points to engage the levator muscle. He thinks that’s this is a decent option in terms of trying to achieve that eyelid fold. She should meet with her doctor to get a clear understanding of the process and the likelihood of her desired outcome.

What are the Possible  Complications of Blepharoplasty (Eyelid Surgery)?
What are the Possible Complications of Blepharoplasty (Eyelid Surgery)?

Eyelid surgery is one of the most precise and delicate types of cosmetic surgery. Eyelid skin is the thinnest skin in the body at less than half a millimeter in thickness. Dr. Amiya Prasad is leading Eyelid Surgery Specialist dedicated to helping his patients look better and maintain optimal eye health . Unfortunately many general plastic surgeons do not have extensive training and experience with eye anatomy and function which can lead to too much removal of eyelid skin creating an unnatural "surprised" look. Further, many people suffer from compromised eye health caused by the inability to close their eyes properly.

Lower eyelid surgery, frequently performed to remove puffy eye bags, is a common surgical procedure. Its popularity has unfortunately led to many patients having complications. Dr. Amiya Prasad, a leading eyelid specialist, performs lower eyelid surgery AKA lower blepharoplasty creating a natural-looking result that can leave virtually no trace of surgery. Many general plastic surgeons who perform the procedure have insufficient experience with eyelid support anatomy which results in eyelids being pulled down, skin exposure, eye overexposure, as well as excessive and visible scarring. Dr. Amiya Prasad performs complex reconstructive eyelid surgery for patients who come from all over the world who have complications.

Complications that may arise during or after a blepharoplasty procedure may include the following: (1) excessive bleeding, (2) infection, (3) undesirable scarring, (4) vision loss, or (5) double vision. These complications do not only affect your appearance, but can also affect the health of your eyes.

The term “complications”, however, must be clearly defined. For example, after having lower or upper eyelid surgery, your surgeon may need to address the issue of extra skin or more fat pockets. These are considered “enhancements” and not complications.

In Dr. Prasad’s practice, people often come to him for revision surgery in order to correct bad results from a previous surgery done by another surgeon. One of the most common reasons people seek out revision surgery is for lower eyelid retraction after lower eyelid surgery. This is a complication wherein the eyes become irritated from the exposure of areas on the eye that were previously protected with the normal position of the lower eyelid.

It is best to review these complications with your surgeon in order to determine how these complications are managed.

For more information, visit our website:

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

Or come to our clinic on the following address for a personal consultation today:

Manhattan, New York City: 61 E 66th St, New York City, NY 10065 * (212) 265-8877

Garden City, Long Island: 901 Stewart Ave, Suite 206 – Garden City, NY 11530 * (516) 742-4636

How Blepharoplasty is Performed by Oculoplastic Surgeon Dr. Amiya Prasad
How Blepharoplasty is Performed by Oculoplastic Surgeon Dr. Amiya Prasad

Eyelid surgery is one of the most precise and delicate types of cosmetic surgery. Eyelid skin is the thinnest skin in the body at less than half a millimeter in thickness. Dr. Amiya Prasad is leading Eyelid Surgery Specialist dedicated to helping his patients look better and maintain optimal eye health . Unfortunately many general plastic surgeons do not have extensive training and experience with eye anatomy and function which can lead to too much removal of eyelid skin creating an unnatural "surprised" look. Further, many people suffer from compromised eye health caused by the inability to close their eyes properly.

Lower eyelid surgery, frequently performed to remove puffy eye bags, is a common surgical procedure. Its popularity has unfortunately led to many patients having complications. Dr. Amiya Prasad, a leading eyelid specialist, performs lower eyelid surgery AKA lower blepharoplasty creating a natural-looking result that can leave virtually no trace of surgery. Many general plastic surgeons who perform the procedure have insufficient experience with eyelid support anatomy which results in eyelids being pulled down, skin exposure, eye overexposure, as well as excessive and visible scarring. Dr. Amiya Prasad performs complex reconstructive eyelid surgery for patients who come from all over the world who have complications.

Blepharoplasty is a general term for upper and lower eyelid surgery designed to improve the appearance and function of the eyes. This procedure is performed to address excess, saggy skin and bulging fat pockets around the eyes.

As an Oculofacial plastic surgeon, Dr. Prasad strongly believes in the utmost importance of performing blepharoplasty with a keen understanding of the health of the eyes, and in having the proper skills to accomplish the goals or the surgery.

A big part of Dr. Prasad’s practice involves performing advanced revision surgery on people who come from all over the world. Dr. Prasad performs all his surgeries in his Joint Commission-certified operating facilities. This type of procedure is normally done with local anesthesia with intravenous or IV sedation. Most of his patients are able to return to work in as little as one week and experience little to no discomfort.

For more information, visit our website:

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

Or come to our clinic on the following address for a personal consultation today:

Manhattan, New York City: 61 E 66th St, New York City, NY 10065 * (212) 265-8877

Garden City, Long Island: 901 Stewart Ave, Suite 206 – Garden City, NY 11530 * (516) 742-4636

What is Transconjunctival Blepharoplasty?
What is Transconjunctival Blepharoplasty?

Lower eyelid surgery, frequently performed to remove puffy eye bags, is a common surgical procedure. Its popularity has unfortunately led to many patients having complications. Dr. Amiya Prasad, a leading eyelid specialist, performs lower eyelid surgery AKA lower blepharoplasty creating a natural-looking result that can leave virtually no trace of surgery. Many general plastic surgeons who perform the procedure have insufficient experience with eyelid support anatomy which results in eyelids being pulled down, skin exposure, eye overexposure, as well as excessive and visible scarring. Dr. Amiya Prasad performs complex reconstructive eyelid surgery for patients who come from all over the world who have complications.

Transconjunctival blepharoplasty is a technique used to address puffy under eye bags from the inside of the eyelid.

One of the most important benefits of this technique is that there is no external incision visible, and therefore leaves no scarring or physical evidence that you’ve had a cosmetic procedure. Another important benefit of using this technique is that the natural shape of the eye is better preserved.

For more information, visit our website:

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

Or come to our clinic on the following address for a personal consultation today:

Manhattan, New York City: 61 E 66th St, New York City, NY 10065 * (212) 265-8877

Garden City, Long Island: 901 Stewart Ave, Suite 206 – Garden City, NY 11530 * (516) 742-4636

Do I Have Eyelid Ptosis or Extra Skin?
Do I Have Eyelid Ptosis or Extra Skin?

Ptosis, or drooping eyelid is caused by a defective or stretched muscle responsible for lifting the eyelid called the levator muscle. Ptosis surgery is not performed by most plastic surgeons. Correcting this thin muscle in the delicate eye area is more frequently performed by specialists with combined training in ophthalmology and facial cosmetic surgery called oculoplastic or oculofacial surgeons. Dr. Amiya Prasad is a leading Oculoplastic Surgeon with offices in Manhattan and Garden City, Long Island.

Ptosis is defined by the positioning of the eyelid margin in relation to the pupil. Extra skin, on the other hand, can weigh down the eyelid and affect its position, which is called mechanical ptosis.

During a routine examination, Dr. Prasad will lift the extra skin in order to determine where the eyelid margin is positioned. If the eyelid margin remains low, then it is likely you have ptosis. You will require ptosis surgery to address this, as it cannot be corrected by blepharoplasty alone.

For more information, visit our website:

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

Or come to our clinic on the following address for a personal consultation today:

Manhattan, New York City: 61 E 66th St, New York City, NY 10065 * (212) 265-8877

Garden City, Long Island: 901 Stewart Ave, Suite 206 – Garden City, NY 11530 * (516) 742-4636

Will the Results of Eyelid Surgery be Permanent?
Will the Results of Eyelid Surgery be Permanent?

Eyelid surgery is one of the most precise and delicate types of cosmetic surgery. Eyelid skin is the thinnest skin in the body at less than half a millimeter in thickness. Dr. Amiya Prasad is leading Eyelid Surgery Specialist dedicated to helping his patients look better and maintain optimal eye health . Unfortunately many general plastic surgeons do not have extensive training and experience with eye anatomy and function which can lead to too much removal of eyelid skin creating an unnatural "surprised" look. Further, many people suffer from compromised eye health caused by the inability to close their eyes properly.

Since our faces and bodies will continue to grow and change as we age, the term “permanent”, in this case, should be rephrased to “long-term”.

Most facial procedures can be estimated to last from 5-10 years. With regard to eye surgery, the longevity of your results will depend on the age that the procedure was performed. For example, someone in their 30s who underwent a lower eyelid blepharoplasty may experience longer lasting results than that of someone who underwent the same procedure in their 60s.

In Dr. Prasad’s practice, he makes sure to help patients understand how to maximize the long-term benefits of surgery by making healthy lifestyle choices, such as getting proper sun protection, eating right and avoiding smoking. Dr. Prasad also educates his patients on the benefits of maintenance procedures such as platelet-rich plasma (PRP) treatments.

For more information, visit our website:

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

Or come to our clinic on the following address for a personal consultation today:

Manhattan, New York City: 61 E 66th St, New York City, NY 10065 * (212) 265-8877

Garden City, Long Island: 901 Stewart Ave, Suite 206 – Garden City, NY 11530 * (516) 742-4636

How Should I Prepare for Eyelid Surgery?
How Should I Prepare for Eyelid Surgery?

Eyelid surgery is one of the most precise and delicate types of cosmetic surgery. Eyelid skin is the thinnest skin in the body at less than half a millimeter in thickness. Dr. Amiya Prasad is leading Eyelid Surgery Specialist dedicated to helping his patients look better and maintain optimal eye health . Unfortunately many general plastic surgeons do not have extensive training and experience with eye anatomy and function which can lead to too much removal of eyelid skin creating an unnatural "surprised" look. Further, many people suffer from compromised eye health caused by the inability to close their eyes properly.

Preparation for eyelid surgery is a straightforward matter.

Check if any medications or supplements you are currently taking have any blood thinning properties, so as to prevent any excessive bleeding during the procedure.

If you have any eye allergies or eye dryness issues, continue to use the medications as prescribed by your ophthalmologist.

Make sure you have enough ice or ice packs at home for your cold compresses after surgery. Dr. Prasad advises that patients continue to use cold compresses for at least 2 days after surgery while at home.

For more information, visit our website:

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

Or come to our clinic on the following address for a personal consultation today:

Manhattan, New York City: 61 E 66th St, New York City, NY 10065 * (212) 265-8877

Garden City, Long Island: 901 Stewart Ave, Suite 206 – Garden City, NY 11530 * (516) 742-4636

How Can I Fix One Drooping Eye?
How Can I Fix One Drooping Eye?

Ptosis, or drooping eyelid is caused by a defective or stretched muscle responsible for lifting the eyelid called the levator muscle. Ptosis surgery is not performed by most plastic surgeons. Correcting this thin muscle in the delicate eye area is more frequently performed by specialists with combined training in ophthalmology and facial cosmetic surgery called oculoplastic or oculofacial surgeons. Dr. Amiya Prasad is a leading Oculoplastic Surgeon with offices in Manhattan and Garden City, Long Island.

Eyelid surgery is one of the most precise and delicate types of cosmetic surgery. Eyelid skin is the thinnest skin in the body at less than half a millimeter in thickness. Dr. Amiya Prasad is leading Eyelid Surgery Specialist dedicated to helping his patients look better and maintain optimal eye health . Unfortunately many general plastic surgeons do not have extensive training and experience with eye anatomy and function which can lead to too much removal of eyelid skin creating an unnatural "surprised" look. Further, many people suffer from compromised eye health caused by the inability to close their eyes properly.

Addressing drooping eyes is a routine procedure that Dr. Prasad is extremely familiar with. If the drooping eye is caused by extra skin (referred to as “dermatochalasis”), a unilateral blepharoplasty is performed. If the drooping eye is caused by ptosis, then ptosis surgery is performed. Meeting with a specialist and getting a proper diagnosis is absolutely essential to determine which procedure is right for your case.

For more information, visit our website:

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

Manhattan, New York City: 61 E 66th St, New York City, NY 10065 * (212) 265-8877

Garden City, Long Island: 901 Stewart Ave, Suite 206 – Garden City, NY 11530 * (516) 742-4636

Browlift Versus Blepharoplasty - Which is Best for Sagging Eyelids?
Browlift Versus Blepharoplasty - Which is Best for Sagging Eyelids?

Eyelid surgery is one of the most precise and delicate types of cosmetic surgery. Eyelid skin is the thinnest skin in the body at less than half a millimeter in thickness. Dr. Amiya Prasad is leading Eyelid Surgery Specialist dedicated to helping his patients look better and maintain optimal eye health . Unfortunately many general plastic surgeons do not have extensive training and experience with eye anatomy and function which can lead to too much removal of eyelid skin creating an unnatural "surprised" look. Further, many people suffer from compromised eye health caused by the inability to close their eyes properly.

If you have excess skin over your eyes, it is vital to determine what is causing it. Is the excess skin caused by the eyebrows drooping, which causes the skin from below the brow to lie on top of the eyelid? Is the excess skin caused by the thinning and stretching of the eyelid skin itself? Or is it a combination of both?

When evaluating a patient whose concern is excess skin over the eyes, Dr. Prasad looks for descent of the eyebrows called brow ptosis, and excess skin over the eyelids called dermatochalasis.

During diagnosis, Dr. Prasad will try to determine from his patient if the eyebrow position is drooping more than it did in the past, he will then also try elevating the brows in order for the patient to see if it looks better for them.

Generally speaking, if there is brow ptosis, then it is likely that there is dermatochalasis as well. For the treatment for sagging eyelids, blepharoplasty is usually the solution, or part of the solution. Brow lifts, on the other hand, only becomes an option if there is brow ptosis present. Thus, the answer to brow lifts versus blepharoplasty is dependent on the source of the skin and the patient’s desired appearance.

For more information, visit our website:

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

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

Or come to our clinic on the following address for a personal consultation today:

Manhattan, New York City: 61 E 66th St, New York City, NY 10065 * (212) 265-8877

Garden City, Long Island: 901 Stewart Ave, Suite 206 – Garden City, NY 11530 * (516) 742-4636

What is Eyelid Surgery Recovery Like When Performed by Oculofacial Plastic Surgeon Dr. Amiya Prasad
What is Eyelid Surgery Recovery Like When Performed by Oculofacial Plastic Surgeon Dr. Amiya Prasad

Eyelid surgery is one of the most precise and delicate types of cosmetic surgery. Eyelid skin is the thinnest skin in the body at less than half a millimeter in thickness. Dr. Amiya Prasad is leading Eyelid Surgery Specialist dedicated to helping his patients look better and maintain optimal eye health . Unfortunately many general plastic surgeons do not have extensive training and experience with eye anatomy and function which can lead to too much removal of eyelid skin creating an unnatural "surprised" look. Further, many people suffer from compromised eye health caused by the inability to close their eyes properly.

The eyelid surgery recovery process begins with a solid foundation that is based on proper diagnosis, meticulous execution of the procedure, and immediate and attentive care during the post-operative process.

After the surgery, patients are advised to apply cold compresses during the day (20 minutes on, 20 minutes off) for the first 48 hours. A prescribed antibiotic ophthalmic ointment is given to the patient as well.

Dr. Prasad’s patients have often reported no discomfort during the recovery process and can usually return to work after 1 week.

For more information, visit our website:

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

Manhattan, New York City: 61 E 66th St, New York City, NY 10065 * (212) 265-8877

Garden City, Long Island: 901 Stewart Ave, Suite 206 – Garden City, NY 11530 * (516) 742-4636

What is the Difference Between an Eyelid Lift, Blepharoplasty, and Ptosis Surgery?
What is the Difference Between an Eyelid Lift, Blepharoplasty, and Ptosis Surgery?

Ptosis, or drooping eyelid is caused by a defective or stretched muscle responsible for lifting the eyelid called the levator muscle. Ptosis surgery is not performed by most plastic surgeons. Correcting this thin muscle in the delicate eye area is more frequently performed by specialists with combined training in ophthalmology and facial cosmetic surgery called oculoplastic or oculofacial surgeons. Dr. Amiya Prasad is a leading Oculoplastic Surgeon with offices in Manhattan and Garden City, Long Island.

Eyelid surgery is one of the most precise and delicate types of cosmetic surgery. Eyelid skin is the thinnest skin in the body at less than half a millimeter in thickness. Dr. Amiya Prasad is leading Eyelid Surgery Specialist dedicated to helping his patients look better and maintain optimal eye health . Unfortunately many general plastic surgeons do not have extensive training and experience with eye anatomy and function which can lead to too much removal of eyelid skin creating an unnatural "surprised" look. Further, many people suffer from compromised eye health caused by the inability to close their eyes properly.

An eyelid lift generally refers to a surgical procedure done to address excess skin and fat around the eyelids.

Blepharoplasty refers to a surgical procedure done on the upper and lower eyelids to address excess skin, fat, and other anatomical issues. A patient can choose to undergo either an upper or lower eyelid blepharoplasty, or both.

Ptosis surgery refers to a surgical procedure specifically done to correct the position of the eyelid margin in relation to the pupil. Such procedures include levator muscle advancement, levator resection, and frontalis sling.

For more information, visit our website:

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

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

Manhattan, New York City: 61 E 66th St, New York City, NY 10065 * (212) 265-8877

Garden City, Long Island: 901 Stewart Ave, Suite 206 – Garden City, NY 11530 * (516) 742-4636

Can I Fix Ptosis Without Surgery?
Can I Fix Ptosis Without Surgery?

Ptosis, or drooping eyelid is caused by a defective or stretched muscle responsible for lifting the eyelid called the levator muscle. Ptosis surgery is not performed by most plastic surgeons. Correcting this thin muscle in the delicate eye area is more frequently performed by specialists with combined training in ophthalmology and facial cosmetic surgery called oculoplastic or oculofacial surgeons. Dr. Amiya Prasad is a leading Oculoplastic Surgeon with offices in Manhattan and Garden City, Long Island.

Ptosis is caused by physical conditions affecting the levator muscle of the eyelid. Since this is an anatomical problem, surgery is your best option to correct this type of issue.

In some cases, an eye drop can be used to temporarily lift an accessory muscle called Mueller’s Muscle about 1-2mm, in order to make the eye appear more open. However, this is usually done for aesthetic purposes such as posing for photography, and is not meant for long-term use.

For more information, visit our website:

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

Manhattan, New York City: 61 E 66th St, New York City, NY 10065 * (212) 265-8877

Garden City, Long Island: 901 Stewart Ave, Suite 206 – Garden City, NY 11530 * (516) 742-4636

How Can I Tell if I Need Blepharoptosis or Blepharoplasty?
How Can I Tell if I Need Blepharoptosis or Blepharoplasty?

Ptosis, or drooping eyelid is caused by a defective or stretched muscle responsible for lifting the eyelid called the levator muscle. Ptosis surgery is not performed by most plastic surgeons. Correcting this thin muscle in the delicate eye area is more frequently performed by specialists with combined training in ophthalmology and facial cosmetic surgery called oculoplastic or oculofacial surgeons. Dr. Amiya Prasad is a leading Oculoplastic Surgeon with offices in Manhattan and Garden City, Long Island.

Eyelid surgery is one of the most precise and delicate types of cosmetic surgery. Eyelid skin is the thinnest skin in the body at less than half a millimeter in thickness. Dr. Amiya Prasad is leading Eyelid Surgery Specialist dedicated to helping his patients look better and maintain optimal eye health . Unfortunately many general plastic surgeons do not have extensive training and experience with eye anatomy and function which can lead to too much removal of eyelid skin creating an unnatural "surprised" look. Further, many people suffer from compromised eye health caused by the inability to close their eyes properly.

Determining whether you need blepharoptosis repair or blepharoplasty depends on the position of the eyelid in relation to the pupil.

It is a common occurrence for ptosis to be missed because a plastic surgeon assumes that performing blepharoplasty will automatically improve the appearance of drooping eyelids. This results in the eyelids still looking droopy, with the addition of the patient looking tired.

For purpose of clarity, prospective patients must familiarize themselves with the following terms:

• Dermatochalasis refers to excess skin over the eyelids, which causes hooding and a tired-looking appearance.
• Blepharoptosis refers the eyelid margin being lower than it should be.

It is not uncommon for some patients to have both dermatochalasis and blepharoptosis, which can sometimes be a challenge when creating a proper diagnosis and surgical plan.

During the initial examination, Dr. Prasad will lift up the excess skin to see whether the eyelid margin improves or not. If the eyelid margin is still low, then it is safe to assume that the patient has eyelid ptosis, which can be corrected with the proper surgery.

For more information, visit our website:

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

Manhattan, New York City: 61 E 66th St, New York City, NY 10065 * (212) 265-8877

Garden City, Long Island: 901 Stewart Ave, Suite 206 – Garden City, NY 11530 * (516) 742-4636

Will My Eyesight Change After Ptosis Surgery?
Will My Eyesight Change After Ptosis Surgery?

Ptosis, or drooping eyelid is caused by a defective or stretched muscle responsible for lifting the eyelid called the levator muscle. Ptosis surgery is not performed by most plastic surgeons. Correcting this thin muscle in the delicate eye area is more frequently performed by specialists with combined training in ophthalmology and facial cosmetic surgery called oculoplastic or oculofacial surgeons. Dr. Amiya Prasad is a leading Oculoplastic Surgeon with offices in Manhattan and Garden City, Long Island.

After ptosis surgery, most people see an improvement in their vision, due to the improvement of the eyelid position in relation to the pupil. Patients often report that the world looks “brighter” and that they no longer feel the strain of keeping their eyes open.

Glasses may be worn, if needed, after surgery. However, Dr. Prasad advises patients to wait at least one week before wearing contact lenses. During this time, an antibiotic ointment is placed on the eyelids and therefore may interfere with the effect of your contact lenses.

After a week, patients may resume wearing contact lenses, provided that they consistently and liberally use lubricating eye drops, in order to prevent eye dryness. Since the eye is more open, the tear film may need supplementation. It is also advisable to check your contact lens prescription several months after the surgery, as drooping eyelids may have caused a very mild astigmatism.

For more information, visit our website:

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

Manhattan, New York City: 61 E 66th St, New York City, NY 10065 * (212) 265-8877

Garden City, Long Island: 901 Stewart Ave, Suite 206 – Garden City, NY 11530 * (516) 742-4636

What is the Cost of Ptosis Surgery?
What is the Cost of Ptosis Surgery?

Ptosis, or drooping eyelid is caused by a defective or stretched muscle responsible for lifting the eyelid called the levator muscle. Ptosis surgery is not performed by most plastic surgeons. Correcting this thin muscle in the delicate eye area is more frequently performed by specialists with combined training in ophthalmology and facial cosmetic surgery called oculoplastic or oculofacial surgeons. Dr. Amiya Prasad is a leading Oculoplastic Surgeon with offices in Manhattan and Garden City, Long Island.

The cost of any surgery, in general, in based on the following factors: (1) surgeon’s fee, (2) anesthesia, (3) facility costs, and (4) aftercare.

Surgical procedures should not be likened to commodities such as electronic goods. Properly executed surgical procedures are the product of meticulous study, preparation and technical expertise by a surgeon, and the result of your surgery is something that you will live with for a long time. Understanding that the cost of delivering a high level of care usually gives patients a better understanding of how we arrive at our fees.

For more information, visit our website:

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

Manhattan, New York City: 61 E 66th St, New York City, NY 10065 * (212) 265-8877

Garden City, Long Island: 901 Stewart Ave, Suite 206 – Garden City, NY 11530 * (516) 742-4636

Plastic Surgeon, Ophthalmologist, or Eyelid Specialist for Eyelid Surgery?
Plastic Surgeon, Ophthalmologist, or Eyelid Specialist for Eyelid Surgery?

Eyelid surgery is one of the most precise and delicate types of cosmetic surgery. Eyelid skin is the thinnest skin in the body at less than half a millimeter in thickness. Dr. Amiya Prasad is leading Eyelid Surgery Specialist dedicated to helping his patients look better and maintain optimal eye health . Unfortunately many general plastic surgeons do not have extensive training and experience with eye anatomy and function which can lead to too much removal of eyelid skin creating an unnatural "surprised" look. Further, many people suffer from compromised eye health caused by the inability to close their eyes properly.

Eyelid surgery is performed by several specialties. Financial interests, however, have caused quite a bit of inter-specialty rivalry and controversy, wherein one group of surgeons claims superiority over another.

As an Oculofacial plastic surgeon with more than 20 years of experience, Dr. Prasad routinely performs advanced revision surgery on people from all over the world. These people have usually had their initial surgery done by board-certified surgeons of several specialties. It is important to emphasize that within every specialty performing eyelid surgery, there is going to be variability in the surgeon’s technical skills, artistry, expertise and experience.

Dr. Prasad also stresses that communication between you and your surgeon is extremely important when you’re considering surgery. Choose a surgeon who will spend time with you and understand your personal aesthetic values and what you want to see improved.

Dr. Prasad advises that you choose a specific surgeon, rather than choosing a specific specialty for your procedure.

For more questions and answers regarding eyelid surgery please check our frequently asked questions page on our website at http://prasadcosmeticsurgery.com/prasad-face-eyes/eyelifts/eye-lift-questions-answers//eye-lift-questions-answers/

Manhattan, New York City: 61 E 66th St, New York City, NY 10065 * (212) 265-8877

Garden City, Long Island: 901 Stewart Ave, Suite 206 – Garden City, NY 11530 * (516) 742-4636

How Does the Recovery for Eyelid Ptosis Correction Surgery Compare to That of Blepharoplasty?
How Does the Recovery for Eyelid Ptosis Correction Surgery Compare to That of Blepharoplasty?

Ptosis, or drooping eyelid is caused by a defective or stretched muscle responsible for lifting the eyelid called the levator muscle. Ptosis surgery is not performed by most plastic surgeons. Correcting this thin muscle in the delicate eye area is more frequently performed by specialists with combined training in ophthalmology and facial cosmetic surgery called oculoplastic or oculofacial surgeons. Dr. Amiya Prasad is a leading Oculoplastic Surgeon with offices in Manhattan and Garden City, Long Island.

Eyelid surgery is one of the most precise and delicate types of cosmetic surgery. Eyelid skin is the thinnest skin in the body at less than half a millimeter in thickness. Dr. Amiya Prasad is leading Eyelid Surgery Specialist dedicated to helping his patients look better and maintain optimal eye health . Unfortunately many general plastic surgeons do not have extensive training and experience with eye anatomy and function which can lead to too much removal of eyelid skin creating an unnatural "surprised" look. Further, many people suffer from compromised eye health caused by the inability to close their eyes properly.

The recovery period from the surgical correction of one of the most common types of ptosis does not significantly differ from that of a standard upper eyelid blepharoplasty. In some cases, however, swelling may last longer, depending on specific issues occurring during, after, or in relation to the surgery.

For more information about the eyelid ptosis surgery procedure please visit our site at
http://prasadcosmeticsurgery.com/prasad-face-eyes/eyelifts/eyelid-ptosis-surgery/

Or come to our clinic on the following address for a personal consultation today:

Manhattan, New York City: 61 E 66th St, New York City, NY 10065 * (212) 265-8877

Garden City, Long Island: 901 Stewart Ave, Suite 206 – Garden City, NY 11530 * (516) 742-4636

After Ptosis Correction Surgery, Will My Eyelid Look the Same as Before?
After Ptosis Correction Surgery, Will My Eyelid Look the Same as Before?

Ptosis, or drooping eyelid is caused by a defective or stretched muscle responsible for lifting the eyelid called the levator muscle. Ptosis surgery is not performed by most plastic surgeons. Correcting this thin muscle in the delicate eye area is more frequently performed by specialists with combined training in ophthalmology and facial cosmetic surgery called oculoplastic or oculofacial surgeons. Dr. Amiya Prasad is a leading Oculoplastic Surgeon with offices in Manhattan and Garden City, Long Island.

This answer is largely based on the objective of the surgery. If you are having ptosis surgery on both eyes, then elevating the height of the eyelids should improve the general appearance of your eyes. If you have unilateral ptosis (ptosis affecting only one eye), Dr. Prasad ensures to match its symmetry and shape with your other eye, in such a way that they will look the way they did before you developed ptosis.

For the complete info about the ptosis correction surgery please check our website at http://prasadcosmeticsurgery.com/prasad-face-eyes/eyelifts/eyelid-ptosis-surgery/

Or come to our clinic on the following address for a personal consultation today:

Manhattan, New York City: 61 E 66th St, New York City, NY 10065 * (212) 265-8877

Garden City, Long Island: 901 Stewart Ave, Suite 206 – Garden City, NY 11530 * (516) 742-4636

Once I've Had Ptosis Surgery, Will I Need Any Other Treatment?
Once I've Had Ptosis Surgery, Will I Need Any Other Treatment?

Ptosis, or drooping eyelid is caused by a defective or stretched muscle responsible for lifting the eyelid called the levator muscle. Ptosis surgery is not performed by most plastic surgeons. Correcting this thin muscle in the delicate eye area is more frequently performed by specialists with combined training in ophthalmology and facial cosmetic surgery called oculoplastic or oculofacial surgeons. Dr. Amiya Prasad is a leading Oculoplastic Surgeon with offices in Manhattan and Garden City, Long Island.

Several factors influence whether or not you will need another ptosis correction surgery: (1) the type of ptosis you have, (2) the age when you had the procedure, (3) changes related to aging, and (4) the elasticity of your own tissues.

For example, a child who has congenital ptosis may have surgery to correct it before the age of six, and then may need to have another surgery done in their teen years or young adulthood.

The more common type of ptosis, like aponeurotic ptosis or levator muscle dehiscence, happen later on in life due to the thinning of the levator muscle, which is responsible for lifting the eyelid. The procedure required to address this type of ptosis can last for years without needing any additional or follow-up surgery. Ptosis surgery may only require some enhancement during the first few months or year if there are any issues with height, symmetry, or contour.

For further information regarding ptosis and surgery please check our website at http://prasadcosmeticsurgery.com/prasad-face-eyes/eyelifts/eyelid-ptosis-surgery/

Or come to our clinic on the following address for a personal consultation today:

Manhattan, New York City: 61 E 66th St, New York City, NY 10065 * (212) 265-8877

Garden City, Long Island: 901 Stewart Ave, Suite 206 – Garden City, NY 11530 * (516) 742-4636

What is the Recovery Process Like After Different Types of Eyelid Surgery?
What is the Recovery Process Like After Different Types of Eyelid Surgery?

Eyelid surgery is one of the most precise and delicate types of cosmetic surgery. Eyelid skin is the thinnest skin in the body at less than half a millimeter in thickness. Dr. Amiya Prasad is leading Eyelid Surgery Specialist dedicated to helping his patients look better and maintain optimal eye health . Unfortunately many general plastic surgeons do not have extensive training and experience with eye anatomy and function which can lead to too much removal of eyelid skin creating an unnatural "surprised" look. Further, many people suffer from compromised eye health caused by the inability to close their eyes properly.

A patient’s recovery phase can be influenced by several factors: (1) the type of ptosis surgery performed, (2) the medical status of the person recovering from surgery, (3) the patient’s experience in the operating room, and (4) the patient’s experience in the recovery area.

Dr. Prasad strongly believes that the experience of the patient during and immediately after the surgery has an impact on short-term recovery and long-term recovery period. Because of this, Dr. Prasad chooses to optimize the following factors in order to make the patient’s recovery process flow smoothly: (1) the anesthesia method, (2) the surgical team involved, (3) the surgical technique used, and (4) the post-operative recovery process.

The Anesthesia Method
In Dr. Prasad’s practice, surgeries are performed under local anesthesia, with intravenous sedation. General anesthesia is rarely used, as it causes longer recovery periods and more bruising and swelling in patients. Dr. Prasad has developed his own customized sedation method which results in his patients waking up without the feeling of nausea or grogginess. Due to this customized sedation method, Dr. Prasad’s patients wake up fresh and are able to go home safely after surgery.

The Surgical Team
Longer surgery times can have an impact on how fast you recover from the surgery, therefore Dr. Prasad knows that it is essential to have a highly capable and efficient surgical team to ensure that the surgery happens smoothly. Dr. Prasad also operates in his own Joint Commission-certified operating rooms with the help of his own surgical team, which has resulted in his patients having a much better recovery experience.

The Surgical Technique
To achieve optimal results in cosmetic and reconstructive surgery, a surgeon must have: (1) an artistic eye, (2) technical proficiency, and (3) a significant amount of experience. With more than 20 years of experience, Dr. Prasad is able to respond well to different types of scenarios in the same way that an experienced pilot is able to handle any type of situation when flying a plane. Dr. Prasad believes that a well-executed surgery also results in a better recovery experience for the patient.

The Post-Operative Recovery Process
Before establishing his own surgical and aftercare facilities, Dr. Prasad performed his surgeries at hospitals and surgery centers. This experience opened his eyes to the reality that there was a significant mismatch between the number of support staff and patients in the recovery area. This resulted in delays in the proper aftercare procedures, which significantly affects the recovery time of the patient. Dr. Prasad firmly believes that one-to-one attentive care is essential for a faster recovery period.

In terms of home recovery, it is normal to have swelling and bruising during the first 24-48 hours. This improves daily, and some patients are able to return to work after 5-7 days.

For more information please visit our site at http://prasadcosmeticsurgery.com/prasad-face-eyes/eyelifts/

Or come to our clinic on the following address for a personal consultation today:

Manhattan, New York City: 61 E 66th St, New York City, NY 10065 * (212) 265-8877

Garden City, Long Island: 901 Stewart Ave, Suite 206 – Garden City, NY 11530 * (516) 742-4636

What is Recovery Like after Ptosis Surgery When Performed by Oculoplastic Surgeon Dr. Amiya Prasad
What is Recovery Like after Ptosis Surgery When Performed by Oculoplastic Surgeon Dr. Amiya Prasad

Ptosis, or drooping eyelid is caused by a defective or stretched muscle responsible for lifting the eyelid called the levator muscle. Ptosis surgery is not performed by most plastic surgeons. Correcting this thin muscle in the delicate eye area is more frequently performed by specialists with combined training in ophthalmology and facial cosmetic surgery called oculoplastic or oculofacial surgeons. Dr. Amiya Prasad is a leading Oculoplastic Surgeon with offices in Manhattan and Garden City, Long Island.

Recovery after ptosis surgery is dependent on the following factors: (1) the type of surgery performed; (2) whether other surgeries are performed alongside it; (3) the method of anesthesia used; (4) the surgical team involved; (5) the surgical technique used; and (6) the post-operative recovery process.
In his practice, Dr. Prasad chooses to optimize the method of anesthesia, the surgical team, the surgical technique and the post-operative recovery process in order to achieve the best results.
With regard to the method of anesthesia, Dr. Prasad prefers to use local anesthesia with intravenous sedation. He has developed his own sedation technique that allows patients to wake up fresh, without a long period of downtime. General anesthesia is rarely used because it means longer downtime, increased risk of nausea and vomiting, and prolonged bruising and swelling.
Dr. Prasad optimizes his surgical team by making sure each member of his staff is experienced and highly capable in any given scenario that one may encounter during a procedure. In addition to that, he performs surgeries in his own operating facilities, which are accredited by the Joint Commission, the same organization that accredits and oversees hospitals. Over the years, Dr. Prasad has observed that working in his own facilities has contributed to a better recovery experience for his patients.
When it comes to the surgical techniques used, Dr. Prasad believes that technical expertise, experience and an artistic eye are all important when it comes to his line of work. Having significant experience and exposure to numerous cases allows a surgeon to make more precise decisions and enables him to respond and adapt well to different scenarios.
Dr. Prasad also favors optimizing the recovery process as much as possible. Hospitals don't have enough support staff like doctors and nurses in the important hours right after surgery. In his own practice, Dr. Prasad and his medical support staff attend to patients needs upon completion of their surgery to help them recover faster. With regard to home recovery, it is normal to experience swelling and bruising in 24-48 hours after the surgery. However, most people can return to work after 5-7 days. A majority of the healing process occurs within the first few months, but the healing can continue for up to one year after surgery.

For further information regarding ptosis surgery and recovery please visit our website at http://prasadcosmeticsurgery.com/prasad-face-eyes/eyelifts/eyelid-ptosis-surgery/

Or come to our clinic on the following address for a personal consultation today:

Manhattan, New York City: 61 E 66th St, New York City, NY 10065 * (212) 265-8877

Garden City, Long Island: 901 Stewart Ave, Suite 206 – Garden City, NY 11530 * (516) 742-4636

What Happens During Ptosis Surgery as Performed by Oculoplastic Surgeon Dr. Amiya Prasad
What Happens During Ptosis Surgery as Performed by Oculoplastic Surgeon Dr. Amiya Prasad

Ptosis, or drooping eyelid is caused by a defective or stretched muscle responsible for lifting the eyelid called the levator muscle. Ptosis surgery is not performed by most plastic surgeons. Correcting this thin muscle in the delicate eye area is more frequently performed by specialists with combined training in ophthalmology and facial cosmetic surgery called oculoplastic or oculofacial surgeons. Dr. Amiya Prasad is a leading Oculoplastic Surgeon with offices in Manhattan and Garden City, Long Island.

In Dr. Prasad’s practice, ptosis surgery in adults is performed under local anesthesia with intravenous sedation. The goal in ptosis surgery is to elevate one or both eyelids to achieve balance and symmetry. In order to accomplish this, during the procedure the patient is instructed to open and close their eyes in both a laying and upright position. This ensures the symmetry of the eyes is correct, or if any adjustments are needed. During this process, the patient is not in any pain. When the correct symmetry is determined, the patient is returned to a laying position and the procedure is completed. After surgery, cold compresses are applied to the affected areas, and patients are usually able to go home without any bandages.

For more information about ptosis and surgery please visit our website on this link http://prasadcosmeticsurgery.com/prasad-face-eyes/eyelifts/eyelid-ptosis-surgery/

Or come to our clinic on the following address for a personal consultation today:

Manhattan, New York City: 61 E 66th St, New York City, NY 10065 * (212) 265-8877

Garden City, Long Island: 901 Stewart Ave, Suite 206 – Garden City, NY 11530 * (516) 742-4636

What are the Alternatives to Ptosis Surgery?
What are the Alternatives to Ptosis Surgery?

Ptosis, or drooping eyelid is caused by a defective or stretched muscle responsible for lifting the eyelid called the levator muscle. Ptosis surgery is not performed by most plastic surgeons. Correcting this thin muscle in the delicate eye area is more frequently performed by specialists with combined training in ophthalmology and facial cosmetic surgery called oculoplastic or oculofacial surgeons. Dr. Amiya Prasad is a leading Oculoplastic Surgeon with offices in Manhattan and Garden City, Long Island.

If your eyelid ptosis causes cosmetic concern or is already affecting your vision, then there is no other alternative other than to get ptosis surgery in order to correct it. Ptosis surgery can be performed safely with minimal risk, provided that you do the appropriate research and meet with an experienced oculofacial plastic surgeon that can properly explain what type of procedure is right for you.

For additional information on ptosis and your options please visit our website http://prasadcosmeticsurgery.com/prasad-face-eyes/eyelifts/eyelid-ptosis-surgery/

Or come to our clinic on the following address for a personal consultation today:

Manhattan, New York City: 61 E 66th St, New York City, NY 10065 * (212) 265-8877

Garden City, Long Island: 901 Stewart Ave, Suite 206 – Garden City, NY 11530 * (516) 742-4636

What are the Risks of Ptosis Surgery?
What are the Risks of Ptosis Surgery?

Ptosis, or drooping eyelid is caused by a defective or stretched muscle responsible for lifting the eyelid called the levator muscle. Ptosis surgery is not performed by most plastic surgeons. Correcting this thin muscle in the delicate eye area is more frequently performed by specialists with combined training in ophthalmology and facial cosmetic surgery called oculoplastic or oculofacial surgeons. Dr. Amiya Prasad is a leading Oculoplastic Surgeon with offices in Manhattan and Garden City, Long Island.

The risks of ptosis surgery can be divided into two sections: (1) risks that are common to surgical procedures in general, and (2) risks that are specific to ptosis surgery.

With general surgery, there are risks when it comes to the kind of anesthesia used –whether it is local, local with sedation, or general. Excessive bleeding, excessive swelling and infection may also become causes for concern in general surgery. Risks that are specific to ptosis surgery include: (1) under-correction of ptosis, wherein the eyelid still droops after surgery; (2) overcorrection of ptosis, wherein the eyelid is too open after surgery; and (3) other problems such as an undesirable cosmetic appearance, scarring, and complications due to infection and inflammation.

It should be emphasized that ptosis surgery can be approached differently, depending on each case. Thus, it is all the more important to discuss the possible risks of the procedure you’re considering with your surgeon.

For more information regarding ptosis and surgery please visit our website http://prasadcosmeticsurgery.com/prasad-face-eyes/eyelifts/eyelid-ptosis-surgery/

Or come to our clinic on the following address for a personal consultation today:

Manhattan, New York City: 61 E 66th St, New York City, NY 10065 * (212) 265-8877

Garden City, Long Island: 901 Stewart Ave, Suite 206 – Garden City, NY 11530 * (516) 742-4636

Who Should Perform Ptosis Surgery?
Who Should Perform Ptosis Surgery?

Ptosis, or drooping eyelid is caused by a defective or stretched muscle responsible for lifting the eyelid called the levator muscle. Ptosis surgery is not performed by most plastic surgeons. Correcting this thin muscle in the delicate eye area is more frequently performed by specialists with combined training in ophthalmology and facial cosmetic surgery called oculoplastic or oculofacial surgeons. Dr. Amiya Prasad is a leading Oculoplastic Surgeon with offices in Manhattan and Garden City, Long Island.

Ptosis surgery is a specialized procedure that requires the skill and experience of a specialist, as opposed to a general surgeon. An oculoplastic/ oculofacial plastic surgeon therefore ideally performs ptosis surgery, as they have combined training in ophthalmology and advanced training in cosmetic and reconstructive surgery of the eyes and face.

For other info about ptosis please visit our website at http://prasadcosmeticsurgery.com/prasad-face-eyes/eyelifts/eyelid-ptosis-surgery/

Or come to our clinic on the following address for a personal consultation today:

Manhattan, New York City: 61 E 66th St, New York City, NY 10065 * (212) 265-8877

Garden City, Long Island: 901 Stewart Ave, Suite 206 – Garden City, NY 11530 * (516) 742-4636

What Causes Ptosis Explained by Oculoplastic Surgeon Dr. Amiya Prasad
What Causes Ptosis Explained by Oculoplastic Surgeon Dr. Amiya Prasad

Ptosis, or drooping eyelid is caused by a defective or stretched muscle responsible for lifting the eyelid called the levator muscle. Ptosis surgery is not performed by most plastic surgeons. Correcting this thin muscle in the delicate eye area is more frequently performed by specialists with combined training in ophthalmology and facial cosmetic surgery called oculoplastic or oculofacial surgeons. Dr. Amiya Prasad is a leading Oculoplastic Surgeon with offices in Manhattan and Garden City, Long Island.

Eyelid ptosis can be either congenital or acquired. Acquired ptosis refers to eyelid ptosis that develops later on in life, whereas congenital ptosis refers to eyelid ptosis that one is born with.

People with congenital ptosis exhibit variations in the levator muscle, and these variations often differ in the levels of severity and muscle function. On the other hand, acquired ptosis often manifests due to interference by physical volume, such as tissue, which then affects the function of the eyelid. This is called “mechanical ptosis”.

Acquired ptosis may also manifest due to muscular or aponeurotic ptosis, which is the stretching or thinning, and subsequent weakening, of a part of the levator muscle. Muscular or aponeurotic ptosis usually occurs after a patient has had eye cataract surgery or Lasik/laser vision surgery.

Other causes for ptosis can also be brought about by certain neurological conditions, such as Horner’s syndrome or third nerve palsy.

For more information, visit our website:

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

Or come to our clinic on the following address for a personal consultation today:

Manhattan, New York City: 61 E 66th St, New York City, NY 10065 * (212) 265-8877

Garden City, Long Island: 901 Stewart Ave, Suite 206 – Garden City, NY 11530 * (516) 742-4636

How to Get Rid of Tired Puffy Eyes, What Causes Wrinkles Prematurely, & Their Treatment
How to Get Rid of Tired Puffy Eyes, What Causes Wrinkles Prematurely, & Their Treatment

A 22-year-old woman says she always looks tired and gets severe lines when she smiles. Her eye bags are always puffy and look like she didn’t sleep well. She wonders if Botox® could make the bags even more prominent.

Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon, explains that puffy bags are mostly due to lower eyelid fat prolapse. In many cases it increases with aging, but it in this woman’s case it is more of a genetic trait. He has had patients as young as 14-years-old who had tremendous bags and he has done surgery to help them.

If a person’s bags are constant and persistent, then a definitive surgical procedure is the solution to the issue. Unfortunately, a lot of people try to camouflage bags that are beyond a certain threshold with fillers and they get themselves in all kinds of problems.

In Dr. Prasad’s practice, he is very hesitant to start people in their early 20s with Botox®, Dysport or any other neurotoxins because he wants to first look at what is causing the lines. There are two significant causes that accelerate aging which are sun exposure and smoking. If they are spending a lot of time in the sun or using tanning beds, it is highly likely that they are photoaging their skin and causing a big impact on the quality of the skin. Aging causes skin to lose collagen and blood supply until the quality diminishes and it becomes thinner. On the other hand, smoking generates carbon monoxide which literally chokes the oxygen away from the skin and generates free radicals that damage the skin. Besides doing horrible things to the lungs or to the blood vessels, its damaging effects are reflected in the skin. Dr. Prasad can literally look at a person and know that they are a smoker because of the quality of their skin as there’s almost a graying quality. If they are smoking or spending a lot of time in the sun, it is recommended that they diminish the amount of sun exposure. They should wear sun block and stop smoking altogether.

Dr. Prasad further explains that 10 units of Botox® which is going to be divided into both eyes is not likely to make the bags look worse because it’s not a really high dose. It is something that she might want to consider trying if she doesn’t have any of the other risk factors he described. However, Botox® reduces the activity of the muscle called the orbicularis oculi muscle. This is the muscle that works when someone squints their eyes. Dr. Prasad always educates his patients to differentiate and to distinguish between the activity of the muscle and the lines that are formed when they smile. When smiling, the cheek moves up and it is almost mistakenly thought of the activity of the muscle. People would mostly come back for Botox® enhancement. When he shows them the difference, then they understand that physical movement cannot be changed with Botox®. They wouldn’t want to stop their cheek from moving up.

Dr. Prasad says that she must get additional opinions and certainly explore the risk factors that might be accelerating the aging of her skin. She should meet with more than one doctor and get some additional opinions to help her understand the situation with her eyes.

For more information, visit our website:

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

The Best Treatment for Eye Bags, and Why Fat Transfer Under Eyes is Not Advised
The Best Treatment for Eye Bags, and Why Fat Transfer Under Eyes is Not Advised

A woman wants to know how she should address her lower eye bags. She is confused between relocation, removal and fat transfer.

Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon, wrote a book a few years ago called “The Fine Art of Looking Younger”. He has been in practice for 20 years as a specialist in oculofacial plastic surgery. He does a lot of eyelids and facelifts. Facial aging is something that he spends a lot of time on and he focuses on helping people understand the elements of the facial aging process and how well a given particular plan impacts it.

Dr. Prasad explains that this woman clearly demonstrates lower eyelid fat prolapse. He points out to his patients who come in for eyelid consultation to look at the adjacent area called the eyelid-cheek junction and area of the cheek called the sub malar area. When someone has bags under their eyes, it is often the dominant feature and it affects the overall appearance of their face. When people have an eyelid procedure to address the fat pockets, they sometimes think that they look hollow or sad. This is because the adjacent areas of the face have also aged and because they weren’t dominant, the focus was not there.

As a specialist, Dr. Prasad says that fat transfer to the lower eyelids is not advisable. He has seen patients from all over the world who have had fat transfer and they end up with irregularities and lumps. They try to build up and restore the fat that’s been lost and then try to camouflage the fat pockets. However, there are several defects in that idea. The fat that is under the eye has prolapsed forward like a hernia. Herniated fat has to be addressed in some way to restore it in its proper position. MRI studies have shown that people with fat prolapse actually have more fat, meaning they have an enlargement or an increase of fat. Thus, it’s justifiable to do procedures to reduce or remove the fat.

Moving fat from the orbit or the space may make sense but a lot of people who get fat transposition will not have a good result. They will actually have chronic swelling in the eyelid-cheek junction. In Dr. Prasad’s practice, he does some fat transposition, but with the majority of his patients he does fat reduction. It is logical to reduce fat that is herniated past the rim to get that type of contour. Concerns about hollowing are always addressed. Since cosmetic surgery is an art, doctors will have different opinions on how to do the procedures. Every doctor comes to the table with their aesthetic sense, experience and technical abilities. When it comes to medical care and surgical care, it is really more of a gestalt of how the patient feels in terms of their comfort level with the doctor, and their style that’s usually demonstrated by looking at before and after results. In the end, it’s always about trust and comfort.

As far as resection versus transposition, Dr. Prasad thinks a lot of very good surgeons do a combination depending on what they see or whatever is appropriate for the patient. Cosmetic surgery is still ideally about customization. Some doctors like to do things a certain way and they’ll always do it the same way. Very often, those are the doctors that get themselves in trouble because a certain percentage of patients don’t have an anticipated or ideal outcome.

Dr. Prasad thinks meeting with doctors who have a lot of experience with eyelid surgery, particularly as a specialty, will probably help her make that decision. At this point, she is someone who has a little bit of information overload and she just doesn’t know what to do. She should understand that it’s her decision to find the doctor that resonates with her.

For more information, visit our website:

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

Eyelid Surgery and Other Cosmetic Surgeries Can Be Done without General Anesthesia
Eyelid Surgery and Other Cosmetic Surgeries Can Be Done without General Anesthesia

A woman has both upper and lower eyelid problems. She wants to know if it can be fixed without general anesthesia.

Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon, advocates and recommends doing upper and lower eyelid surgery without general anesthesia. Approximately 20 years ago when he started his practice, he committed to the idea of avoiding general anesthesia as much as possible for cosmetic surgery. During his training, he noticed that much of the issues with the healing process and the recovery had to do more from recovering from general anesthesia than the actual surgery itself, so he made it his mission to prove that he can do upper and lower eyelid surgery as well as face lifting surgery under local anesthesia. Presently, he does everything with the exception of complex rhinoplasties under local anesthesia with LITE™IV sedation. This means the patient gets low doses of medication intravenously to relax them, but does not require any breathing support in the throat like in general anesthesia. He also appeared in several TV programs and performed the surgery with the patient wide awake.

Lower eyelid surgery requires a physical exam. When Dr. Prasad makes a decision whether or not do the surgery from the outside or inside, he assesses if there is extra eyelid skin. There are a lot of board certified plastic surgeons who get themselves in trouble because they fail to distinguish extra skin from skin quality or lack of skin quality. When people complain that their skin looks crêpey, or when they smile there’s a lot of extra skin, a lot of well-meaning doctors would take away skin. Unfortunately, that result in problems like ectropion where the eyelid everts out, or eyelid retraction where the eyelid is pulled downwards or even combinations of both. Dr. Prasad also determines the integrity of the orbicularis muscle under the eye and the lateral canthal tendon which support the eyelid.

When there is a little extra skin, Dr. Prasad does a transconjunctival approach for the prolapse of fat and repositioning fat from the inside of the eyelid. He may also do a skin pinch or a removal of a small amount of skin if there is extra skin. It’s very important to understand that eyelid surgery is not about wrinkles. The causes of reduction in skin quality and crêpiness is loss of blood supply and collagen. To maximize the skin quality, he often does procedures such as fractional CO2 laser, platelet-rich plasma which is using the patient’s own blood and using the growth factors that can be separated to stimulate their own body’s collagen. In addition, if there is any laxity with the lateral canthal tendon, he does procedures such as lateral tarsal strip, lateral canthoplasty, or things to reposition so that the eyelid doesn’t pull down.

Dr. Prasad really advocates on doing procedures under local anesthesia with LITE™ IV sedation. His patients recover a lot faster and get back to work in a week. As far as the eyelid surgery is concerned, it really requires a physical exam to determine the indications going from the inside to the outside, so in skilled and experienced hands, either technique is valid. It’s more about what is right for the patient. At this point, Dr. Prasad would recommend meeting with qualified and experienced cosmetic surgeons. He also suggests that she meet with people who have a lot of experience with eyelid surgery and can understand the complexities of other procedures necessary to maximize the outcome.

For more information, visit our website:

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

Why a Hair Transplant Isn't Advised in the 20s, and a Non-Surgical Hair Restoration Treatment
Why a Hair Transplant Isn't Advised in the 20s, and a Non-Surgical Hair Restoration Treatment

A 24-year-old gentleman has been receding for the last 5 years. His hair is thick everywhere but his hairline keeps on rising.

Dr. Amiya Prasad, a hair restoration specialist, explains that most transplant surgeons choose not to operate on patients in their 20s because of significant limitations of hair transplant surgery. The problem is the patient is losing hair far greater than the amount of hair available to restore what is lost. These hairs are taken from the donor area which has a limited amount of hairs. Today, it’s popular to perform procedures called FUEs (follicular unit extractions) and there are also common "mega sessions" of thousands of hairs being transferred. Unfortunately, the donor area is very limited. If someone gets a transplant, they continue to recede and get another transplant, and another until they run out of donor hairs.

In Dr. Prasad’s practice, he developed a method called Hair Regeneration which is not surgery but an injection. This method was developed using a material called extracellular matrix (ECM) derived from pig bladder and combining it with platelet-rich plasma(PRP). Extracellular matrix is a material that was originally designed for wound healing. It allows the duplication of cells native to a particular area, for example if it is applied to a muscle, it regenerates muscle, or if applied to skin, it regenerates skin. While ECM does not duplicate or clone hair, it was noted that when used to assist in the healing of a donor area for a strip method for hair transplant, the thinning hairs became thicker.

In the past several years, Dr. Prasad has been developing a formulation and delivery technique of Hair Regeneration. It appears to restore the cells and signals necessary to reverse the thinning process- instead of hairs becoming thinner, they become thicker. He always advises prospective patients to get this done sooner because he can save the hairs that are thinning, but he can’t save the hairs that are gone.

Dr. Prasad also says that he has an option for the two FDA approved medications: minoxidil and finasteride. Minoxidil does not help reverse hair thinning but appears to prolong the presence of hair that’s thinning on the scalp which makes the hair look a bit thicker. On the other hand, Finasteride blocks an enzyme called 5-alpha reductase which reduces testosterone conversion to dihydrotestosterone (DHT). DHT can cause hair follicles that are susceptible to the effects of DHT to thin. Finasteride can reduce DHT with certain people with male pattern hair loss, so they can get improvement. Unfortunately, people who are younger and have progression of frontal recession tend to not respond well to finasteride. In addition, there is a lot of concern about finasteride's long-term sexual side-effects.

Dr. Prasad suggests that he should learn more about Hair Regeneration. Unfortunately, he doesn’t have specifics of the exact reason why this works. It appears that the basic science of hair growth has yet to discover all of the critical stem cells and signals necessary for hair growth, which is why hair cloning remain elusive, and all of the biotechnology companies who have tried to corner the market of hair loss have not done very well. Fortunately, Dr. Prasad has been successful in trying to use this material which is already FDA approved and using it in an off-label way to treat hair loss.

For more information, visit our website:

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

Possible Complications from Eyelid Surgery with Ptosis Repair and a Non-Incisional Revision Option
Possible Complications from Eyelid Surgery with Ptosis Repair and a Non-Incisional Revision Option

A woman had incisional blepharoplasty plus ptosis repair. However, she is not satisfied with the results. She wants to know if she is having surgical complications.

Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon, observed from the photos she submitted that her right eye appears to have several folds of skin on the upper eyelid and it appears that the right eye was the one which had ptosis surgery. He also observed that the right eye is more elevated compared to the previous photo.

Mueller’s Resection Surgery to elevate the eyelid is a standard operation done for ptosis. Its advantage is avoiding the anterior approach to elevate the eyelid approximately 2 millimeters. The removal of a thin strip of skin may have been adequate at the time of surgery, but sometimes the connection between the eyelid skin and levator muscle necessary to create an eyelid crease loosens or separates. This results in multiple folds in the eyelid.

Ptosis surgery is very sensitive to factors that occur intra-operatively and post-operatively than can result in some variability. In his practice, Dr. Prasad makes the best efforts to maximize the predictability. When Dr. Prasad does ptosis surgery, he actually lets his patients open and close their eyes during the surgery. They don’t feel anything but they can cooperate so he can adjust the eyelid height and contour precisely. He also lets the patient sit up during the surgery to make sure that he can get maximal symmetry. As a general rule of thumb, if the eyelid height is within 2 millimeters of symmetry between the two eyes, aesthetically it doesn’t make much of a difference. Depending on the time frame since her surgery, this woman may want to consider observation because sometimes swelling can have an impact on the eyelid height.

As far as the multiple eyelid creases are concerned, Dr. Prasad has successfully been able to restore the crease using a non-incisional method. If the eyes are closed, a person can actually assess if there is excess skin. Most of the time, the multiple folds are not because of excess skin. To recreate a crease using the non-incisional technique, Dr. Prasad makes some fixed entry points from the outside and connecting skin and orbicularis muscle to the levator muscle. He has been able to help a lot of his patients to get that ideal crease even if the crease wasn’t well defined during excisional surgery.

Dr. Prasad suggests that this woman maintain some faith and communication with her doctor. As long as this doctor was open and communicating with her, revision surgery may ultimately be best performed by her surgeon. She can certainly get additional opinions, but in general, it’s always good to have the first surgeon who’s a specialist in this area do the revision surgery. The original surgeon knows your anatomy and what they were dealing with from the first surgery.

For more information, visit our website:

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

How to Reduce Puffiness Under Eyes and Treat Facial Skin Discoloration
How to Reduce Puffiness Under Eyes and Treat Facial Skin Discoloration

A gentleman has under eye hollows due to naturally hollow cheek bones. He also has thin under eye skin and a prominent brow. He wants to know what treatment would be recommended for him.

Dr. Amiya Prasad, an oculofacial plastic surgeon, explains that puffiness is mostly because of lower eyelid fat prolapse. Lower eyelid fat prolapse means that the fat that is normally below the eyes pushes forward and creates a visible bulge. Skin discoloration also commonly follows this problem.

To address lower eyelid fat prolapse and skin discoloration, Dr. Prasad does a combination approach. One procedure is called transconjunctival blepharoplasty to reduce the fat pockets from the inside of the eyelid. By doing that, he is able to reduce, reposition and do whatever is necessary to restore the contour. When it comes to the discoloration of the skin, he routinely helps people with a material called platelet-rich plasma (PRP). Platelet-rich plasma is derived from the patient’s own blood. It is essentially a concentration of the growth and healing factors that are necessary for wound healing. PRP improves skin quality significantly.

By doing these types of procedures, Dr. Prasad is taking away the negative that dominates the face that draws attention. In the field of cosmetic surgery, he looks at things both in the close-up view as well as the holistic view. Dr. Prasad looks for that dominant feature taking away from the face. For example, when someone has bags under their eyes and they always look tired, it affects everything in their whole face.

In this person’s situation, his cheeks may be a negative vector. It means that the cheekbone is relatively less projected compared to the eyeball or front of the cornea. That is a set-up in certain patients for issues related to cosmetic eyelid surgery such as lower eyelid retraction. Dr. Prasad has seen a lot of patients all over the world that unfortunately had eye bag surgery done from an external approach called the transcutaneous blepharoplasty. The skin was removed and nothing was done to support and control the position of the lower eyelid. What eventually happened in the healing process is that the lower eyelid was pulled down and created retraction. In some cases, it actually everts and causes ectropion - the eyelid being exposed from the inside.

In Dr. Prasad’s practice, he is very sensitive to this and he manages to avoid these types of issues 99% of the time. He may start by first dealing with the issue on his face that is most dominantly negative which is the puffiness under the eyes. After that procedure is complete, if he still feels that he wants more cheek projection or he want other things dealing with his nose, then he can pursue those things.

A lot of plastic surgeons are biased because when they look at a patient, they want to address everything. Since many surgeons tend to do everything under general anesthesia, they want to try to do as much as they can for that patient during that one general anesthesia session. Dr. Prasad doesn’t use general anesthesia -everything from: eyelids, facelift, breast augmentation, liposuction and tummy tucks under local anesthesia with sedation. He is able to give his patients a lot of flexibility from that perspective.

At this point, Dr. Prasad suggests that he meet with other cosmetic surgeons and get some other opinions. He should find a doctor that he resonates with and get a realistic sense of the outcome. Once he does that, he can make the decision and move forward.

For more information, visit our website:

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

Other Facial Cosmetic Procedures that Complement Facelift Surgery
Other Facial Cosmetic Procedures that Complement Facelift Surgery

A woman is planning a facelift. She wants to know other procedures that can be done along with a facelift to give her optimal results.

Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon practicing for 20 years specializing in eyelid surgery and face lifting surgery, deals with these types of situations every day in his practice. In facial rejuvenation in particular, people are bothered by loss of jawline definition, the sagging of the skin and neck. Most individuals look at a particular area in their face that they don’t like and magnify those areas. However, others look your face as a whole.

After assessing the photos this woman submitted, Dr. Prasad says that there is a great opportunity to harmonize her full face by doing something to address the hooding over the eyes. He can also address any puffiness, fine lines and wrinkles under the eyes. Those procedures would fall into the category of upper and lower eyelid blepharoplasty, and non-surgical facial rejuvenation.

In Dr. Prasad’s practice, he routinely combines eyelid surgery with face lifting surgery. In addition, he also does fraction CO2 laser. CO2 laser helps to address the lines and wrinkles in the skin that have an impact on skin quality. There’s a distinction between skin quantity and skin quality in face lifting surgery. The surgeon can’t pull all the wrinkles flat because a lot of those wrinkles are static wrinkles or static lines that are in the skin. These types of wrinkles will benefit from a procedure such as laser resurfacing or fractional CO2 laser. Dr. Prasad would also routinely employ platelet-rich plasma which helps in a regenerative way to improve the quality of the skin by increasing blood supply, collagen and other factors that make the skin healthier.

These procedures can be done later after a facelift. In Dr. Prasad’s practice, a lot of his patients want to take small steps and so they recognize that they want to have their upper and lower eyelid surgery done but they’d rather get the facelift done first. Dr. Prasad doesn’t have any issue with that because he doesn’t use general anesthesia. Routinely, he does everything under local anesthesia with sedation which results in a quicker recovery so he is very comfortable with people dividing their procedures.

Dr. Prasad says that this is a discussion with her surgeon before she moves forward with the final surgical date or at least have a game plan before her final surgery. She must understand the additional time required and the recovery involved and hopefully she will come to a conclusion of what will work for her. In Dr. Prasad’s experience with doing the eyelid surgery with the facelift, the recovery time is really not increased. Basically, they overlap in terms of the recovery time so his patients typically look pretty good in a week and look really good in two weeks.

For more information, visit our website:

http://prasadcosmeticsurgery.com/prasad-face-eyes/facial-surgery/facial-enhancements/

How Lower Eyelid Retraction is Caused by Skin Removal and Revision Surgery for its Repair
How Lower Eyelid Retraction is Caused by Skin Removal and Revision Surgery for its Repair

A woman had upper and lower blepharoplasty 9 years ago. However, her almond-shaped eyes turned into rounded ones. She wants to know the cause of this and the procedures that can correct her eyes.

Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon for 20 years and a specialist in revision eyelid surgery, says that he encounters this problem a lot. He has had patients who come from all over the world and the common issue is that the lower eyelids are pulled down called lower eyelid retraction. In other words, the patient had a natural almond shape before the surgery and the lower eyelid was at the same level with the colored part of the eye called the iris. However, after surgery, they got rounded where more sclera (the white of the eye) showed, which is called scleral show or lower eyelid retraction. Unfortunately, enhancements are typically not that successful unless proper anatomy is restored.

The lower eyelid is a very complex structure. Its position is a balance of several factors: one is the lateral canthal tendon which is responsible for the attachment of the lower eyelid to the inner aspect of the bone, the other factor is the vertical support of the lower eyelid which is keeping that area up, and the integrity of the skin and orbicularis muscle. The orbicularis muscle pulls the eyelid in position.

Very commonly, surgeons will do this procedure from the outside, take away the fat, and trim off skin without doing anything to restore the integrity of the lateral canthal tendon. They initially believed that there is extra eyelid skin. This is because during surgery, when a person is lying down, everything is shifted upwards which makes it appear as if there’s more skin than there actually is, so after surgery there is a skin shortage. In addition, the lateral canthal tendon is not properly reinforced so everything sags.

Dr. Prasad explains that the revision procedure for this woman’s lower eyelid is likely to be more involved than doing just a simple tuck up or limited procedure. A lot of his patients had multiple revisions and they end up more with skin shortage, wider scars and he has to do a lot more surgery. This includes grafting of tissue on the inside of the eyelid, grafting skin on the outside of the eyelid and even doing a drill hole canthopexy where he drills holes on the bone in order to restore the integrity of the tendon. However, this doesn’t mean she will need all those things but it is important to understand that the three elements of balance are very important for lower eyelid position and restoration of the anatomy.

It is crucial that she and her doctor have the same aesthetic values so that both of them can define the success of the procedure. A lot of people in the Upper East Side of Manhattan have the retracted eyelid look and they feel really good about it. When it comes to eyelid surgery, it is important to maintain and protect the health and integrity of the eye itself. If she has an understanding of what her doctor is recommending, and she feels comfortable that things will work out with any type of revision surgery that her doctor is suggesting, then she can move forward to have it done. Dr. Prasad suggests that she do more research about lower eyelid retraction after cosmetic eyelid surgery so that she can appreciate more about what others experience in a similar situation.

For more information, visit our website:

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

How Incisional Asian Double Eyelid Surgery Can Change with Too Much Fat and Skin Removal
How Incisional Asian Double Eyelid Surgery Can Change with Too Much Fat and Skin Removal

A woman had double eyelid surgery 3 months ago. She feels her creases are now too high. She wants to know if is possible to lower her crease by stretching the upper eyelid.

Dr. Amiya Prasad, an oculofacial plastic surgeon explains that the challenge after incisional Asian eyelid surgery is that it is almost impossible to get the results that the patient had before surgery. Excisional procedure involves removing skin and fat in order to connect the skin to the muscle called the levator muscle. The levator muscle is responsible for lifting the eyelid. When someone has a crease, nature has allowed a connection between the levator muscle and the skin so that there is a crease. In surgery, he creates that crease artificially with sutures.

If the patient wants to stretch the skin, they have a long time before it becomes stretched enough to cover the area over. In addition, this patient is 3 months after surgery and she’s still in a healing phase. The process of healing will go on up to a year. She needs to express her concerns to her doctor. If the eyes closed and the crease being in a particular position is not as relevant compared to how the eyes are like when they are open. If there is a proper or appropriate aesthetic fold of skin that shows a narrow type of shell for a platform as everyone refers to as the lid, then it should look natural and satisfactory with how the patient wanted it to look like when they decided on Asian eyelid surgery.

In Dr. Prasad’s practice, when a patient comes in, he will do fat grafting to fill an area where too much fat has been removed or if the person lost fat because of aging. One of the things that is observed with Asians is they have full eyelids when they are younger, but as they get older the eyelids hollow out. If there is extra skin, the eyelids can look like there is actual volume or fat loss. In those situations, he will do fat grafting.

At this point, Dr. Prasad suggests that she should be patient about the progression of her healing process. She can’t undo everything that’s been done like when she had skin and fat removed. She should meet with her doctor, review her before pictures and after photos and see if there are ways that her doctor can help her get to a point where she will be satisfied with her result.

For more information, visit our website:

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

Why a Hair Transplant May Damage Thinning Hair at the Crown, & a New Hair Loss Treatment
Why a Hair Transplant May Damage Thinning Hair at the Crown, & a New Hair Loss Treatment

A gentleman was told by a hair transplant surgeon that he’s not a candidate for transplantation. He is currently taking finasteride. He wants to know if a hair transplant is a good option for him.

Dr. Amiya Prasad, a hair restoration specialist, explains that a hair transplant is the strategic movement of hairs from the area at the back of the scalp which are genetically resistant to hair loss. This area is called the donor area. An example is a male who has advanced hair loss where they have a horseshoe pattern. That horseshoe pattern is permanent and it’s not going to fall out. Since it's permanent, those hairs can be cut out and then placed in another area strategically.

Dr. Prasad added that the surface area of this gentleman’s crown is fairly large and it is very common for men to think they can cover that space easily with hairs. Unfortunately, it requires a large number of grafts to cover and the donor area is fairly limited. In addition, if the hair is thinning, there are existing hairs and not entirely bald areas. Placing grafts might destroy those existing viable hair follicles. His doctor may have suggested finasteride to see if it can reverse the hair thinning.

Finasteride is a 1mg tablet taken once a day. It is used to inhibit an enzyme called 5-alpha reductase which converts testosterone to dihydrotestosterone (DHT). Dihydrotestosterone can cause susceptible hair follicles to eventually disappear. Many men with crown hair loss will respond to it. Unfortunately a lot of men, especially in their 20s and 30s, don’t want to take finasteride because of concerns about long-term sexual side effects.

Dr. Prasad’s practice has been in a leadership position with a treatment called Hair Regeneration. It was discovered several years ago after the introduction of a material called extracellular matrix derived from pig bladder that helps wound healing. It uses the body’s adult stem cells to heal by duplication of tissue that is native to a given area where the extracellular matrix is applied - when it’s applied to muscle, it regenerates muscle. Since hair is an organ, it is not possible to regenerate or duplicate hairs or clone hairs but through this procedure, it is able to restore the cells and signals necessary for hair growth. Through this treatment, the hair that’s thinning will come back thicker. The results are first noticed from a months to 18 months. With ,ale pattern hair loss, Dr. Prasad is approaching a 100% success rate defined by significant improvement that people can see and appreciate with before and after pictures. He also routinely does microscopy to follow and assess his patients very closely.

Dr. Prasad says that it is actually hard to find this particular treatment especially with all the fake solutions being publicized. Now that he has learned about this, he can investigate this method as an option for him and find a provider who can perform this. Dr. Prasad thinks that the trial of finasteride is worth considering. He should see how he does with it and learn more about Hair Regeneration to help him stop his hair loss and restore hairs that may or may not to be responding to finasteride.

For more information, visit our website:

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

Possible Eyelid Surgery Complications and the Right Timing for an Eyelid Specialist Revision
Possible Eyelid Surgery Complications and the Right Timing for an Eyelid Specialist Revision

A woman has asymmetry after blepharoplasty. She says that one eye droops and there seems to be ectropion. She wants to know if this needs to corrected ASAP.

Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon that specializes in revision surgery for cosmetic eyelid surgery, explains the appropriate timing if a revision is necessary. He has had patients who come from all over the world who have difficulty with eye closure from too much skin from the upper eyelids being removed. More commonly, he also has a lot of patients who have had lower eyelids pulled down, or ectropion where it’s everted and turned away resulting in severe exposure or irritation of the eyelid. Ultimately, they want an aesthetic revision because they don’t like the way their eyelids look and because they don’t feel like they look like themselves. When someone gets rounding of the lower eyelids and used to have an almond shape, they can be very distressed about it and this something that Dr. Prasad does a lot of work with.

Dr. Prasad says that it has been 10 days since this woman’s surgery and predicting how her eyelids will resolve is dependent on factors such as: the degree of swelling, the nerves that innervate these muscles, and the absolute amount of the skin for the eyelid to be in proper position. She also has to consider the health and integrity of the eye itself even with conservative management. Conservative management includes topical lubrication, keeping the eyes moist with artificial tears, ointment at night, wearing of goggles or keeping a humidifier in the room. These are ways to keep that eye moist so that the surgeon can time the surgery where the tissue is less swollen is very beneficial. Swelling is like working on a moving target when the surgeon is doing surgery. It distorts the anatomy and makes it challenging to predict consistent results.

At 10 days, Dr. Prasad explains that as long as her doctor is advising her about how to keep her eyes lubricated and managed in terms of the procedure itself and of eye health, she has some time before revision surgery. The surgeon can make these decisions based how much scar tissue he thinks can hinder any type of revision surgery. Before a lot of scar tissue forms, it is advisable to revise the surgery and that can be within the first couple of months rather than days. She may wait 6 months to a year to allow for full healing and softening of the scar tissue. As long as things don’t move in the wrong direction or undesirable direction, she has some time.

Dr. Prasad suggests doing everything to protect the integrity and quality of the health of the eyes. In addition, she should work with the doctor as far as the management. Sometimes when the lower eyelid is everted slightly, people will often successfully massage the eyelid up and get enough of improvement. If there is skin shortage then usually that doesn't work. These conservative methods are appropriate early in the healing phase. She should continue working with her doctor and hopefully things will resolve as times goes on.

For more information, visit our website:

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

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