Find the Videos, Producers, & Vloggers You Want Faster
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.
A woman has sagging skin around the corners of her mouth she thinks make her look old. She wants to know the best procedure for this and the sagging around her chin.
Oculofacial plastic surgeon Dr. Amiya Prasad explains that facial aging is the descent or weakening of the support structure of both the skin and the underlying tissue called the SMAS (superficial musculoaponeurotic system). When people come to his practice with this concern, they do a mirror lift where they physically and vertically lift everything upward. Through this, they are able to see if a facelift is an appropriate procedure for them.
When patients do their research, they will see terms such as facelift, face and neck lift, and neck lift. They’ll also come across proprietary names that have been given to various quick recovery procedures or procedures that claim to be remarkable discoveries that are done by a particular company. It can certainly be confusing. A lot of times people are afraid of having a procedure like a facelift or face and neck lift because they’ve seen pictures in magazines, read horror stories on the web or they know someone who had a procedure and that person went through a very rocky healing process.
In Dr. Prasad’s 20 years of practicing cosmetic surgery, specializing in facial aging effects on the eyes and face, he has seen a lot of fads come and go. Definitively, he says that the best thing is to choose the surgery that gives the patient the best result that will be long-term and is done properly. There was a point in time where people were very excited about short scar limited incision facelifts and unfortunately for people who have more volume shifting in their face, they can get an improvement but they don’t necessarily get everything that they want. A consultation is very important and the patient should make sure that you have a very good communication with the surgeon they choose.
In Dr. Prasad’s practice, he developed over 20 years a quick recovery concept without doing shortcut procedures. He decided to do procedures that were typically done under general anesthesia, but performs them under local anesthesia with minimal sedation. By developing this technique, he was able to get the full benefit of a more proper procedure and still reduce the risks and prolonged recovery related general anesthesia.
When Dr. Prasad first moved to the Upper East Side in New York City, he was very shocked to see how many people looked very pulled and over tightened. Overtime, he learned that the desired look is based on the aesthetic style of both the patient and the surgeon. He wrote a book a few years ago called “The Fine Art of Looking Younger” where he explained that there are different surgeons with different styles. His particular style is more of a natural look, other people are more of an exaggerated look and it is a matter of person’s individual taste and comfort level. He always feel that every patient’s face has a unique character. It is his role as their surgeon to maintain that character and to restore the key elements of their appearance that make them look more youthful, such as elevating the cheek, improving the jawline, and improving the neck.
At this point, Dr. Prasad thinks it’s best for this woman to start meeting with surgeons and learn about each individual surgeon’s particular style of how they do their procedure. He can’t stress enough the importance of communication. When meeting with doctors, make sure that they are given the appropriate amount of time so they feel comfortable and understand what they are committing to.
A 29-year-old woman has had bags for as long as she can remember. She also has hyperpigmentation which she feels make it look worse. She wants to know the best way to improve the look of her under eyes, and has avoided fillers because she read they can make it worse.
For years, non-surgeons tried to help patients with under eye bags by filling in hollows using hyaluronic acid fillers such as restylane and Juvederm to try to camouflage the appearance of the bags. In Dr. Amiya Prasad’s practice, he does this type of procedure but he says there is a limited volume that can be placed that can be effective. Because this material is so soft, patients actually have the hyaluronic acid removed by an enzyme called Hyaluronidase. This is because fillers don’t work on puffiness that’s beyond a certain level.
Puffiness under the eyes is caused by lower eyelid fat prolapse- the fat normally around the eyes pushes forward and creates a bulge. Puffiness make the eyes look puffy and tired, and is mainly a genetic trait. In fact, Dr. Prasad has operated on several generations in the same family with this type of situation.
In a young person like this woman and if there’s no excess skin, Dr. Prasad will do something called a transconjunctival blepharoplasty. Transconjunctival blepharoplasty is a procedure where he approaches the lower eyelid from the inside thereby avoiding an external scar. This way, he is able to reduce, reposition and address the herniated the fat. Through this procedure, he can make the eyes appear like the person has never had bags under their eyes. The hesitancy about doing surgery is because of the type of anesthesia. Fortunately in his practice, he does these procedures under local anesthesia with LITE™ IV sedation. Through this process, it is very easy for younger people to have it done with minimal interruption and disruption in their lives. People have told Dr. Prasad that if they knew it was this easy, they would have had the surgery done sooner.
Pigmentation can be due to genetics just like a regular skin colour, or from environmental factors such as sun exposure or people who work outside or have spent a lot of time with incidental sun exposure. To help people with dark circles or pigmentation, Dr. Prasad does an injection of platelet-rich plasma (PRP). Platelet-rich plasma is from the patient’s own blood. He draws the blood like a regular lab test and then spins it so that he can concentrate the platelets, the serum, the healing and growth factors necessary for wound healing. When this is injected on the skin or under the eyes, there is a significant improvement in skin quality. In some cases, he also does laser to tighten and to resurface the skin. So there are complementary procedures to help maximize the overall appearance of the lower eyelids.
At this point, Dr. Prasad’s recommendation is that she meet with qualified experienced cosmetic surgeons and discuss her options as to how to address this area. He also suggests avoiding general anesthesia for the procedure to minimize risks and speed up healing and recovery.
A woman had blepharoplasty and ptosis repair done twice. However, one eye is smaller and the fold feels very heavy. She wants to know if this heaviness can be fixed.
Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon practicing for 20 years, says that ptosis is one of those procedures where a surgeon can do a great job and create something that looks fantastic and beautiful. However, it can also result in not just one but more than one revision surgery. It can be understood that the sense of heaviness is often the result of internal or tissue swelling and it can also cause the eyelid to drop a little, particularly if there is enough swelling that causes a physical weight on the eyelid. It is sometimes referred to as mechanical ptosis where it is actually a lesion weighing down on the eyelid. In addition, the healing process of the levator muscle takes a little bit of time so that the eyelid may come up a millimetre or half a millimetre and make it look asymmetrical.
To ensure the likelihood of success, in other words getting the proper: height, contour, shape, and symmetry, Dr. Prasad actually lets the patient sit up during surgery. The patient doesn’t feel any pain because they’re numb but they’re alert enough for him to look at their eyelid and make adjustments while they are sitting up to get as close as possible to the final result. Statistically, about 95%-98% of the time, he is able predict that if it looks good during the procedure,and it will look good after. Of course, over his 20-year career, there are exceptions to that rule.
Dr. Prasad suggests that it is important that she meet with her doctor. Both of them should discuss the feeling of heaviness on the eyelid and let the doctor examine her so that she can get an idea of what to anticipate. Any surgical procedure, regardless of location, can take up to one year for full healing. In Dr. Prasad’s experience, there are even scars and other things that further mature beyond a year. In this area of delicate tissue which is less than a half a millimetre in thickness, one can understand that a little swelling can cause a lot of impact. She should probably allow some time for adjustment. In addition, in ptosis surgery, the levator muscle may not move in the same way as the other eye and it may take some time and adaptation.
A 25-year-old male is having continued hair loss despite using minoxidil and Deutomix. He wants to know another alternative from taking these medications.
Dr. Amiya Prasad, a hair restoration specialist, explains that male patter hair loss or male pattern baldness is a genetic trait which runs in families and has variable expressions. It's not a direct dominant or recessive trait and can affect only certain siblings - one can have lots of hair while another can have tremendous hair loss.
In the United States, the drugs that are approved for hair loss are finasteride and minoxidil. Finasteride is a 1 mg tablet that is taken daily and is used to inhibit an enzyme called 5-alpha reductase. 5-alpha reductase converts testosterone to dihydrotestosterone (DHT). Dihydrotestosterone will affect susceptive hair follicles which will then thin and eventually disappear. Minoxidil is a topical that is available over the counter. However, minoxidil does not stop the progression of hair loss. Finasteride can slow down the progression because it's working systemically from the inside in a specific way. Unfortunately, a significant percentage of men do not respond to finasteride. At this time, many men in their 20s and 30s are concerned about reports of long-term sexual side effects, so they refuse to take it altogether.
The traditional alternative is to do a hair transplant. A hair transplant is a surgical relocation of hairs that are resistant to hair loss which are located at the back of the scalp called the donor area. Genetically resistant hair means hair from this area will never fall out - no matter how long one lives, the hair will remain in place. Unfortunately, the donor area is limited and there are just a few hairs that a surgeon can move.
In general, it is more acceptable to have hair loss in men in their 30s, 40s or 50s. In Dr. Prasad's experience in 20 years of practice, men in their 20s expect to have a lot more hair volume. The Rule of Decades, a rule of thumb in hair restoration, states for men in their 20s, 20% will have hair loss while 80% will have a lot of hair. Even with transplant, a person won't get the volume they desire and will only have a limited amount of hair. In addition, nothing is stopping the progression of hair loss, therefore a person will continue to lose hair and eventually, their transplant area or donor area will be tapped out.
In Dr. Prasad's practice, he has had tremendous success with a method of restoring thinning hair called Hair Regeneration. This concept is something that he developed over several years and has been very successful in treating male and female pattern hair loss using a material called extracellular matrix. He developed a process of protocol and a method that combines platelet-rich plasma and extracellular matrix. Platelet-rich plasma is the patient's own blood that is spun down to concentrate the platelets and growth factors when separated from red blood cells. Extracellular matrix is derived from pig bladder which is used traditionally for would healing. It happened to be a remarkable serendipitous observation that when used for the benefit of a hair transplant incision, the area of hair that was not transplanted which was thinning actually became thicker. For the past 3-5 years of data, Dr. Prasad has had limited need for reinjection. He has close to a 100% success rate for male pattern hair loss.
Dr. Prasad does not negate the potential of hair transplants which he does perform, but in his practice he has shifted philosophy. He has been helping a lot of his patients by not having a hair transplant but rather to do injections and see how much volume of hair is restored through this method. If they still want to transplant, then he can be more strategic. One should remember that they are dealing with a limited donor area, so by strategically restoring hair which is limited in terms of the coverage, they can actually get significant coverage by doing a non-surgical treatment through this injection. Unfortunately, hair loss is an area where a lot of predatory behaviors occur where people are offering supplements and miracle treatments and all kinds of gimmicks and gadgets that don't work. Hair Regeneration is something that has tremendous data about and Dr. Prasad thinks this person will benefit from learning more about it.
A woman is 14 months after a facelift. Before, her face looked smooth and perfect. However, things changed and he wants to know if her face has a lateral sweep.
Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon, explains that when evaluating a patient with any unusual appearance after a facelift, it takes more than a photo to guide someone. As a surgeon, he would advise that she meet the original surgeon who did her facelift. If everything looked very good until recently, then chances are that her surgeon will have an explanation for what happened. Every surgeon who does face lifting surgery has their own signature style and has an understanding of what their patient looks like during their procedure.
There are many reasons why someone has a relative lateral sweep. It has to do with the relaxing of every face and neck lift procedure. It is the intention as surgeons to maximize the tone of the muscle under the skin called the SMAS, or the superficial musculoaponeurotic system, as well as to redrape and trim the excess skin so that it goes on very smoothly, looks nice, natural, and does not have vectors of tension. When someone has lateral sweep tension, it can sometimes be from descent of one area of the face where it was higher and came down almost like a pleat action. It could be the resolution of swelling that was present and made the area look better before, but then the swelling went down. Changes in tissue dynamics cause this pleating. Lastly, it could also be the skin quality.
There are many different ways to look at this type of issue and in a physical exam, the surgeon would actually vertically lift different areas and feel for areas of tension and opportunity. This may be something that is amenable to fillers. It could also be amenable to minimal enhancement. Although this woman submitted a very good photo, Dr. Prasad thinks that a physical exam has to be performed. If she is comfortable with her original surgeon, then that's probably where she'll find her solution. If for any reason she isn't comfortable, then getting additional opinions is warranted. Meeting with a doctor and getting additional opinions will give her a better idea on what's going on at the 14th month point of her process.
A woman had ptosis surgery 3 weeks ago and her ptosis now is worse than before. She wants to know the reason for this.
Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon, explains that ptosis surgery has its own unique challenges that involve a muscle called levator muscle. In a posterior approach or behind the eyelid, there are a couple of different procedures that are applied including Mueller's resection or posterior levator resection as well as Fasanella-Servat. These are names that are technical but if somebody is first concerned about their eyelid height, it's usually associated with some degree of swelling. The physical weight of the eyelid can push the eyelid down. In addition, the healing processes of the muscle and all the other related issues that occur especially in the first one to two weeks after surgery also affect the eyelid height.
From her photo, Dr. Prasad assesses that it doesn't look like she has so much swelling, so with that factor eliminated, there may be an issue with the connection or the way the tissue is supposed to heal. It might also be because of some stitches that have been broken or some separation.
Dr. Prasad thinks that her surgeon must be at least informed of her issue. The timing of any revision surgery may be dependent on when her surgeon was informed. In Dr. Prasad's own practice, if such a thing would have happened, he would prefer to find out sooner rather than later. It's a balance of when the patient wants to be operated depending on the degree of swelling, healing and what kind of impact there is on the eyelid height. When there is a real separation before the tissue has the chance to develop scar tissue, there is actually a window of opportunity to do a revision without complications. It's not necessarily within a few days or week. There is actually enough time, but it's a matter of what the surgeon's preference is.
Dr. Prasad insists that she let her surgeon see her sooner. If there are any questions or concerns, Dr. Prasad would always tell his patients that he'd rather see them than guess what they look like. Even if they show photos or pictures from their phone, or have someone to take a picture with a camera, it's always better to see that patient. Considering that this woman had her surgery recently, Dr. Prasad thinks that meeting with her doctor would be the best thing for her to do. Also, she should get an understanding of what's going on and what would be the appropriate step to do next.
A woman was told that she has upper eyelid ptosis of her right eye and that it's bilateral. She wants to know what surgery would be performed to correct it.
Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon, explains that whenever he sees a patient with ptosis, he would ask how long the ptosis has been like that. He would also ask if it was something new or has been happening over time. A thorough history is critically important to establish the diagnosis of ptosis. If it was mentioned to the patient that they have ptosis, or if there was an incidental statement that they were never aware of, then it means that they were never bothered by it. Ptosis in itself is not a reason to do surgery unless the patient is concerned about the aesthetic appearance or if there is also a functional issue related to vision.
In order to do a proper ptosis examination and to evaluate whether a person needs one eye or both eyes done, they ultimately would need a proper ptosis physical evaluation. The eyelid muscle called the levator muscle is very sensitive and there are certain things about that muscle that makes it more complicated to deal with. This is why 99.9% of board certified plastic surgeons don't do this type of surgery and this is the domain of the oculofacial plastic surgeons.
That being said, one of the things that is tricky about ptosis is a particular physiologic basis called Hering's law that has to do with the amount of tone each eyelid receives. It's called muscle innervations or the amount of tension that muscle has. If a person lifts one eyelid, the other eyelid would actually come down. That's why during ptosis surgery, in the pre-operative photos, a person can look like one eye is low and the other eye is high. Then when a surgeon does just one side, the first side can look high and normal and the other side can be low.
A patient has to decide if they are bothered about the ptosis at all. Within the normal population, 1- 2 millimeters difference between the eyes is accepted as normal and most people don't notice it. When people notice ptosis, it is because other people tell them.
It takes several exact visits for Dr. Prasad to make a decision before he decides to move forward with a ptosis operation. When a person comes in with a relative subtle amount of ptosis, he wants to look at them at several times of the day. Maybe at the end of the day, they can be more fatigued and the ptosis is more prominent.
Dr. Prasad recommends that she meet with qualified experienced oculofacial plastic surgeons who can guide her. She should get some opinions, look at their work and get a sense of what threshold would be right for her. She submitted one photo and it's clear that there's a slight difference between the two eyes, but for Dr. Prasad it's only slight.
A woman has malar bags as well as under eye bags. She wants to know if they can treated and the best procedure for her condition.
Dr. Amiya Prasad, an oculofacial plastic surgeon for 20 years, says that the treatment for eyebags is fairly straightforward. However, malar bags have been one of the most challenging things that anyone who works in this area has to deal with.
Under eye bags are caused by something called lower eyelid fat prolapse. Lower eyelid fat prolapse is an anatomic diagnosis where the fat pockets that are around the lower eyelids, behind the skin and the structure called the septum push forward and create a bulge. This tendency most commonly comes from a genetic pattern. In fact, Dr. Prasad has operated on 3 generations in the same family with exactly the same issue.
In order to treat lower eyelid fat prolapse especially in younger people, Dr. Prasad would routinely do a transconjunctival blepharoplasty. Transconjunctival blepharoplasty is an approach of addressing the fat pockets from the inside of the eyelids to avoid an external incision or scar. At the same time, he is able to get the nice natural contour as if the patient never had eye bags.
On the other hand, malar bags are the result of fluid over the most prominent area of the cheek bones. They are typically associated with allergies, sinuses, smoking and genetics. The basis is that fluid tends to back-up into the cheek area and stays there. Since malar festoons or malar edema is due to fluid, surgical procedures are not really effective in making significant improvements. The patients who make the most dramatic improvements are the ones who have the worst festoons that you can directly excise them and they will look better. When they are subtle, Dr. Prasad usually doesn't do anything. But when they are a little bit more obvious, he does procedures that can soften the transition between the eyebags and the malar edema. He has done things like the use of platelet-rich plasma to try to improve circulation.
There are some doctors that really advocate lasers, but these areas are very tricky and when someone applies heat in this area, there is no guarantee that the festooning will not get worse. Dr. Prasad has not been an advocate of using laser in addressing the festoons alone. That being said, the patient can consider options such as treating underlying allergies, sinuses or advise the smoker to stop smoking. In addition, Dr. Prasad employs the use of fillers as well as platelet-rich plasma (PRP). Platelet-rich plasma is a product of the patient's own blood: the blood is drawn, spun to concentrate the healing factors, then injected into the area. This has some improvement in the skin quality as well as the circulation that can make the area look better.
For more information, visit our website at:
A 42-year-old woman has puffy eyes and dark circles. She is considering eyelid surgery but wants to know other treatments for her situation.
Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon for 20 years, practicing in New York's Upper East Side and Garden City, Long Island, sees this type of issue everyday in his practice. The puffiness is caused by something called lower eyelid fat prolapse. Lower eyelid fat prolapse means the fat that is normally around the eyes pushes forward. In some studies, it has been shown to actually increase in volume. When it pushes forward, it creates a bulge-like hernia called herniated fat. The strategy for herniated fat is to do some type of procedure to reduce, sculpt as well as reposition.
Dr. Prasad explains that there is variability in puffiness of the lower eyelids because the fat pockets are affected by fluid. Fluid may be the response of the body in situations such as allergies and sinus issues where there is some backup of fluid. Food sensitivities can cause puffiness from fluid. Lack of sleep will also cause puffiness. The type of puffiness can be about fluid as opposed to volume caused by anatomy of fat.
Dark circles under the eyes are typically a combination of genetics, ethnic pigmentation, sun exposure or environment changes, as well as the quality of the skin. The skin can be so thin that someone can see through it and see the blood vessels and the muscle underneath. Sometimes in people with cases of allergies, it will be dark called allergic shiners.
In a situation like this woman's, in the absence of a physical examination, Dr. Prasad would typically recommend a transconjunctival blepharoplasty. This involves the strategic reduction of fat pockets from the inside of the eyelid, thereby avoiding an external incision and repositioning and sculpting as appropriate. He also combines this with platelet-rich plasma (PRP) which is drawn from the patient's own blood to help accelerate the healing the process. When he deals with the dark circles under the eyes, he typically does first a platelet-rich plasma treatment under the skin to improve skin quality. He will also combine that with a procedure like fractional CO2 laser. The combination of treating the physical volume as well as the skin quality yields nice results that his patients appreciate.
The puffiness after the surgery has to do with fluid management. If it is caused by allergies or sinus problems, then they have to be treated. If it's salt intake or other foods that might cause the fluid to occur, then the patient might need to be careful about their diet.
At this point, Dr. Prasad suggests that she meet with qualified experienced cosmetic surgeons who have a lot of experience with eyelid surgery and who could guide her further. The thing that he can't do in a discussion like this is a physical examination. Judging the integrity of the lower eyelid tone, the canthal tendon and the skin quality is a 3-dimensional experience so meeting with the doctor is important.
For more information, visit our website:
A 29-year-old gentleman started losing his hair when he was 21 years old. He wants to know the procedures appropriate for him
Dr. Amiya Prasad, a hair specialist, explains that male pattern loss appears to have a family history or has a tendency to run in families. From the level of progression that this gentleman has, he can predict that within a few years, he'll will have much less hair.
Dr. Prasad enumerates two drugs that are used for hair loss: finasteride and the other is minoxidil. Finasteride is a pill that is taken daily. It inhibits an enzyme called 5-alpha reductase which is responsible for the conversion of testosterone to dihydrotestosterone (DHT). It's been shown that specific men have hair follicles sensitive to the effects of dihydrotestosterone. When finasteride was introduced, a lot of men benefited. Unfortunately, there is a lot of concern about long-term sexual side-effects of finasteride. In Dr. Prasad's practice, it is more typical for men in their 20s and 30s to refuse or consider taking finasteride. The other drug is minoxidil, a topical treatment that helps prolong the presence of hair that's thinning. It is something that is applied once at night.
Traditionally, the only other alternative to these medical options is a hair transplant. Unfortunately, the reality is that a lot of younger men who have this rapid progression of hair loss, after one transplant, they need another transplant. To make matters worse, the donor area which is the area at the back of the scalp is very limited and a surgeon cannot cover the space once covered with tens of thousands of hairs with only a few thousand hairs.
In Dr. Prasad's practice, he developed a treatment called Hair Regeneration using a material called extracellular matrix by Acell combined with platelet-rich plasma and injected under the skin of the scalp. This is a onetime treatment session that has effectively stopped the progression of hair loss, reverse the thinning process and thickens thinning hair. He has approximately 3-5 years of data and close to a 100% response rate with male pattern hair loss. He is developing more protocols for more advanced hair loss in terms of later stages of procedures. This material that was originally used for wound healing is derived from pig bladder to help heal by duplication of cells. It's not by duplicating hair follicles but restoring the cells and signals necessary for the hair growth process to continue.
Dr. Prasad suggests that this gentleman consider the Hair Regeneration treatment. It has been very successful as a single treatment. Dr. Prasad follows his patients very closely by seeing them at 1 month, 3 months, 6 months and all the way to 18 months to the present time to see improvement.
For more information, visit our website:
A 58-year-old woman is looking for a qualified doctor for a non-surgical way to lighten up saggy jowls.
Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon, wrote a book called "The Fine Art of Looking Younger" where he explained that that facial aging has two processes. One is volume loss where consisting of diminishing bone, muscle, fat, skin and soft tissue. In a younger person, there's a lot of fullness to their face. The other process is descent and sagging, which is probably what this woman is manifesting with the jowls. When the face sags, there is the descent of the skin and decent on the underlying support structure called the SMAS which stands for superficial musculoaponeurotic system, which is an extension of the platysma muscle. When someone has jowls, it is the sagging of an area of fat that is below the jawline that diminishes its nice shape.
In order to solve this issue, Dr. Prasad says that some type of face lifting or face and neck lifting procedure needs to be done. However, there is a proliferation of laser and heating devices that that claim that their effects are the same as surgical procedures. In the 90s, there was a lot of excitement about the CO2 laser which claimed was going to make facelifts obsolete. There were also several equipment manufacturers that through a combination of selective language and creative photography make it appear that the results are equivalent to surgical procedures. In Dr. Prasad's practice every day, he sees people who have had some type of thermal device and basically had less money because they spent doing this procedure and did not see the result.
Dr. Prasad has observed that newer thermal devices heat up the skin so aggressively which reduces the quality of the skin. There is a very important layer of skin for a youthful appearance. The concept of heating up the skin to the point that it contracts to make it tighter causes trauma and damage to the blood supply and fat. As a surgeon, he feels bad for people who have bought into this. The principles remain the same: if the face is sagging and has jowls, there are different options and kinds of surgical procedures which can be minimally invasive, or a more extensive face and neck lifting procedure. For some people, having just a little bit of a jowl only requires liposculpture or maybe a little bit of neck tightening which would be the least aggressive procedure.
Before people invest their money in non-surgical solutions for jowls, they must do their research and look at actual results. They'll probably realize that avoiding surgery altogether is not necessarily a smart way to go. However, there are also non-surgical options that can help improve the appearance of the jowls. For example, some plan their face and neck lift about 1 or 2 years later, but for the short term, if they have important events coming up, Dr. Prasad can soften the appearance of the jowls by strategic placement of fillers such as Radiesse. As described, volume loss is a factor in facial aging and so with limited correction on those areas of volume loss, particularly along the area of the jawline called the mandibular notch and the mesolabial fold, can soften the appearance of the roundness of the jowl and make the jawline look a little bit better.
In Dr. Prasad's practice, he does all his face and neck lifting procedure with a quick recovery concept. He does everything under local anesthesia with LITE™ IV sedation and his patients recover quickly. The hesitation about pursuing face and neck lifting surgery has to do mostly about anesthesia and the recovery time. In the past 20 years, he has developed a way to minimize that hesitation while still doing proper face and neck lifts without shortcuts.
At this point, Dr. Prasad recommends that she meet with cosmetic surgeons. He specifically says surgeons because unlike non-surgeons, surgeons are able to do everything. They have devices as well as injectables which they can offer to help the patient. So he suggests that she meet with doctors, look at their results and think of how these procedures are done.
For more information, visit out website:
A woman had ptosis surgery on her right eye. She also had revision surgery 6 months later to remove excess skin. She thinks her surgeon didn't remove enough. She wants to know the procedure to fix the issue.
Dr. Amiya Prasad, an oculofacial plastic surgeon explains that in the normal population, if the eyelids are one to two millimeters from each other, it doesn't draw attention and considered normal. After reviewing this woman's photos with her eyes open, Dr. Prasad thinks that the objective of making the eyelid elevated and getting relative symmetry, shape and contour appears to be achieved. When he measures successful ptosis surgery, he measures the height, contour, aesthetics and symmetry of the eyelids. It is obvious with her eyes looking down that there is a difference with her eyes closed but with her eyes open, it appears that she achieved her objective.
Dr. Prasad thinks that it is best that she continue communicating with her doctor who did the original surgery. If she's concerned about extra skin, her original surgeon knows whether or not that's the case. Sometimes the folds, variability and the appearance is not a function of excess skin but rather the skin being attached or folding in a certain way. An example is non-incisional Asian eyelid surgery where it may appear to have overlapping skin when actually there is no extra skin but the skin is attached in a way so that the eyelid crease can form. A variation of this procedure is done for ptosis surgery when it is appropriate. So Dr. Prasad's advice is for her to continue communicating with her original oculofacial plastic surgeon. This is the doctor who knows her eye very well and has reasons for doing the procedure the way it was done.
In choosing revision procedures, Dr. Prasad suggests that she may want to consider some procedures just to improve the scar quality. In his practice, he uses a material called platelet-rich plasma which is drawn from the patient's own blood to help scars that are very thick. He has found this to be very helpful in softening scars. However, there was no clear indication from this woman's question as to the time frame of where she is in the healing process. Eyelid healing, whether it's skin or muscle, can last 6 months to a year and not just a few months. Particularly in eyelid surgery, an undesirable scar can change over the course of a year so she may want to do some conservative options before considering another surgery. Dr. Prasad's advice is to meet with the original doctor and discuss her options. If she doesn't feel confident about the recommendations, she can consider second opinions.
For more information, visit our website:
A woman has deep hollows and purple veins that showed through her thin skin. She also has jowls and marionette lines. She wants to know the procedures she might benefit from.
Dr. Amiya Prasad, a cosmetic oculofacial surgeon specializing in facial aging surgery for 20 years, does a lot of lower and upper eyelid surgery as well as face and neck lifts. He explains that the lower and upper eyelids are in a very unique space called the orbit. Although a person can physically move everything, which is called the mirror lift, it may look better but it is not in a level that is sustainable when doing aggressive face lifting. A lower eyelid procedure and face lifting procedure are two separate procedures. Although there may be some secondary benefit to the lower eyelid by repositioning the cheek as ut occurs in a facelift, trying to change the lower eyelid position, tone and overall appearance from a face lifting procedure will not likely be successful.
The lower eyelid is a very complex structure. As a specialist, Dr. Prasad deals with patients from all over the world, where they had lower eyelid surgery by board certified plastic surgeons but had severe lower eyelid retraction, skin loss, exposure and their lower eyelid was disconnected from their outer corners. Lower eyelid anatomy is fairly complex and sometimes surgeons who don't have specialized training will get themselves in trouble because of the limitations of what they know. The lower eyelid tone and position is critical. It is an important in the patient's decision making process when they meet with prospective doctors in choosing who will do their lower eyelid surgery.
Dr. Prasad often combines the lower eyelid surgery with the face and neck lift surgery. When patients meet with a doctor, understanding if the doctor has a mastery level of lower eyelid surgery involves various tests to check the tone of the lower eyelid such as a pull test or a snap test. With that, there are options on how to ensure that the lower eyelid position is maintained or enhanced with procedures such as lateral tarsal strip. When patients are doing their consultations, they may decide whether to do the procedures together or to do them separately. It might be practical for this patient with that level of anxiety to do the lower eyelids first and make sure everything turns out right.
In Dr. Prasad's practice, he doesn't use general anesthesia routinely for any procedure. He does everything in local LITE™ IV sedation. By doing that, his patients have the benefit of being able to make their decisions based on their own comfort rather than the decisions where there's an incentive to do as much as the surgeon can because they are going under general anesthesia.
Dr. Prasad suggests that this woman should learn more about her situation and meet with qualified experienced cosmetic surgeons about her lower eyelids, face and neck lift. Once she feels comfortable, she can move forward and have these procedures done.
For more information, visit our website:
Platelet-rich plasma (PRP), the healing factors from your own blood for a patient who traveled a great distance to Dr. Amiya Prasad to help improve her skin.
Originally used in orthopedics and sports medicine for injury healing, Dr. Prasad has become one of the leading experts in the regenerative properties of PRP for anti-aging and cosmetic procedures.
Platelet-rich plasma when used as an anti aging serum has several properties:
● Improve blood supply
● Increase collagen
● Improve the fat layer of the skin
When used on the face such as the area under the eyes, PRP injection can help improve the pigmentation and dull skin quality that causes dark circles under the eyes. New collagen and increased blood supply also benefits common aging issues like fine lines and wrinkles. PRP injection increases blood supply, collagen, and growth factors which can improve volume in the eyelid-cheek area for a fuller, younger appearance. PRP can also be combined with cosmetic fillers such as Restylane, Juvederm and Radiesse for even better results. For aging changes around the mouth, PRP can improve the appearance of vertical lines around the lips, the marionette lines, and the downward turn of the outer corners of the mouth. PRP injection can also be used to improve the appearance of forehead lines and horizontal neck lines.
PRP injection has been effective in improving the skin quality of acne scars and other types of scars.
The platelet-rich plasma treatment is almost painless. A customized topical anesthetic is applied to the skin before the PRP injection treatment so the patient feels little discomfort.
Dr. Prasad uses platelet-rich plasma (PRP injection) in other aspects of his practice. PRP can be used together with lower eyelid surgery where eye bags are reduced - the PRP helps the appearance of the accompanying dark circles. PRP together with dermal filler can help improve facial lines and creases. Dr. Prasad's Hair Regeneration treatment uses PRP and ACell's extracellular matrix (ECM) to thicken thinning hair and stop future hair loss.
For more information, visit prasadcosmeticsurgery.com
A woman has eyebags and discoloured under eye circles. She wants to know her options to treat her eyelids.
Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon for 20 years practicing in Manhattan and Long Island, says that there are many over-the-counter and other types of remedies which claim to treat bags and discolorations under the eyes, but none make a difference. He explains that puffy bags are typically believed to be related to lack of sleep, fatigue, etc. When the bags are there constantly, it's due to something called lower eyelid fat prolapse. Lower eyelid fat prolapse means the fat that's normally around the eyes pushes forward. In several studies, it is shown to increase the volume and results like a hernia. There is an anatomic issue involved. Naturally, the first line of treatment which is usually getting more sleep and using some topicals and creams don't really work because the volume of fat pockets creates a bulge that is deeper than what is applied on the skin.
Dark circles under the eyes is one of the most common complaints which is understandable. There is a wide spectrum of issues related to dark circles. Sometimes it is due to heredity or just natural pigmentation that runs in families. It is sometimes due to sun exposure. The skin becomes very thin and wrinkly. In addition, there are other factors such as allergies where someone can actually see through the skin and see the blood vessels and iron deposits. These are due to pooling of the blood, which are often referred to as allergic shiners.
Dr. Prasad has a global approach for a light-skinned person with puffy bags under the eyes. For a younger person with good muscle tone and with the absence of extra skin, he distinguishes there is a difference between the quality of skin versus excess skin. He approaches this problem by doing transconjunctival blepharoplasty. Transconjunctival blepharoplasty is an approach of addressing the puffy bags from behind the eyelid, avoiding any external incision and maintaining the integrity of the anatomy of the lower eyelid. From behind the eyelid, he reduces the fat pockets, repositions and other manoeuvres to make it look as if the bags were never there.
In terms of the skin quality under the eyes, Dr. Prasad is using something a lot of doctors are not doing at this time - platelet-rich plasma. Platelet-rich plasma (PRP)is derived from the patient's blood. It is process where he draws the blood like a typical lab test situation and spins it. He spins it to isolate the platelets and the plasma to concentrate the healing and growth factors. When he injects this material under the skin of the eyelid, it improves the skin quality of the eyelid by improving vascularity, collagen and overall health of the skin.
In addition, in selected cases, Dr. Prasad would use fractional CO2 laser. This a technology which transfers light energy into heat to take off the top layers of the skin selectively, and to deliver thermal energy into the skin there's a tightening effect. When done in combination, the results can be quite dramatic and most importantly, can look very natural. He does this procedure under local anesthesia with LITE™ sedation which is a minimal intravenous sedation. He avoids general anesthesia so patients have a quicker recovery.
If someone like this woman comes to Dr. Prasad's practice, he would typically do a transconjunctival blepharoplasty combined with platelet-rich plasma injection and possibly the use of a fractional CO2 laser for the skin quality improvement. Typical recovery is about a week. Usually, his patients tend to heal very quickly by avoiding general anesthesia and using LITE™ sedation.
Dr. Prasad suggests that she meet with doctors in person. He also stresses the importance of safety factors of eyelid surgery. This is a very delicate area so she should make sure the doctor she meets is highly experienced and is able to handle the problems that can occur with eyelid surgery. Once she finds a doctor that she resonates with, she should move forward.
For more information, visit our website:
A woman is very worried about her eyes. She is 9 weeks since her upper blepharoplasty incision technique and her creases are still uneven. She wants to know if it will continue to look swollen and if she needs to a get a revision.
Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon for 20 years, is familiar with both the incisional and non-incisional procedures for eyelid surgery and has a lot of experience with revisional Asian eyelid surgery. He explains that Asian eyelid surgery is a little different from other types of eyelid surgery. Incisional and non-incisional Asian eyelid surgery have one goal - a well defined crease. This goal is the connection of the skin to the levator muscle or the levator aponeurosis at a specific height. The levator muscle lifts the eyelid. In order to that, whether it's the non-incisional or incisional approach, he places sutures from the skin to that muscle. By doing that, there's a tight space between the eyelash margin and the crease. This tight space causes a tendency to develop swelling. Swelling can temporarily elevate the crease and make the crease look too high.
Dr. Prasad suspects that this woman's doctor probably explained this to her. Dr. Prasad always tells his patients that swelling can linger. He has had patients whose swelling from the eyelash to the crease lasted a year. He sees and monitors his patients in a regular interval usually at one week for suture removal, then at one month, 3 months, 6 months and ongoing. The door is always open between those visits if they have any concerns. He always observed that there's a dynamic nature to this procedure in terms of the ultimate result. At a certain point, one eyelid can be more swollen than the other. The creases can also look a little bit asymmetric and look like they're too swollen on one side. A little bit of swelling can go a long way and can have tremendous impact on the appearance of the eyes.
Dr. Prasad does the surgery in a way that can be very accurate in terms of predictability of the outcome. In some cases, he can let the patient open their eyes at a certain point in the surgery, but of course they don't feel anything. He can have them open their eyes and see how things look. And in other cases, especially if he is doing ptosis surgery at the same time, he lets the patient sit up and look at them to see how things look before some of the swelling starts to occur.
Dr. Prasad's recommendation is that she meets with her original doctor who did her surgery. It is only 9 weeks since the time of her surgery and of course, she should be able to express her concerns and understand what to expect. She should communicate with her doctor so that she knows what to anticipate and know where she is in the healing process.
For more information, visit our website:
A 41-year-old woman thinks she is experiencing premature aging. She thinks she has nasolabial folds, a heavy jaw area and downward facing mouth corners. She wants to know if a facelift is a good option for her.
Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon, wrote a book a few years ago called "The Fine Art of Looking Younger" where he explained that facial aging is composed of volume loss, and sagging or decent. In the early 40s, people usually don't have much sagging and descent. In Dr. Prasad's practice, the youngest patient he has ever done a facelift for was 37 and another patient was 42, so it's not impossible but is rare that someone as young as this woman considers a facelift.
With the photos this woman submitted, the one thing that Dr. Prasad did not see was any jowling. For example, a patient of his who was 42 whom he did a facelift on, was of Irish descent. Her skin was very loose, she started to have some jowls and she happens to be a mother of a two-year-old. Everyone thought she was the grandmother. But when Dr. Prasad examined her, he lifted the skin and saw that the jawline would really improve from lifting. With the photos this woman submitted, it doesn't look like she has any jowling and it doesn't even look like she has any cheek descent.
The one thing Dr. Prasad can't do by reviewing photos is a physical examination. So a simple test of just lightly pushing the skin can give a patient an idea of how much laxity there is. Dr. Prasad says that this woman might have volume loss rather than actual descent, so addressing volume loss would be better for her than doing a lifting procedure.
Dr. Prasad suggests that she do her research, meet with doctors in person and get a proper examination. She must understand that although she can push things up, it's not going to be surgically possible to lift as much or as aggressively as when she lifts in front of the mirror (AKA mirror lift). There's a certain amount of elasticity that has to be accounted for. For most of Dr. Prasad's patients in the early 40s, he suggests volume correction. This includes fillers such as Radiesse and Restylane to add volume, and platelet-rich plasma to help skin quality. In some cases, he would even do fat transfer. He also recommends that she meet with qualified experienced cosmetic surgeons in person and get some opinions. She might even want to try some of these fillers first to get an understanding whether or not the results are satisfactory for her.
For more information, visit out website:
A woman had upper and lower blepharoplasty with an endoscopic browlift almost 5 months ago. However, one eyelid is wrinkly and crepey. She wants to know if she needs a revision and if there is a non-surgical option for this.
Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon, explains that during a discussion about eyelid and brow surgery, that there's a distinction between skin quantity and skin quality. There is a common perception that wrinkled skin equals excess skin, and that is rarely the case. There may be some redundancy with both wrinkled skin and excess skin, but wrinkled skin is more about skin quality.
Dr. Prasad thinks that the strategy that her surgeon employed most likely was to do the brow lifting procedure and he estimated the amount of skin to be removed in the upper eyelids. The surgeon then reevaluated after lifting the brow because as a surgeon lifts the brow, there's less skin over the upper eyelid. As with many brow lifting procedures, especially endoscopic procedures, there's going to be some regression; initially, the brows look very high. Often it is necessary to overcorrect with that understanding that regression is expected, but this is on a case by case basis. As the brow descends a little bit, more skin will appear. In general, most cosmetic surgeons to allow six months to a year so that the brow position is stable and the patient can see how much excess skin or dermatochalasis there is.
If the patient is concerned about the skin quality, it is typically addressed by treatments such as laser or platelet-rich plasma. Dr. Prasad suspects from this woman's question that she is describing more about redundancy where there appears to be more skin. As far as non-surgical approaches, she may get suggestions about heating devices or lasers. However, Dr. Prasad suggests staying away from heating devices. From his experience, many people in the New York City and Long Island area have been seduced by the aggressive promotion of heating devices like ultrasound-based or radio frequency based. There's a limit of how much a brow can be lifted or skin tightened. Often the attempt to tighten or lift using heating devices results in excess heat which makes the skin thinner. That's why in Dr. Prasad's practice, he focuses on regenerative treatment such as platelet-rich plasma and the limited use of fractional CO2 laser, or Pelleve or a radio frequency device for darker skinned patients .
For now, Dr. Prasad thinks that she should allow the brows to settle and see how much skin there is in the upper eyelid. If she's talking about redundancy, then an enhancement may be necessary to get her closer to the ideal. She should keep communicating with the original surgeon as they know the anatomy of her face and eyes. Sometimes something as simple as retinol or retin-A or something in the retinol family can help improve the crêpey quality of the skin without having an invasive procedure.
For more information, visit our website:
A woman had upper blepharoplasty 8 weeks ago. At present, the creases look asymmetric. She wants to know if she needs a revision.
Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon, explains that one important part of a pre-operative and initial post-operative discussion is the maturation of the surgery. For any type of surgery like eyelid surgery, there is an initial impression where the surgeon can conclude that the overall surgery was successful. That means that the incision lines look like they're healing well. Naturally, there's going to be swelling because true surgical healing can take 6 months to a year.
As a doctor, Dr. Prasad follows his patients closely. He tries to keep an open communication with them and his door's always open if they have any questions. He thinks that this woman may be projecting too quickly about what her final result will be. It is natural for variability in swelling between the two eyes. It is not unusual to have an appearance of asymmetry during the early phases of healing. Two months is not long after surgery. Dr. Prasad always distinguishes to his patients that there is functional recovery after one week where people can go back to work, but swelling and healing will take 6 months to a year.
Dr. Prasad says that it is important that she maintain faith and communicate with her about her concerns. Dr. Prasad has been a practicing surgeon for 20 years and he can say that any doctor who has experience doing this type of work can able tell what the patient is going through based on a physical examination. A photo is good but it is not enough in comparison to a physical examination of a 3-dimensional appearance.
Dr. Prasad suggests that she continue meeting with her doctor on regular visits. He suspects that her doctor will be more than willing to do any type of enhancement if necessary. Every cosmetic surgeon is generally comfortable and understands very well that the human body is elastic and there is some stretch and variability in healing, and enhancements may be necessary. He thinks it's too early at the two month point to draw any conclusions. Dr. Prasad suggest that she communicates with her doctor and hopefully, as time goes on, her appearance will improve and she will have a result that she'll be satisfied with.
For more information, visit our website:
A woman is considering cosmetic surgery to treat aging. She wants to know what procedures are appropriate for her problem areas.
Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon, observed from the photos this woman submitted that she has some particular issues with the upper and lower eyelids such as dermatochalasis which means extra skin. She also has fat prolapse of the upper eyelid and lower eyelids. From the side view as well as the view from below, there is clearly extra skin under the neck. There are also two bands in the neck area called platysmal bands. Dr. Prasad says that she is a candidate for blepharoplasty (eyelid surgery), facelift and neck lift surgery. What she needs to ask herself is if she is ready for all those procedures.
Dr. Prasad spends a lot of time talking to his patients. He feels that communication is very important. Many people go to plastic or cosmetic surgeons and their consultations are very short and they get pushed to doing something that they would have done otherwise. They feel that they are pushed without getting proper information. All surgeries have risks and benefits. A detailed discussion of what's involved, how the procedure is done, where the incisions are placed, why the incisions are placed and what to expect are important things to discuss. Very often, it is the combination of a good discussion, physical examination and review of the doctor's previous patients to get an idea of what their personal style is. These are the things that are important so that the patient can make an informed decision.
Doctors have overlapping concepts of what a facelift and a neck lift are. Dr. Prasad defines a facelift from the cheek to the jawline, and a necklift from the jawline into the neck. Most of his facial rejuvenation surgeries for people at her stage would be a face and necklift. These are explained through the location of the incisions and the vectors in how things are lifted.
Although it's her daughter that mentioned the excess skin on the neck, it's how much of her personal importance that matters. In Dr. Prasad's practice, there are patients who are very focused on their eyes. Dr. Prasad says that if someone's going to do anything on their face related to facial aging, it will be the eyes. The eyes make a very big impact on facial appearance. That said, when the patient decides to do the eyes, face and necklift together, they literally bring back 10 years if not more. They will look really great but it's a very subjective thing. They should always think what they want to see change and how motivated they are. They should be ready to make an investment on money, time and the whole process.
In Dr. Prasad's practice, it's his mission to avoid general anesthesia. He feels that people do much better with local anesthesia with LITE™ IV sedation. His patients recover faster and surgical results improve. This is something that his patients have found tremendous appreciation and value.
For more information, visit our website:
A lady is considering blepharoplasty for her genetic eyebags. She wants to know if this is the right course of action if fillers are a better choice for her age and type of eyebags.
Dr. Amiya Prasad, a practicing oculofacial plastic surgeon for 20 years, has operated on people as young as 14-years-old for bags under the eyes. Genetic ye bags runs in families and he's operated on 3 generations of the same family. Dr. Prasad explains that there are some key important factors that will help someone decide which option is right for them. The first factor is how prominent the bags are. In this lady's photo, she appears to have relatively prominent eyebags, but lighting and other factors can impact how 3-dimensional the bags are. If the bags are very subtle, then maybe it can be camouflaged with a filler like Restylane or other hyaluronic acid filler . If the bags are more prominent, especially when she looks up and they bulge more forward, then she can consider a lower eyelid blepharoplasty. In a younger person, Dr. Prasad would typically do a transconjunctival blepharoplasty.
In addition, allergies accumulate a lot of fluid in the eye area. Management of allergies is very important when someone is considering rejuvenation of the lower eyelids. If her eyes are itchy or if she has watery eyes and she needs eye drops, those things should be managed. If she needs to take antihistamines, then she should take them. Allergies can still affect the appearance of a person's under eye area.
When puffiness is removed, even if someone has allergies, it won't look as puffy than when she did have the fat pockets there. She would probably be best served when doing a blepharoplasty as opposed to having a filler. Again, 3 dimensions can only be seen in a physical examination.
Dr. Prasad further explains that skin quality with allergies is an also an issue so she has to think about good topical skin care. Sometimes people with chronic allergies rub their eyes a lot and the skin becomes irregular and ages in appearance. In Dr. Prasad's practice, he would routinely do a platelet-rich plasma injection and use of fractional CO2 laser. However, it is important first to do a physical exam.
If her mother is doing her research, it will be good for her to tag along and have a consultation. Dr. Prasad recently did a facelift and eyelift on a mother and daughter and they supported each other very nicely during their healing process. This might be worth considering when she does her consultation. Most importantly, she should understand the level of fat prolapse she has - if it's beyond a certain level, she's probably best served with having the lower eyelid blepharoplasty.
For more information, visit our website:
A woman had blepharoplasty surgery but her eyelids are not symmetrical. She wants to know if she needs a correction and more surgery.
Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon for 20 years, is assuming that the surgery that this woman had is more than 6 months in the past. In other words, she has gone through the swelling phase so the eyelids are now pretty much stable, and one side has a nice crease while the other side doesn't appear to have a significant crease at all. The other thing to establish is whether or not she had an incisional versus excisional procedure. Based on this woman's question, Dr. Prasad assumes that she had an excisional procedure where a thin strip of skin was removed and the skin was closed in a way to try to create a crease. However, the crease did not form.
With that scenario in mind, Dr. Prasad explains how he approaches this in his practice. As a cosmetic oculofacial plastic surgeon, he says that Asian eyelid surgery is sometimes a little more involved that it could appear initially. There are factors such skin thickness, the way someone heals, and the natural anatomy of the patient. There are so many factors that can result in some asymmetry or lack of definition in the eyelid crease.
If there is no need to remove any more skin, then an option a person can consider is a non-incisional procedure. This is done through small entry points on the skin. A stitch is placed that connects the levator muscle. This muscle is responsible for lifting the eyelid. In addition, the crease that is natural is formed from fibers that come from the levator muscle and go to the orbicularis and the skin of the eyelid. Essentially, what a surgeon is doing in crease-forming surgery is artificially creating the connection. By doing a non-incisional procedure and doing the suture technique, he is able to create the crease, not remove skin and ultimately get a better result.
Dr. Prasad thinks it's best that she discuss this with her original doctor. Most likely when she made the decision to do the surgery she chose a surgeon who was experience with Asian eyelid surgery. Once she discusses her concern about not being able to close her eyes, then she can ask about non-incisional development of the crease so that way she is not worried about too much skin being removed. Asian eyelid surgery is not about skin unless the surgeon is dealing with an older person who has a lot of extra skin. Usually with people who are younger, there is a limited amount of skin that can be removed to create a crease, so that is part of the decision of which approach to use.
For more information, visit our website:
A 28-year-old woman feels that she looks much older because of bags under her eyes. She wants a recommendation on how to reduce them.
Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon, explains that puffiness under the eyes can make a person look older. The anatomy of puffy bags under the eyes that are persistent is caused by lower eyelid fat prolapse. This means the fat that is normally around your eyes pushes forward and creates a bulge. Most of his patients have tried topical creams, looked online, and bought all kinds of different things that don't work. They've also used tea bags and cucumbers. Unfortunately, those things can't work because it's a physical volume of fat pushing forward.
For a young person, Dr. Prasad's typical is to perform a procedure called transconjunctival blepharoplasty. Transconjunctival blepharoplasty means reduction and repositioning of fat pockets from the inside of the eyelid. This way he avoids any external incision and scars. He is able to preserve the beautiful shape and character of the eyes in this procedure. He also does this procedure under local anesthesia with LITE™ IV sedation. That means the patient doesn't have to go under general anesthesia. The patient is basically relaxed and within a relatively short period, the puffy bags are reduced.
Dr. Prasad also noticed that there are a few fine lines under this woman's eyes. This is something that he can't make a recommendation for unless she has a proper physical examination. However, when there are fine lines under the eyes, it is very important that she wear sunblock and protect her skin especially since she lives in Florida. He will sometimes do a little fractional CO2 laser as well as platelet-rich plasma injection to help improve the collagen and appearance of fine lines. Sometimes, it's just the use of a simple topical retinol product. In his practice, he actually has a whole skin care line and has some nice retinol products too.
Dr. Prasad thinks that her next step is to meet with some qualified experienced cosmetic surgeons and look at some before and after pictures. She should find a doctor that she clicks with and move forward. Having the bags reduced from her eyes will make a very big difference in the appearance of her face and certainly brighten her up, especially for someone as young as her.
For more information, visit our website:
A woman feels that the skin under her eyes looks loose and appears she has small bags under her eyes. She wants to know if she needs a surgeon to help her tighten her skin. She also wants to know what type of surgeon she needs to go to.
Dr. Amiya Prasad, a 20-year practicing cosmetic oculofacial plastic surgeon, explains that it is critically important to first define what the issues are that result in a lower eyelid appearance. As a specialist with eye surgery background and specialized training in cosmetic surgery of the eyes, he further explains that the anatomy of the lower eyelid is one of the most challenging areas to work with because of the critical structures needed for proper lower eyelid position. People who have had eyelid surgery may have their lower eyelids pulled down or rounded and they look like their eyes are bulging. That is not an aesthetic that Dr. Prasad likes. In his practice, it's all about people looking natural. He actually wrote a book about this a few years ago "The Fine Art of Looking Younger".
When Dr. Prasad looked at this woman's photo, he noticed that the outer corners are slightly down. It may be that she never had a very high almond shape to her eyes but he suspects given her appearance that a combination of genetics and aging changes has probably resulted in some looseness. What she interprets as loose skin can be attributed to lateral canthal tendon laxity. The lateral canthal tendon is the support that keeps the eyelid attached to the bone. When Dr. Prasad describes the scenario of people having their eyes rounder or pulled down, most of the time it's because of a board certified plastic surgeon did not address that lateral canthal tendon.
When Dr. Prasad does an evaluation of the lateral canthal tendon, he does something called the pull test and a snap test to see how much spring there is to the lower eyelid. Then he looks at the amount of fat that's under the eye and whether or not there's extra skin.
In choosing a surgeon in the field of cosmetic surgery, there are many types of specialists. Patients can do their research and learn about levels of specialization and training. Every type of surgeon, whether they're a general plastic surgeon, oculoplastic surgeon or facial plastic surgeon will do eyelid surgery. However, everyone has their own style and there are different levels of experience and practice-focus that helps distinguish one doctor from another. The functional aspect of the lower eyelid and the complexity that is often missed on how lower eyelid surgery is done can be a caution for someone to do the research. The patient should also understand the level of expertise that their doctor has. Patients usually look at pictures of before and afters and get a sense of the doctor's style.
Another aspect that Dr. Prasad mentions is how the surgery is done whether it's done under general anesthesia or under local anesthesia with sedation. In his practice, he does things exclusively under local anesthesia with sedation. In particular, when he does eyelid surgery, he likes to do the procedure in a way where the patient is asleep but he can wake them up easily. When he is doing the art of the lower eyelid surgery, even though people are afraid that they'll move or there'll be pain, that's not an issue. In an eyelid procedure, when he is doing tightening and he wants to get a nice shape and symmetry, he can actually ask the patient to open their eyes during the procedure and let the patient sit up. However, this is done on a case-by-case basis. This is one way to get that precise and natural appearance of the eyelid.
In addition, it is important for a patient to feel that the doctor can handle the different levels of complications and very advanced issues. Most patients feel that an experienced doctor could handle any issues because all surgeries have some risk. Dr. Prasad suggests that she do some research and learn more about different doctors who perform eyelid surgery in her area. Hopefully she'll make a good decision and be happy with her results.
For more information, visit our website:
A woman's eyelids are very puffy and heavy. She wants to know if a double eyelid surgery or removal of fat or muscle could treat it.
Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon focusing on Asian eyelid surgery and in practice for 20 years, explains that there is a lot of discussion needed and a proper physical exam is also necessary. In other words, the questions that this woman is asking can be answered to a degree with just photos but nothing replaces the 3-dimensional aspect of appreciating the skin quality, fat volume, the eyelid crease and the amount of hooding. In his practice, he actually places a Q-tip inside to create a fold to give them some idea of what to anticipate.
Dr. Prasad always tells his patients that in cosmetic surgery literature, it is often quoted that 50% of people who have Asian descent have a crease and 50% do not. Nature gives a bit of space and permission to work with. When a surgeon fights too much, then they can get some unpredictability. A lot of his patients who come in who want a specific style often bring pictures of people who they admire and who they want to look like. But if their skin quality, anatomy and the position of the eyes is different then he has to think of some kind of customization that's right for them.
Dr. Prasad anticipates from experience that someone like this woman would probably be better served with a tapered crease, as well as extending relatively parallel without a flare in the outer aspect to address the hooding. This is something that can still be customized in degree of fat reduction and the amount of crease that can be shown. Again, this is a discussion that is best served by a physical examination. He would suggest that she meet with experienced cosmetic surgeons and have this discussion.
The factors to also discuss have to do about whether or not she has extra skin. She can choose between an icisional Asian eyelid surgery or a non-incisional - there are many choices and variables. With that understood, an examination would probably help her understand better what her choices are. She should meet with a few doctors, get a sense of what is realistic, be sure that she is comfortable with the choice and that she has a sense of what she will look like when everything is settled.
For more information, visit our website:
A 46-year-old woman has been getting Radiesse in her upper cheeks, Botox around her eyes and various fillers around her mouth. She asks if it is too soon for her to consider surgical procedures for aging.
A few years ago, Dr. Amiya Prasad wrote a book called "The Fine Art of Looking Younger". He explains that with this woman's age, there are some genetic components that are probably playing a role. He thinks fillers play a very important role in helping people fill the areas where there's volume loss. Very often, people are afraid of looking overdone but he always teaches his patients that when he does fillers, it's mostly to correct rather than augment.
The one thing that Dr. Prasad can't do with photos is a physical examination. If she looks at the mirror and pushes the skin upwards, if she has some laxity and it moves very easily, she might be a good candidate for a mini lift. But it might be that when her plastic surgeon examined her, they pushed the skin, and the wasn't much movement, then it may not be the best idea.
Dr. Prasad thinks that with the photos she submitted, the lower eyelid puffiness draws his attention. As an oculofacial plastic surgeon, eyelids and facelifts what he does every week on a regular basis. For many of his patients when they look at in the mirror, they look at their eyes first which is why eyelid surgery is such a popular procedure. Dr. Prasad says that she must ask herself what are the things that really matter most to her, and if she can hold off any procedure, whether it's the cheek implant or the facelift and she can buy time with fillers, he thinks that's a pretty reasonable strategy. From his perspective, addressing the eyes would make a significant difference.
Dr. Prasad suggests that she consider discussing with her surgeon about blepharoplasty and what would be an alternative to the significant amount of puffiness. In his practice, he typically does the transconjunctival approach and he doesn't remove skin. This is something that's technical. He thinks the choices and the things that she consider are reasonable. There is a limit to what fillers can do. So she must consider doing an upper lid blepharoplasty, a lower lid blepharoplasty, cheek implants and with or without a mini lift are still within the realm of possibility.
For more information, visit our website:
A lady had a follicular unit extraction (FUE) eyebrow transplant 12 days ago. She explains that her doctor missed an area she wanted. She wants to know if there is a risk if she will have another transplant.
Dr. Amiya Prasad, a hair restoration specialist, explains that hair transplants to specialized areas of the eyebrow are more complex than doing a transplant from the scalp. People desire hair density to make the eyebrows look natural. Eyebrow hair has a certain angularity to the placement of the hairs to make it look natural. At the same time, it is very important that each graft has a proper blood supply. Even if the patient wanted to add more hair, sometimes the doctor has to stop because if they place too many, the survival of the transplanted hair is compromised.
In Dr. Prasad's practice, he uses a method that he derived from his Hair Regeneration treatment using something called extracellular matrix. This helps in accelerating healing so that the patient gets this maximum yield from the transplants. In terms of the physiology of the growth of the hairs, this lady's doctor is certainly consistent with the standard in the field.
Hair grows in cycles. There is a shock phase where existing hairs as well as transplanted hairs can fall out temporarily. It can take months for new hairs to grow in. In Dr. Prasad's practice, he sees his patients fairly regularly to ensure that he has this communication so they don't worry about second guessing if something doesn't look right. This lady has to realize that it is not likely that her doctor missed a spot. She may also be noticing a spot looks empty because the hair has shed or it's just from normal tissue swelling. 12 days after her hair transplant, she will still have some swelling.
Dr. Prasad advises that this lady should continue to communicate with her doctor's office and expect that there will be progression. He tells his eyebrow transplant patients that although he will place as many grafts as he can, they should be prepared to do additional surgery if they want a certain result and density. She should also understand the goal of the surgery. She'll be surprised how quickly a year goes by and she'll have a different perception. By then, she can see if she wants to do additional grafting at that time.
For more information, visit our website:
A woman is 7 days after her Asian eyelid blepharoplasty, or double eyelid surgery. She is worried about her crease being too high and looking unnatural. She wants to know if this is normal and asks what she can do to address this problem.
Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon for 20 years, does a lot of Asian eyelid surgery, written about it and is well-versed with the different methods and techniques. One of the things that he always discusses with his patients is that the initial swelling after eyelid surgery typically makes the crease look very high. The space between the eyelid and the crease called the pretarsal area can swell tremendously. But there is variability - some people swell more than others.
Whether it's non-incisional or incisional, the very nature of Asian eyelid surgery is the suturing of the skin to the levator muscle. The levator muscle is responsible for lifting the eyelid. It almost acts like a tourniquet to cause swelling to stay in a very limited space and expand. When it expands, it makes the crease look high. The patient should anticipate that after the 7 days have passed, every week that swelling will change and that is true eyelid surgery healing. Even though the patient can have functional healing within a week, true healing is still within 6 months to a year. It takes a lot of time to really understand what the final result will be.
Dr. Prasad doesn't have the benefit of the pre-operative photo so he cannot predict if the skin will fold over. If this woman made her decision based on finding a surgeon who has a lot of experience with Asian eyelid surgery, she can be confident that the doctor anticipated that in order to create a crease, and a certain amount of overlap was necessary to create a natural double fold. There is an art to doing this that's adjusted depending on the patient's skin type, thickness, age, and degree of fat volume. There are many factors that are taken into consideration that certainly makes Asian eyelid surgery a challenge. Most likely, this woman is not going to get a prediction of the overlap until the swelling comes down. It's seems intuitive that as the swelling goes down, the skin that would likely overlap would sink in place and be more in position. When Dr. Prasad does Asian eyelid surgery or surgeries such as ptosis surgery, he will sometimes allow the patients to wake up a little bit so he can see them open their eyes and see how things look. Typically, by doing the measurements and planning ahead, he can consistently get a nice result.
Dr. Prasad advises this woman to continue communicating with her doctor and allow the time to pass. She is not going to be able to do anything interventional anytime soon without disrupting the natural healing process. The communication with her doctor will help her feel better about her anticipated recovery time.
For more information, visit our website:
A woman has developed jowls and her face has dropped. She also developed lines on her lower face. She wants to know the best treatment if she should she go abroad.
Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon practicing for 20 years, explains that facial rejuvenation happens to be an area he specializes in. He wrote a book called "The Fine Art of Looking Younger" and can help people like her who are confused about fillers as well as other procedures.
Facial aging is a combination of volume loss and laxity. Volume loss means loss of bone, muscle, fat, collagen and soft tissue. As people get older, the baby fat diminishes and everything gets smaller. That's why fillers have such a vital role especially in the earlier decades of facial aging such as 30s and 40s. On the other hand, laxity or loss of elasticity where tissues such as the skin and the tissue under the skin called the superficial muscloaponeurotic system, or SMAS, gets loose, becomes thinner and sags.
In Dr. Prasad's 20 years of practice, he has seen so many procedures come and go that are supposed to be shortcuts. These include thread lifts, mini weekend lifts, various heating devices that are supposed to take over facelifts and lasers. However, there are no shortcuts - there are ways that procedures can be done to optimize the results but certainly shortcuts never work.
When someone has to make a decision and money is an issue, from Dr. Prasad's perspective that is where people make a lot of mistakes. As a specialist and as someone who has become well-known, he has patients who come to me from all over the world and all over the country who have had some unfortunate results by going for less expensive options. Unfortunately, in the field of cosmetic surgery, there appears to be two types of doctors: doctors who do high volume and low prices, doctors who do low volume and higher prices. There are also people in the middle. Unfortunately, quality does cost. The cost of anesthesia, operating facilities and the art of doing the surgery cannot be rushed, so the adage that you do get what you pay for is true.
People have come back after going to different countries for surgeries where they needed additional aftercare. Surgery is a single procedure, many people need more care for the incision, swelling or other areas that need treatment with steroids. The aftercare process is so important and they missed that by going to another country. They come to someone like Dr. Prasad or a colleague and they are surprised that they have to deal with all of these issues. Being in the United States or going to a doctor who has the qualifications, experience and who is accessible has tremendous value. Dr. Prasad always teaches his patients that their procedure is an investment that will pay long-term dividends in terms of the benefit after many years. Being in practice for many years, his patients and he have gotten old together and at one point, he'll do their eyes and they'll come back and he'll do their face. His accessibility is a greatly valued by his patients.
Dr. Prasad's advice is to meet with several experienced cosmetic surgeons and come up with plan. If it's about the budget, then she should choose the things she is most concerned about and address them first. In Dr. Prasad's practice, he does everything under local anesthesia with LITE™ IV sedation. If someone cannot afford everything, they don't feel bad that they are not going under general anesthesia and having to go back to it. When his patients do the sedation, they recover very quickly and when the time is right they'll come back and do another procedure. Anesthesia is certainly a factor and helps patients budget their priorities. Unfortunately, when someone goes under general anesthesia, there's pressure to do more procedures just because it's not the best experience in terms of the risks involved.
Dr. Prasad suggests to have a plan and an idea of what a person needs to do. They may need to do a limited procedure as long as the patient and the doctor are clear on what the ultimate benefit is. In his experience, shortcut procedures are not the best way to do things. Most of his procedures, like facelifts or face and neck lifts, he does it aggressively enough so that they feel that their jawline is tight, their neck angle is well defined, cheeks are up and it looks very good. Shortcuts may result in a better jawline but then there's neck sagging and laxity. Dr. Prasad would discourage from going abroad. There are many highly qualified experienced cosmetic surgeons here and he thinks it's a matter of finding the right one and budgeting intelligently.
For more information, visit our website:
A woman says she is tired of looking tired. She has under eye bags and slight dark circles around her eyes. She wants to know the best choice of procedure to address her problem.
Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon practicing in Manhattan and Long Island, deals with this issue everyday in his practice. He explains that the puffiness under this woman's eyes is called lower eyelid fat prolapse. Lower eyelid fat prolapse has to do with the anatomy around the eyes. The puffiness is fat pockets that have pushed forward. In many circumstances, people first try topical creams, put cucumbers and teabags. But since the puffiness is a physical volume of fat, these modalities help the skin but don't do anything to the puffiness.
In Dr. Prasad's practice, for someone like this woman, his procedure of choice would be transconjunctival blepharoplasty. Transconjunctival blepharoplasty means that he is approaching the fat pockets to reduce and reposition them from the inside of the eyelid to avoid any external incision. Therefore, there are no issues with marks or incision lines even though a transcutaneous approach can be done very artfully. In particular, this procedure maintains the natural shape of the eyes. This is something that's very important especially in younger people who have a nice, natural almond shape of the eyes. He had many patients come to him from all over the world who had an external approach. It's not the approach itself that's an issue, but the actual surgery that was done and it resulted in the rounding of the eyes. To repair these issues, he has to do very complex procedures such grafting, drill hole canthopexies, and other things to restore that almond shape.
For under eye circles, it's it usually melanin pigment in ethnic variations in skin quality and texture, from external factors such as environment, sun exposure and allergies. Dr. Prasad routinely uses platelet-rich plasma to help the skin quality of the lower eyelid skin and then that helps with the dark circle issue. He often recommends the combination of transconjunctival lower eyelid blepharoplasty with platelet-rich plasma which he does routinely in his practice at local anesthesia with LITE™ IV sedation. This way he avoids general anesthesia altogether and it allows his patients to recover faster and go back to normal life quickly. It has been extremely successful and effective.
Dr. Prasad suggests that she meet with qualified and experienced cosmetic surgeons. She should find one that she clicks with move forward.
A male in his early 20s has eye bags and loss of volume at the eye-cheek junction. He wants to know the best treatment for his situation.
Dr. Amiya Prasad, an cosmetic oculofacial plastic surgeon, explains that in the absence of a physical exam, it's very difficult to make a definitive recommendation. People like him are in a situation where it's more about the volume loss than it is about the fat prolapse. Thanks to more recent fillers, it is actually possible to camouflage that transition or restore a little bit of volume along the orbital rim. This area is referred to as the V deformity. Basically, it is just a relative hollow.
In Dr. Prasad's practice, he routinely uses hyaluronic acid such as Restylane. He has also been doing a combination of hyaluronic acid with platelet-rich plasma. There has been some very well established information of the synergistic effect of platelet-rich plasma. Platelet-rich plasma is derived from the patient's own blood and contains growth factors and helps improve skin quality. Hyaluronic acid provides some volume and there's collagen deposition that helps to improve these areas more long- term. A lot of his younger patients appreciate avoiding surgery and having this type of treatment. If the fat pockets underneath their eyes are too prominent, then he recommends a surgical procedure.
Dr. Prasad cautions patients about fat grafting. Lower eyelid skin is the thinnest skin in the body and is about half a millimeter in thickness. In his experience, he had many patients from all over the world that have him treat them because they had fat grafting and they ended up with a lot of irregularities, scars, lumps and basically things that are very complex to deal with.
Dr. Prasad thinks that this man's puffy under eye bags are not that prominent and he can use a hyaluronic acid filler. However, there's an art to doing this. It may take a doctor more than one treatment to get it right but it's the least invasive and most effective way to treat someone. Hyaluronic acid can last from months to over a year, but there's some variability. If a person is doing anything that is any way toxic to their skin then it's advisable to stop, including: smoking, trying to lose weight and doing any crash dieting or even drinking excess alcohol. These are things that are very toxic and can advance the aging process.
He should consider fillers as a starting off point before moving ahead with surgery. Again, in the absence of a physical examination, it's hard to appreciate this man's situation in 3-dimensions.
For more information, visit our website:
A 27-year-old male was told he is not a candidate for hair transplant. He wants to know other options that might help his hair loss.
Dr. Amiya Prasad, a hair restoration specialist, says based on the photo he submitted, that he appears to have male pattern hair loss. Male pattern hair loss is commonly a hereditary issue and the choices that people have in addition to hair transplant also include medical therapy. The medical therapy that is currently approved by the FDA of the United States includes two drugs. One is finasteride and it is a tablet that's taken daily. It inhibits a particular enzyme called 5-alpha reductase and prevents the conversion of testosterone to dihydrotestosterone. It's very well established that a certain subset of male pattern hair loss is associated with hair follicles that are sensitive to dihydrotestosterone. So when people take finasteride, they are diminishing the amount of dihydrotestosterone and reversing the thinning process. The other drug is minoxidil and it is a topical over-the-counter drug under several brand names. Minoxidil does not stop the progression of hair thinning but appears to prolong the time that thinning hairs stay on the scalp making the hair look thicker.
At this time, there has been a concern about the long term sexual side effects of finasteride. Many younger males in their 20s and 30s are not even considering finasteride because of this. Paradoxically, Dr. Prasad has had many patients in their 40s and 50s and even older who have been taking finasteride for years since the late 1990s without any side effects.
In Dr. Prasad's practice, he does a treatment called Hair Regeneration. Many years ago, it was noticed that a material called extracellular matrix derived from pig bladder when used to heal a donor area for hair transplant, the thinning hairs near the donor area actually became thicker. Over the past couple of years, he has been developing a method combined with a formulation for male and female pattern hair loss as well as some unusual types of hair loss such as alopecia areata and lupus. He does a single injection and has about 3-5 years of data supporting this. This injection appears to reverse the thinning process. He's using a wound healing technology that is combined with platelet-rich plasma which is derived from the patient's own blood and has helped hundreds of patients who have come to him from all over the world to treat their thinning hair. Hair Regeneration can be used on both men and women.
Dr. Prasad says that this man consider this type of option and learn a little bit more about it and find a provider that performs this procedure. This is also exactly how Dr. Prasad offers treatment to his patients - he doesn't go straight to the injection, he first educates his patients about the medical therapies and then they make an informed decision of whether or not to do the injection.
For more information, visit our website:
A gentleman has a negative vector. His right eyelid is droopy and there are prominent wrinkles under his right eye. He also has prominent eye bags. He wants to know the best choice of surgery to deal with his problem areas.
Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon, explains that a negative vector means that the eye is very prominent compared to the projection of the cheek. As a specialist in cosmetic oculofacial plastic surgery, he has had many patients who come from all over the world to let him repair lower eyelid retraction and a negative vector. Their plastic surgeon removed fat and skin and the eyelid became averted and developed into eyelid retraction.
The youngest person that Dr. Prasad ever did lower eyelid surgery for was a 14-year-old boy who had very prominent and big bags under his eyes. Everyone in school was teasing him for being on drugs. So it is certainly fine for someone as young as this gentleman to have a lower eyelid blepharoplasty.
With his age and the negative vector he has, the approach Dr. Prasad would use most likely would be transconjunctival blepharoplasty. This means that he would address the fat pockets from the inside of the eyelid to avoid any comprise to the skin and muscle that's below the eyelid. This means that the support of the eyelid remains intact.
The tone of the lower eyelid has to do a lot with the lateral canthal tendon. Judging by the position of this gentleman's lower eyelid, it is clear to Dr. Prasad that there is probably some laxity. In addition, if there's a history of allergy and eye rubbing then there is some tone that needs restoring. The procedure to restore that is called lateral canthoplasty or a lateral tarsal strip. However, he can't tell if this gentleman needs some type of graft of spacer graft to give some vertical support. That is something that requires physical examination.
With that being said, it is important for this gentleman to explore his options and go to several experienced specialists. He should have consultations with people who do a lot of lower eyelid surgery for complex eyelid procedures and have a lot of options to offer him, and someone who knows how to handle any anatomic issues particularly with the negative vector. An experienced surgeon should be able to help him get an improvement of the overall appearance.
In Dr. Prasad's practice, he employs something called platelet-rich plasma for a lot of his patients to help with the hollowness or dark circles and also to improve the skin quality. In this gentleman's situation, without a history of allergies and other factors, Dr. Prasad can't make that recommendation specifically. Some surgeons would lift the lower eyelid skin or tighten to reinforce it. In addition, some would also support the lower eyelid at an internal aspect for the vertical support. However, Dr. Prasad would avoid removing any eyelid skin for his situation. At his age, he probably doesn't have any extra skin.
A gentleman had just undergone a hair transplant. After the transplant, he received platelet-rich plasma (PRP) treatment. He wants to know if there are any benefits with the PRP treatment.
Dr. Amiya Prasad, a hair restoration specialist, explains that platelet-rich plasma is used in several fields such as orthopedic surgery, oral surgery as well as in wound care medicine. It is very well established to help wound healing. In the hair restoration field, many people have used platelet-rich plasma very effectively to treat hair loss as a single type of treatment as well as to facilitate healing whether it's in the donor area or the areas of the grafts.
In Dr. Prasad's practice, he uses platelet-rich plasma routinely combined with a material called extracellular matrix. Extracellular matrix is a material that's derived from pig bladder that is originally designed for wound healing. He uses it when he closes the donor area and finds that the healing is exceptional. Many people are concerned about the scars from the strip method. By combining good surgical technique, right patient and the use of extracellular matrix and platelet-rich plasma, he has had very nice healing in the donor areas. In addition, he has been using platelet-rich plasma with extracellular matrix to actually treat hair loss in a treatment called Hair Regeneration. So, for his patients, whether they have a transplant or not, he is able to help them with the progression of hair thinning.
From Dr. Prasad's clinical experience, platelet-rich plasma does help in healing. As far as soreness is concerned, there is going to be soreness for some time. It is normal for an area where there was surgical trauma, which is controlled trauma, to normally have inflammation and some tenderness. If there is severe pain or fever, that is a different story but that is something that the patient has been very well instructed by their doctor. At this point, this gentleman should continue communicating with his doctor.
For more information, visit our website:
A gentleman is one week post hair transplantation. He noticed a lot of scabs and crust while washing his scalp. He is worried if the grafts are coming out.
Dr. Amiya Prasad, a hair restoration specialist says that this gentleman's concern is very common. Everyone who had a transplant is afraid that they will dislodge the graft and think that the grafts are very delicate. In Dr. Prasad's practice, he does a fair number of hair transplants and the routine is fairly straightforward. He does hundreds or thousands of grafts in a session and within the first 24-48 hours, the grafts are so well in place that it would take a surgical instrument to physically remove the graft from the scalp. He also uses a material called extracellular matrix which further facilitates the healing process and treats the thinning hair concurrently.
The scabs that one sees are the combination of some old blood, some very dry skin and are a part of a normal healing process. In the first week, Dr. Prasad lets his patients wash their hair with a bowl of water and pour it gently to let this superficial scabbing dislodge. He also lets them spray the hair with some saline to keep it a little moist. By the second week, he encourages his patients to scrub a little bit. Of course, he examines his patients before he gives them this advice to make sure that they are not doing anything that can be traumatic.
Seeing a hair in the scab doesn't mean they lost the graft. The base of that graft is called the dermal papilla and is the root of the hair which does the growing. Sometimes, the hair will break or shed and that is normal. Dr. Prasad suggests thinks that communicating with the doctor is critically important. Every experienced hair restoration surgeon will be able to give a patient an advice from their experience. With a little bit of guidance, one can anticipate what will happen beyond this initial early point in the healing process.
For more information, visit our website:
A 27-year-old gentleman has big under eye bags. He wants to know if he is a good candidate for surgery.
Dr. Amiya Prasad, an oculofacial plastic surgeon, says that based on the photos, it appears that he has lower eyelid fat prolapse. Lower eyelid fat prolapse means that the fat that is normally around the eyes has pushed forward and is creating a bulge. That bulge is creating this continuous look of puffiness under the eyes. After 20 years of practice as an oculoplastic cosmetic surgeon, he has heard of a lot of his patients say that they are, "tired of looking tired."
Do-it-yourself remedies such as cucumber slices, tea bags and topical creams can't remove fat under the eyelid skin. The definitive procedure is surgery called lower eyelid blepharoplasty. For most of Dr. Prasad's younger patients, he performs a transconjunctival blepharoplasty where he addresses the fat pockets under the eyes from the inside of the eyelid. This way he avoids an external scar, and maintains and preserves the anatomy of the eyelid. At times he combines it with other procedures such as the use of platelet-rich plasma to help with skin quality under the eyes.
Dr. Prasad suggests that these procedures be performed under local anesthesia with LITE™ sedation which he does in his practice. He actually trademarked a name called LITE™ anesthesia. This helps in quick recovery and minimizes the trauma and stress to the patient's body, and for the safety and natural appearance of the eyelid.
The quest for natural appearance basically should look as if the person never had the bags. When people look at them, they shouldn't know that they had surgery. They should say that they look good or that there's something that's changed but they couldn't figure out what it is. Meeting with qualified and experienced cosmetic surgeons is an appropriate next step for this gentleman. He should look at the doctor's before and after pictures and move forward with the procedure.
For more information, visit our website:
A woman's hairline has receded and caused her to be unhappy with her appearance. She wants to know what to expect with hair transplantation.
Dr. Amiya Prasad, a hair restoration specialist, explains that it is estimated that 30% of women under the age of 50 and 50% of women over the age of 50 have hair loss. When a woman comes to his practice with hair loss, he doesn't discuss surgery to create their desired look, but first looks at the cause of the hair loss. It may be caused by genetic or traction alopecia from wearing tight ponytails and tight braids. In addition, he also systemically assesses the patient for hormonal and nutritional factors. Prior to a transplant, a proper workup must be done to establish the medical basis of hair loss.
Any experienced hair transplant surgeon can give an estimate as to how many hairs it will take to fill an area. However, the patient has to think about the future and where their hair loss may be progressing. For example, males who've had hair transplants and have continued hair loss have these hair plugs on their scalp that represent the transplanted hair, but the native hair once around them were lost.
In a hair transplant procedure, the patient shouldn't consider only the density or number of hairs. The diameter or the caliper of the hair is an important factor. People with thick hair have thicker hair because of the diameter of each hair strand and this covers more of the scalp. A person with fine blonde hair needs more grafts to cover an area compared to someone who has dark and thick hair. In addition, it is typical to need more than just one transplant in order to get the maximal density to mimic what nature creates. When a male has a transplant, it is acceptable to have less density. But for women, they need a lot of density or otherwise, the hairs look too far apart and create an artificial look.
Placing a hair graft is literally placing an organ. It is a combination of the hair shaft, the follicle and the tissue around that area. A graft needs proper blood supply and in order for the blood supply to reach the graft, there has to be coverage around the area. Covering 4 sides of the graft is important to have good circulation for it to take. When there are many grafts in an area, a certain amount of those grafts are not going to survive because they don't have enough nutrition.
In Dr. Prasad's practice, when he does a transplant, he uses a material called or extracellular matrix that helps aid in the healing as well as in treating the thinning process. The only currently approved FDA drug for female hair loss is minoxidil. So a lot of women have been coming to him to have Hair Regeneration treatment. His Hair Regeneration treatment is the combination of extracellular matrix with platelet-rich plasma to maximize the benefit of a transplant. This is by maximizing the longevity of the existing hair. If there's a thinning process going in, the thinning process is stabilized, reversed and the hairs are thickened. So if someone is getting a transplant, they would want to get the maximal yield of the transplant in terms of survival of the grafts as well as the stability of their thinning process.
For more information, visit our website:
A woman has low brows and finds herself raising them in photos so that she doesn't look so unintelligent and bored. She wants to know if a brow lift can solve her problem.
Dr. Amiya Prasad, an oculofacial plastic surgeon explains that each surgeon has a different perspective about the aesthetics of the eyebrows. This is greatly influenced by their artistic vision as well as the patient's personal desires. In the mid to late 90s, it was very popular to perform brow lifts in the northeast and in New York. However, brow lifts have decreased in popularity over time. Unfortunately, a lot of people were getting their brows lifted that gave them a permanently surprised look. Dr. Prasad's focus in his practice is a natural appearance. His perception of the position of the brows and how it looks in an individual is about the character the face. The brow position has such an impact on a person's face and can change the person's expression significantly.
Dr. Prasad further explains that there are different aesthetics not only in his area in Manhattan but also throughout the country. When he visited colleagues in other parts of the country, he has seen that the desire for very high arched brows is very popular in certain regions, so this is a very personal question for a patient to decide. If the patient raises their eyebrows and feels that there's a lot more of eyelid showing, is it really worthwhile to have their eyebrows arched all the time? Dr. Prasad thinks that based on the photo this woman submitted, in order to achieve that, the brows would have to be raised fairly high. In his opinion, he doesn't think that would look natural.
Dr. Prasad suggests that she should consider some type of upper eyelid surgery as an alternative to brow lifting and that is based on the absence of a proper physical examination. A browlift is a procedure that can significantly affect someone's facial expression. If for any reason that is the look that a person desires then moving forward with a brow lift would make sense. From Dr. Prasad's aesthetic, he thinks a high arch brow would take too much from the character of the face and revealing more of the upper eyelid. The patient should think about the long-term impact of having brow lifting surgery on the overall facial expression and not just in the isolated area of the eyes. They should consider the alternatives of doing a natural looking upper eyelid blepharoplasty to open up their eyes, and do their research on this type of procedure. Also, they should meet with qualified experienced cosmetic surgeons and then move forward with a plan that they are comfortable with.
For more information, visit our website:
A 23-year-old gentleman has deep set eyes and noticed that his eyelids are drooping. He wants to know if he should consider surgery and if there are less harmful solutions.
Dr. Amiya Prasad, an oculofacial plastic surgeon explains that with the photo he submitted, there is certainly a little bit of droop of extra skin over his eyes. To determine if what procedure is appropriate for him, Dr. Prasad usually uses a Q-tip to roll the skin up a bit and looks at the patient's eyes. As someone who is boarded with facial cosmetic surgery and who does a lot of facelifts and other rejuvenation procedures in addition to cosmetic eyelid procedures, he doesn't look at the eyes in isolation but looks at the eyes and how they impact the whole face.
The impact of the improved appearance after eyelid surgery can be significant and at the same time it can be natural. Dr. Prasad always stresses particularly to many of his male patients and younger patients that less is more is the best way to go. So if the patient can see a difference when rolling up the eyelid skin and if that is significant enough for them to feel good about it, then it's worthwhile to meet with cosmetic surgeons. Unfortunately, there are a lot of male patients and celebrities who have eyelid surgery and had their eyelids overdone. Retaining a masculine appearance is very important. It's not about how much surgery done, it's how the surgeon does the surgery in an artful way so that it looks like the patient naturally looks that way.
When a patient goes for consultations and meet with doctors, they should ask to look at their specific before and after examples of their male patient to get a sense of their aesthetic style. Unfortunately, a lot of people get surgery and then try to undo it. He recommends considering the option of doing an upper eyelid blepharoplasty. However, patients should understand that it's going to be relatively conservative and there are risks and benefits. This is a 3-dimensional procedure and so a photo alone doesn't allow anyone to make a definitive recommendation. If a conservative amount of skin removal makes a difference for the patient and they know what to anticipate after surgery, then moving forward with it may be right thing for them.
For more information, visit our website:
A 27-year-old woman say that her under eye bags are hereditary. She has tried many products but her bags are always there and have gotten worse over the years. She wants to know the best procedure for her.
Dr. Amiya Prasad, an oculofacial plastic surgeon says that the puffiness under this woman's eyes is a condition called lower eyelid fat prolapse - the fat normally around the eyes has pushed forward. This is also referred to as extraconal fat. Generally, when that fat pushes forward, it creates this continuous appearance of puffiness. Puffiness under the eyes is perceived by most people as looking tired. Very often, patients who come to him say that they are tired of being asked why they look tired.
In Dr. Prasad's practice, for most of his patients who are younger, have good skin quality and skin tone, he performs a procedure called transconjunctival blepharoplasty. Transconjunctival blepharoplasty is a technique and a procedure where he addresses the fat pockets from the inside of the eyelid. That involves reduction, repositioning and whatever needs to be done from the inside of the eyelid. This way he avoids any external scars and there is a real preservation of the overall anatomy of the lower eyelid so it looks very natural. In fact, once it's done and he patient is healed, it would be difficult for anyone to tell that they had this procedure done.
In addition, Dr. Prasad performs this procedure under local anesthesia with LITE IV sedation which means he avoids general anesthesia. With the exception of rhinoplasties (nose jobs), every procedure in Dr. Prasad's practice is done with local anesthesia, including facelifts, liposuction and tummy tucks. So transconjunctival blepharoplasty is a very nice, natural and quick recovery move to address the fat pockets and it will not come back. Properly taking care of one's health and doing the right things that are good for the skin will certainly enhance the benefit of the procedure.
At this point, it is best if this woman meets with qualified and experienced cosmetic surgeons. She should meet with somebody who she is comfortable with and agrees with their surgical style by looking at the results of their before and after pictures. These are things she needs to understand so that she can make a decision about not only the surgery but also how that surgery is done so she can get the best experience she can.
A woman had incisional double eyelid blepharoplasty, fat removal and muscle correction of her right eye. She wants to know if swelling after 3 months is normal.
Dr. Amiya Prasad, an oculofacial plastic surgeon explains that when someone has Asian eyelid surgery, swelling in the space between the eyelash margin or eyelid crease, also referred to as the pretarsal area, is normal. The amount of swelling and its duration varies in individuals. From his experience, it is not unusual for someone to have this type of swelling at 3 months. He often tells his patients that this particular type of surgery almost creates a limitation in the displacement of fluid during the normal healing process and each individual will ultimately see a resolution of their swelling from 6 months to a year. Very often, the 3-month point is a transition point where the swelling can significantly change and diminish.
The critically important thing is to have an ongoing dialogue with their surgeon. Although some patients can get concerned and it's understood that they may want to get additional perspectives about their healing process, only their surgeon was there for their surgery. Every surgeon has a particular style in how they do their surgery as well as their own experience in the healing process for their type of surgery.
When Dr. Prasad does an incisional Asian eyelid surgery or any upper eyelid surgery, he always tells his patients that for the early post-operative period which is the first month or beyond, the collagen in their body that is being used is in a disorganized orientation. The body then goes through a process called wound remodeling or collagen remodeling. It goes from irregularly lumpy to parallel, soft and flatter. He monitors his patients closely; he sees them after 1 week, 1 month, 3 months and as often as needed. He observes the healing process and their feedback about what they are doing on their own. Patients should avoid using over-the-counter anti-scar medications because the oils, preservatives and other chemicals in those can actually make the scars become worse. Sometimes patients will do things which they think is good for them and end-up doing something that actually causes inflammation or irritation.
When Dr. Prasad looks at the area between the transition of the eyelid and the epicanthal fold, it looks a little bit raised and thick. Her surgeon will know from their experience if this is typical. Someone other than her surgeon might interpret this as atypical or unusual. So if she decides to get additional opinions, she must be prepared for a different style in the approach to her healing process. Some may recommend a steroid injection or something to reduce the thickening of the incision line, but this is a process that takes time. Anybody looking at her from a different perspective will have their own ideas and it may confuse her even further. Dr. Prasad is pretty confident that she did her research before she chose her surgeon and so mostly likely her surgeon has proven to her that he has the necessary experience to do this type of surgery. Her surgeon can guide her as to what's going on and what to anticipate.
For more information, visit our website:
A 22-year-old gentleman has been losing hair since he was 18. He wants to know if he is an eligible candidate for a hair transplant.
Dr. Amiya Prasad, a hair restoration specialist, explains that there are only two drugs that are used and approved for male pattern hair loss: minoxidil (Rogaine)and finasteride (Propecia). Finasteride is a drug that is used to block an enzyme called 5-alpha reductase which converts testosterone to dihydrotestosterone. Dihydrotestosterone has been identified as a factor to cause susceptible hair follicles to become thinner. Hair thinning doesn't mean that existing hair goes from thick to thin. Rather, during the normal growth cycle as the hair is shed, the hair that comes back is thinner.
Finasteride has been shown to help people with male pattern hair loss reverse the thinning process, but there are some limitations to the use of finasteride that you should also be aware of. From Dr. Prasad's clinical experience, he has been prescribing finasteride since 1997 and 1998 when it was first approved. Younger males who have aggressive hair loss typically don't respond as well as males who are in their mid to late 30s who are starting to have a slow and progressive expansion of the bald spot area. Even on these medications, people still have progressive hair loss. There has also been a concern about the long-term sexual side effects of finasteride. Interestingly in Dr. Prasad's practice, he has patients who have been taking finasteride for 20 years and they are fine and even patients in their 50s who are coming in for prescription renewals. At the same time, he has patients who are coming in their 20s and 30s who won't take finasteride because of its side effects.
When someone first notices hair loss, they've already lost 50% of their hair. The rule of thumb for hair loss is referred to as the Rule of Decades - when someone is in their 20s, about 20% of their contemporaries have hair loss, and 80% of their contemporaries have lots of hair. As someone gets to their 40s and 50s, 40 to 50% of men have significant hair loss. Dr. Prasad has seen so many patients who got hair transplants in their 20s who continue to lose hair because they were not able to take medical treatment like Propecia. What are left in their scalp are the transplanted hair.
When Dr. Prasad first trained in hair transplant surgery over 20 years ago, he learned from his teachers to avoid doing transplants on younger males. Men in their 20s who are losing hair with a rapid rate of loss, combined with the unexpected results added up to too many unfavorable variables. Unfortunately in the modern world, with aggressive internet advertising and television commercials, medical procedures are sold and overhyped. People are only shown the benefits and given very compelling testimonials that make someone want their products. However, the reality is that the area where the transplants are taken from called the permanent zone or the donor area is very limited.
In Dr. Prasad's practice, he developed Hair Regeneration which is a method and a procedure that combines a material called extracellular matrix which is derived from pig bladder and originally designed for wound healing, with platelet-rich plasma - a byproduct of a person's own blood that has growth factors. Platelet-rich plasma is commonly used to help hair loss but on its own, it doesn't reverse hair thinning. Dr. Prasad reverses hair thinning with his Hair Regeneration treatment. This is something that he has developed for several years and he can boast close to a 100% success rate for male pattern hair loss. This is a onetime injection and literally reverses the thinning of hair and thickens the hair.
Dr. Prasad recommends Hair Regeneration as a treatment for this. He follows up on his patients very closely and sees people at one month, 3 months and even up to 2-3 years. Once a patient is in his practice, the door is always open. Dr. Prasad further explains that one should be mindful of the limitations and expectations of a hair transplant procedure and learn about this extracellular matrix technology and Hair Regeneration and see if they could find a provider that would be right for them.
For more information, visit our website:
A woman had canthopexy which resulted in her having scleral show. She wants to know if this can be reversed and the procedures to address this.
Dr. Amiya Prasad, an oculofacial plastic surgeon, says that if the goal of canthopexy was to elevate the lower eyelids and the corners and also to create a shape that she likes, then her lower eyelid position is several millimeters below the iris or the limbus. Although there is a lot of genetic variation, this is the area where the lower eyelid meets the iris. Getting that vertical height to the lower eyelid can be a challenge depending on several factors. One approach is to provide support laterally and try to elevate to get a few millimeters or two without doing anything else. The other factors include the prominence of the eyes as well as the available skin to vertically move it to the position she desires. There are many people who genetically have prominent eyes who have their lower eyelids relatively low and that is basically a family trait. There are also people who have thyroid eye disease whose eyes are very prominent. Lastly, there are people who have had surgery in the past which cause their lower eyelids to be retracted downward.
In Dr. Prasad's practice, he looks at the position of the lower eyelid at three factors: the lateral support which is the outer corner of the eyelid where she had her canthopexy performed, the front of the eyelid which is called the anterior lamella, and the posterior lamella. These three parts are very important. The posterior lamella probably has the most significant impact in terms of the physical vertical support. Dr. Prasad refers to them as pillars that keep the eyelids in a particular position.
That being said, this woman has to figure out for herself what her definition of a successful result would be. For every one to two millimeters that she wants to elevate to reduce the scleral show, it can involve procedures such as a posterior lamellar graft. In Dr. Prasad's practice, he uses a material called Enduragen and do repositioning of the outer corner of the eye. He also sees if the laxity of the outer corner of the eyelid may require some tightening. Even when a surgeon does a canthopexy or canthoplasty procedure, the eyelid can stretch a little bit. The patient can get a little elastic regression and may need an enhancement there.
For someone who is relatively young, the anterior lamella is a very significant challenge. A relative amount of skin can be recruited to this area. The skin can be recruited via a skin graft which is often not desirable especially in a younger person who has not had surgery in this area in the past or through an approach such as a mid facelift. It's been Dr. Prasad's experience that most mid facelifts do not recruit as much as long-term as they do short-term. He has seen many patients who have had mid facelifts where the surgeon tried to elevate the cheek and it may have been successful in the beginning, but eventually it descends and causes further descent of the lower eyelid.
In the absence of a physical examination, it is very hard to make those recommendations but Dr. Prasad thinks it is important for people to understand the anatomy that is involved in getting that vertical height. Some plastic surgeons think of the lower eyelid from one perspective which is the outer corner. Unfortunately, this resulted in some patients having outer corners and eyelids which were way too high in attempt to reach that goal of elevating the lower eyelid. It is very important that this woman communicate with the original surgeon about her concerns and desires and see if this is something that her surgeon is able to accomplish. If for any reason she feels that her surgeon is not comfortable or if her surgeon doesn't want to do anything else, then a second opinion is always recommend.
For more information, visit out website:
A woman is 12 days post Asian upper eyelid surgery. She is wondering if she has ptosis or just plain swelling resulting in a hollow appearance.
Dr. Amiya Prasad, an oculofacial plastic surgeon, explains that Asian eyelid surgery recovery period is a little bit longer compared to a non-Asian eyelid procedures. There are some anatomic factors that involve an area of the eyelid called the pretarsal area - the space between the eyelid crease and the eyelashes. Asian eyelid surgery is done to create a crease to a person who has a little bit of extra skin or has almost no extra skin but has fat that is blocking the connection of the levator muscle. This is the muscle that is responsible for lifting the eyelid.
In Asian eyelid surgery, the surgeon is not removing a lot of fat because the more fat that is removed, the more relative hollowing the patient can get. Rather, he looks to see if the fat will get in the way of the attachment that he is surgically creating. He is taking the skin between the crease and the lashes and connecting it to the levator muscle which creates a tight compartment.
After the surgery, swelling usually occurs and it takes time to subside. Dr. Prasad usually observes his patients closely in the first few weeks after the surgery to help them feel confident that what they are experiencing is normal. It is normal to have swelling from the crease to the eyelashes. In some people, that swelling can last for several months and subtle degrees of swelling can make a huge difference in the appearance. A lot of people will feel panicked that the crease is too high because the swelling of the pretarsal area causes the eyelid crease to look higher. He always explains that where the patient is at one week to three months is going to be an evolution. If there are other factors such as sinus issues, allergies or even allergy to the antibiotic ointments, then they can prolong the swelling of the eyelids.
It is very important that patients communicate with their doctor and not jump to conclusions about their appearance. People can certainly look like they are hollowed out in the beginning. This is an area where there's a dynamic architectural change. For most people, what Dr. Prasad likes to do during surgery is have them open their eyes to take a look of how the eyelid creases in. It gives a window of opportunity to identify if the eyelid crease looks the way he intends it to look. If it looks good during surgery, then it'll probably look good after surgery. There are also exceptions and sometimes revisions that are necessary, but that's a part of cosmetic surgery. In this woman's situation, she's probably early in drawing her conclusions and that she should communicate with her doctor about her concerns. Her doctor has her photos before surgery and can review with her what she can anticipate. Her concerns are consistent with the typical healing process related to Asian eyelid surgery. No one knows better exactly what happened during surgery better than a patient's surgeon, so communication with the doctor is always very important.
For more information, visit our website:
A gentleman thinks he has excess tissue in the upper eyelid which is causing him to have asymmetry as well as a droopy and tired appearance. He wants to know if blepharoplasty is suitable for him.
Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon who has a background training in eye surgery followed by specialized training in plastic surgery of the eyes, assessed that this gentleman's upper eyelid looks a little bit lower than normal. He suspects that he has a condition called ptosis. Ptosis means drooping of the eyelid. To examine the eyelid, Dr. Prasad does a ptosis evaluation. He looks at the center of the pupil and how it relates to the upper eyelid called the marginal reflex distance. When it's above a certain level, there is no ptosis, but if it's below a certain level, there is ptosis. Ptosis is also graded: mild, moderate or severe.
Dr. Prasad noticed that the gentleman's creases are very high and there is a slight difference of skin between the two eyes. If that skin was removed, which is what is typically done in an eyelid blepharoplasty, Dr. Prasad thinks there would be no significant difference. He has seen many patients who had upper eyelid surgery where the plastic surgeon removed skin in the upper eyelids and yet the person still looked tired. A significant percentage of those cases were due to the fact that the patient actually had ptosis or drooping of the eyelid.
Before this gentleman moves forward with a procedure, Dr. Prasad thinks it's important that he get a proper diagnosis. In order to properly diagnose ptosis and come up with a treatment plan, there are some elements of the examination needed. It is important to assess the marginal reflex distance and then look at the activity of a muscle called levator muscle which is responsible for most of the function of elevating the eyelid.
Dr. Prasad explains that the next step would be to meet with an ophthalmologist or an oculofacial plastic surgeon to get an evaluation. A proper examination to diagnose the situation is critical or the patient may end up getting a cosmetic procedure that does not address the problem. He may need a combination of a levator muscle procedure, otherwise known as a ptosis correction, to help him improve that tired look. In addition, it's very important when evaluating ptosis that he look at his history such as old photos and determine if there is a change in his appearance.
For more information, visit our website:
A woman has hereditary dark circles even if she gets enough sleep and doesn't smoke or drink. She wants to know the treatment to remove dark circles.
Dr. Amiya Prasad, an oculofacial plastic surgeon, explains that genetic dark circles limit one's options on how to address them. It very common for a certain ethnic group and anyone with Mediterranean skin or darker to have dark circles under the eyes.
When Dr. Prasad looks at a patient with this concern, he breaks down the elements that contribute to the dark circles that can be addressed, and their contribution to the overall appearance of the eyes. In the lower eyelid, he looks at the pigmentation of the skin, the skin quality and the areas with relative hollowing. He pays particular attention to an area called the tear trough, where the edge of the eyelid meets the cheek area. He also looks at the under eye area for puffiness or under eye bags. Lastly, he looks at the area adjacent to the eyelid and cheek called the eyelid-to-cheek junction to look at the orbital rim or the bone under the eye as well as the cheek volume. There are many levels to approach and treat under eye dark circles.
As someone who has been in practice and performing oculofacial plastic surgery for over 20 years, Dr. Prasad can say that there were very few options years ago. Fortunately, these days there are more options. The hollowing component of the under eye circles means that it needs some type of volume enhancement. It is fortunate today to have a lot of fillers such as those in the hyaluronic acid family like Restylane. Restylane can be placed very strategically in the tear trough area. However, it is not done exactly the same between doctors. There's an art to filling that space to help soften the depth, darkness and shadow created by the relative hollow.
In addition, Dr. Prasad has been using a material that's derived from the patient's own blood called platelet-rich plasma. Platelet-rich plasma is using the components of their blood that are required for healing called platelets, and the plasma that is rich in growth factors that stimulate the quality of the skin. When there's a genetic dark circle under the eyes, platelet-rich plasma improves the circulation and triggers collagen production. In addition, he combines platelet-rich plasma with hyaluronic acid to have a synergistic benefit. Based in wound healing literature, the combination of platelet-rich plasma with hyaluronic acid enhances volume, blood supply and healing response. Although the response to these procedures varies from patient to patient, it has a long-term benefit which is superior to using a filler alone, and that's a very important distinction.
This type of work requires both the treatment and observation of the response and no two patients respond the same way. In this woman's situation, it is worthwhile to explore platelet-rich plasma, hyaluronic acid filler and the combination as a strategy to help improve the dark circles under her eyes. She should meet with qualified experienced cosmetic surgeons who perform these procedures and hopefully she will get a result that she is happy with.
For more information, visit our website:
A 35-year-old female has been losing her hair slowly for the past 6 years. She wants to know if a hair transplant would help her hair stay or will it just continue to fall out after the transplantation.
Dr. Amiya Prasad, a hair specialist, explains that when a woman loses hair, it is important to get a proper medical workup which includes hormonal and iron levels. Women are very sensitive to a lot of stressors that manifests in diffuse hair loss like telogen effluvium AKA shock loss. In addition, 30% of women under the age of 50 have some kind of hair loss which can be androgenetic alopecia and female pattern hair loss. It is also advisable to be evaluated for something called a scarring alopecia. These are also things which someone first does before they even consider transplantation.
Dr. Prasad is in a unique position where he has had patients who come to him from all over the world for a procedure he developed called Hair Regeneration. Hair Regeneration is a treatment where he combines platelet-rich plasma with a material called extracellular matrix. By doing this injection and this method of delivery, he has been able to help patients with male pattern hair loss, female pattern hair loss and even rare conditions such as alopecia areata and lupus related hair loss. When a patient comes to him with a history of unusual hair loss, it is first critical that before he does any type of treatment, the patient first gets a proper diagnosis.
Before moving for any type of medical or surgical procedure, Dr. Prasad advises that the patient sees their own physician and get the workup necessary to be sure what type of hair loss situation they have. A lot of times, people come to him after they already eliminated hormonal and autoimmune issues. They may even get a biopsy or see a dermatologist and learn that what they have is more of a female pattern hair loss or may even be a variant of an alopecia spectrum. A proper diagnosis is absolutely critical.
As advanced and remarkable Hair Regeneration is, there are still going to be limits. One of the limits happens to be scarring alopecia and if the hormonal situation is not under good control. It becomes very difficult if these are not diagnosed because again, women are very sensitive to a lot of different stressors in the body and it is often manifested as hair loss.
The lady should meet with doctors who would first evaluate her medical status, and also see a dermatologist to evaluate the scalp, the skin quality and what may be going on. She may even need to undergo biopsies. A proper diagnosis is important before she pursues any kind of non-surgical or surgical modalities.
For more information, visit our website: